Janelle Yorke looks at nursing indicators and wonders how might they be relevant to specialist respiratory nursing?
Nursing metrics, now called indicators, are becoming common place in nursing. Indeed, England’s first set of national outcome indicators specifically relating to nursing care are now available. These include pressure ulcers, falls and urinary tract infections.
I have previously spoken about nursing indicators in a blog and since then indicators specific to specialist nursing have appeared in the literature. In this time of financial uncertainty, performance indicators related to specialist nursing may provide an important evidence base for specialist respiratory nurses. Identifying indicators for specialist respiratory nursing may have the potential to not only ensure quality patient care, but may help to clarify and strengthen the contribution of such nurses.
Nurse sensitive outcomes and indicators have recently been identified and published for ambulatory chemotherapy. Examples include safe medication administration, nausea and vomiting, pain, nutrition and quality of the patients’ experience. A significant amount of work lay behind the identification of these indicators. As discussed by the authors themselves, the strength of the evidence was not strong but the indicators selected seem to be those that are most sensitive to nursing care.
Great, these specialist nurses now have a platform from which to measure performance, improve patient care, and ultimately have a tool to start collecting the evidence for the difference they make to patient care. Armed with this evidence, these nurses will have the ability to prove unequivocally that they represent good value for money to NHS managers, Government, commissioners and the general public.
This begs the question: what nurse indicators are relevant to specialist respiratory nursing?
To answer this one needs to consider the requirements of a workable indicator including importance, and able to be measured at a relatively low cost and low burden to the team. I would not like to speculate as to what such indicators may entail. This would require a significant amount of searching and synthesising the available literature and possibly conducting primary research. However, breathlessness management and correct inhaler technique do immediately spring to mind. Many issues need to be explored if such a list of respiratory indicators was to be developed – should indicators be disease specific and dependent upon where care is delivered (i.e. community and acute setting)?
Of course one obstacle to such work is how certain we can be that any indicator reflects nursing care alone? We work as part of a team and no one professional group wholly determines patient outcomes. However, we know that there are certain patient outcomes that seem to be most sensitive to specialist respiratory nursing. The challenge that lies ahead is to find the evidence to support the link between respiratory nursing and patient outcomes.
About the author
Dr Janelle Yorke is a senior lecturer and researcher at the University of Salford