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Evaluation of documented nursing care plans by the use of nursing-sensitive outcome indicators
Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
Institute of Health and Care Sciences, The Sahlgrenska Academy at Gothenburg University, Sweden.
Institute of Health and Care Sciences, The Sahlgrenska Academy at Gothenburg University, Sweden.
2010 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 16, no 3, p. 611-618Article in journal (Refereed) Published
Abstract [en]

Abstract Rationale and aim: There is a lack of evidence that nursing care plans affect patient outcomes. The aim of the present study was to evaluate whether documented nursing care plans affect patient outcomes by the use of nursing-sensitive outcome indicators. Method: A retrospective, cross-sectional design with patients surveyed at time of discharge from two hospital units for patients with stroke and after 2-3 weeks at home. The control unit (A) did not employ care plans. The intervention unit (B) used care plans on a daily basis. Outcome was measured by 'the National Stroke Register' and the two questionnaires: 'Quality of patients' perspective' and 'Euroquol five dimensions'. Data were collected over a 5-month period (October 2007-February 2008). Results: In total, 87 patients were included in the study. Patient characteristics in the two groups at admission and the health-related quality of life 2 to 3 weeks after discharge were similar. The patients from unit B were more satisfied with individual care (P = 0.03) and participation (P = 0.007). Unit B also had a shorter length of stay (P = 0.004). Conclusions: The effects of documented care plans are difficult to evaluate from a patient perspective, as many factors can improve the outcome. However, documentation of care plans is a prerequisite for measuring the quality and outcome of the care provided. This small study indicates that documented care plans may affect patient satisfaction regarding individual care, participation and length of hospital stay.

Place, publisher, year, edition, pages
Oxford: Blackwell Publishing, 2010. Vol. 16, no 3, p. 611-618
Keywords [en]
Care plans, Empirical research report, Nursing diagnosis, Outcome, Stroke
National Category
Nursing
Identifiers
URN: urn:nbn:se:hh:diva-3709DOI: 10.1111/j.1365-2753.2009.01233.xISI: 000278077900034PubMedID: 20039996Scopus ID: 2-s2.0-77952940643OAI: oai:DiVA.org:hh-3709DiVA, id: diva2:288719
Available from: 2010-01-21 Created: 2010-01-21 Last updated: 2018-03-23Bibliographically approved
In thesis
1. Planerad processorienterad omvårdnad - nytta och implementering
Open this publication in new window or tab >>Planerad processorienterad omvårdnad - nytta och implementering
2010 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

To ensure the provision of good and safe nursing care in the ward, the nursing needs of each patient should be established and clearly documented in the form of care plans in his/her medical record. There is a lack of scientific evidence of the benefits of this method of working as well as why this part of the nursing process is not always successful. The main aim of this thesis was to describe the assessment and decision-making process pertaining to nursing needs performed by nurses, to evaluate the consequences of planned, process oriented nursing care and to identify the factors and conditions that have had an impact on the implementation of individual care plans (ICP) and standardized care plans (SCP).

 

In studies I and III, qualitative methods were used. In study I, data collection and analysis were carried out by means of Grounded theory. Study III was conducted by means of directed content analysis and guided by “The Promoting Action on Research Implementation in Health Services framework”. In studies II and IV, quantitative methods were employed.

 

The benefits of a planned, process oriented method of working involving documentation of care plans have been investigated from the perspective of both the patient and the nurse. Nurses who applied the process oriented method adopted a nursing perspective in the assessment of and decision making pertaining to the patient’s nursing needs, which was not the case with nurses who did not work in this way and who instead exhibited a more medical approach (I). Patients cared for in wards where care plans were documented reported being more involved and that the care was more tailored to their individual needs compared to those not cared for in this manner (II). Leadership that prioritises the development of nursing care is essential for the implementation and continued use of ICPs and SCPs. Another important factor was the presence of internal facilitators in the ward in the form of nurses with a clear mandate to work with these issues. The nurses reported that they did not discuss scientific evidence as a basis for performing planned process oriented nursing care and that they did not listen to patient experiences to any great extent (III, IV).

 

The conclusion is that structured, process oriented nursing care based on written care plans probably promotes the nursing perspective and enables patient participation. Leadership as well as facilitators with a clear role and mandate are important factors in the implementation of this method of working and scientific evidence is of less importance.

Place, publisher, year, edition, pages
Göteborg: Göteborgs Universitet, 2010. p. 67
Keywords
Nursing process, assessment, judgment, individual care plans, standardized care plans, implementation, PARIHS framework
National Category
Nursing
Identifiers
urn:nbn:se:hh:diva-5612 (URN)978-91-628-8043-9 (ISBN)
Public defence
2010-05-07, Göteborg, 13:00 (Swedish)
Supervisors
Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2018-03-23Bibliographically approved

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