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Improved Quality of Nursing Documentation: Results of a Nursing Diagnoses, Interventions, and Outcomes Implementation Study


  • Maria Müller-Staub, PhD (c), MNS, EdN, RN, is Head of Pflege PBS, Stettlerstrasse 15, CH-3006 Bern, Switzerland; Ian Needham, is Professor, Director of the Nursing Research Institute, PhD, MNS, EdN, RN, University of Applied Sciences St. Gallen, Department of Health, CH-9000 St. Gallen, Switzerland; Matthias Odenbreit, MNS, EdN, RN, is Project Director, Spial Solothurn soH, Bürgerspital Solothurn, CH-4500 Solothurn, Switzerland; Mary Ann Lavin, ScD, RN, FAAN, is Associate Professor, Saint Louis University School of Nursing, 3525 Caroline Mall, St. Louis, MO 63104, USA; Theo van Achterberg, PhD, MSc, RN, is Professor, Nursing Science, Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, PO Box 9101, NL-6500 HB Nijmegen, The Netherlands.


PURPOSE. To evaluate the impact of the quality of nursing diagnoses, interventions, and outcomes in an acute care hospital following the implementation of an educational program.

METHOD. In a pretest–posttest experimental design study, nurses from 12 wards of a Swiss hospital received an educational intervention—an introductory class and consecutive classes, using a case discussion method—to implement nursing diagnoses, interventions, and outcomes. Two sets of 36 randomly selected nursing records were evaluated before and after implementation. The quality of documented nursing diagnoses, interventions, and nursing-sensitive patient outcomes was assessed by 29 Likert-type items with a 0–4 scale instrument, called Quality of Nursing Diagnoses, Interventions, and Outcomes (Q-DIO) and tested using t-tests.

FINDINGS. Significant enhancements in the quality of documented nursing diagnoses, interventions, and outcomes were found following the implementation of a planned educational program.

CONCLUSIONS. The implementation of NANDA, NIC, and NOC (NNN) nursing diagnoses, interventions, and outcomes led to higher quality of nursing diagnosis documentation, etiology-specific nursing interventions, and nursing-sensitive patient outcomes.

IMPLICATIONS FOR NURSING PRACTICE. Educational measures support nurses to improve documentation of diagnoses, interventions, and outcomes. The Q-DIO is a useful audit tool.