Collaborative Efforts for Representing Nursing Concepts in Computer-based Systems: International Perspectives

Current nursing terminology efforts have converged toward meeting the demand for a reference terminology for nursing concepts by building on the foundation of existing interface and administrative terminologies and by collaborating with terminology efforts across the spectrum of health care. In this article, the authors illustrate how collaboration is promoting convergence toward a reference terminology for nursing by briefly summarizing a wide range of exemplary activities. These include: 1) the International Classification of Nursing Practice (ICNP) activities of the International Council of Nurses (ICN), 2) work in Brazil and Korea that has contributed to, and been stimulated by, ICNP developments, 3) efforts in the United States to improve understanding of the different types of terminologies needed in nursing and to promote harmonization and linking among them, and 4) current nursing participation in major multi-disciplinary standards initiatives. Although early nursing terminology work occurred primarily in isolation and resulted in some duplicative efforts, the activities summarized in this article demonstrate a tremendous level of collaboration and convergence not only in the discipline of nursing but in multi-disciplinary standards initiatives. These efforts are an important prerequisite for ensuring that nursing concepts are represented in computer-based systems in a manner that facilitates multi-purpose use at local, national, regional, and international level

The interplay between global standards and local practice in nursing

Submitted manuscript version. Published version available at https://doi.org/10.1016/j.ijmedinf.2013.02.005.Purpose: The paper assesses the extent, form, and transformation of global nursing classifications (NANDA) in a nursing practice during a period of 5 years. Method: A longitudinal case study was used to trace implementation, adoption and use of nursing classifications as an integral part of an electronic nursing module. A mixed method of data collection was used, including semi-structured interviews, observation and document analysis. Results: A surprisingly high proportion of nursing diagnoses was consistent with the global standard, in spite of a gradual increase of user-generated concepts. This is elaborated more thoroughly through a co-constructing perspective, emphasizing how the global standard and the practice mutually shaped each other over several years. Conclusion: Standardization is an iterative process that is performed in close relationship with practice. The mutual interrelation between formal classifications (NANDA) and local practices are co-constructed in a dynamic interplay that evolves over time. In such a process, the use of local classifications and local strategies can be a means to bridge the gap between these two extreme points. Highlights: ► Extensive use of standardized classification after implementation of electronic care plan. ► Local classifications evolved during long-term use. ► Co-construction of classifications was used to bridge the gap between global classifications and local needs

Understanding the use of standardized nursing terminology and classification systems in published research : a case study using the International Classification for Nursing Practice®

Background In the era of evidenced based healthcare, nursing is required to demonstrate that care provided by nurses is associated with optimal patient outcomes, and a high degree of quality and safety. The use of standardized nursing terminologies and classification systems are a way that nursing documentation can be leveraged to generate evidence related to nursing practice. Several widely-reported nursing specific terminologies and classifications systems currently exist including the Clinical Care Classification System, International Classification for Nursing Practice®, Nursing Intervention Classification, Nursing Outcome Classification, Omaha System, Perioperative Nursing Data Set and NANDA International. However, the influence of these systems on demonstrating the value of nursing and the professions’ impact on quality, safety and patient outcomes in published research is relatively unknown. Purpose This paper seeks to understand the use of standardized nursing terminology and classification systems in published research, using the International Classification for Nursing Practice® as a case study. Methods A systematic review of international published empirical studies on, or using, the International Classification for Nursing Practice® were completed using Medline and the Cumulative Index for Nursing and Allied Health Literature. Results Since 2006, 38 studies have been published on the International Classification for Nursing Practice®. The main objectives of the published studies have been to validate the appropriateness of the classification system for particular care areas or populations, further develop the classification system, or utilize it to support the generation of new nursing knowledge. To date, most studies have focused on the classification system itself, and a lesser number of studies have used the system to generate information about the outcomes of nursing practice. Conclusions Based on the published literature that features the International Classification for Nursing Practice, standardized nursing terminology and classification systems appear to be well developed for various populations, settings and to harmonize with other health-related terminology systems. However, the use of the systems to generate new nursing knowledge, and to validate nursing practice is still in its infancy. There is an opportunity now to utilize the well-developed systems in their current state to further what is know about nursing practice, and how best to demonstrate improvements in patient outcomes through nursing care

Exploring Standardized Nursing Languages: Moving Toward a Faith Community Nursing Intervention

There are many benefits when a specialty is able to translate nursing interventions into a standardized language. One of the benefits is that nurses from different specialties, geographic areas, or countries are able to understand terminologies and concepts. The aim of this paper is to examine three standardized nursing languages and their use in describing faith community nursing through an integrative literature review. General descriptions, recognitions, populations, translations, reliability/validation/utility, and components of the Omaha System, the Nursing Intervention Classification, and the International Classification for Nursing Practice were presented. The author did not find literature to support the use of one standardized language over another in Faith Community Nursing. The lack of research using the Omaha System and the International Classification in this specialty may suggest a gap with exploratory potential. The presence of Faith Community Nursing research successfully using the Nursing Intervention Classification may suggest familiarity with this taxonomy and its ability to describe interventions unique to the practice

The development of a nursing subset of patient problems to support interoperability

Since the emergence of electronic health records, nursing information is increasingly being recorded and stored digitally. Several studies have shown that a wide range of nursing information is not interoperable and cannot be re-used in different health contexts. Difficulties arise when nurses share information with others involved in the delivery of nursing care. The aim of this study is to develop a nursing subset of patient problems that are prevalent in nursing practice, based on the SNOMED CT terminology to assist in the exchange and comparability of nursing information. Explorative qualitative focus groups were used to collect data. Mixed focus groups were defined. Additionally, a nursing researcher and a nursing expert with knowledge of terminologies and a terminologist participated in each focus group. The participants, who work in a range of practical contexts, discussed and reviewed patient problems from various perspectives. Sixty-seven participants divided over seven focus groups selected and defined 119 patient problems. Each patient problem could be documented and coded with a current status or an at-risk status. Sixty-six percent of the patient problems included are covered by the definitions established by the International Classification of Nursing Practice, the reference terminology for nursing practice. For the remainder, definitions from either an official national guideline or a classification were used. Each of the 119 patient problems has a unique SNOMED CT identifier. To support the interoperability of nursing information, a national nursing subset of patient problems based on a terminology (SNOMED CT) has been developed. Using unambiguously defined patient problems is beneficial for clinical nursing practice, because nurses can then compare and exchange information from different settings. A key strength of this study is that nurses were extensively involved in the development process. Further research is required to link or associate nursing patient problems to concepts from a nursing classification with the same meaning

The Effects of Structured Health Policy Education on Connecticut Registered Nurses\u27 Clinical Documentation

Registered Nurses use clinical documentation to describe care planning processes, measure quality outcomes, support reimbursement, and defend litigation. The Connecticut Department of Health, guided by federal Conditions of Participation, defines state-level healthcare policy to include required care planning processes. Nurses are educated in care planning process standards, however no policy-required competency verification processes in academia or employers exists. Guided by the advocacy coalition framework, the purpose of this quasi-experimental study was to determine if the quality of nurse coalition actors’ clinical documentation, a relatively stable parameter, would increase after attending policy-centered structured education. Data were extracted from 272 electronic medical records (136 pre - 136 post attendance) and mean quality scores were computed using the Müller-Staub Q-DIO scale from 17 nurse coalition actors. A two group dependent t test was used to examine quality score differences and linear regression was used to isolate process education subsections that significantly predicted post mean score improvements. Findings indicate a statistically significant difference between pre and post education quality scores (p \u3c .001) and improvement drivers of the post-education quality scores were identified in the subscales of ‘diagnosis as a process’ (p \u3c .001) and ‘interventions’ (p \u3c .001). Implications for positive social change include recommendations to state-level policy makers to mandate confirmation of graduating nurses’ documentation quality and to install continuing education requirements as a condition of bi-annual license renewal; each area acting to reduce non-compliant clinical documentation in light of federal Conditions of Participation rules

Standardization of Work : Co-constructed Practice

Submitted version (preprint).There is strong pressure to achieve greater uniformity, standardization and application of best practices in the service professions, a sector that is growing in presence and importance. At the same time, there is a conflicting demand for the delivery of high-quality (or high-priced or "knowledge-intensive") specialized or localized services. Our article analyzes information systems-enabled standardizing of service work through an in-depth interpretative study of an ongoing standardization initiative within the field of nursing. Nursing provides a graphic illustration of the dilemmas involved in the standardization of service work. In nursing, standardization is commonly a feature of projects to improve both efficiency and quality in health care. In contrast to the dominant conception of standardization as a largely top-down, imposed process, we offer a view of standardization as incomplete, co-constructed with users, and with significant unintended consequences. The article contributes by (a) developing a theoretical perspective for the standardization of information-system-embedded service work and (2) providing operational and practical implications for system design and health care management