This competing renewal application seeks funding for Phase II of a program of research to identify, classify, and evaluate nursing sensitive patient outcome measures. The purposes of this study are to: 1) identify the Nursing Outcome Classification (NOC) outcomes that are most relevant for patients in specialty nursing practice areas and in selected field sites representing the continuum of care; 2) evaluate measurement scales for the NOC outcomes, including beginning identification of risk adjustment factors; and, 3) continue the development, classification, and evaluation of outcome measures for individuals and for family units. In Phase I, 190 outcomes were developed, tested for content validity and piloted in three sites. Measurement scales developed for each of the outcomes will be evaluated for interrater reliability and criterion validity in eight clinical settings: 2 tertiary care hospitals, 1 community hospital, 1 parish nursing service, 2 home care services, and 1 nursing center for family care. Kappa will be used to evaluate interrater reliability. Criterion validity will be assessed on all NOC outcomes for which criterion measures are available. Independent ratings into known groups or comparison with another critical criterion (when possible) will be used if criterion measures are not available. Unique linkages between nursing diagnoses, interventions, and outcomes will be described. Correlation, analysis of covariance and hierarchial linear modeling will be used to describe relationships between selected patient characteristics and outcome achievement to identify risk adjustment factors. Fehring (1987) content validity scores will be used to evaluate the content validity of new outcomes.
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