Nursing Terminologies as Evolving Large-Scale Information Infrastructures

This paper describes the slowly evolving nature of large-scale terminology-based information infrastructures. The strategic aim of implementing standardized terminologies is to share and compare information within and across domain-specific and organizational boundaries. We are particularly interested in working classification systems focused on specific domains’ and classes, and even more specifically in reference terminologies with the capability to interconnect different existing classification systems. We examine this empirically through a threefold case based on data from three Norwegian university hospitals, where we also track a national recommendation of a reference terminology. The reference terminology, which was initially promoted as a means to achieve integration and harmonization, is increasingly perceived as competing with other terminologies. This “gateway” has been presented as a purely technical and politically neutral system, but may be more complex in reality: such integration processes require considerable adaptations, negotiations, and manual maintenance

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

Psychometric properties of the attitudes assessment scale towards the recovering self-care process

Introduction: After a critical event, which has left the person dependent in self-care activities, their recovery is influenced by the emotions and attitudes that the person adopts. Objective: To develop an instrument that allows the assessment of attitudes and emotional factors with the greatest impact on recovery, of a person dependent on basic self-care activities. Methods: A methodological study that aims to describe the construction and study of the metric properties of the Attitudes Assessment Scale during the self-care recovery process. Data were collected at a hospital and two long-term care units, between October 2019 and December 2020, 118 people with dependence on basic self-care activities participated. Results: A four-dimensional structure with 37 items showed adequate psychometric characteristics of validity after an exploratory factorial analysis. The coefficient alpha of Cronbach varied between 0.84 and 0.96, suggesting a good internal consistency. Conclusion: Assessment of emotional disorders and attitudes of the person, with a deficit in self-care, during the recovery process, contributes to a more effective and integrated recognition and planning of care needs, ensuring higher quality and a more personalized care. The replicability and validation of this measure in other contexts, countries and cultures, can probably contribute to a more informed analysis of the attitudes of the person with dependence in the basic self-care activities, during the recovery process after a disabling event.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

A Taxonomy of Case Management: Development, Dissemination and Impact

Background Case management is a widely-accepted care coordination strategy, although complex and variable due to the interaction of its components: model (theory); context (service); population and health condition; case manager's actions. This complexity impedes practice, quality analysis, policy and planning. The aim was to develop a case management taxonomy for a common understanding and language and assess the impact of international dissemination. Method The mixed methods used to develop the case management taxonomy included: scoping and mapping review to examine key components described in the literature; critical review of international frames for conceptual and technical frameworks; a nominal group of experts and feasibility analysis. After development, there was extensive international dissemination and impact assessment of dissemination to diverse groups. Results The taxonomy identifies the components and their relationship (two taxonomy trees), provides a glossary. The service tree comprises acute, mobility and intensity characteristics. The intervention tree comprises the main actions, actions and related actions of case manager interventions. There were 51 personalised taxonomy presentations to audiences across 11 countries and numerous non-personalised presentations. After dissemination data was collected from two questionnaires and opportunistic information. The taxonomy was perceived as highly acceptable and practical. Impact ratings (n=43) showed the taxonomy was: translated into meso organisation policy and international frameworks; embedded in tertiary education; used in practice with emerging uses in research. Conclusion The taxonomy provides a framework to manage case management complexity. It identifies and defines the components and their relationships. Impact ratings show the case management taxonomy is a useful tool in different sectors and fit for purpose across different health conditions, hereafter called the ‘case management taxonomy’

Translation and National clinical validation of the Nursing Management Minimum Data Set (NMMDS) in hospitals in the country of Iceland

Rising health care costs place increased burden on patients, health care personnel, administrators and policymakers. Decisions in health care are influenced by data which can be transferred into valuable information and knowledge. Data sets that facilitate data collection, information management and knowledge building are needed by nurse managers to support administrative decision- making. The Nursing Management Minimum Data Set (NMMDS,,¦) offers a standardized method to capture core data that can be collected in information systems, shared and reused for multiple purposes to support safe and cost-effective care. The purpose of this descriptive study was to adapt to Iceland and clinically test the NMMDS-ICE in all adult inpatient care units in the country of Iceland (excluding psychiatry). The aims of the study were to 1) translate the NMMDS from source language (English) to target language (Icelandic); 2) to validate the translated instrument; and 3) to describe the environment, nursing care resources, and financial resources across acute adult inpatient care units in Iceland. Instrument development consisted of translation, expert validation, and psychometric testing. The target population was all adult acute care units in hospitals in Iceland, and the nurse managers (n=38) representing these units. Data collection included a mailed survey. The sample equaled the population. Furthermore, 134 staff nurses on these units (excluding staff nurses at Landspitali) completed a job satisfaction survey. Return rate was 74% for nurse managers and 71% for staff nurses. Semantic and content equivalence of the NMMDS-ICE was established. Five of seven subscales of the instrument received Cronbach¡¦s alpha score of 0.70 or higher. Results indicated that it was feasible to collect the NMMDS-ICE in hospitals in Iceland, albeit, there was an issue with time commitment to do so. The specialty services that best described the patient population were medical-, surgical services, birthing, and geriatrics. Furthermore, nurse managers seem to perceive good control on their units, and both nurse managers and staff nurses are satisfied with their job. A positive correlation was found between autonomy and satisfaction with nursing management, nursing administration, and own level of autonomy. Statistical differences were identified in environmental and staffing resources between hospitals.The Icelandic Nurses Association (Félag Íslenskra Hjúkrunarfræðinga) and Sigma Theta Tau Internationa