Document Type

Dissertation

Date of Degree

Spring 2016

Degree Name

PhD (Doctor of Philosophy)

Degree In

Nursing

First Advisor

Sue Moorhead

Abstract

Cardiovascular diseases (CVD) and diabetes are the most significant chronic diseases globally due to their high prevalence and mortality. People with CVD or diabetes need to know how to self-manage their health conditions to promote, maintain, and restore their health status. The Nursing Outcomes Classification (NOC) has assisted nurses and other health care providers to evaluate and quantify the status of the patient and has reflected the current health care issues that are to prevent progression of chronic diseases. Based on the current health focus, additional knowledge and self-management NOC outcomes were developed and added to the latest edition of NOC published in 2013. Generally, validation of measurement tools is required to provide trustworthy evidence for use in practice. As measurement tools, NOC outcomes with their definitions, indicators, and measurement scales need to be validated for accuracy, meaningfulness, and usefulness before they are widely used in various health settings. To provide clinical evidence for effective nursing practice such as accurate assessments and evaluations, validation of NOC outcomes is required. The purpose of this study was to validate 12 NOC outcomes focused on knowledge and self-management for people with CVD and diabetes.

A descriptive exploratory design was used to validate the selected NOC outcomes, and a two round survey using the Delphi technique was used to collect data from the invited experts via email. Two subject populations were invited. The first expert group was related to standardized nursing languages (SNL) and invited experts were members of NANDA International or a fellow of the Center for Nursing Classification and Clinical Effectiveness (CNC). The second expert group was related to self-management and invited experts were members of two research interest groups which are Health Promoting Behaviors Across the Lifespan and Self Care in the Midwest Nursing Research Society (MNRS). Descriptive statistics were used to determine the definition adequacy, clinical usefulness of measurement scales, and similarity between content of knowledge and self-management outcomes. The Outcome Content Validity (OCV) method was used for the content validity of outcomes and their indicators.

A total of 46 and 27 nurse experts participated in the first and second round surveys, respectively. The mean age of participants was 51.87 years (SD=13.03) and the mean of experience in nursing was 27.67 (SD=14.75) years. Most participants had experience using SNL (82.6%). Each outcome reported acceptable psychometric properties. The range of definition adequacy of the 12 NOC outcomes was from 3.71 to 4.29 (perfect score is 5.0). The range of clinical usefulness for using measurement scales was from 3.77 to 4.29. The range of content similarity of the six pairs was from 3.88 to 4.35. Every evaluated NOC outcome identified as critical with over .80 OCV scores (perfect score 1.0). More than 80% of indicators were categorized in the critical level in the first round. Thus, psychometric properties of the 12 NOC outcomes were acceptable to use in the clinical settings.

By using validated NOC outcomes, nurses caring of patients with CVD or diabetes can evaluate patient outcomes effectively, and determine the effect of nursing interventions accurately. Development of new NOC outcomes and validation of them will provide nurses with measurement tools to use with patients, clinical evidence for quality improvement and knowledge development in nursing.

Public Abstract

Current health environments have widely adopted electronic health records. Nurses also use these systems for nursing documentation. To use these systems, development of standardized nursing languages was required, and one of those nursing languages is the Nursing Outcomes Classification (NOC). NOC outcomes measures reflect current health care issues, and new NOC outcomes have been developed. With the health care reform, current health care focuses on health promotion to prevent the development of chronic diseases. Specifically, cardiovascular diseases (CVD) and diabetes are the most significant chronic diseases due to their high prevalence and mortality. People with both diseases have to know how to self-manage their health conditions to promote, maintain, and restore their health. In order to evaluate health outcomes of the people with both diseases, new NOC outcomes focused on self-management for people with CVD or diabetes were developed. The purpose of this study was to validate 12 new knowledge and self-management outcomes for people with CVD or diabetes.

Nurse experts validated these NOC outcomes using an online survey twice. A total of 46 and 27 nurse experts participated in the first and second round surveys, respectively. The 12 NOC outcome definitions were evaluated as quite adequate to describe the outcomes. The 12 NOC outcomes were identified as critical, and more than 80% of their indicators were categorized as critical to measuring the outcome. The measurement scales for the outcomes were evaluated as quite relevant for use as scales in clinical settings. Additionally, indicators in the knowledge and self-management outcomes describing the same diseases or conditions were similar to each other to evaluate the patient outcomes. By using validated NOC outcomes, nurses who take care of patients with CVD or diabetes can evaluate patient outcomes effectively and determine the effect of nursing interventions accurately.

Keywords

publicabstract, Cardiovascular Diseases, Diabetes, Nursing Outcomes Classification, Self-Management, Validation

Pages

xvi, 225 pages

Bibliography

Includes bibliographical references (pages 217-225).

Copyright

Copyright 2016 HYUNKYOUNG OH

Included in

Nursing Commons

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