Good Morning!

It is indeed a pleasure to welcome each of you to

the conference on “Patient Outcomes Research: Examining the Effectiveness of Nursing Practice.” An exciting

agenda and array of notable speakers will facilitate the

critical examination of the state of the science regarding

patient outcomes in three definitive areas; 1) identification of the existing body of knowledge concerning nursing interventions and patient outcomes, 2) articulation of

the salient methods and measurement issues pertaining to

nursing research evaluating patient outcomes, and 3) recommendations of future directions for nursing focused

patient outcomes research.

Attention to patient outcome research in relationship to the interventions of health care providers has rapidly gained visibility and prominence during the last several years. Donabedian’s and Zimmerman’s early attention to structure, process and outcomes was only the forerunner of what was to become a very formalized field of

practice and research. As Hegyvary has noted, concentrating the focus on patient outcomes is critical since it

allows us to target our concerns and issues appropriately

in perspective to the recipient of care, i.e., the client. In

addition, the patient outcome focus challenges health care

providers of all kinds to be accountable and responsible

for the results of their therapeutic actions. It sensitizes

health care professionals to the need to be systematic, deliberative, and carefully predictive of the results of our

interventions.

The major emphasis of this conference is the critical examination of the state of the science and research

base needed to guide the deliberative process of achieving particular patient outcomes. We are all aware that

predicting and achieving specific outcomes resides in our

ability to generate a body of accurate and reliable knowledge from which such systematic expectations can be defined. In considering the state of the science, several issues need to be examined.

! First, what is the theoretical state of the science

in terms of patient outcomes from the nursing

perspective? Is nursing science ready for a fullblown emphasis on patient outcomes research,

i.e., explication of outcomes, interventions, and

the explanatory relationships which allow us to

understand the mechanisms through which certain expected outcomes can be predicted from deliberative therapeutic actions? Are there several

preliminary research programs which need to be

conducted first in relationship to identification of

specific outcomes and particularly, in explication

and refinement of the effective components of

nursing interventions?

! Second, what are the particular outcomes which

can be identified that are sensitive to nursing interventions and therapeutic actions? The traditional types of outcomes such as mortality, morbidity and disability, are criteria which can be used

by all health care providers but do not provide

Welcome To

Patient Outcomes Research Conference

Ada Sue Hinshaw
particularly informative data for understanding

the outcomes of nursing interventions. More specific outcomes such as quality of life, functional

status, broader symptom intensity and patient satisfaction may be more appropriate for capturing

the results of major nursing interventions.

! Third, patient outcome research focused on medical effectiveness has primarily defined indicators

which are sensitive to medical treatments in relation to particular disease processes. From a nursing perspective, particular clinical conditions need

to be identified which are more specific to

nursing’s focus on prevention, health promotion,

and symptom management and the amelioration

of the effects of acute and chronic illnesses. We

are all familiar with clinical conditions that are

more central to our practice, such as skin integrity, pain, urinary incontinence, nausea and vomiting, nutritional deficits, confusion, restricted

mobility, depression, fatigue, and illness related

stress. It will be particularly important that we

begin in our research programs to both define and

refine the patient outcomes specific to interventions focused on such clinical conditions.

! Fourth, timing in relationship to understanding

patient outcomes which result from particular

nursing therapeutic actions is another major issue. Questions of just when to predict certain

outcomes and be able to effectively evaluate them

must be done in terms of whether the outcomes

expected from particular interventions are short

term in nature or whether the long term response

is more critical such as with patient education and

maintenance of behavioral change. Thus, understanding which outcomes are expected at specific

points in time and generating the knowledge to

predict the dynamic status of such outcomes, is

of major concern.

Several methodological issues are also critical as

you consider the status of patient outcome research in

relationship to nursing effectiveness.

! The sensitive, valid and reliable measurement of

patient outcomes is a critical area for study. New

measures need to be developed operative indicators of nursing sensitive outcomes which reflect

strong psychometric characteristics such as sensitivity, validity and reliability.

! Level of analysis issues are critical in patient outcome research since the result may reflect individual or aggregate entities. Methodological approaches for handling different levels of analysis

and integrating these in theoretical context are

important to develop.

! Large existing national data bases and nursing’s

ability to utilize these effectively poses a particularly difficult issue. Nursing elements are usually absent from large scale health care data bases.

The paucity of nursing sensitive outcomes which

can be identified with these data bases as well as

the difficulties of extrapolating the few existing

indicators in the data sets to measure the effectiveness of nursing interventions poses a particularly relevant challenge.

Attention to patient outcomes in practice and in

our scientific programs of research, by nature, requires a

multidisciplinary approach. Patient outcomes may reflect

the interventions of numerous health care providers and

must be considered within the context of multidisciplinary

practice. Research programs in patient outcomes must

also account for such a team endeavor. Collaboration

will be a necessity as we seek with other health care scientists to understand the results of our actions, and to define more sensitively and precisely the expected outcomes

of professional practice.
Your deliberations and shared collective wisdom

in the next several days are of critical importance to the

National Center for Nursing Research. The recommendations which you evolve by the end of this conference

will provide one of the major bases from which program

initiatives will be developed for the NCNR’s patient outcomes research activities. The field of study is broad and

diverse. We need your assistance in identifying the priority areas of study. If nursing is to systematically build

the body of knowledge needed to guide the delineation of

nursing interventions, in relation to nursing sensitive outcomes, we need to focus our endeavors to facilitate building depth in the science and providing stepping stones for

the careful evolution and substantiation of knowledge in

this field. As experts in this area of research, we look to

you to provide the judgment needed to guide the development of a program in patient outcome research which

will enhance a systematic examination of the effectiveness of nursing practice.

I envy you the challenge you face and the excitement of the endeavor.

Again welcome - we are looking forward to the

outcomes of your collective wisdom.