Master's Theses

Document Type

Thesis - campus only access

Date of Award

Spring 1996

Degree Name

Master of Science in Nursing (MSN)

Department

Nursing

Advisor

Mary R. Hassett

Abstract

The purpose of this investigation was to provide a temporal database model to “represent the progression of states of a nursing home resident's care plan over an interval of time" (Hassett et al., 1993, pp. 290). The investigation used an exploratory and descriptive design which extended the studies of Hassett, Hassett and Rupp (1993) and Lin (1993). Nolan's Stage Model served as the theoretical framework for this investigation. The nursing minimum data set (NMDS) (Werley, Devine, Zorn, Ryan, & Westra, 1991) was used along with the nursing interventions classifications of the Iowa Project (McCloskey & Bulechek, 1992). The interventions of the nursing process were collected for immobility residents to provide a framework for a temporal nursing care plan model in the nursing home. Following a pilot study, a random sample (N = 10) of an equal number of male and female residents was selected. The average age of male subjects was younger than that of the female subjects (M = 77 vs. F = 81). The average residency for female was longer than that of male subject. All subjects were white. This investigation was retrospective and therefore contact with individual residents did not occur. Research question one examined the availability of the NMDS elements abstracted from the records of the nursing home residents with impaired physical mobility. Findings showed that the overall availability of the NMDS elements was 96.36% in the male residents ' records and 94.55% in the female residents' records. These were not available for the intensity of nursing care, unique number of principle registered nurse provider, discharge date, and disposition of patient or client. Research question two compared the different information values (nursing interventions) between a snapshot database approach and a temporal database approach for the nursing home residents with impaired physical mobility. Findings showed that more additional immobility nursing interventions were provided when using the temporal database versus using the current snapshot database. Therefore, the temporal database would provide more information to help the nurse to predict and control the immobility resident's disease process and health problems, and also provide the nurse researcher with the future research reference. Limitations of the investigation were: (1) a small sample size. (2) the nursing interventions (data) from the temporal data management model was limited to only one Midwestern nursing home, (3) only one nursing diagnosis related nursing intervention was examined, and (4) the nursing home has been using the North American Nursing Diagnosis Association (NANDA) nursing diagnoses for only eight years. Recommendations for the future research are: (1) replicate this investigation in more nursing homes or other health agencies, with a larger sample, and choosing more nursing diagnoses and nursing interventions, (2) add nursing outcomes for research-based nursing interventions and nursing intensities as they relate to the temporal database, and (3) use nursing interventions classification (NIC) as a standard nursing interventions classification taxonomy. This investigation used the Nolan's stage model to examine the possible success of using the nursing home as a site for beginning the study. It was an effective guide for the investigation. The nursing home provided an excellent pool of subjects and an adequate source for NMDS items. When the investigator compared the snapshot database approach to the temporal database approach, the temporal database provided more immobility nursing interventions than the snapshot database. For example, the temporal database can be computerized and capture all nursing interventions for each resident, nursing interventions change patterns during an interval, and duration for each nursing intervention. Nurses can use the information system collected from historical data, and provide for more informed choices regarding present and future decision making. Then, based on various diagnoses, the effective nursing interventions may be compared to the needs of individual nursing home residents. A problem for nurses is maintaining and providing valuable nursing interventions information throughout the resident's stay in the nursing home. If the temporal database is applied in the nursing home and other health care agencies, it can provide improvement in the quality of nursing care, patient outcomes, and cost management structure. From the administration viewpoint, administrators can use the intensity of nursing care data to effectively plan staffing, with risk management assessment, analysis of resource utilization patterns, and marketing analysis. Administrators need a good knowledge of information systems to choose a good database for nursing records. More studies are needed to develop the temporal database model for the nursing units of the future.

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Rights

© 1996 Hui-fan Lee

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