Finnish Doctoral Education Network in Nursing Science IMPROVING THE QUALITY AND SAFETY OF HEALTH CARE THROUGH OUTCOMES RESEARCH, 8 ECTS Time and place: Lectures and Seminars 28 th September 2 nd October, 2015 University of Tampere, School of Health Sciences, Nursing Science Lääkärinkatu 1, 33014 University of Tampere, Room C333 Course leader: Professor Tarja Suominen Teachers: Professor Sean Clarke, RN, PhD Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, USA Professor Tarja Suominen, RN, PhD School of Health Sciences, Nursing Science, University of Tampere Credits: 8 ECTS Registration: By 14 th August 2015 via www-page form: https://www.webropolsurveys.com/s/a5d7161a1d4b29a5.par Contact person: Coordinator Kaisa Kauppi kaemka@utu.fi
COURSE DESCRIPTION For nurses and many other health professionals, objective performance data on past practice behaviours and outcomes are often not readily available. This can lead to the assumption that performance is adequate and there is no need for improvement. It is essential that we link the conduct and focus of outcomes research with opportunities for improvement in care. Feedback about the outcomes or results of care enables healthcare professionals to evaluate their practice and make changes to improve the quality of health care. In this course students will examine the role of outcomes research for improving the quality of nursing care. They will develop an understanding of how to identify outcomes for nursing, learn about different approaches to measurement, and examine contemporary issues in outcomes assessment. COURSE OBJECTIVES Upon completion of this course it is expected that students will demonstrate: 1. Knowledge of how outcome research can be used to improve the quality of health care. 2. Knowledge of which outcomes are sensitive to nursing care. 3. An understanding of different approaches to outcomes measurement. 4. An understanding of how to enhance the quality of outcomes measurement. 5. An understanding of the relationship between quality work environments, nurse staffing, and patient outcomes. COURSE ORGANIZATION AND TEACHING METHODS Time: 28 th September 2 nd October, 2015, 9-4pm (On Monday 10-4pm) (see details in Appendix at the end of the paper) COURSE MATERIAL A reading list, including journal articles and recommended texts will be provided. Specific Topics 1. Health outcomes research: Terminology and designs 2. The role of outcomes research in improving the quality of nursing/ health care evidence-based practice and management. 3. Identifying outcomes sensitive to nursing care and nurse-related factors. 4. State of the science on nursing sensitive outcomes. 5. Patient safety indicators and research 6. What can be learned from administrative databases about the outcomes of health care? 7. Relationship between quality work environments, nurse staffing and patient outcomes.
COURSE REQUIREMENTS (1) A student seminar: Discuss how outcomes measurement is related to your own doctoral research study or could be. (2) A student paper, exploring a specific outcome, its applicability to a practice or research issue, and measurement issues. (Could be the same topic as in (1).) GUIDELINES FOR STUDENT SEMINAR PRESENTATION In the seminar students are expected to explore how outcomes measurement is relevant to their own doctoral research study. s are expected to explore conceptual and methodological issues as these related to the type of study that will be pursued in the doctoral research. s are expected to use a variety of teaching strategies in order to facilitate learning of the content. Each seminar should be no more than 30 minutes in length, including the time for class discussion. The following criteria will be considered in grading the seminar: (1) clarity in the of ideas, (2) creativity in the, (3) stimulation of discussion, critical thinking, (4) ability to stay within the allotted time frame, (5) openness to other students ideas, (6) originality, (7) organization, (8) critical evaluation, (9) depth of knowledge, and (10) command of ideas. The student should turn in 2 copies of the PowerPoint in paper form to the course instructors on the first day of class (2 copies). GUIDELINES FOR THE SCHOLARLY PAPER ON OUTCOMES RELEVANT FOR EVALUATING NURSING PRACTICE The scholarly paper should select an outcome for evaluating the effectiveness of your clinical or leadership (or education) practice. Conduct a search of the literature for evidence to support the outcome selected, using the framework suggested by Hermann and Palmer (2002). Discuss the evidence concerning the outcome indicator, succinctly synthesize the evidence, and advance recommendations for measurement. The paper should address the following issues: Rationale for selecting the outcome for evaluating clinical or leadership practice or learning outcomes of education, with supporting evidence from the literature Description of methodology for the literature review Application of the framework for critically reviewing the literature specifically addressing the following: 1. Is there potential for improvement in the outcome as evidenced by variation in levels of outcome achievement between people or between practice settings; 2. Are there established evidence-based recommendations for improving the outcome, such as care maps, nursing best practice guidelines, clinical practice guidelines? 3. Is there a reliable measure/method for assessing the outcome? For instance is there a measure with demonstrated internal consistency reliability or inter-rater reliability? 4. Does the approach to measurement have demonstrated validity as evidenced by content
validity or construct validity? 5. Does the approach to measurement yield meaningful or interpretable values/scores for end-user interpretation? The paper should be written in the format of a short scholarly paper using APA guidelines and be restricted to 10-15 double spaced pages, excluding references. The paper is due 30th October 2015. The paper should be sent to Professor Tarja Suominen by mail, address: University of Tampere, School of Health Sciences, Nursing Science, Lääkärinkatu 1, 33014 University of Tampere. The language for the course is English. The paper after the week could be done either in English or Finnish. The following criteria/rubric will be used for grading the paper: Criterion Marks Adequate rationale for selecting the outcome for evaluating clinical or 20 leadership practice based on evidence from the literature or from practice Description of methodology for the literature review, including keyword 20 search, databases searched, and inclusion criteria for literature Application of the framework in critically reviewing the literature on nursing 50 sensitive outcome, addressing each criteria Clarity in of ideas and use of APA formatting 10
SUGGESTED READING LIST: BOOKS (OPTIONAL) Iezzoni, L., Risk Adjustment for Measuring Healthcare Outcomes (4 th ed.). Chicago: Health Administration Press.* (the leading text in the field but expensive and specialized for consultation but not necessarily purchase) Doran, D.M. (Ed.) (2012). Nursing outcomes: The state of the science. (2 nd ed.). Sudbury, MA: Jones & Bartlett. Kane, R.L., and Radosevich, D.M. (2011). Conducting health outcomes research. Sudbury, MA: Jones & Bartlett. Wachter, R.M. (2012). Understanding patient safety (2nd ed.). New York: McGraw-Hill Medical. ARTICLE FOR PAPER ASSIGNMENT Hermann, R.C., & Palmer, R.H. (2002). Common ground: a framework for selecting core quality measures for mental health and substance abuse care. Psychiatric Services, 53, 281-287. SUGGESTED ARTICLES Conceptualizing nurse-sensitive outcomes Mitchell, P. H., Ferketich, S., & Jennings, B. M. (1998). Quality Health Outcomes Model. Image: Journal of Nursing Scholarship, 30, 43-46. Mitchell, P. H., & Lang, N. M. (2004). Framing the problem of measuring and improving healthcare quality. Has the quality health outcomes model been useful? Medical Care, 42, II4 - II- 11. Montalvo, I. (2007). The national database of nursing quality indicators (NDNQI). The Online Journal of Issues in Nursing, 12(3). Retrieved January 11 th, 2011 from http://www.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/table ofcontents/volume122007/no3sept07/nursingqualityindicators.aspx Patrician, P.A., Loan, L., McCarthy, M., Brosch, L.R. & Davey, K.S. (2010). Towards evidencebased management: Creating an informative database of nursing-sensitive indicators. Journal of Nursing Scholarship, 42(4), 358-366. Schneider, J.S., Barkauskas, V., & Keenan, G. (2008). Evaluating home health care nursing outcomes with OASIS and NOC. Journal of Nursing Scholarship, 40(1), 76-82. Sermeus, W., Delesie, L., Van den Heede, K., Diya, L., & Lesaffre, E. (2008). Measuring the intensity of nursing care: Making use of the Belgian nursing minimum data set. International Journal of Nursing Studies, 45(7), 1011-1021.
Van den Heede, K., Clarke, S.P., Sermeus, W., Vleugels, A., Aiken, L.H. (2007). International experts perspective on the state of the nurse staffing and patient outcomes literature. Image: Journal of Nursing Scholarship, 39(4), 290-297. Nurse staffing and patient or nurse outcomes Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. Canadian Nurses Association. (2012). Staff Mix Decision-making Framework for Quality Nursing Care. https://cna-aiic.ca/~/media/cna/page-content/pdf-en/staff_mix_framework_2012_e.pdf Clarke, S.P., Donaldson, N.E. (2008). Nurse staffing and patient care quality and safety. In Patient safety and quality: An evidence-based handbook for nurses. (AHRQ Publication No. 08-0043). Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/nurseshdbk/ Doran, D., Mildon, B., Clarke, S. (2011). Towards a national report card in nursing: A knowledge synthesis. Nursing Leadership, 24(2), 38-57. Kovner, C., & Gergen, P. J. (1998). Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image: Journal of Nursing Scholarship, 30, 315-321. Needleman, J., Buerhaus, P., Pankratz, V.S., Leibson, C.L., Stevens, S.R., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal of Medicine, 64(11), 1037-1045. Rafferty, A.M., Clarke, S., Coles, J., Ball, J., James, P., McKee, M., & Aiken, L.H. (2007). Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records. International Journal of Nursing Studies, 44, 175-182. Penoyer, D.A. (2010). Nurse staffing and patient outcomes in critical care: a concise review. Critical Care Medicine, 38(7), 1521-8. Van den Heede, K., Sermeus, W., Diya, L., Clarke, S.P., Lesaffre, E., Vleugels, A., & Aiken, L.H. (2009). Nurse staffing and patient outcomes in Belgian acute hospitals: Cross-sectional analysis of administrative data. International Journal of Nursing Studies, 46(7), 928-939.
Patient safety Beaulieu, M.J. (2009). Failure to rescue as a process measure to evaluate fetal safety during labor. MCN, American Journal of Maternal Child Nursing, 34, 18-23. Clarke, S.P. (2004). Failure to rescue: Lessons from missed opportunities in care [Invited commentary]. Nursing Inquiry, 11(2), 67-71. Clarke, S.P., and Aiken, L.H. (2003). Failure to rescue. American Journal of Nursing, 103(1), 42-47. D Amour, D., Dubois, C.A., Tchouaket, E., Clarke, S., Blais, R. (2014). The occurrence of adverse events potentially attributable to nursing on medical units. International Journal of Nursing Studies, 51(6), 882-91. Dubois, C.A., D'Amour, D., Tchouaket, E., Clarke, S., Rivard, M., Blais, R. (2013). Associations of patient safety outcomes with models of nursing care organization at unit level in hospitals. International Journal of Quality in Health Care, 25(2), 110-117. Economic outcomes Dall, T.M., Chen, Y.J., Seifert, R.F., Maddox, P.J., & Hogan, P.F. (2009). The economic value of professional nursing. Medical Care, 47, 97-104. Evidence-based practice and patient outcomes Berwick DM. (2015, Feb 3). Measuring surgical outcomes for improvement: was Codman wrong? JAMA, 313(5), 469-70. Doran, D.M., & Sidani, S. (2007). Outcomes-focused knowledge translation: a framework for knowledge translation and patient outcomes improvement. Worldviews on Evidence-Based Nursing, 4(1), 3-13. Etzioni DA, Wasif N, Dueck AC, Cima RR, Hohmann SF, Naessens JM, Mathur AK, Habermann EB. (2015, Feb 3). Association of hospital participation in a surgical outcomes monitoring program with inpatient complications and mortality. JAMA, 313(5):505-11. Kitson, A. (1997). Using evidence to demonstrate the value of nursing. Nursing Standard, 11(28), 34-39. Kitson, A. (2002). Recognizing relationships: reflections on evidence-based practice. Nursing Inquiry, 9(3), 179-186. Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence-based practice: a conceptual framework. Quality in Health Care, 7, 149-158. Osborne NH, Nicholas LH, Ryan AM, Thumma JR, Dimick JB. (2015, Feb 3). Association of hospital participation in a quality reporting program with surgical outcomes and expenditures for Medicare beneficiaries. JAMA, 313(5), 496-504.
Appendix 1 Time Monday Time Tuesday Wednesday Thursday Friday 9.15- Lecture/S Lecture/S Lecture/S Lecture/S 10.45 10.15- Introduction 10.45-11.00 Break Break Break Break to the 11.45 course 11.00-11.45 Lecture/S Lecture/S Lecture/S Lecture/S 11.45-12.30 Lunch 11.45-12.30 Lunch Lunch Lunch Lunch 12.30 Lecture/S 12.30- Lecture/S Lecture/S - 14.00 Lecture/S 14.00 Closing 14-14.30 Break 14-14.30 Break Break Break 14.30 Lecture/S 14.30- -16.00 Lecture/S 16.00