Harmonising nursing terminologies using a conceptual framework

The International Classification for Nursing Practice (ICNP®) and the Clinical Care Classification (CCC) System are standardised nursing terminologies that identify discrete elements of nursing practice, including nursing diagnoses, interventions, and outcomes. While CCC uses a conceptual framework or model with 21 Care Components to classify these elements, ICNP, built on a formal Web Ontology Language (OWL) description logic foundation, uses a logical hierarchical framework that is useful for computing and maintenance of ICNP. Since the logical framework of ICNP may not always align with the needs of nursing practice, an informal framework may be a more useful organisational tool to represent nursing content. The purpose of this study was to classify ICNP nursing diagnoses using the 21 Care Components of the CCC as a conceptual framework to facilitate usability and inter-operability of nursing diagnoses in electronic health records. Findings resulted in all 521 ICNP diagnoses being assigned to one of the 21 CCC Care Components. Further research is needed to validate the resulting product of this study with practitioners and develop recommendations for improvement of both terminologie

A modified Delphi study to enhance and gain international consensus on the Physical Activity Messaging Framework (PAMF) and Checklist (PAMC)

Abstract Introduction Physical activity messaging is an important step in the pathway towards improving population physical activity levels, but best practice is not yet understood. A gap in the literature exists for a physical activity messaging framework to help guide creation and evaluation of messages. This study aimed to further develop and improve, and gain international expert consensus on, a standardised Physical Activity Messaging Framework and Checklist. Methods A modified Delphi study consisting of three online survey rounds was conducted. Each survey gathered feedback from an international expert panel using quantitative and qualitative methods. The framework and checklist were amended between each round based on survey results until consensus (defined a priori as 80% agreement) was reached. Results The final expert panel (n = 40, 55% female) came from nine countries and comprised academics (55%), healthcare and other professionals (22.5%) and government officials or policymakers (22.5%). Consensus was reached in survey 3 with 85 and 87.5% agreement on the framework and checklist, respectively. Conclusion This study presents an expert- and evidence-informed framework and checklist for physical activity messaging. If used consistently, the Physical Activity Messaging Framework and Checklist may improve practice by encouraging evidence-based and target audience-focused messages, as well as enhance the research base on physical activity messaging by harmonising key terminologies and improving quality of reporting. Key next steps include further refining the Physical Activity Messaging Framework and Checklist based on their use in real-world settings

Towards a standardized nutrition and dietetics terminology for clinical practice:An Austrian multicenter clinical documentation analysis based on the International Classification of Functioning, Disability and Health (ICF)-Dietetics

Background High quality, continuity and safe interdisciplinary healthcare is essential. Nutrition and dietetics plays an important part within the interdisciplinary team in many health conditions. In order to work more effectively as an interdisciplinary team, a common terminology is needed. This study investigates which categories of the ICF-Dietetics are used in clinical dietetic care records in Austria and which are most relevant to shared language in different medical areas. Method A national multicenter retrospective study was conducted to collect clinical dietetic care documentation reports. The analysis included the “best fit” framework synthesis, and a mapping exercise using the ICF Linking Rules. Medical diagnosis and intervention concepts were excluded from the mapping, since they are not supposed to be classified by the ICF. Results From 100 dietetic records, 307 concepts from 1807 quotations were extracted. Of these, 241 assessment, dietetics diagnosis, goal setting and evaluation concepts were linked to 153 ICF-Dietetics categories. The majority (91.3%) could be mapped to a precise ICF-Dietetics category. The highest number of ICF-Dietetics categories was found in the medical area of diabetes and metabolism and belonged to the ICF component Body Function, while very few categories were used from the component Participation and Environmental Factors. Conclusions The integration of the ICF-Dietetics in nutrition and dietetic care process is possible. Moreover, it could be considered as a conceptual framework for interdisciplinary nutrition and dietetics care. However, a successful implementation of the ICF-Dietetics in clinical practice requires a paradigm shift from medical diagnosis-focused health care to a holistic perspective of functioning with more attention on Participation and Environmental Factors.(VLID)489878

The International Classification of Functioning, Disability and Health (ICF) in nursing: Persons with spinal-cord injury as an example

The core aim of nursing practice is to improve or maintain the person’s well-being and quality of life. The use of standardized classifications and terminologies can contribute to this aim by facilitating intra- and inter-professional communication. Therefore, it is important to explore approaches that enhance common use of the current standard classifications of all health-care professions. The overall objective of this doctoral thesis was to investigate whether the International Classification of Functioning, Disability and Health (ICF) is a practicable and useful classification for nurses - using spinal-cord injury (SCI) nursing as an example. This doctoral thesis comprises the research, results and conclusions of two original studies published in the nursing journal “Journal of Advanced Nursing” first authored by the doctoral candidate. The objective of the first study was to identify the conceptual and practical relationships between the inter-professional ICF and the nursing-specific NANDA-I Taxonomy II for nursing diagnoses. The specific research questions were: (1) What are the commonalities and differences between the conceptional frameworks and assessment principles of the ICF and the NANDA-I Taxonomy II? and (2) Can the two classifications serve as a combined approach in SCI nursing practice? The discussion of the conceptual and practical relationships between the ICF and the NANDA-I Taxonomy II is based on (1) the most recently published descriptions of both classifications and (2) the illustration of a SCI-specific case example presenting the combined use of both classifications. The objective of the second study was to analyse the extent to which the intervention goals of nurses when caring for persons with SCI can be expressed in the standardized language of the ICF. The specific research questions were: (1) Which problems, resources and aspects of the environment of persons with SCI relevant to nurses can be translated into the ICF language? and (2) Which problems, resources and aspects of the environment relevant to nurses are still missing in the ICF? The method used to answer these questions was a worldwide Delphi Survey with SCI nurses. The results of this doctoral thesis shed light on the use of the ICF in nursing practice. First, I discuss the commonalities and differences between the ICF and the NANDA-I Taxonomy II that should be taken into account when implementing both 10 classifications in nursing practice. Important clinical requirements that are exclusive to nursing can be met with the NANDA-I Taxonomy II. The application of the ICF helps nurses communicate abbreviated nursing issues with other health professionals in a common language. A combined application of the ICF and the NANDA-I Taxonomy II is valuable, and they can complement each other to enhance the quality of clinical teamwork and nursing practice. Second, I provide a list of patients’ problems, patients’ resources or aspects of their environment treated by SCI nurses that might be introduced in nursing practice for a comprehensive standardized documentation and for a better exchange of information in a common language with other health professionals. Third, I show the strengths and weaknesses of the ICF when used in nursing care specific to SCI and provide evidence for the update and future revisions of the ICF. For example, I propose to add two qualifiers, one for “Risk for” and one for “Resource for” to the existing qualifier scale. Several recommendations for future research are based on the results of this doctoral thesis. First, there is a need to continue exploring the simultaneous use of the ICF and NANDA-I Taxonomy II. A complete linking of both classifications could reveal their commonalities and differences in a more detailed way and identify all missing elements in the ICF for nursing purposes. Second, the list of patients’ problems, patients’ resources or aspects of their environment treated by SCI nurses should be validated in different nursing settings (e.g. acute hospital care, rehabilitative care and community care). This list should also be compared with the existing Comprehensive ICF Core Sets for SCI in the early post-acute context and long-term context. Third, the personal factors identified should be taken into account when developing the ICF component Personal Factors.Das Wohlbefinden und die Lebensqualität eines Menschen zu verbessern oder zu erhalten ist das Kernziel der Pflegepraxis. Zu diesem Ziel kann der Einsatz von standardisierten Klassifikationen und Terminologien beitragen, indem diese die intra - und interprofessionelle Kommunikation erleichtern. Deshalb ist es sinnvoll, Ansätze zu untersuchen, die die gemeinsame Nutzung von standardisierten Klassifikationen der Gesundheitsfachberufe unterstützen. Das übergeordnete Ziel dieser Dissertation war zu untersuchen, inwieweit die Internationale Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) eine praktikable und nützliche Klassifikation für Pflegende darstellt - exemplarisch gezeigt anhand der Pflege von Personen mit Rückenmarksverletzung. Diese Dissertation umfasst die Untersuchungen, Ergebnisse und Schlussfolgerungen von zwei Studien, die von der Doktorandin als Erstautorin in der Pflegefachzeitschrift “Journal of Advanced Nursing” veröffentlicht wurden. Das Ziel der ersten Studie war die konzeptionellen und praxisrelevanten Beziehungen der interprofessionellen ICF und der pflegespezifischen NANDA-I Taxonomy II für Pflegediagnosen zu identifizieren. Die spezifischen Forschungsfragen waren: (1) Was sind die Gemeinsamkeiten und Unterschiede der ICF und der NANDA-I Taxonomy II bezüglich der konzeptionellen Rahmenwerke und Prinzipien der Erhebung? und (2) Inwieweit können beide Klassifikationen zur gemeinsamen Anwendung für die Pflege von Personen mit Rückenmarksverletzung genutzt werden? Die Diskussion über die konzeptionellen und praxisrelevanten Beziehungen zwischen der ICF und der NANDA-I Taxonomy II basiert (1) auf den zuletzt veröffentlichten Beschreibungen beider Klassifikationen und (2) auf der Darstellung einer kombinierten Verwendung beider Klassifikationen anhand eines Fallbeispiels einer Person mit Rückenmarksverletzung. Das Ziel der zweiten Studie war zu analysieren, in welchem Ausmaß die Behandlungsziele von Pflegenden für Personen mit Rückenmarksverletzung in der standardisierten Sprache der ICF ausgedrückt werden können. Die spezifischen Forschungsfragen waren: (1) Welche Probleme, Ressourcen und Aspekte der 7 Umwelt von Personen mit Rückenmarksverletzung, die pflegerelevant sind, können in die Sprache der ICF übersetzt werden? und (2) Welche Probleme, Ressourcen und Aspekte der Umwelt, die pflegerelevant sind, fehlen noch in der ICF? Um diese Fragen zu beantworten, wurde als Methode eine weltweite Delphi-Befragung von Pflegenden, die mit der Pflege von Personen mit Rückenmarksverletzung Erfahrung haben, gewählt. Die Ergebnisse dieser Dissertation geben Aufschluss über die Anwendbarkeit der ICF in der Pflege. Zuerst diskutiere ich die Gemeinsamkeiten und Unterschiede der ICF und der NANDA-I Taxonomy II, die bei der Implementierung beider Klassifikationen in die Pflegepraxis berücksichtigt werden sollten. Mit der NANDA-I Taxonomy II können wichtige praxisnahe Anforderungen, die ausschließlich für die Pflege relevant sind, erfüllt werden. Die Anwendung der ICF wiederum ist hilfreich für Pflegende um mit anderen Gesundheitsfachberufen anhand einer gemeinsamen Sprache vereinfacht über Pflegeprobleme zu sprechen. Eine kombinierte Anwendung der ICF zusammen mit der NANDA-I Taxonomy II ist nützlich, weil sie einander im klinischen Alltag ergänzen können und somit die Qualität der Teamarbeit und der Pflegepraxis bereichern. Zweitens stelle ich eine Liste mit Problemen, Ressourcen und Aspekten der Umwelt von Patienten mit Rückenmarksverletzung zur Verfügung, die alles umfasst, was von Pflegenden behandelt wird. Diese Liste könnte in der Pflegepraxis zur umfassenden und standardisierten Dokumentation eingesetzt werden und für einen besseren Informationsaustausch mit anderen Gesundheitsfachberufen in einer gemeinsamen Sprache dienen. Drittens zeige ich die Stärken und Schwächen der ICF in der Pflegepraxis für Rückenmarksverletzte auf und erbringe Evidenz für Verbesserungen und zukünftige Revisionen der ICF. Beispielsweise schlage ich vor, zur bestehenden Skala der Beurteilungsmerkmale, die beiden Beurteilungsmerkmale „Risiko für“ und „Ressource für“ hinzuzufügen. Aus den Ergebnissen dieser Dissertation ergeben sich einige Empfehlungen für zukünftige Forschungsarbeiten. Erstens bedarf es weiterer Forschung hinsichtlich der gleichzeitigen Verwendung der ICF und der NANDA-I Taxonomy I. Eine vollständige Verknüpfung der beiden Klassifikation auf Item-Ebene (sog. „linking“) könnte ihre Gemeinsamkeiten und Unterschiede auf eine detailliertere Weise 8 offenbaren und somit weitere fehlende Elemente hinsichtlich der Ansprüche der Pflege an die ICF identifizieren. Zweitens sollte die Liste mit Problemen, Ressourcen und Aspekten der Umwelt von Patienten mit Rückenmarksverletzung in verschiedenen Versorgungsformen validiert werden (z.B. in der Pflege im Akutkrankenhaus, in der Rehabilitationspflege und in der ambulanten Pflege). Diese Liste sollte zudem mit den existierenden sog. Umfassenden ICF Core Sets für Personen mit Rückenmarksverletzung in der Frührehabilitation und in der Langzeitversorgung verglichen werden. Drittens sollten die personbezogenen Faktoren, die in dieser Dissertation identifiziert wurden bei der Entwicklung der ICF-Komponente der Personbezogenen Faktoren berücksichtigt werden

A PROCESS FOR ACHIEVING COMPARABLE DATA FROM HETEROGENEOUS DATABASES

The current state of health and biomedicine includes an enormity of heterogeneous data ‘silos’, collected for different purposes and represented differently, that are presently impossible to share or analyze in toto. The greatest challenge for large-scale and meaningful analyses of health-related data is to achieve a uniform data representation for data extracted from heterogeneous source representations. Based upon an analysis and categorization of heterogeneities, a process for achieving comparable data content by using a uniform terminological representation is developed. This process addresses the types of representational heterogeneities that commonly arise in healthcare data integration problems. Specifically, this process uses a reference terminology, and associated maps to transform heterogeneous data to a standard representation for comparability and secondary use. The capture of quality and precision of the “maps” between local terms and reference terminology concepts enhances the meaning of the aggregated data, empowering end users with better-informed queries for subsequent analyses. A data integration case study in the domain of pediatric asthma illustrates the development and use of a reference terminology for creating comparable data from heterogeneous source representations. The contribution of this research is a generalized process for the integration of data from heterogeneous source representations, and this process can be applied and extended to other problems where heterogeneous data needs to be merged

Caminhos percorridos pela Enfermagem brasileira para o desenvolvimento de subconjuntos terminológicos

Objetivo: discorrer sobre os caminhos percorridos pela enfermagem brasileira no desenvolvimento de subconjuntos terminológicos da Classificação Internacional para a Prática de Enfermagem. Método: pesquisa documental, realizada nas dissertações de mestrado e teses de doutorado, que desenvolveram subconjuntos terminológicos, disponíveis no Banco de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. Foram analisadas as variáveis: instituição, ano, nível acadêmico, tipo de serviço de saúde, abordagem metodológica, clientela, referencial teórico, validação de termos, mapeamento cruzado, modelagem de novos conceitos, validação das afirmativas, método utilizado para elaboração, coleta de termos, finalização e divulgação. Resultados: foram encontradas 124 teses de doutorado e dissertações de mestrado, excluídas 91 e incluídas 33, sendo 23 (69,70%) dissertações de mestrado, com maior produção em 2014 (n= 10; 30,30%), com destaque para o Nordeste (36,36%); o cenário ‘Atenção Básica’, com seis estudos (18,18%) e a clientela predominante foi de pacientes oncológicos. Quanto às características metodológicas, em 96% dos estudos, empregou-se a abordagem quantitativa; em 2%, a abordagem qualitativa e 2% associaram a abordagem quantitativa e a qualitativa. Quanto ao tipo de estudo, 60% foram metodológicos e 24% descritivo-exploratórios, sendo o modelo de Horta o mais utilizado (36%). Conclusão: os caminhos são exitosos, contudo ainda permeados de fragilidades nas validações e nas potencialidades para uniformizar a linguagem.Objective: to discuss the paths taken by Brazilian Nursing in the development of terminological subsets of the International Classification for Nursing Practice. Method: documentary research, carried out in master’s dissertations and doctoral theses, which developed terminological subsets, available at the Bank of Doctoral Theses and Master’s Dissertations of the Under-graduation Personnel Improvement Coordination. The variables were analyzed were institution, year; academic level, type of health service, methodological approach, clientele, theoretical reference, validation of terms, cross mapping, modeling of new concepts, validation of statements, method used for elaboration, term collection, finalization and dissemination. Results: 124 doctoral theses and master’s dissertations were found, 91 were excluded and 33 were included, 23 (69.70%) of which were master’s dissertations, with the highest production in 2014 (n=10; 30.30%), with emphasis on the Northeast (36.36%); the ‘Primary Care’ scenario, with six studies (18.18%); and the predominant clientele was cancer patients. As for the methodological characteristics, in 96% of the studies, the quantitative approach was used; in 2%, a qualitative approach; and 2% associated the quantitative and qualitative approaches. As for the type of study, 60% were methodological and 24% descriptive-exploratory, with the Horta model being the most used (36%). Conclusion: the paths are successful, yet still permeated by weaknesses in the validations and potentialities to standardize the language.Objetivo: discurrir sobre los caminos recorridos por la Enfermería brasileña en el desarrollo de subconjuntos terminológicos de Clasificación Internacional para la Práctica de Enfermería. Método: investigación documental, realizada en tesis de magister y tesis de doctorado, que han desarrollado subconjunto terminológicos disponibles en el Banco de Tesis de Doctorado y Tesis de Magister de la Coordinación de Perfeccionamiento de Personal de Nivel Superior. Se analizaron las siguientes variables: institución, año, nivel académico, tipo de servicio de salud, enfoque metodológico, clientela, marco teórico, validación de términos, mapeo cruzado, modelación de nuevos conceptos, validación de afirmaciones, método utilizado para elaboración, recolección de términos, finalización y divulgación. Resultados: se encontraron 124 tesis de doctorado y tesis de magister, se excluyeron 91 y fueron incluidas 33, siendo 23 (69,70%) tesis de magister, con mayor producción en 2014 (n= 10; 30,30%), con prevalencia del Nordeste (36,36%); el escenario ‘Atención Primaria’, con seis estudios (18,18%) y la clientela predominante fue la correspondiente a pacientes oncológicos. En relación a las características metodológicas, en 96% de los estudios se empleó el método cuantitativo; en 2% el enfoque cualitativo y en 2% se advirtió la fusión entre los métodos cuantitativo y cualitativo. En lo atinente al tipo de estudio, 60% fueron estudios metodológicos y 24% descriptivo-exploratorios, siendo el modelo de Horta el más utilizado (36%). Conclusión: los caminos han sido exitosos, aunque todavía estén atravesados por déficits en las validaciones y en las potencialidades para estandarizar la terminología