1. Fulton, Janet S. PhD, RN

Article Content

The spring conference season is over, and I was pleased to attend several annual professional gatherings, all with excellent cutting-edge presentations. Several sessions that I attended provoked a question for me that was similar to a question raised by reviewers' response to manuscripts submitted to the journal; that is, how do we best report outcomes of clinical nurse specialist (CNS) practice? Clinical nurse specialists often develop and direct projects and programs at unit and system levels. The best outcome measure for these initiatives is not always easy to determine. Outcomes may occur on several levels or at different points. Because CNSs are challenged to define the outcomes of practice, selecting outcome measures is an important decision.


At one conference session, I listened to a CNS report on a project that addressed the underappreciated problem of delirium in oncology patients. For multiple reasons, including disease, medical treatment, and symptom management therapies, patients with cancer are at risk for delirium. In response, the CNS and her team initiated a delirium-screening instrument and, through a series of educational initiatives, increased staff nurse screening for delirium in this target population. As a result, the assessment instrument was incorporated into the electronic medical record, so it was reported. I wondered how many more patients with delirium were identified. Did the incidence of delirium increase due to better identification? In addition, what was the relationship between early identification and interventions to prevent further delirium? For example, did the identification of delirium prevent or lessen complications such as falls? In short, what were the benefits to patients?


The journal frequently receives manuscripts describing projects at the unit or system level that benefit patients; however, the outcomes are presented as either process-focused or system-level changes. What is all too often missing from these manuscripts is a report of outcomes framed as benefits to patients. To be able to report patient benefits from a project means that the problem must be defined, in part, from a patient's perspective. For example, how many patient falls are retrospectively determined or suspected to be related to delirium? If the problem were defined from a patient's perspective, the outcome of a delirium assessment could be reported as the decrease in falls due to early identification of the risk factor delirium.


Clinical nurse specialists lead, mentor, and coach staff in the delivery of evidence-based nursing care. Indeed, many of the changes that CNSs initiate lead to improved patient care delivered by staff nurses. However, it is important to identify problems in patient terms and frame at least some of the project goals as patient outcomes. Doing so will allow us to more directly identify the link between CNS practice and patient outcomes. I look forward to your manuscripts describing innovative projects and programs. Do not forget to include the benefits to patients!