Clinical Concept Analysis and Application

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Clinical Concept Analysis and Application

• Dianna Spies Sorenson,
• PhD, RN, CNS

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Concept Analysis Application
Concept Selection
Theoretical Application
Readings
Learning Activities
Clinical Application
Outcomes Evaluation
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Concept Selection

• Concept should be specific to the client
  assessment.
• List the client assessments r/t the concept
• The concept may be general (e.g. nutrition) or
  specific (e.g. calcium intake to prevent
  osteoporosis)

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Readings

• Should
• be specific to both the client and the concept
  selected
• reflect research and practice bases
• address nursing and non-nursing literature

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Learning Activities

• Should enhance the understanding, synthesis, or
  experience with the concept. May relate to prior
  
• clinical experiences
• personal experiences

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Theoretical Application

• May be a mid-level or practice level theory
• Addresses the definition, antecedents,
  theoretical links, and projected outcomes
• Draw a schematic model of the theory

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Clinical Application

• Use the theoretical components to guide the
  interventions
• Use established practice guidelines to guide
  interventions (e.g. Agency for Healthcare
  Research Quality)
• Describe the specific interventions to address
  the concept. Include
• Counseling techniques
• Specific behavioral techniques
• Education
• Skill performance

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Outcome Evaluation

• Evaluates the efficacy of the theory in this
  situation (I.e. does the theory work?)
• How do you measure progress toward your outcome
  goals? BE VERY SPECIFIC!
• Actual behaviors skills
• Psychological readiness for change
• Physiological parameters
• Emotional indicators
• Knowledge and development

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Outcomes Measurement
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Outcomes Definition

• The results of care in terms of what happens to
  the patient

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Outcomes Depends on the Perspective of Interested
Affected Parties

• Patients
• Providers
• Purchasers
• Payers
• Accrediting agencies
• Politicians

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Outcomes Selecting Appropriate Assessments

• Applicability
• Practicality
• Comprehensiveness
• Reliability
• Validity
• Responsiveness

• Basis for Comparison (I.e. Normative vs.
  Successful)
• Cost Effective

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Applicability

• Discriminates between subjects at a point in time
• Predict future outcomes
• Evaluate changes over time
• Screen for problems
• Assess quality of care

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Practicality

• Outcomes important to patients
• Short easy
• Questions easy to understand
• Scores reflect condition
• Easily scored
• Clinically useful information
• Performance based

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Comprehensiveness

• Generic measures to summarize a spectrum of
  concepts applied to different impairments,
  illnesses, patients populations
• Disease specific measures

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Reliability

• Can be influenced by day-to-day variations
• Discriminates between items

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Validity

• Consensus of scientifically admissible criteria
• Gold standards for measurement

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Responsiveness

• Indexed for evaluative measures
• Detects changes
• Aggregate Vs subscale scores
• Differentiates between baseline variability Vs tx
  effect scores
• Temporal relationship between intervention
  outcome

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Basis for Comparison (I.e. Normative vs.
Successful)

• Are there known normative successful
  data/standards?

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Cost Effective

• Direct costs
• Indirect costs
• Immediate costs
• Long-term costs

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OutcomesMeasurement

• What?
• Why?
• Who?
• How?
• When?
• Where?

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Critical Thinking
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Discontinue Services or Interventions
Establish new goals (e.g. move from normal to
successful)
Reconsider the 5 Rs -right time -right
pt/population -right dose -right
intervention -right frequency
Findings
Continue intervention over time
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References

• Jennings, B.M. (1995). Outcomes Two directions
  research and management. AACN Clinical Issues,
  1, 79-88.
• Buchanan, L.M. (1994). Therapeutic nursing
  intervention knowledge development and outcome
  measures for advanced practice nurses. Nursing
  and Health Care, 15(4), 190-195.
• National Guideline Clearinghouse
  (www.guideline.gov)
• Harris, M. R. Warren, J.J. Patient outcomes
  Assessment issues for the clinical nurse
  specialist. Clinical Nurse Specialist,