FINDING VALUE IN NURSING-CARE - A FRAMEWORK FOR QUALITY IMPROVEMENT AND CLINICAL-EVALUATION

Fiscal constraints have heightened attention to health care costs and patient outcomes as measures of health care system effectiveness. Dete rmining which patient and costs outcomes nurses may be held accountabl e for requires differentiating the impact of dependent, independent an d interdependent nursing activities. A nursing role effectiveness mode l that includes a number of structural variables is offered to help tr ack quality improvement and research activities. Some of the nurse-sen sitive patient outcomes that have been identified include: freedom fro m complications, clinical outcomes, functional health outcomes, knowle dge outcomes, perceived health benefit (or satisfaction), and costs ou tcomes. This model can be used to evaluate the effectiveness of curren t as well as evolving nurse roles, processes, and structural changes.