The Oncology Nursing Minimum Data Set: a new tool to do research by taking care of patients

Transcription

1 The Oncology Nursing Minimum Data Set: a new tool to do research by taking care of patients A.Milani Anniversary event of EONS

2 NMDS The NMDS is composed by nursing essential data defined as the specific information that is used on a regular basis by the most of nurses in different contexts and in all nursing care (Werley et al, 1991) A. Palese

3 Nursing Outcome A measurable condition, behaviour or perception of patient or his family conceptualized as a variable and largely affected by, or sensitive to nursing care (IOWA Outcomes Project 2000 Nursing Outcomes classification) The measurable change in the patient s condition that can be attributed to the care received (Donabedian 1980) A. Palese

4 As nurses.. Which results do we achieve in our clinical practice? outcomes Which data do we need to achieve and record these results? NMDS Record instrument A. Palese

5 ONMDS ONMDS composed by 15 categories of 49 outcomes Pain Skin and subcutaneous outcome Vascular devices outcome Gastro-intestinal outcome Urinary tract outcome Respiratory outcome Fluid and electrolyte balance outcome Neurological outcome Safety Psychosocial dystress ADL IADL Functional status Nutritional status Self care

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7 Must we use 49 scales to measure these nursing sensitive outcomes?

8 CTCAE The CTCAE is a descriptive terminology which can be utilized for Adverse Event reporting, elaborated by the National Cancer Institute to collect toxicity in clinical trials A grading severity scale is provided for each Adverse Event.

9 Grading

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14 Pre-test Post-test Standard JCI Total clinical records (50) Total clinical records (50) Total p-value Nursing care is planned within 24hrs from incharge (COP 2.1.a) 0 (0%) 50 (100%) 50 <.0001 Nursing care is tailored on collected data (COP 2.1.b) 0 36 (72%) 36 <.0001 Nursing plan is updated and modified on the basis of patient reassessment (COP 2.1.c) 0 48 (96%) 48 <.0001 Patients needs are identified on the basis of nursing and medical assessment and they are registered (AOP.1.3.b) 9 (18%) 50 (100%) 59 <.0001 All patients underwent a screening of pain (AOP a) 48 (96%) 50 (100%) The patient is subjected to revaluation in order to determine the response to treatment (AOP.2.a) 10 (20%) 50 (100%) 60 <.0001 The patient is subjected to revaluation in order to plan for continuity of care (AOP.2.b) 0 (0%) 46 (92%) 46 <.0001 The patient is subjected to revaluation at appropriate intervals depending on the treatment plan and needs identified (AOP.2.c) 0 (0%) 44 (88%) 44 <.0001

15 1. Assessment (AOP.1) Pre-Test *P < 0,05

16 1. Assessment (AOP.1) Post-Test

17 2. Revaluation (AOP.2) Pre-Test

18 2. Revaluation (AOP.2) Post-Test AOP.2.c: the patient is subjected to revaluation at appropriate intervals depending on the treatment plan and needs identified

19 3. Planning (COP) Pre test COP.2.1.a: nursing care is planned within 24hrs from incharge COP.2.1.c: nursing plan is updated and modified on the basis of patient reassessment

20 3. Planning (COP) Post test COP.2.1.a: nursing care is planned within 24hrs from incharge

21 Conclusion ONMDS promotes a new way to collect nursing data that could be used to performed epidemiology research on health priority needs Ensures a standardized and shared data source Provides data on patients outcome suggesting future areas suitable for nursing research and intervention based on severity of outcome manifestation Provides a standard for the description of nursing sensitive outcome in oncology using a common terminology among oncology nurses working in different areas

22 Conclusion Compare incharge assessment with the discharge assessment allows the evaluation of nursing impact on patients outcome improving nursing interventions quality and safety A numeric assessment which reflects patients complexity allows an objective evaluation of workloads and nurses needed competences

23 Why not? An ONMDS shared at the international level could be a tool for doing multicentred research assisting patients without extra cost or effort we could bring not only the research results at the bedside, but the research itself, leading associations in setting research priorities and building a common professional culture

24 Nursing outcomes AIMS Record changes in patient s status Improve individual outcomes Support nurses decision making Understand nurses contribution in patient care Guide knowledge and evidence development to support and improve evidence based Measure the effectiveness of specific nursing interventions Know nursing impact/influence: outcomes lack represents an important information gap (Bauman 1991) A. Palese