Nursing Outcome Classification

John Mark L. Bocarile, RN

´What is the client·s response to the nursing intervention?µ

Nursing Process
y 6-step process (ADOPIE) y ASSESSMENT y DIAGNOSIS y OUTCOME IDENTIFICATION y PLANNING y IMPLEMENTATION y EVALUATION

(ANA, Standards of Clinical Practice, 2008)

Outcome Identification .

realistic and client-focused goals that will provide the basis for evaluating nursing diagnosis.Outcome Identification y refers to formulating and documenting measurable. y Expected Outcome or the anticipated goal of the identified care interventions and actions needed to treat the patients· conditions. y Establish client·s goals and outcome criteria .

Example of Verbs Used in Goal Setting y Calculate y Classify y Communicate y Compare y Define y Demonstrate y Describe y Construct y Contrast y Distinguish y Draw y Explain y Express y Identify y List y Name y Maintain y Perform y Particular y Practice y Recall y Recite y Record y State y Use y Verbalize y Ambulates .

Example y Ambulates safely with one-person assistance. . y Demonstrates signs of sufficient rest before Surgery. y Identifies actual & risk environmental hazards.

General Qualifiers to Predict Care Outcomes y To Improve patient's condition y To Stabilize patient's condition y To Support Deterioration or Death of patient's condition .

y The client identifies a support system and strategies to use to reduce stress and anxiety related to the surgical experience. y The client discusses fears & concern regarding surgical procedure after client teaching. y Possible Criteria >After client teaching. the client verbalizes decreased anxiety. .Example y Goal ²The client will report a decreased anxiety level regarding Surgery.

. y Possible Criteria _____________________________________________ ____________________________________________ ____________________________________________ _____________________________________.Example y Goal ² The client will demonstrate safety habits when performing activities of daily living.

y The client identifies modification for home safety (removal of throw pillows. non-skid slippers when transferring to chair or getting out of bed. better lighting of hallway and stairway). 12 hours after nurse·s instruction about home safety. the client uses call light system for assistance when needs to use the bathroom. y The client demonstrates safety practices when dressing and doing personal hygiene. installation of hand rails in hallway.Possible Outcome Criteria y Immediately after instruction by the nurse. y The client uses over-the-bed lights. .

.Example y Goal ² The client will mobilize lung secretions. y Possible Outcome Criteria _____________________________________________ ____________________________________________ ____________________________________________ _______________________.

.Possible Outcome Criteria y After teaching session. vibration and postural drainage before discharge. y The client drinks at least 6 glasses of water per day while in the hospital. the client demonstrates proper coughing techniques. y The caregiver or significant other demonstrates proper technique of chest physiotherapy including percussion.

Evaluation .

It is concurrent or on-going because the nurse evaluates and makes decision during the implementation phase of the process.Evaluation y Nurses· make decisions all throughout patient (client) care situations. . evaluation³ the sixth phase³is a concurrent and a terminal process. y Actual Outcome depicting the outcome of care resulting from the interventions and action types used to treat the patient. Within the context of the nursing process.

??????? .Types of Evaluation y Structure Evaluation ² Environment y Process Evaluation ² Nurse y Outcome Evaluation .

Outcome Evaluation y ´Outcome evaluationµ occurs when the client becomes the focus of evaluation. y Here the nurse is concerned with changes in the client that occur as an effect of the nursing interventions. y Outcome evaluation answers the question ´To what degree are the client goal and predicted outcomes achieved?µ .

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NOC .

increased use of technology. increasing emphasis on computerized patient records and care planning options. Journal of Nursing Care Quality. and an emphasis on outcomes rather than process.Situation y The health care environment in which nurses deliver care is experiencing constant change characterized by decreased lengths of stay in acute care settings. These changes dictate that nursing as a profession ensures that the work of nursing is visible in this health care environment and included in the data used to make health policy decisions (Moorhead et. al. increasing markets dominated by managed care. 1998) ..

(Mosby's Medical Dictionary. NOC outcomes have been linked to NANDA diagnoses. Elsevier) y . standardized system to classify outcomes of nursing interventions. NOC includes 385 nursing outcomes for use for individual patients or individual family caregivers in the home. At present. It is a clinical tool developed by a research team at the University of Iowa that describes and defines the knowledge base for nursing curricula and practice. desired outcomes. © 2009. interventions used. It is considered part of the clinical decision making of the nurse to decide and document the nursing diagnoses. and outcomes achieved.Nursing Outcome Classification y It is a comprehensive. 8th edition.

The Online Journal of Issues in Nursing. an outcome: patient. Outcomes may defined as the end results of care. yet when quality of care is being measured outcomes are linked to diagnoses. expected. In addition to the term "result". desired. predicted. and actual outcome. effective. nursesensitive. outcomes are indicators of problem resolution or progress toward resolution (Gordon. eight terms are commonly used in the literature to modify. From this perspective.Outcome Classification y Health care providers have appreciated the importance of outcomes as requirements for measuring economic efficiency and system effectiveness in a cost-control environment. projected. 1998) .

Becker. y In 1988 Heater. 1978). She was the first in nursing to use changes in characteristics of patients to evaluate nursing care delivery. and Olson completed a meta-analysis of studies that suggested a growing interest in nursing goals and outcomes during the previous decade. such as "the patient's self care skills" (Hover and Zimmer.Historical Perspective: Outcome Classification y Aydelotte (1962) was an early pioneer in the measurement of patient outcomes. . Outcomes at this time were general.

funded project Johnson and Maas (1997) and a team of investigators at the University of Iowa developed a set of outcomes and proposed their linkages to nursing diagnoses. or elements.use of resources. Nursing includes client knowledge and behaviors. These authors also note that nursing outcomes differ in content from medical outcomes. to be used in classification. p. Outcomes and their indicators are the concepts. y In a large. home maintenance.5).5). . and caregiver status (1997. p.Historical Perspective: Outcome Classification y Johnson and Maas summarized the multiple reports of outcome generation that were characteristic of the 1980s and early 1990s and concluded that identification of outcomes was based mainly on literature reviews and practical experience rather than research or conceptual frameworks" (1997. safety .

1997) . (Johnson. NOC evaluates the effects of nursing care as a part of health care.Nursing Outcome Classification y The Nursing Outcomes Classification (NOC) describes patient outcomes sensitive to nursing intervention. Standardized patient outcomes are essential to ensure that nursing becomes a full participant in clinical evaluation science along with other health disciplines.

Nursing Outcome Classification y The Nursing Outcomes Classification (NOC) is a comprehensive taxonomy of patient outcomes influenced by nursing care. 1998) . The classification has a number of advantages. comprehensive. indicators. The classification provides outcomes that can be used across the care continuum to assess patient status following nursing interventions. standardized. Each outcome is stated as a variable concept measured on a five point Likert scale and includes a definition. It was developed lay a large research team that included clinical experts and has been subjected to testing (Marion and Meridean. Journal of Nursing Quality. and flexible for clinical use. including being research based. and references.

for use in clinical information systems. . The outcomes are developed for use in all settings and with all patient populations. for the development of nursing knowledge and the education of professional nurses. An outcome is a measurable individual.y Standardized outcomes are necessary for documentation in electronic records. or community state. family. behavior or perception that is measured along a continuum and is responsive to nursing interventions.

rather than as goals. Since publication. behavior. For this work. Each NOC outcome has a definition. a list of indicators that are useful in evaluation of patient status.Brief History of NOC y The Nursing Outcomes Classification contains 190 outcomes listed alphabetically during the year it was published by Mosby in 1997 (Iowa Outcomes Project. allows for the identification of positive or negative changes or no change in a patient's status. a measurement scale. or perception that is measurable along a continuum and responsive to nursing interventions. and a short list of references used in development of the outcome . 1997). an outcome is stated as a variable concept representing a patient or family caregiver state. Stating the outcomes as variable concepts. an additional 28 outcomes and the taxonomy have been developed.

Brief History of NOC y Since August 1991. a research team consisting of 43 nurses representing service agencies and nursing education has been conducting a study of nursing-sensitive patient outcomes. label. validate. . The purposes of the research are to: y 1) identify. and classify nursing-sensitive patient outcomes and indicators y 2) evaluate the validity and usefulness of the classification in clinical field testing y and 3) define and test measurement procedures for the outcomes and indicators.

Evaluation of Measurement Scales (1998-2002) Phase V . y Phase I .Refinement and Clinical Use (1997 .Construction of the Outcomes (1993-1996) Phase III .Pilot Work to Test Methodology (1992-1993) Phase II .Brief History y The research to develop NOC began with the formation of the outcomes research team in 1991 and has progressed through the following phases.Present) .Construction of the Taxonomy and Clinical Testing (1996-1997) Phase IV .

The outcomes are developed for use in all settings and can be used across the care continuum to follow patient outcomes throughout an illness episode or over an extended period of care. nursing centers. community agencies. community hospitals.y Clinical sites used to test the NOC included tertiary care hospitals. . Since the outcomes describe patient/client status. and a nursing home. other disciplines may find them useful for the evaluation of their interventions.

Nursing Outcome Classification y The classification contains patient outcome categories and y y y y y indicators at four levels of abstraction and empirical measurement scales. The taxonomy of domains and labels can be obtained from the NOC project office at the University of Iowa. Most Abstract Nursing-Sensitive Outcomes Domains High-Middle Level Abstraction Nursing-Sensitive Outcome Classes Middle Level Abstraction Nursing-Sensitive Outcome Labels Low Level Abstraction Nursing-Sensitive Outcome Indicators Empirical Level Measurement Activities for Outcomes .

to the Taxonomy of Nursing Practice. to Omaha System problems. to resident admission protocols (RAPs) used in nursing homes.Nursing Outcome Classification y The outcomes have been linked to NANDA International diagnoses. to Gordon's functional patterns. . to the OASIS System used in home care and to NIC interventions.

For nearly a decade the University of Iowa College of Nursing has been a leader in developing standardized languages to describe the work of nursing. established in 1995.THE CENTER FOR NURSING CLASSIFICATION y Classification research conducted at Iowa is unique and crucial to the documentation and study of nursing care and to the articulation of nursing care with that of other providers. The Center for Nursing Classification. facilitates the continued development of this important work. .

Benefits y The Classifications will benefit health care providers. · Facilitate appropriate selection of nursing interventions. . · Facilitate the teaching of clinical decision-making to novice nurses.They will: · Provide a standardized language for nursing. · Standardize and define the knowledge base for nursing curricula and practice. and third-party payers in many ways. patients. · Define and predict outcomes nurses can achieve with patients. · Facilitate communication of nursing treatments to other nurses and other providers.

. · Enable researchers to examine the effectiveness and cost of nursing care. · Communicate the nature of nursing to the public. · Facilitate the development of computerized information systems. · Promote the development of a reimbursement system for nursing services. · Assist educators in developing curricula that better conform with clinical practice.Benefits y Assist administrators in effectively planning for staff and equipment resources.

NOC . Examples of scales used with the outcomes are: 1=Extremely compromised to 5= Not compromised and 1=Never demonstrated to 5=Consistently demonstrated. a five-point Likert scale to measure patient status. . place to identify the source of data. a target outcome rating.) are listed in alphabetical order. a list of indicators that can be used to evaluate patient status in relation to the outcome. For 76 of the outcomes an additional measurement scale was added to the outcome based on feedback from our research in 10 clinical sites. Each outcome has a definition. and a short list of references used in the development of the outcome.Description y The 330 NOC outcomes in Nursing Outcomes Classification (NOC) (3rd ed.

The NOC outcomes are grouped in a coded taxonomy that organizes the outcomes within a conceptual framework to facilitate locating an outcome.) includes 311 individual level outcomes. Psychosocial Health. Each outcome has a unique code number that facilitates its use in computerized clinical information systems and allows manipulation of data to answer questions about nursing care quality and effectiveness. Physiologic Health. The 330 outcomes are grouped into thirty-one classes and seven domains for ease of use. The seven domains are: Functional Health. . Perceived Health. and Community Health.Description y The NOC (3rd ed. Health Knowledge & Behavior. The classification is continually updated to include new outcomes and to revise older outcomes based on new research or user feedback and is published on a 4 year cycle. Family Health.NOC . 10 family and 9 community level outcomes.

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Coding .

.Strengths y Comprehensive ² The NOC contains outcomes for individuals. caregivers. y Research-based ² The research. and communities that can be used with all clinical specialties in numerous settings. y Developed inductively and deductively ²Research team focus groups reviewed outcomes in eight (8) broad categories that were drawn from the Medical Outcomes Study and nursing literature. Both qualitative and quantitative strategies were used to develop the classification. conducted by a large team of University of Iowa College of Nursing faculty and students in conjunction with clinicians from a variety of settings began in 1991. families.

care plan guides. outcomes. and clinical information systems.Strengths y Grounded in clinical practice and research ² Developed initially from nursing texts. the outcomes were reviewed by clinical experts and many were tested in clinical field sites. . indicators and measurement scales. y Uses clear. clarity and usefulness of the language has been emphasized. classes. clinically useful language ² Throughout the development of the NOC. y Has easy to use organizing structure ² The taxonomy has five (5) levels: domains. Feedback from clinicians and educators is solicited through a defined feedback process. All five levels have been coded for use in practice.

y Funded by extramural grants ² To date. . or community states at a conceptual level. the outcomes describe patient. the NOC research has received nine (9) years of peer-reviewed grant funding: one (1) year from Sigma Theta Tau International and eight (8) years from the National Institute of Nursing Research (NINR). y Optimizes information used for the evaluation of effectiveness ² The outcomes and indicators are variable concepts.Strengths y Outcomes can be shared by all disciplines ² Although the NOC emphasizes outcomes that are most responsive to nursing interventions. They allow for measurement of the patient. family. family or community outcome at any point on a continuum from most negative to most positive and at different points in time.

Linkages among NANDA diagnoses. NOC outcomes. and NOC linkage: . its development.Strengths y Tested in clinical field sites ² Testing of the NOC has been conducted in a variety of clinical field sites y Dissemination emphasized ² Information about the classification. and use is available. NIC. y Linked to other nursing languages ² Linkages have been developed by the NIC and NOC research teams to assist nurses with the use of the classifications and to facilitate use in clinical information systems. and NIC interventions are available in the book NANDA. Linkages with NANDA-International diagnoses and Gordon·s Functional Health Care Patterns are included in the book.

and refined by the NOC research team. Continued refinement will be facilitated through the Center for Nursing Classification and Clinical Effectiveness. and the University of Iowa. the College of Nursing. and listed as one of the languages that meets the standards set by ANA·s Nursing Information and Data Set Evaluation Center (NIDSEC). y Recipient of national recognition ² NOC is recognized by the American Nurses Association (ANA). . developed.Strengths y Included in initiatives for electronic clinical record y Developed as companion to the NIC ² Experience with the NIC at Iowa has aided the NOC research. included in the CINAHL index. y Structure for continued development and refinement ² The classification continues to be evaluated. included in the Metathesaurus for a Unified Medical Language at the National Library of Medicine.

Activity Example .

NOC .

Indicators y Have respiratory rate within normal limits. compared with baseline (14-20/min) y Express relief of (or improvement in) feelings of shortness of breath y Relate causative factors and ways of preventing or managing them. (Carpenito-Moyet. 2008) .

Coherent. ´Madali nga talaga akong mapagod ngayon at di ko magawa yung mga gusto kong gawinµ Objective: >Conscious.Example y Case Scenario: Medical Diagnosis: CHF Mr. Conversant >Weak-looking >Easy fatigability >Experiencing discomfort after an activity as evidenced by facial grimace >Increased in RR 24 to 30cpm and HR 108 to 124bpm every activity >O2 saturation: 95% >Cold Clammy on Peripherals . Art Faylur. 68/M Subjective: The patient verbalized.

Nursing Diagnosis: Activity Intolerance related to imbalance of oxygen supply and demand secondary to CHF .

Outcome Criteria y Goal: y Objectives: .

weakness. and fatigue. .Outcome Criteria y Goal:Client can perform the activity without complications y After 8 hours to a week of nursing intervention the patient will maintain activity level within capabilities. as well as absence of shortness of breath. as evidenced by normal heart rate and blood pressure during activity. y Patient verbalizes and uses energy-conservation techniques.

0005 Activity Tolerance: Physiologic response to energyconsuming movements with daily activities C. 0200 Ambulation: Ability to walk from place to place independently with or without assistive device D. 1308 Adaptation to Physical Disability: Adaptive response to a significant functional challenge due to a physical disability B.Which NOC? A. 0400 Cardiac Pump Effectiveness: Adequacy of blood volume ejected from the left ventricle to support systemic perfusion pressure .

Correct! 0005 Activity Tolerance: Physiologic response to energyconsuming movements with daily activities .

Suggested NOC y 0005 Activity Tolerance: Physiologic response to energy- consuming movements with daily activities y 0002 Energy Conservation: Personal actions to manage energy for initiating and sustaining activity y 1813 Knowledge: Treatment Regimen: Extent of understanding conveyed about a specific treatment regimen .

Suggested NIC y Energy Management y Teaching: Prescribed Activity/Exercise .

such as NOC. The ability to quantify the effects of the care nurses provide is essential for describing the value of nurses to consumers and other providers . offers nursing the opportunity to assume accountability for the effects of nursing interventions on the health of individual patients and the patient populations it serves.y The use of standardized outcome measures.(Marion Johnson. University of IOWA) . 1997.

End of Report

CHF: A case study
y Name: Mr. EI y Sex: Male y Address: Makati City y Age: 64 years old y Religious Affiliation: Roman Catholic y Civil Status: Married y Room : MICU y Chief Complaint: Difficulty of breathing and chest pain y Medical Diagnosis: CHD y Date of Admission: January 2012

PAST MEDICAL HISTORY
y The past illnesses of the client include colds, cough, fever,

measles, and mumps. He said that he can·t remember anything when asked about his immunizations. He has no allergy to any foods, drugs and other things. He has been hospitalized in V. Luna General Hospital on 1990 for a total deep implant of the right hip due to work related accident His second hospitalization was on 1991 in Camp Panophio for a partial implant of the left hip. He discovered his Diabetes Mellitus on 1978 and has been insulin dependent 15 years ago.

According to the client. .5 liters per hour. client experience chest pain and difficulty of breathing.HISTORY OF PRESENT ILLNESS y One day prior to his admission. He has supply of oxygen of 180 liters in his house to be consumed in a day estimated regulation of 7. this is not his first time to be confined with this condition. He has maintenance drugs such as Imdur. Metformin and Aspirin. The client said that these were his problems in a day.

their eldest sibling died of heart disease and three among his living siblings have Diabetes Mellitus also. his father died because of the complication of the heart while his mother died of being aspiration because of complications. According to the patient. According to the client. .FAMILY HISTORY y The patient has a family history of cardiovascular disease and diabetes.

he prefers variety of foods.SOCIAL HISTORY y According to the patient he has no vices since then. He is a retired captain of the Philippine Constabulary (Philippine National Police now). . but at the present his diet are mostly fruits. y According to him. He doesn·t smoke or even drink alcoholic beverages. vegetables and fish he seldom eats meat.

NURSING CARE PLAN .

Nursing Care Plan .

Nursing Care Plan .

Nursing Care Plan .

Nursing Care Plan .

Sample NIC and NOC y NIC ² Hemodynamic Regulations y NOC ² 0400 Cardiac Pump Effectiveness . angina.Desired Outcomes >Display hemodynamic stability >Report decreased episode of dsypnea.Adequacy of blood volume ejected from the left ventricle to support systemic perfusion pressure . dysrhytmmias >Demonstrate an increase in activity intolerance .

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