Academic journal article Scholarly Inquiry for Nursing Practice

Caregiving: Concept Analysis and Outcomes

Academic journal article Scholarly Inquiry for Nursing Practice

Caregiving: Concept Analysis and Outcomes

Article excerpt

More than ever before, caregiving has become a salient public policy issue. A number of recent and anticipated demographic, economic and social changes have occurred that make it imperative for researchers to critically examine the impact of caregiving on family caregivers' health, behavior, emotions, and social status. Researchers at the University of Iowa College of Nursing are working to classify standardized nursing-sensitive patient outcomes for use in language development, practice, research, and education to evaluate the effectiveness of nursing interventions and clinical nursing services. This article focuses on family caregiving and the analysis of caregiver role performance in both direct and indirect care, linking outcomes and indicators, to enable nurses to promote the health of caregivers.

OVERVIEW AND PURPOSE

Caregivers are a critical resource for the care of elderly people and those who are chronically ill. Family and friends provide valuable, informal, unpaid assistance to people who have disabling health problems and remain in the community. More than 70% of the caregivers are women (U.S. Senate Special Committee on Aging, 1991) who have provided care for at least 1 year, and 80% of these individuals are involved in caregiving activities 7 days per week (U.S. Senate Special Committee on Aging, 1991). The expanding need for informal caregivers, the growing cost of health care, and the emphasis on community versus institutional care make it imperative to evaluate patient and caregiver outcomes.

Outcomes research has major implications for nursing practice and care delivery. Concerns about cost, quality, and distribution of health care drive the need to demonstrate the effectiveness of nursing management and clinical interventions. These forces and the recognized necessity for standardized language (Lane & Jacox, 1993; McCloskey & Bulecheck, 1994; Werley & Lang, 1988) are highlighting the necessity for a classification of nursing-sensitive patient outcomes. Classifications of nursing diagnoses (Martin & Sheet, 1992; North American Nursing Diagnosis Association (NANDA), 1992; Saba et al., 1991) and nursing interventions (Iowa Intervention Project, 1992; Saba et al., 1991) have been developed. A classification of nursingsensitive patient outcomes, which will have multiple purposes, including the evaluation of management interventions, is in the beginning stages of testing.

Nursing's ability to assess its effectiveness is seriously hampered by the lack of a standardized language for patient outcomes that are influenced by nursing management and clinical interventions. Both nurse administrators and clinicians are handicapped by the lack of standardized outcomes when developing computerized nursing information systems and when using standardized databases to evaluate the effectiveness of management innovations and clinical nursing services. This article briefly overviews the work of a large research team at the University of Iowa College of Nursing to classify nursing-sensitive patient outcomes, and then focuses on the group work in the area of family caregiving. This group is one of eight focus groups within the large research team. This article reports results of the focus group's work on the following outcomes: (1) Caregiver role performance: Direct caregiving; and (2) Caregiver role performance: Indirect Caregiving.

The Nursing Outcomes Classification (NOC) research team, funded by Sigma Theta Tau International and the National Institute of Health, National Institute of Nursing Research (1RO1NR03437-01), has been conducting a study to clarify nursing-sensitive patient outcomes. The purposes of the research are to: (1) identify, label, validate, and classify nursing-sensitive patient outcomes and indicators; (2) evaluate the validity and usefulness of the classification in clinical field testing; and (3) define and test measurement procedures for the outcomes and indicators. …

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