Souraya Sidani - Profile on Academia.edu (original) (raw)
Papers by Souraya Sidani
Cultural adaptation and translation of measures: An integrated method
Research in Nursing & Health, 2010
Differences in the conceptualization and operationalization of health‐related concepts may exist ... more Differences in the conceptualization and operationalization of health‐related concepts may exist across cultures. Such differences underscore the importance of examining conceptual equivalence when adapting and translating instruments. In this article, we describe an integrated method for exploring conceptual equivalence within the process of adapting and translating measures. The integrated method involves five phases including selection of instruments for cultural adaptation and translation; assessment of conceptual equivalence, leading to the generation of a set of items deemed to be culturally and linguistically appropriate to assess the concept of interest in the target community; forward translation; back translation (optional); and pre‐testing of the set of items. Strengths and limitations of the proposed integrated method are discussed. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:133–143, 2010
Nursing Research, 2006
Background: Most administrative databases do not contain good information about nursing-sensitive... more Background: Most administrative databases do not contain good information about nursing-sensitive outcomes. b Objectives: To determine (a) the reliability of the instruments
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières
Self-care is an outcome of nursing care that is instrumental for promoting recovery and preventin... more Self-care is an outcome of nursing care that is instrumental for promoting recovery and preventing complications following hospitalization. The Therapeutic Self-Care (TSC) measure was developed to assess self-care ability in acute-care settings. Its content was derived from a conceptualization of self-care generated from an extensive literature review. Clinical experts considered the 13 items of the TSC measure as relevant, supporting its content validity. Findings of 1 study indicate that the items are internally consistent and loaded on 1 factor. The TSC scores correlate with relevant concepts. The TSC measure quantifies patients' perceived ability for self-care, operationalized in behaviours related to taking medications, recognizing and managing symptoms, carrying out activities of daily living, and managing changes in condition. It can be used to guide and evaluate nursing care. French L'autogestion des soins est un résultat de soins infirmiers déterminant pour le rétab...
Nursing-Sensitive Outcomes Data Collection in Acute Care and Long-Term-Care Settings
Nursing Research, 2006
Most administrative databases do not contain good information about nursing-sensitive outcomes. T... more Most administrative databases do not contain good information about nursing-sensitive outcomes. To determine (a) the reliability of the instruments measuring nursing-sensitive outcomes, (b) whether the outcome measures are sensitive to changes in patients' health, and (c) whether the outcome measures are associated with nursing interventions. The sample consisted of 890 patients from acute care hospitals and long-term-care facilities. A repeated measures design was used. Functional status was assessed on admission and discharge using Minimum Data Set 2.0 items. Symptom (pain, nausea, dyspnea, fatigue) frequency and severity were assessed with 4-point and 11-point numeric scales, respectively. Therapeutic self-care was assessed on discharge from acute care. Nursing interventions were assessed by documentation review. The outcome measures demonstrated very good interrater reliability with weighted Kappa ranging from .64 to .93. The internal consistency reliability was high for functional status and therapeutic self-care. The outcome tools were sensitive to change in patient condition. Select nursing interventions were related to functional status, therapeutic self-care, and symptom outcomes. The findings suggest that nurses are able to collect data on nursing-sensitive patient outcomes in a reliable and valid way.
Research in Nursing & Health, 2011
Imbedding a response tree into self-report scales is a strategy recommended to improve item compr... more Imbedding a response tree into self-report scales is a strategy recommended to improve item comprehension and reduce burden in older adults. However, researchers have posed potential utility, validity, and reliability limitations to this strategy that have not been examined in the clinical setting. We evaluated the effect of the response tree format (RTF) on the psychometric properties and utility of three scales measuring symptoms in 86 rehabilitation inpatients. The RTF had little effect on the scales' psychometric properties or utility. Time to complete the scales differed for one scale only. The two formats manifested comparable levels of utility, reliability, and validity in the study sample, and may be used with older adults who experience difficulty responding to the original scales. ß
Canadian Journal of Diabetes, 2013
and sharing with colleagues.
Examining Appreciative Inquiry as a knowledge translation intervention in pain management
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2008
Despite a solid evidence base for pain management, pain is not always well managed in practice. I... more Despite a solid evidence base for pain management, pain is not always well managed in practice. Interventions to implement pain management evidence need to be shifted from a focus on individual characteristics to knowledge translation strategies that are grounded in theory and attend to the organizational context and social dimension of translating evidence into practice. The authors examine Appreciative Inquiry (AI) as an innovative knowledge translation intervention in the area of pain management in nursing. Their aims are to advance the current state of knowledge translation interventions in pain management and to examine the usefulness of potential interventions based on their congruence with theory. The theory and practice of AI are compared to the concept of knowledge translation and the elements of the Promoting Action on Research Implementation in Health Services framework. Discussion is grounded in pain management in nursing.
Research in nursing & health, 2003
Effectiveness research is undertaken to evaluate the effects of interventions in achieving desire... more Effectiveness research is undertaken to evaluate the effects of interventions in achieving desired outcomes when tested in the real-world conditions of everyday practice. Although the randomized clinical trial (RCT) is considered the gold standard for effectiveness research, its feasibility, generalizability, and the clinical utility of its results are being questioned. This state of the science prompted the call for a paradigm shift, characterized by alternative methods for clinical research. The alternative methods attempt to account for clinical realities when conducting research, with the goal of minimizing discrepancies in the perspective and assumptions underlying practice and research. In this article a theory-driven approach to intervention evaluation is presented as a viable alternative paradigm for clinical research. The application of this approach demands changes in four aspects of research: participant selection criteria, assignment to treatment options, delivery of the...
Development of a Measure to Assess Healthcare Providers’ Implementation of Patient-Centered Care
Worldviews on Evidence-Based Nursing, 2014
Patient-centered care (PCC) is a vaguely defined element of high-quality care, which precludes it... more Patient-centered care (PCC) is a vaguely defined element of high-quality care, which precludes its consistent and precise operationalization. A conceptualization of PCC was derived from the literature and guided the development of an instrument to assess implementation of PCC by healthcare providers. The items of the instrument capture specific activities that reflect three components of PCC: holistic, collaborative, and responsive care. This paper reports on the measure's content and construct validity and reliability. Content validity was evaluated in a sample of 11 nurse practitioners who rated the relevance of each items' content in reflecting the respective component of PCC. The content validity index (CVI) was estimated. Construct validity and internal consistency reliability were examined in a survey of 149 nurse practitioners employed in acute care institutions, using factor analysis and the KR-20 coefficient, respectively. The CVIs were 100% for the three subscales assessing the holistic, collaborative, and responsive care components of PCC. The items in each subscale loaded on one factor. The KR-20 coefficients were .66, .70, and .42, respectively. Overall, the majority (>70%) of respondents indicated performance of the activities comprising the three components of PCC. The PCC measure demonstrated acceptable psychometric properties. The low variance in responses, which is anticipated for instruments assessing fidelity of intervention implementation, accounts for the low reliability coefficients. Additional testing of the measure's psychometric properties in different groups of healthcare providers is warranted. The measure can be used to monitor healthcare providers' implementation of PCC in their usual practice.
International Journal of Older People Nursing, 2010
Worldviews on Evidence-Based Nursing, 2009
Objectives: This systematic review will describe the theoretical grounding, components, duration,... more Objectives: This systematic review will describe the theoretical grounding, components, duration, mode of delivery, and outcomes of communication interventions for health care providers delivering care in residential care settings and will evaluate the effectiveness of these interventions.
Patient-centered care: clarification of its specific elements to facilitate interprofessional care
Journal of Interprofessional Care, 2014
Patient-centered care (PCC) has been described as a vague concept, which yields an inconsistent o... more Patient-centered care (PCC) has been described as a vague concept, which yields an inconsistent operationalization and implementation of this approach to care. This integrative review of the literature, guided by the conceptualization of PCC as a complex intervention, aimed to identify the specific elements of PCC. Conceptual, empirical and clinical literature in different health professions (n = 178 articles) was critically analyzed. Comparing and contrasting the definitions and descriptions of PCC revealed three specific elements that were represented in these components: holistic, collaborative and responsive care. Activities that constitute each component were specified. The implementation of PCC components is facilitated by a non-specific element: the therapeutic relationship. The results inform the development of protocols that can be used to promote the fidelity with which PCC is delivered by different professionals in a variety of healthcare settings.
Implementation Science, 2010
Background: Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention th... more Background: Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. Methods: A mixed-methods case study design was used. The case was a surgical unit in a pediatric academicaffiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. Results: Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. Conclusions: Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study.
Evaluation and Program Planning, 1995
Clinical Nursing Research, 2013
The pilot study aimed to explore the effects of an educational intervention on patients' foot sel... more The pilot study aimed to explore the effects of an educational intervention on patients' foot self-care knowledge, self-efficacy, and behaviors in adult patients with type 2 diabetes at low risk for foot ulceration. The intervention consisted of three sessions and was given over a 3-week period. A total of 70 eligible consenting participants were recruited for this pilot study. Fifty-six participants completed the study. The outcomes were assessed at pretest, following the first two sessions, and 3-month follow-up. The findings indicated that the foot self-care educational intervention was effective in improving foot self-care knowledge, self-efficacy and behaviors in adult patients with type 2 diabetes at low risk for foot ulceration. The findings support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with type 2 diabetes at low risk for foot ulcerations.
Influence of treatment preferences on validity: a review
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2009
Random assignment of participants to experimental and comparison treatments is believed to enhanc... more Random assignment of participants to experimental and comparison treatments is believed to enhance the comparability of the study groups on baseline characteristics. Despite its benefits, random assignment presents threats to validity. It ignores participants' treatment preferences. If not accounted for when participants are allocated to treatments, preferences influence enrolment in the study, representativeness of the accrued sample, attrition, adherence to treatment, and outcomes. This methodological article describes the mechanisms underlying the influence of treatment preferences on the external and internal validity of an intervention evaluation study. The authors present empirical evidence to support the points of discussion. They describe alternative research designs that account for treatment preferences, for use in future nursing intervention research.
Assessment of preferences for treatment: Validation of a measure
Research in Nursing & Health, 2009
Research in Nursing & Health, 2006
The extent to which nursing interventions provided during hospitalization are associated with pat... more The extent to which nursing interventions provided during hospitalization are associated with patients' therapeutic self-care and functional health outcomes was explored with a voluntary sample of 574 patients. Nurses collected data on patient outcomes at admission and discharge using the minimum data set (MDS) and the therapeutic self-care scale (TSCS).
Aim: The aim of the project was to develop an electronic information gathering and dissemination ... more Aim: The aim of the project was to develop an electronic information gathering and dissemination system to support both nursing-sensitive outcomes data collection and evidence-based decision-making at the point-of-patient care.
Cultural adaptation and translation of measures: An integrated method
Research in Nursing & Health, 2010
Differences in the conceptualization and operationalization of health‐related concepts may exist ... more Differences in the conceptualization and operationalization of health‐related concepts may exist across cultures. Such differences underscore the importance of examining conceptual equivalence when adapting and translating instruments. In this article, we describe an integrated method for exploring conceptual equivalence within the process of adapting and translating measures. The integrated method involves five phases including selection of instruments for cultural adaptation and translation; assessment of conceptual equivalence, leading to the generation of a set of items deemed to be culturally and linguistically appropriate to assess the concept of interest in the target community; forward translation; back translation (optional); and pre‐testing of the set of items. Strengths and limitations of the proposed integrated method are discussed. © 2010 Wiley Periodicals, Inc. Res Nurs Health 33:133–143, 2010
Nursing Research, 2006
Background: Most administrative databases do not contain good information about nursing-sensitive... more Background: Most administrative databases do not contain good information about nursing-sensitive outcomes. b Objectives: To determine (a) the reliability of the instruments
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières
Self-care is an outcome of nursing care that is instrumental for promoting recovery and preventin... more Self-care is an outcome of nursing care that is instrumental for promoting recovery and preventing complications following hospitalization. The Therapeutic Self-Care (TSC) measure was developed to assess self-care ability in acute-care settings. Its content was derived from a conceptualization of self-care generated from an extensive literature review. Clinical experts considered the 13 items of the TSC measure as relevant, supporting its content validity. Findings of 1 study indicate that the items are internally consistent and loaded on 1 factor. The TSC scores correlate with relevant concepts. The TSC measure quantifies patients' perceived ability for self-care, operationalized in behaviours related to taking medications, recognizing and managing symptoms, carrying out activities of daily living, and managing changes in condition. It can be used to guide and evaluate nursing care. French L'autogestion des soins est un résultat de soins infirmiers déterminant pour le rétab...
Nursing-Sensitive Outcomes Data Collection in Acute Care and Long-Term-Care Settings
Nursing Research, 2006
Most administrative databases do not contain good information about nursing-sensitive outcomes. T... more Most administrative databases do not contain good information about nursing-sensitive outcomes. To determine (a) the reliability of the instruments measuring nursing-sensitive outcomes, (b) whether the outcome measures are sensitive to changes in patients' health, and (c) whether the outcome measures are associated with nursing interventions. The sample consisted of 890 patients from acute care hospitals and long-term-care facilities. A repeated measures design was used. Functional status was assessed on admission and discharge using Minimum Data Set 2.0 items. Symptom (pain, nausea, dyspnea, fatigue) frequency and severity were assessed with 4-point and 11-point numeric scales, respectively. Therapeutic self-care was assessed on discharge from acute care. Nursing interventions were assessed by documentation review. The outcome measures demonstrated very good interrater reliability with weighted Kappa ranging from .64 to .93. The internal consistency reliability was high for functional status and therapeutic self-care. The outcome tools were sensitive to change in patient condition. Select nursing interventions were related to functional status, therapeutic self-care, and symptom outcomes. The findings suggest that nurses are able to collect data on nursing-sensitive patient outcomes in a reliable and valid way.
Research in Nursing & Health, 2011
Imbedding a response tree into self-report scales is a strategy recommended to improve item compr... more Imbedding a response tree into self-report scales is a strategy recommended to improve item comprehension and reduce burden in older adults. However, researchers have posed potential utility, validity, and reliability limitations to this strategy that have not been examined in the clinical setting. We evaluated the effect of the response tree format (RTF) on the psychometric properties and utility of three scales measuring symptoms in 86 rehabilitation inpatients. The RTF had little effect on the scales' psychometric properties or utility. Time to complete the scales differed for one scale only. The two formats manifested comparable levels of utility, reliability, and validity in the study sample, and may be used with older adults who experience difficulty responding to the original scales. ß
Canadian Journal of Diabetes, 2013
and sharing with colleagues.
Examining Appreciative Inquiry as a knowledge translation intervention in pain management
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2008
Despite a solid evidence base for pain management, pain is not always well managed in practice. I... more Despite a solid evidence base for pain management, pain is not always well managed in practice. Interventions to implement pain management evidence need to be shifted from a focus on individual characteristics to knowledge translation strategies that are grounded in theory and attend to the organizational context and social dimension of translating evidence into practice. The authors examine Appreciative Inquiry (AI) as an innovative knowledge translation intervention in the area of pain management in nursing. Their aims are to advance the current state of knowledge translation interventions in pain management and to examine the usefulness of potential interventions based on their congruence with theory. The theory and practice of AI are compared to the concept of knowledge translation and the elements of the Promoting Action on Research Implementation in Health Services framework. Discussion is grounded in pain management in nursing.
Research in nursing & health, 2003
Effectiveness research is undertaken to evaluate the effects of interventions in achieving desire... more Effectiveness research is undertaken to evaluate the effects of interventions in achieving desired outcomes when tested in the real-world conditions of everyday practice. Although the randomized clinical trial (RCT) is considered the gold standard for effectiveness research, its feasibility, generalizability, and the clinical utility of its results are being questioned. This state of the science prompted the call for a paradigm shift, characterized by alternative methods for clinical research. The alternative methods attempt to account for clinical realities when conducting research, with the goal of minimizing discrepancies in the perspective and assumptions underlying practice and research. In this article a theory-driven approach to intervention evaluation is presented as a viable alternative paradigm for clinical research. The application of this approach demands changes in four aspects of research: participant selection criteria, assignment to treatment options, delivery of the...
Development of a Measure to Assess Healthcare Providers’ Implementation of Patient-Centered Care
Worldviews on Evidence-Based Nursing, 2014
Patient-centered care (PCC) is a vaguely defined element of high-quality care, which precludes it... more Patient-centered care (PCC) is a vaguely defined element of high-quality care, which precludes its consistent and precise operationalization. A conceptualization of PCC was derived from the literature and guided the development of an instrument to assess implementation of PCC by healthcare providers. The items of the instrument capture specific activities that reflect three components of PCC: holistic, collaborative, and responsive care. This paper reports on the measure's content and construct validity and reliability. Content validity was evaluated in a sample of 11 nurse practitioners who rated the relevance of each items' content in reflecting the respective component of PCC. The content validity index (CVI) was estimated. Construct validity and internal consistency reliability were examined in a survey of 149 nurse practitioners employed in acute care institutions, using factor analysis and the KR-20 coefficient, respectively. The CVIs were 100% for the three subscales assessing the holistic, collaborative, and responsive care components of PCC. The items in each subscale loaded on one factor. The KR-20 coefficients were .66, .70, and .42, respectively. Overall, the majority (>70%) of respondents indicated performance of the activities comprising the three components of PCC. The PCC measure demonstrated acceptable psychometric properties. The low variance in responses, which is anticipated for instruments assessing fidelity of intervention implementation, accounts for the low reliability coefficients. Additional testing of the measure's psychometric properties in different groups of healthcare providers is warranted. The measure can be used to monitor healthcare providers' implementation of PCC in their usual practice.
International Journal of Older People Nursing, 2010
Worldviews on Evidence-Based Nursing, 2009
Objectives: This systematic review will describe the theoretical grounding, components, duration,... more Objectives: This systematic review will describe the theoretical grounding, components, duration, mode of delivery, and outcomes of communication interventions for health care providers delivering care in residential care settings and will evaluate the effectiveness of these interventions.
Patient-centered care: clarification of its specific elements to facilitate interprofessional care
Journal of Interprofessional Care, 2014
Patient-centered care (PCC) has been described as a vague concept, which yields an inconsistent o... more Patient-centered care (PCC) has been described as a vague concept, which yields an inconsistent operationalization and implementation of this approach to care. This integrative review of the literature, guided by the conceptualization of PCC as a complex intervention, aimed to identify the specific elements of PCC. Conceptual, empirical and clinical literature in different health professions (n = 178 articles) was critically analyzed. Comparing and contrasting the definitions and descriptions of PCC revealed three specific elements that were represented in these components: holistic, collaborative and responsive care. Activities that constitute each component were specified. The implementation of PCC components is facilitated by a non-specific element: the therapeutic relationship. The results inform the development of protocols that can be used to promote the fidelity with which PCC is delivered by different professionals in a variety of healthcare settings.
Implementation Science, 2010
Background: Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention th... more Background: Appreciative inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. This study explored the innovative use of AI as a theoretically based KT intervention applied to a clinical issue in an inpatient pediatric care setting. The implementation of AI was explored in terms of its acceptability, fidelity, and feasibility as a KT intervention in pain management. Methods: A mixed-methods case study design was used. The case was a surgical unit in a pediatric academicaffiliated hospital. The sample consisted of nurses in leadership positions and staff nurses interested in the study. Data on the AI intervention implementation were collected by digitally recording the AI sessions, maintaining logs, and conducting individual semistructured interviews. Data were analysed using qualitative and quantitative content analyses and descriptive statistics. Findings were triangulated in the discussion. Results: Three nurse leaders and nine staff members participated in the study. Participants were generally satisfied with the intervention, which consisted of four 3-hour, interactive AI sessions delivered over two weeks to promote change based on positive examples of pain management in the unit and staff implementation of an action plan. The AI sessions were delivered with high fidelity and 11 of 12 participants attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. Participants labeled AI a 'refreshing approach to change' because it was positive, democratic, and built on existing practices. Several barriers affected their implementation of the action plan, including a context of change overload, logistics, busyness, and a lack of organised follow-up. Conclusions: Results of this case study supported the acceptability, fidelity, and feasibility of AI as a KT intervention in pain management. The AI intervention requires minor refinements (e.g., incorporating continued follow-up meetings) to enhance its clinical utility and sustainability. The implementation process and effectiveness of the modified AI intervention require evaluation in a larger multisite study.
Evaluation and Program Planning, 1995
Clinical Nursing Research, 2013
The pilot study aimed to explore the effects of an educational intervention on patients' foot sel... more The pilot study aimed to explore the effects of an educational intervention on patients' foot self-care knowledge, self-efficacy, and behaviors in adult patients with type 2 diabetes at low risk for foot ulceration. The intervention consisted of three sessions and was given over a 3-week period. A total of 70 eligible consenting participants were recruited for this pilot study. Fifty-six participants completed the study. The outcomes were assessed at pretest, following the first two sessions, and 3-month follow-up. The findings indicated that the foot self-care educational intervention was effective in improving foot self-care knowledge, self-efficacy and behaviors in adult patients with type 2 diabetes at low risk for foot ulceration. The findings support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with type 2 diabetes at low risk for foot ulcerations.
Influence of treatment preferences on validity: a review
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2009
Random assignment of participants to experimental and comparison treatments is believed to enhanc... more Random assignment of participants to experimental and comparison treatments is believed to enhance the comparability of the study groups on baseline characteristics. Despite its benefits, random assignment presents threats to validity. It ignores participants' treatment preferences. If not accounted for when participants are allocated to treatments, preferences influence enrolment in the study, representativeness of the accrued sample, attrition, adherence to treatment, and outcomes. This methodological article describes the mechanisms underlying the influence of treatment preferences on the external and internal validity of an intervention evaluation study. The authors present empirical evidence to support the points of discussion. They describe alternative research designs that account for treatment preferences, for use in future nursing intervention research.
Assessment of preferences for treatment: Validation of a measure
Research in Nursing & Health, 2009
Research in Nursing & Health, 2006
The extent to which nursing interventions provided during hospitalization are associated with pat... more The extent to which nursing interventions provided during hospitalization are associated with patients' therapeutic self-care and functional health outcomes was explored with a voluntary sample of 574 patients. Nurses collected data on patient outcomes at admission and discharge using the minimum data set (MDS) and the therapeutic self-care scale (TSCS).
Aim: The aim of the project was to develop an electronic information gathering and dissemination ... more Aim: The aim of the project was to develop an electronic information gathering and dissemination system to support both nursing-sensitive outcomes data collection and evidence-based decision-making at the point-of-patient care.