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

Writing electronic nursing care plans. An approach to facilitate navigating the standardized Nursing vocabularies NANDA and NIC

The introduction of the standardized nursing languages NANDA and NIC to write electronic care plans is hard for nurses, as reported by several projects. Both the need to relate to a new software tool and to the totally unknown domains of the standardized languages contributes to this. With an existing tool for care plan writing as basis, we have used the unified process to develop an improved tool, in order to make the introduction smother. Care has been taken to make the interface and workflow as intuitive as possible, allowing novice computer users to use the tool. An automatic presentation of the information in the languages is implemented, to further meet the needs of unskilled users. To ease navigation in the classifications of the standardized languages, a three level harmonized classification for the two languages was chosen. The two uppermost levels of the classification are presented in one screen, resulting in an efficient browsing for NANDA diagnoses and NIC interventions. To make it possible for users unacquainted with the language to find NANDA diagnoses, a search facility was developed. An information retrieval method was implemented, making it possible to search for diagnoses on the basis of signs and symptoms. The query interface was deliberately made as simple as possible; one or more keywords are entered, and a list of diagnoses is returned ranked according to relevance to the keywords. The search facility also helps in the process of exploring and learning the classification hierarchy. Usability tests shows improvement both in ease of use and support for exploring the standardized languages for the new system compared with the original