ICNP® in nursing documentation – when expectations meet reality

The International Classification for Nursing Practice (ICNP®) terminology was in 2016 implemented in three Norwegian municipalities through the introduction of five standardized care plans in the Electronic Patient Record (EPR) system. This poster provides results from an exploratory, qualitative study, investigating how nurses in these municipalities applied the care plans into their daily informational work. Keywords: Electronic Patient Records, Documentation, Terminolog

Formal nursing terminology systems: a means to an end

In response to the need to support diverse and complex information requirements, nursing has developed a number of different terminology systems. The two main kinds of systems that have emerged are enumerative systems and combinatorial systems, although some systems have characteristics of both approaches. Differences in the structure and content of terminology systems, while useful at a local level, prevent effective wider communication, information sharing, integration of record systems, and comparison of nursing elements of healthcare information at a more global level. Formal nursing terminology systems present an alternative approach. This paper describes a number of recent initiatives and explains how these emerging approaches may help to augment existing nursing terminology systems and overcome their limitations through mediation. The development of formal nursing terminology systems is not an end in itself and there remains a great deal of work to be done before success can be claimed. This paper presents an overview of the key issues outstanding and provides recommendations for a way forward

Estudio de caso de un adolescente según el Modelo Teórico de Ajuste al Cáncer Parental

Objective: To describe and analyze the experience of an adolescent experiencing parental cancer, based on A Model of Children’s Adjustment to Parental Cancer, and to prescribe nursing interventions in classified language. Method: This is a single case study, qualitative, of a 16-year-old adolescent experiencing maternal cancer. We analyzed a semi-structured interview, based on a script conceptualized by the selected theoretical model. Data processing took place through content analysis. Authorization was obtained from the Research Ethics Committee TI 25/2020. Results: The analysis of the adolescent’s interview allowed identifying categories in agreement with the model variables. Psychosocial adjustment dimensions and stress response symptoms, such as academic performance and somatic symptoms, were recognized in the adolescent’s adjustment process. Nursing interventions will focus on education and support. Conclusion: The theoretical model contributed to assess the needs of adolescents experiencing parental cancer, allowing nursing interventions to be prescribed in classified language that consider moderating and mediating variables, promoting adjustment. The model proved to be suitable for future interventions for adolescents experiencing similar situations.info:eu-repo/semantics/publishedVersio

'Nursing Hours' or 'nursing' hours - a discourse analysis

This thesis is about the business of nursing; the making and remaking of nurses’ work in the context of private healthcare. Nurses in Australia, as in other countries around the world, have experienced considerable workplace changes over the past 15 years due to governments and public and private healthcare organisations seeking to reform healthcare service delivery. These reforms have significantly changed not only how private hospitals manage care, but the nursing role in practice. This ethnographic study explores the impact of these reforms on nurses’ work in one Australian acute care private hospital. It critically examines nurses’ organising practices in light of the workload measurement method used to staff the hospital, unit and ward with minimum staffing. Using Foucault’s (1972) archaeological approach and drawing upon governmentality theory as the analytical framework, I will argue that within the political rationality of neo-liberalism, ‘care’ in nursing is a technology of governance. As such, nurses’ ‘care’ transforms contemporary healthcare policy, in particular policy pertaining to private healthcare, from a macro to the micro level of everyday practice. Care is the means of producing a ‘business savvy’ nurse; someone who is not only an expert clinician with transferable skills but who knows the private health market and is able to work within a competitive business environment. Analysis reveals the contradictions and tensions that exist for nurses between the clinical and economic foci, and the economics and business of health as the nursing role is played out within the organisational imperatives of their work. This study illustrates the shifting boundaries of nurses’ work in relation to the ascendancy of business concerns in healthcare delivery. While methods of workload measurement may well represent what counts as the nursing hours in healthcare organisations, the nurses in this study spoke at length of the strategies they used to make the nursing hours ‘work’. Findings indicate that nurses employ specific discursive strategies when talking about ‘nursing hours’. When addressing their workloads, their discourses centred on the business of care delivery, of nurse-to-patient ‘allocations’ and ‘handover’, or the many instances of ‘handing over’ their work. The study challenges nurses’ professional discourses about what nursing is, what nurses actually do and the sophistication with which this is accomplished at work. Conceiving of nurses’ work in terms of ‘nursing’ hours rather than patients in the business of health service delivery provides a different way of thinking about nursing workforce issues at a time when healthcare organisations and systems worldwide grapple with the question of how many nurses and what kind of nurses they need

Creating archetypes for patient assessment with nurses to facilitate shared patient centred care in the older person

The process of what information is captured in documenting patient care assessment and how it is summarised, communicated and interpreted by nurses across different healthcare services is the main focus of this thesis. Currently in Ireland, systems within the domain of healthcare are undergoing transformation. Existing practices where health information is collected at one local health organisation level and often duplicated across differing services will not support the strategic goals of the newly established clinical directorates. The political vision is simple: Ireland must move towards a nationally integrated electronic record to support patient centred care. Whilst the political vision may be simple, the process of implementation is not and forms the main topic of this thesis. Strategic goals to move nationally towards integrated electronic records are motivated by the global concerns of an ageing population associated with an increase in the prevalence of chronic illness and co-morbidity. The main objective of this thesis is to evaluate the impact of a pilot study which identified the semantic and syntactic clinical requirements for the testing and implementation of a shared discharge/transfer summary assessment record for persons over the age of 65. This summary record was designed in accordance with ISO 13606, the International standard for Electronic Healthcare Record (EHR) communication and is underpinned by ISO 18104, the international standard for Categorial Structures for Representation of Nursing Diagnosis and Nursing Actions in Terminological Systems. A participatory action research approach was adopted, using an exploratory mixed methods research study design. This translational study was completed in two local health organisation areas in Dublin with six service providers across the primary, acute and continuing care services over a two year period. The qualitative element of the study involved 17 interviews, 7 focus group sessions with participants including policy makers and nurses from each of the participating services. Quantitative data included questionnaires from nurses (n = 14) and patients (n=5) evaluating the effectiveness of the summary record. The quantitative data also analysed information from a set of cumulative assessment records (n = 16) which were interpreted in tandem with the qualitative data and then analysed statistically. The shared discharge/transfer summary care record was piloted on 16 patients over an extended timeframe. The quantitative data showed a statistical significance commensurate with the qualitative data collected on patient participants. An evaluation of the pilot study produced qualitative data which was used to gain insight into the differing contexts that healthcare professionals practice within. This data was illustrated in graphical configurations to make evident to policy makers the various roles that nurses engage with in the course of their care delivery. Data collected from both the qualitative and quantitative analysis suggest that the test implementation of the record template was fit for purpose. Identification of the clinical requirements and testing of the summary record over a two year period was a labour intensive process which was logistically difficult to implement. One consequence of this study was the education of the nursing participants on gaining a common understanding of what needs to be measured in patient assessment to inform future theory testing for outcome based research. A second consequence was the empowerment of the nursing participants to develop archetypes for inclusion in future electronic healthcare records in Ireland. The prototype archetypes designed for assessment of the older person in this study are at present informing a number of practical applications within the nursing community in Ireland. Over the course of the study the participatory action research design altered in its focus and emerged as a dominant qualitative mixed methods study

Applicability of the nursing interventions classification in the psychiatric outpatient care setting

Standardized nursing terminologies (SNT) have been developed to describe the nursing process systematically. The aim of this research was to study the applicability of the Nursing Interventions Classification (NIC) in the psychiatric outpatient care setting in Finland. The research includes three phases. In the first phase using an integrative literature review we identified nursing interventions in research publications (n=60) and used the NIC to analyze the identified interventions. In the second phase, we used an ethnographically oriented work-place study to identify interventions in the clinical setting. This included observations and interviews and the findings were analyzed together with nurses (n=17). The core interventions were identified using the Delphi method. The panelists consisted of nurses and nurse managers (round one n=54, round two n=26). In the third phase we identified nursing interventions in nursing progress notes (n=1150) and in nursing care summaries (n=17) and mapped these into the NIC. In all we identified 105 different nursing interventions, of which 95% could be mapped into the NIC. The emphasis was in interventions aiming at behavioral change and more specifically interventions that support coping by building on patients’ strengths. In nursing documentation, the most frequent interventions were Surveillance and Care Coordination. The group delivery method was common in all phases. The findings of this study emphasize the need for a systematic terminology to describe nursing interventions for nurses to conceptualize their work, to make the work visible and to ensure the quality of nursing documentation. The broad coverage, descriptiveness of the interventions and the taxonomical structure of the NIC support its applicability. However, the interventions in the classification were found to be overlapping which limits the systematic transfer of information and the possibilities for secondary use of data. Additional limitations are the lack of semantic coherence with the concepts used in research and the difficulty of describing interventions delivered using the group method. This research generated recommendations for the development of the classification. The most central ones include the need to include multiple methods in the research and development and the integration of concepts used in research literature.Hoitotyön interventioiden luokituksen soveltuvuus aikuispsykiatrian avohoitoon Hoitotyön systemaattinen kuvaaminen edellyttää yhteisen kielen ja käsitteistöjen käyttöä. Tässä tutkimuksessa selvitetään hoitotyön interventioiden luokituksen (Nursing Interventions Classification, NIC) soveltuvuutta aikuispsykiatrian avohoitoon. Tutkimus koostuu kolmesta osavaiheesta. Ensimmäisessä vaiheessa integratiivisen kirjallisuuskatsauksen avulla tutkimuksista (n=60) tunnistettiin hoitotyön interventioita ja nämä analysoitiin NIC-luokituksen avulla. Toisessa vaiheessa hyödynnettiin etnografista työntutkimusta. Hoitotyön interventioita tunnistettiin hoitajien työtä havainnoimalla ja hoitajia haastattelemalla. Analysointi tapahtui yhdessä hoitajien (n=17) kanssa. Ydininterventioiden tutkimus tapahtui sähköistä Delfoi-menetelmää hyödyntäen. Panelisteina toimivat sairaanhoitajat ja hoitotyön lähijohtajat (ensimmäisellä kierroksella n=54, toisella kierroksella n=26). Kolmannessa vaiheessa tutkittiin hoitotyön päivittäiskirjauksia (n=1150) ja hoitotyön yhteenvetoja (n=17), joista tunnistetut interventiot yhdistettiin NICluokitukseen. Tutkimuksessa tunnistettiin yhteensä 105 interventioita, joista 95 %:lle löytyi vastine luokituksesta. Keskeisiä interventioita kirjallisuuskatsauksessa, etnografisessa työntutkimuksessa ja ydininterventioiden tutkimuksessa olivat käyttäytymisen muutokseen tähtäävät psykososiaaliset interventiot ja erityisesti voimavaralähtöinen selviytymiskyvyn tukeminen. Hoitotyön kirjauksissa korostuivat seuranta ja hoidon koordinointi. Interventioiden ryhmämuotoinen toteutustapa oli yleinen kaikissa tutkimusvaiheissa. Tutkimuksen tulokset korostavat yhteisten käsitteiden tarvetta hoitotyön interventioille työn käsitteellistämisen, näkyväksi tekemisen ja kirjaamisen laadun näkökulmista. Tutkitun luokituksen soveltuvuutta tukevat sen kattavuus, käsitteiden hyvä tunnistettavuus ja hierarkkinen rakenne. Luokituksen interventiokäsitteet ovat osittain päällekkäisiä heikentäen sen systemaattista käytettävyyttä ja tiedon toisiokäytön mahdollisuuksia. Soveltuvuutta rajoittavat myös luokituksen vähäinen yhteys tutkimuskirjallisuudessa käytettyihin käsitteisiin ja vaikeus kuvata ryhmämuotoisia interventioita. Tutkimus antaa suosituksia luokituksen jatkokehittämiselle. Keskeisimpänä ovat monimenetelmäisyys tutkimuksessa ja kehittämisessä sekä tutkimuskirjallisuuden käsitteistöjen vahvempi integroiminen luokitukseen

Transitional Care Interventions as Implemented By Faith Community Nurses

Hospitals are seeking innovative and efficient methods of decreasing avoidable readmissions. Despite the volume of nursing literature exploring the use of advanced practices nurses in providing transitional care, only one study mentions the use of a faith community nurse. The faith community nurse operates in the community and has the skills to provide transitional care. The purpose of this study was to describe transitional care as implemented by faith community nurses using a standardized nursing language: the Nursing Intervention Classification (NIC). A mixed method descriptive design was selected to facilitate a thorough exploration of the interventions implemented by faith community nurses. The findings suggested that the majority of interventions are in the coping assistance, communication enhancement, and patient education Classes of the Behavioral Domain. The most frequently selected nursing interventions in NIC (n=26) were found and validated by the faith community nurse focus group. Results were compared to evidenced-based priority transitional care interventions described in research. In addition, results were compared to previous faith community nursing research describing the practice. Results were also described using the Faith Community Nursing conceptual framework. The results may provide the underpinnings for further testing of transitional care interventions

Construcción y validación de impresos: sistematización del cuidado de personas en hemodiálisis

Objective: create and validate forms to subsidize the systematization of nursing care with people on hemodialysis. Method: institutional case study to support the systematization of assistance from the construction of forms for data collection, diagnoses, interventions and nursing results, using cross-mapping, Risner's reasoning, Neuman's theory, taxonomies of diagnoses, interventions and nursing results with application in clinical practice and validation by focal group with specialist nurses. Results: 18 people on hemodialysis and 7 nurses participated. Consensus content of form matter with specialist nurses in the area (Crombach 0.86). The papers captured 43 diagnoses, 26 interventions and 78 nursing results depicting human responses in their singularities. Final considerations: the validated forms fill a gap by enabling the capture of human responses from people on hemodialysis and by subsidizing the planning of nursing care on a scientific basis.Objetivo: crear y validar impresos para subsidiar la sistematización del cuidado de enfermería con personas en hemodiálisis. Método: estudio de caso institucional para subsidiar la sistematización de la asistencia a partir de la construcción de impresos para recolección de datos, diagnósticos, intervenciones y resultados de enfermería, utilizando el mapeo cruzado, el raciocinio de Risner, la teoría de Neuman, taxonomías de diagnósticos, intervenciones y resultados de enfermería con aplicación en la práctica clínica y validación por grupo focal con enfermeras especialistas. Resultados: participaron 18 personas en hemodiálisis y 7 enfermeros. Consensuados contenidos de los impresos con enfermeras especialistas del área (Crombach 0,86). Los impresos captaron 43 diagnósticos, 26 intervenciones y 78 resultados de enfermería retratando respuestas humanas en sus singularidades. Consideraciones finales: los impresos validados llenan una brecha al posibilitar la captación de respuestas humanas de personas en hemodiálisis y al subsidiar la planificación de los cuidados de enfermería en bases científicas