A review of 81 research papers published predominantly since 1990 examining the relationship between organizational structures/processes and patient mortality/adverse events revealed that nursing surveillance was one of three organizational process variables consistently related to lower mortality (Mitchell and Shortell, 1997). Studies of quality of care before and after implementation of the Medicare prospective payment system for hospitals found better-quality nursing surveillance to be predictive of lower severity-adjusted Medicare mortality (Kahn et al., 1990; Rubenstein et al., 1992).

Although the type and frequency of patient assessment and monitoring activities carried out by licensed nurses vary by the setting of care, the clinical condition, and other characteristics of the patient, such activities are performed by nurses for each patient in every setting in which health care is delivered—ambulatory primary care sites, hospitals, schools, workplace health sites, home health agencies, and nursing homes. In nursing homes, each resident receives a comprehensive assessment performed or coordinated by an RN upon admission and at regularly scheduled intervals thereafter. This assessment employs a federally prescribed minimum data set (MDS)3 to document each resident’s diagnoses and health conditions, dental and nutritional status, skin condition, medications, discharge potential and other special treatments or conditions needed, customary routines, cognitive patterns, communication, vision, mood and behavior patterns, psychosocial well-being, physical functions, continence, and other physical and psychosocial characteristics. When this assessment detects areas of concern, a more detailed resident assessment protocol is initiated (Morris et al., 1995).

For chronically ill homebound patients, home health nurses assess the health status and responses to treatments of individuals too ill to leave their home using a wide array of assessment instruments and tools. Examples of these include stethoscopes, sphygmomanometers (blood pressure measurement devices), Doppler fetal monitors, depression screening tools, Denver Developmental Screening tests, pain scales, the Braden scale for pressure ulcer prevention, wound measurement instruments, diet recall checklists, glucose tests, urine tests, fall risk assessment tools, an Alcohol Consumption Questionnaire, functional independence measurements, safety checklists, the SF-12 and other health surveys, tools for measuring activities of daily living (ADLs) and instrumental ADLs, a Mini-Mental Status Examination, a Family Assessment for School Nurses, and vision and hearing assessment tools (Martin, 2002). In addition, since 1999 the Medicare pro-


Code of Federal Regulations, Chapter 42, Part 483, Subpart B, “Requirements for Long Term Care Facilities.”

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