The Pattern of Use of NOC Outcomes for Patients Hospitalized with CHF
The need for standardized information about the patient outcomes documented by
nurses has increased as organizations have restructured to achieve greater cost
effectiveness and qualitative care with patient safety (Moorhead et al., 2009). The
Nursing Outcomes Classification (NOC) facilitates the identification and analysis of
outcome status for specific patients’ populations and also facilitates the identification of
realistic standards of care for specific populations.
To realize these benefits, identifying the patterns of NOC outcomes for a
particular patient or a group is the first step. In this study, the outcomes for patients
hospitalized with CHF were identified. The average number of NOCs selected were 8.15
nursing outcomes per patient with a range from 1 to 35 and sixty-three different NOCs
was selected by nurses. The top six NOCs were Knowledge: Treatment Regimen, Safety
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Behavior: Fall Prevention, Risk Control, Tissue Integrity: Skin & Mucous Membranes,
Cardiac Pump Effectiveness, and Fluid Balance. These NOC accounted for almost 50%
of the total NOCs selected for patients hospitalized with CHF.
Physiologic Health (35%) is the most frequently selected NOC domain followed
by Health Knowledge & Behavior (30%), Functional Health (21%), Psychological Health
(8%), Family Health (3%) and Perceived Health (3%). These findings were not surprising
because the selected NOCs were related to NICs to assess and measure them. NOC
domains are reflective of NIC domains. However, it is necessary to study what factors
could affect selections of NOCs. Moorhead et al (2008) identified that a number of
factors are considered when selecting an outcome, including the type of health concern,
the nursing or medical diagnoses and health problems, patient characteristics, patient
resources, patient preferences, patient capacities, and treatment potential. There are a
number of aids available that can assist in selecting outcomes for the individual patient,
patient groups, or standardized care plans or when teaching staff about the use of the
classification and outcomes.
As a tool for assessment and measurement, NOC was used for assessment before
interventions and for measurement of outcomes after interventions in this study while
other studies only identified the frequency of NOCs in diverse settings such as acute care
setting or school settings (Behrenbeck, Timm, Griebenow, & Demmer, 2005; Cavendish,
Lunney, Luise, & Richardson, 2001). One study identified the nursing outcomes that
were most relevant for acute care nursing practice and assessed the adequacy of measures
in 434 patients including cardiac surgery intensive care (n=76) in cardiac transplant unit
(n= 153), and medical unit (n= 205) during 14 months at tertiary care center. Thirty- six
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NOC outcomes were used 10 or more times and 16 NOCs had an inter-rater reliability of
75% or higher (Behrenbeck, Timm, Griebenow, & Demmer, 2005). Cavendish and
colleagues (2001) identified the useful NOCs in school settings for documentation of the
effectiveness of nursing interventions.
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