Nursing Outcomes for Temporal Data Management in a Nursing Home

One of the most important roles of the nurse in the delivery of patient care is the management of clinical information. The use of computerized patient records can improve nursing's ability to document care given to patients, evaluate nursing quality care, and contribute to the development of nursing knowledge, which requires the use of patient outcome measures. The temporal database model can provide access to past states of the database such as points in time and duration (Etzion, Jajodia & Sripada. 1998). By utilizing a temporal database information system with standardized patient outcomes, patient progress or regression can be captured and available for more effective decision making for the caregivers. This investigation was the fourth stage of the Hassett and Hassett ongoing research project on a temporal database model to represent the progression of states of nursing home residents' care plans over intervals of time. An exploratory descriptive design was used, to extend the studies initiated by Hassett, Hassett and Rupp (1993), and continued with Lin (1993) and Lee (1996). Nolan's Stage Model (1993) served as the theoretical framework to study the possible success of using the nursing home as a site for future computerization. The purpose of this investigation was to examine the available nursing sensitive patient outcomes in response to nursing interventions for residents with impaired physical mobility documented in the resident record and to compare the different information values between a snapshot database approach and a temporal database approach. Ten sample resident's records were chosen from a mid-western nursing home, and studied for documentation of nursing sensitive patient outcomes. This investigation was retrospective and therefore contact with individual residents did not occur. The investigator found the nursing diagnosis and nursing documentation of the care plan were computerized but the nursing outcomes were documented in a narrative format. The narrative charting made it difficult for the investigator to find the documentation of nursing outcomes consistently in the records. The use of a standardized language would assist the nursing staff to classify outcomes to be used in determining the effectiveness or ineffectiveness of nursing interventions. If a temporal database model were used it would facilitate the retrieval of past responses to nursing interventions and data needed to meet the future needs of the residents. The recommendation for future research includes replicating this study in more nursing homes, with a larger sample and more nursing diagnoses, interventions and outcomes, studying the use of nursing intervention classification (NIC) and nursing outcome classification (NOC) as standard taxonomy for nursing interventions and nursing outcomes and the inclusion of nursing outcomes in the computer software for clinical information systems.