Document Type


Date of Degree

Spring 2012

Degree Name

PhD (Doctor of Philosophy)

Degree In


First Advisor

Swanson, Elizabeth A

First Committee Member

Reimer, Toni T

Second Committee Member

Buckwalter, Kathleen C

Third Committee Member

Specht, Janet K

Fourth Committee Member

Helms, Lelia B


In 2009, the Government Accountability Office reported that 15% of federal nursing home (NH) recertification surveys nationwide and 25% of surveys in nine states underscored serious deficiencies in nursing care provided to 1.5 million residents residing in NHs. The state nursing home survey agencies' surveyors attributed the Centers for Medicare and Medicaid Services (CMS) administrative rules and the documents in the surveyor guidance manual as too complex and ambiguous to correctly assign deficiency severity scores. In review of nursing literature, it was noted that standardized nursing language can increase the clarity of complex systems. The premise of this exploratory study was to determine if the standardized language of the Nursing Outcomes Classification (NOC) could provide a cross-linkage of the CMS rules, indicators of substandard nursing care, and the full guidance manual used to assign deficiency severity scores. The study attempted to achieve this goal by aligning select NOC outcomes and indicators with nursing outcomes indicators in the CMS administrative rules, select documents in the surveyor guidance manual and select documents in the Quality Indicator Survey. The data analysis suggested the relationship of the origin of the CMS rule and documents to the degree of alignment with the select NOC outcomes and indicators. It was also found that the intent of the CMS rule and select documents shared common themes. In addition, the data analysis revealed that the CMS rule and select documents aligned in various degrees with all of the selected NOC outcomes and respective indicators. The data analysis confirmed that there is sufficient evidence of a degree of alignment of select NOCs with the CMS rule and documents in the guidance manual for activities of daily living and functional status. Furthermore, the data analysis confirmed that this body of work can be a baseline for future research to develop an NOC specific to NHs as a viable cross-link to the CMS rules and guidance manual.


Centers for Medicare and Medicaid Services, Nursing Home, Nursing Outcomes Classification, regulation, survey


vii, 128 pages


Includes bibliographical references (pages 125-128).


Copyright 2012 Elaine K. Cook

Included in

Nursing Commons