FUTURE TALK: PERIANESTHESIA DATA ELEMENTS

The Importance of Measurable OutcomesLinda Wilson, PhD, RN, CPAN, CAPA, BC, CNE, H. Lynn Kane, MSN, MBA, RN, CCRN,

Kathleen Falkenstein, PhD, RN, PNP-BC, CCTC

345

NURSING LANGUAGE has a very importantrole in communicating, describing, defining,and organizing nursing care.1 Nursing docu-mentation, which is based on the nursing pro-cess, has been the foundation for clinicaldecision-making. A standardized language isimperative in nursing to ensure consistencyand to provide common understanding acrossall nursing specialties.

Standardized nursing diagnoses have been un-der development since 1973, when the firstmeeting of the national conference groupfor the classification of nursing diagnoseswas held.2 The North American NursingDiagnosis Association (NANDA) is the organi-zation that formalized the development ofnursing diagnoses.3 Since that time, the nurs-ing diagnosis extension and classificationteam at the University of Iowa, as well asNANDA, have added, updated, and revisednursing diagnoses.4

The Nursing Interventions Classification (NIC)is a comprehensive classification of nursing in-terventions developed by a team at the Univer-sity of Iowa.5 Later, another University of Iowateam developed the Nursing Outcomes Classi-fication (NOC), which presents standardizedterminology and measures for nursing-sensi-tive patient outcomes that result from nursinginterventions.6

For nursing to fully participate in clinical eval-uation, clinical research, policy development,and interdisciplinary team work, it is impera-tive that patient outcomes influenced by nurs-ing care be clearly identified and measured.6 Itis recognized that many identified patient

Journal of PeriAnesthesia Nursing, Vol 23, No 5 (October), 2008: pp 345-348

outcomes are not specifically influenced bynursing alone, but when discipline-specificoutcomes do exist, it is important that theybe identified.6

Outcome Development

Measurable nurse-sensitive outcomes are essen-tial for all areas of perianesthesia nursing, in-cluding preanesthesia and postanesthesialevels of care. The systematic use of outcomesto evaluate the effects of health care treatmentsand interventions began with Florence Nightin-gale during the Crimean War.7 Since then, nu-merous approaches to outcome evaluationhave emerged.8 Outcomes are health statuschanges, either favorable or adverse, of people,groups, or communities that result from prioror concurrent care.9 The concept of lookingat outcomes as the validation of quality ofcare is not a novel concept.10 Historically, thetriad of structure, process, and outcomeshas been used as the gauge of quality.11 Struc-ture was assessed through organizational stan-dards, and process was assessed by qualityassurance programs evaluating details such ascharges and record-keeping. Outcomes were

Linda Wilson, PhD, RN, CPAN, CAPA, BC, CNE, is an Assistant

Professor in the College of Nursing and Health Professions at

Drexel University, Philadelphia, PA; H. Lynn Kane, MSN, MBA,

RN, CCRN, is a Clinical Nurse Specialist at Thomas Jefferson

University Hospital, Methodist Division, Philadelphia, PA;

and Kathleen Falkenstein, PhD, RN, PNP-BC, CCTC, is an Assis-

tant Professor in the College of Nursing and Health Profes-

sions at Drexel University, Philadelphia, PA.

Address correspondence to Dr Linda Wilson, PO Box 1969,

Drexel University, Philadelphia, PA 19105-1969; e-mail

address: lbw25@drexel.edu.

� 2008 by American Society of PeriAnesthesia Nurses.

1089-9472/08/2305-0007$34.00/0

doi:10.1016/j.jopan.2008.07.008

346 WILSON, KANE, AND FALKENSTEIN

typically assessed in terms of morbidity, mortal-ity, length of stay, and readmissions.10 Today,the concept of outcomes has been expandedto fit with the World Health Organization’sdefinition of health, which includes physical,social, and psychological well-being.12 Assess-ment of the effects of treatment should alsoinclude consideration of patient safety, satisfac-tion, patient preferences, self-assessment offunctional capacity, and quality of life. Clini-cians and patients have always looked at func-tional outcomes as the vital definitive measureof the success of the intervention.

Outcomes research attempts to establishwhich treatments work, are cost-effective,and achieve or contribute to a desired out-come.13 Outcomes can be global or end out-comes, such as health status or patientsatisfaction. Outcomes can be intermediateoutcomes that assess patient knowledge, atti-tudes, and behaviors or measure wellnesscare.14 These intermediate outcomes aremost frequently addressed by nursing inter-ventions and must be measured to demon-strate the value of longitudinal care, patienteducation, and physical and emotional sup-port to the health of individuals and popula-tions.15 The development of valid andreliable instruments to measure function andhealth status, in general and in disease-specificterms, is imperative if nurses are to under-stand and to evaluate outcomes-specific ele-ments of health care. To facilitate the analysisof nursing care quality and cost in clinical set-tings, outcomes and interventions need to belinked in the clinical record to the diagno-ses—nursing or medical.

Preanesthesia

Preanesthesia level of care, according toASPAN, includes care of the patient in bothpreadmission and on the day of surgery. Inthe preadmission area, the nursing roles ‘‘fo-cus on physical, psychological, socioculturaland spiritual preparation for the experience.Interviewing and assessment techniques areused to identify potential or actual problems

that may result. Education and interventionsare initiated to optimize positive patient out-comes.’’16 In the day-of-surgery procedurearea, the nursing roles ‘‘focus on validating ex-isting information and providing nursing careto complete preparation for the experi-ence.’’16

The following are examples of possible out-come measures for the preanesthesia area:

1. Communication2. Family support3. Fear level4. Stress level5. Knowledge level6. Pain level7. Comfort level8. Emotional level9. Vital signs

10. Documentation

Each outcome measure needs to be individual-ized to the patient.

Postanesthesia

Postanesthesia level of care, according toASPAN, includes three patient care phases:PACU Phase I, PACU Phase II, and ExtendedObservation. In PACU Phase I level of care,the nursing roles ‘‘focus on providing post-anesthesia nursing care in the immediate post-anesthesia period, transitioning the patients toeither Phase II or the in-patient setting, or to anintensive care setting for continued care. Basiclife-sustaining needs are of the highest priority.Constant vigilance is required during thisphase.’’16 In PACU Phase II level of care, thenursing roles ‘‘focus on preparation of the pa-tient for care in the home, extended observa-tion, or an extended care environment.’’16 InExtended Observation, the nursing roles ‘‘fo-cus on providing care when extended observa-tion/intervention after discharge from Phase Ior Phase II is required.’’16

The following are some examples of possibleoutcome measures for the PACU Phase I levelof care:

MEASURABLE OUTCOMES OF ASPAN PDEs 347

1. Pain management2. Nausea and vomiting management3. Pain level4. Neurologic status5. Cardiovascular status6. Respiratory status7. Gastrointestinal status8. Genitourinary status9. Electrolyte and acid base balance

10. Tissue perfusion11. Postprocedure recovery status12. Condition of dressing13. Condition of drains or tubes14. Intravenous therapy15. Patient safety

Each outcome measure needs to be individual-ized to the patient.

The following are some examples of possibleoutcome measures for the PACU Phase II levelof care:

1. Pain management2. Nausea and vomiting management3. Pain level4. Neurologic status5. Cardiovascular status6. Respiratory status7. Gastrointestinal status8. Genitourinary status9. Tissue perfusion

10. Urinary elimination11. Discharge readiness12. Patient satisfaction13. Self care14. Body image15. Family support

Each outcome measure needs to be individual-ized to the patient.

The following are some examples of possibleoutcome measures for the Extended Observa-tion level of care:

1. Pain management2. Nausea and vomiting management3. Pain level4. Neurologic status5. Cardiovascular status6. Respiratory status7. Gastrointestinal status8. Genitourinary status9. Tissue perfusion

10. Urinary elimination11. Discharge readiness12. Patient satisfaction13. Self care14. Nutrition15. Family support

Each outcome measure needs to be individual-ized to the patient.

ASPAN Perianesthesia Data Elements

ASPAN has been developing the ASPAN Peri-anesthesia Data Elements since 2004. ASPAN’sgoal is to develop a ‘‘comprehensive data dic-tionary synthesized from peer reviewed andvalidated clinical perianesthesia nursing as-sessments, diagnoses, interventions and out-comes.’’17 At the completion of this project,this data dictionary will provide a sound foun-dation for further language tool developmentspecific to perianesthesia practice and themeasurement of health outcomes specific tothis specialty.17

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