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Health Serv Res. 1999 December; 34(5 Pt 1): 1011–1032.
PMCID: PMC1089070

Does what nurses do affect clinical outcomes for hospitalized patients? A review of the literature.


OBJECTIVE: Through a review of the literature, to identify and describe (1) empirical studies of inpatient nursing care quality that evaluate links between nursing care processes and health-related patient outcomes, (2) nursing care processes for which process-outcome links have been established, and (3) important nursing care processes that have not yet been evaluated. DATA SOURCES/STUDY SETTING: Published empirical studies of inpatient nursing care quality that evaluated links between processes of nursing care and health-related patient outcomes. STUDY DESIGN/DATA COLLECTION/EXTRACTION METHODS: This literature review used a five-step article search and review method. PRINCIPAL FINDINGS: Of 257 data-based studies of nursing care quality identified, 135 investigated a process-outcome link but only 17 met study inclusion criteria. The literature provides evidence that the quality of nursing care processes affects health-related patient outcomes during and after hospitalization. Gaps in the literature that evaluates nursing quality are identified. CONCLUSIONS: Although some nursing care processes affect health-related patient outcomes, the full extent of nursing process-outcome links is relatively understudied. Further evaluation of the interrelationships between nursing care processes and outcomes is critical.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Aiken LH, Smith HL, Lake ET. Lower Medicare mortality among a set of hospitals known for good nursing care. Med Care. 1994 Aug;32(8):771–787. [PubMed]
  • Anderson MA, Helms LB. Quality improvement in discharge planning: an evaluation of factors in communication between health care providers. J Nurs Care Qual. 1994 Jan;8(2):62–72. [PubMed]
  • Brooten D, Kumar S, Brown LP, Butts P, Finkler SA, Bakewell-Sachs S, Gibbons A, Delivoria-Papadopoulos M. A randomized clinical trial of early hospital discharge and home follow-up of very-low-birth-weight infants. N Engl J Med. 1986 Oct 9;315(15):934–939. [PubMed]
  • Dietrick-Gallagher M, Polomano R, Carrick L. Pain as a quality management initiative. J Nurs Care Qual. 1994 Oct;9(1):30–42. [PubMed]
  • Dillon P, Murphy M, Larson S. Continuous quality improvement for peritoneal dialysis patients. Nurs Clin North Am. 1995 Mar;30(1):117–128. [PubMed]
  • Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966 Jul;44(3 Suppl):166–206. [PubMed]
  • Edwards J, Reiley P, Morris AM, Doody J. An analysis of the quality and effectiveness of the discharge planning process. J Nurs Qual Assur. 1991 Jul;5(4):17–27. [PubMed]
  • Farren EA. Effects of early discharge planning on length of hospital stay. Nurs Econ. 1991 Jan-Feb;9(1):25–63. [PubMed]
  • Harrell JS, McConnell ES, Wildman DS, Samsa GP. Do nursing diagnoses affect functional status? J Gerontol Nurs. 1989 Oct;15(10):13–19. [PubMed]
  • Heard K. Improving patient outcomes in a dialysis unit: an integrated approach to CQI. J Nurs Care Qual. 1994 Oct;9(1):44–50. [PubMed]
  • Hegyvary ST, Haussman RK. The relationship of nursing process and patient outcomes. J Nurs Adm. 1976 Nov;6(9):18–21. [PubMed]
  • Henry SB, Holzemer WL, Reilly CA. The relationship between type of care planning system and patient outcomes in hospitalized AIDS patients. J Adv Nurs. 1994 Apr;19(4):691–698. [PubMed]
  • Kahn KL, Rogers WH, Rubenstein LV, Sherwood MJ, Reinisch EJ, Keeler EB, Draper D, Kosecoff J, Brook RH. Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. JAMA. 1990 Oct 17;264(15):1969–1973. [PubMed]
  • Laughon D, Ax S, Boyington C. From unit-based quality assurance to multidisciplinary continuous quality improvement in the coronary care unit. J Nurs Care Qual. 1993 Apr;7(3):19–27. [PubMed]
  • McGarvey RN, Harper JJ. Pneumonia mortality reduction and quality improvement in a community hospital. QRB Qual Rev Bull. 1993 Apr;19(4):124–130. [PubMed]
  • Mitchell PH, Shannon SE, Cain KC, Hegyvary ST. Critical care outcomes: linking structures, processes, and organizational and clinical outcomes. Am J Crit Care. 1996 Sep;5(5):353–365. [PubMed]
  • Naylor MD. Comprehensive discharge planning for hospitalized elderly: a pilot study. Nurs Res. 1990 May-Jun;39(3):156–161. [PubMed]
  • Proos M, Reiley P, Eagan J, Stengrevics S, Castile J, Arian D. A study of the effects of self-medication on patients' knowledge of and compliance with their medication regimen. J Nurs Care Qual. 1992;Suppl:18–26. [PubMed]
  • Rantz MJ. Quality measurement in nursing: where are we now? J Nurs Care Qual. 1995 Jan;9(2):1–7. [PubMed]
  • Richard-Smith A, Buh S. Reducing central line catheter infections in bone marrow transplant patients. Nurs Clin North Am. 1995 Mar;30(1):45–52. [PubMed]
  • Rosenthal GE, Halloran EJ, Kiley M, Pinkley C, Landefeld CS. Development and validation of the Nursing Severity Index. A new method for measuring severity of illness using nursing diagnoses. Nurses of University Hospitals of Cleveland. Med Care. 1992 Dec;30(12):1127–1141. [PubMed]
  • Ruckstuhl MC, Marchionda EE, Salmons J, Larrabee JH. Patient falls: an outcome indicator. J Nurs Care Qual. 1991 Oct;6(1):25–29. [PubMed]
  • Rudisill PT, Phillips M, Payne CM. Clinical paths for cardiac surgery patients: a multidisciplinary approach to quality improvement outcomes. J Nurs Care Qual. 1994 Apr;8(3):27–33. [PubMed]
  • Yano EM, Fink A, Hirsch SH, Robbins AS, Rubenstein LV. Helping practices reach primary care goals. Lessons from the literature. Arch Intern Med. 1995 Jun 12;155(11):1146–1156. [PubMed]

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