NOC: Most comprehensive outcomes measurements
NOC: Most comprehensive outcomes measurements
System is versatile, easy to use
While there are many vocabulary and classification systems that measure patient care issues, interventions, and outcomes, there’s not a more comprehensive outcome measurement tool than the Nursing Outcomes Classi fi cation (NOC) developed at the University of Iowa in Iowa City.
The tool has over 100 outcomes with indicators, elements a nurse would measure to determine whether that outcome was met, and the scales on which to base the measurement, explains Connie Delaney, PhD, RN, FAAN, associate professor at the University of Iowa. Many of these outcomes can be linked to patient education. For example, in the area of knowledge, the outcomes include:
• knowledge of treatment regimens;
• knowledge of prescribed activity;
• knowledge of health resources;
• knowledge related to the disease process.
Knowledge of the disease process would be measured by determining how familiar a patient is with the disease name, whether or not he or she is able to describe the disease process, the cause or contributing factors, risk factors, effects of the disease, signs and symptoms, usual disease course, measures to minimize the disease progression, complications, signs and symptoms of complications, and precautions to prevent further complications. Each indicator is measured on a scale of one to five, with one equaling "no knowledge" and five equaling "extensive knowledge."
NOC can be used to design educational programs as well as evaluate the quality and effectiveness of the education. Any facility can use this outcome measurement system. If they don’t have a computer to analyze data, it can be done on paper, says Delaney.
"NOC gives sustenance, so to speak, to the actual teaching, not just saying the patient met the goal or they didn’t or that they understood or didn’t," says Mary Clarke, MA, RN, informatic nurse specialist at Genesis Medical Center in Davenport, IA. The results can show that the more teaching patients receive over time, the better their score, or that retention is low and the material needs to be reinforced in some way. It’s a much better method than just documenting what was taught, she says.
For example, at Genesis Medical Center, NOC was used to measure knowledge in cardiac surgical patients in three phases: pre-op, a few days post-op, and during continuing rehabilitation sessions. It also was used to determine how nursing outcome scores were affected at each point of teaching, including the preadmission nurses, nurses on the unit, dietitians, and rehabilitation nurses. "We saw improvement over time. The more information they obtained, the better the scores were," says Clarke.
While NOC is the classification tool described in this article, the nursing vocabulary or classification method used by an institution should depend on its goal and setting. However, any tool selected should be recognized by the American Nurses Association in Washington, DC, advises Delaney.
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