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Activity 5:   OUTCOMES RESEARCH Fall 2021

                 KNAPP ARTICLE/ NDNQI/Nurse Sensitive Indicators


  1.  Many hospitals are seeking Magnet Recognition from the American Nurses Credentialing Center (ANCC). The original 14 Forces of Magnetism were based on research findings from a study published by Kramer and Schmalenberg. Review the ANCC website to discover the role of nursing research in the Magnet process.

 What is the role of nursing research in the Magnet process?


2.  Introduction: Using current best research evidence is best guided by a relevant clinical question

     using the PICOT format.

    PICOT is useful in creating a searchable question, identifying, and critically appraising the relevance     

    of the literature found, and developing evidence-based protocols, algorithms, guidelines, and  

    policies for practice.

•  The PICOt format includes:

P— Population of interest

I— Intervention needed for practice (new one)

C— Comparisons of interventions to determine the best intervention (current or old one)

O— Outcomes needed for practice and ways to measure the outcomes in practice

T – Time

3.  Critical Thinking Activity: Review the Knapp Article on assisting families of ICU patients in managing stress.

Apply the PICOt format to explain the EBP question in the Knapp article as a PICOt question.


4.  Name two nurse sensitive indicators (see below) where nursing actions are directly related

     to the outcome for patient safety, quality healthcare, or a professional, safe work      

     environment and are related to nursing staffing/practice.



5.  How is data collected in the National Database Nursing Quality Indicators?

       Explain about the Press Ganey Survey.  What is the purpose?

       website at:





The 3 Types of Nursing Sensitive Indicators

November 2, 2011






Efforts to define the quality of nursing practice began with Florence Nightingale, as she worked to improve hospital conditions and measure patient outcomes. More recently, research linking hospital nurse staffing issues and adverse patient outcomes has caught the attention of those both inside and outside of health care. Numerous studies were done on the correlation between the two during the ’90s and the early 2000s, an era when news about the nursing shortage was bleak and nurses were reporting under-staffed units, burnout, and job dissatisfaction. When it was reported that under-staffing was associated with increased mortality, the media and the public became interested in the conclusions of these studies. The resulting attention has helped to pave the way for measuring other indicators that relate to the quality of care.

It was in 1996 that a team of researchers coined the phrase “nursing-sensitive indicators” to reflect elements of patient care that are directly affected by nursing practice – and it’s become a bit of a buzzword in health care today.

What are Nursing Sensitive Indicators?

Nursing Sensitive Indicators are said to reflect three aspects of nursing care: structure, process, and outcomes.

  • Structural indicators include the supply of nursing staff, the skill level of nursing staff, and the education and certification levels of nursing staff.
  • Process indicators measure methods of patient assessment and nursing interventions. Nursing job satisfaction is also considered a process indicator.
  • Outcome indicators reflect patient outcomes that are determined to be nursing-sensitive because they depend on the quantity or quality of nursing care. These include things like pressure ulcers and falls. Other types of patient outcomes are related to other elements of medical care and are not considered to be nursing-sensitive – these include things like hospital readmission rates and cardiac failure.

In 1999, the American Nurses Association (ANA) identified 10 critical nursing sensitive indicators for acute care settings. In 2002 the ANA added 10 others that are applicable to community-based, non-acute care settings. Since then, the lists have been refined and expanded many times, with new indicators being added annually. The ten original indicators that apply to hospital-based nursing are:

  • Patient satisfaction with pain management
  • Patient satisfaction with nursing care
  • Patient satisfaction with overall care
  • Patient satisfaction with medical information provided
  • Pressure ulcers
  • Patient falls
  • Nurse job satisfaction
  • Rates of nosocomial infections
  • Total hours of nursing care per patient, per day
  • Staffing mix (ratios of RNs, LPNs, and unlicensed staff)

What Do Nursing Sensitive Indicators Provide?

By identifying this first group of indicators, the ANA became a pioneer, of sorts, in evidence based practice. The next step was a literature search to identify other indicators that were potentially nurse-sensitive. Those were then reviewed and either validated as being truly nurse-sensitive, or discarded.

In 1998, the ANA established the National Database of Nursing Quality Indicators™ (NDNQI®), in order to continue to build on data gained from earlier studies. There was already an established link between nurse staffing and patient outcomes, but more data and reporting was needed to evaluate other indicators of nursing quality at the unit level. The NDNQI became the very first database to gather such unit-level information. It now supplies hospitals with performance reports that allow administrators to compare their data with national averages, percentile rankings, and other important information.

Nursing sensitive quality indicators are an important part of the equation when it comes to establishing evidence-based practice guidelines. But measuring these indicators is not simply good science – it’s an ethical imperative. Nursing’s foundational principles and guidelines state that, as a profession, nursing has a responsibility to measure, evaluate, and improve the quality of nursing practice.



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