The Need for and Use of Standardized Nursing Languages (SNLs) for the Electronic Health Record - PowerPoint PPT Presentation

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The Need for and Use of Standardized Nursing Languages (SNLs) for the Electronic Health Record

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The Need for and Use of Standardized Nursing Languages (SNLs) for the Electronic Health Record Margaret Lunney, RN, PhD Professor, College of Staten Island/CUNY, New York – PowerPoint PPT presentation

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Title: The Need for and Use of Standardized Nursing Languages (SNLs) for the Electronic Health Record


1
The Need for and Use of Standardized Nursing
Languages (SNLs) for the Electronic Health Record
  • Margaret Lunney, RN, PhD
  • Professor, College of Staten Island/CUNY, New York

2
What are SNLs?
  • Names uniformly used with definitions
    descriptions
  • Language systems based on rules
  • of inclusion organization. e.g.,
  • ICD 9 (medical diagnoses)
  • CPT (medical interventions U.S.)
  • SNLs-3 elements of nursing care as defined by the
    Nursing Minimum Data Set (NMDS)
  • Diagnoses of human responses (NDxs)
  • Nursing interventions (NRxs)
  • Nursing-sensitive patient outcomes (NSPOs)

3
ANA Approved SNLs (U.S.)
  • NANDA (NDx)
  • NIC (NRx)
  • NOC (NSPOs)
  • Omaha System (NDx, NRx, POs)
  • Home Health Care Class. (NDx, NRx, POs)
  • Patient Care Data Set (NDx, NRx, POs)
  • Perioperative Data Set (NDx, NRx, POs)

4
Why SNLs?
  • Scientific names needed-word usage varies
  • Meanings of words-extensional intensional
  • Scientific names provide extensional meanings
  • Prejudice (inaccurate interpretation of pt. data)
    occurs when only the intensional is used

5
Why SNLs?Standardized names are needed for
computer systems EHR(U.S. National Committee
for Vital Health Statistics)
6
Why SNLs?
  • Communication through language is
  • Tool for communication (with self others)
  • Source of cooperative actions
  • Tool to improve human experiences
  • Naming is great step forward-makes discussion
    possible
  • Fundamental to growth survival (Nursing HC)
    Hayakawas Linguistics Theory

7
Why SNLs?
  • Words and phrases are maps to the territory
  • Many maps are needed to know a territory
  • No maps fully represent the territory
  • All maps together do not equal the territory
  • Goal is to make good maps of the territory
  • Example Pluteus cervinus mushroom
  • fawn mushroom, deer mushroom, fawn pluteus, the
    deer mushroom, fawn shieldcap
  • North American Commission for Common Names for
    Mushrooms created in 2000

8
Why Select Names for Nursing Phenomena?
  • We experience only a small fraction of phenomena
  • We must abstract the objects of experiences
  • It makes no sense to distrust abstractions
  • We need to be aware of abstracting
  • Connect words with
  • experiences
  • avoid this

9
Why SNLs?
  • SNLs represent pooled nursing knowledge
  • Use of pooled knowledge helps nurses to plan,
    interpret, intervene and evaluate
  • Sciences seek generally useful vocabularies, ones
    that produce results
  • Results quality of care

10
Effects on Nursing Careof Using SNLs
  • Naming Thoughts
    Discernment
  • Communication Cooperation Action
  • Improved Access, Cost Effectiveness, Quality
  • Lunney, 1999

11
NANDA International (I)
  • Nursing diagnoses are human responses (HRs) to
    health problems and life processes for which
    nurses provide interventions
  • Purposes Name human responses of concern to
    nurses so accuracy can be addressed and the best
    NRxs can be selected for positive outcomes

12
NANDA I Examples
  • Pain
  • Death Anxiety
  • Impaired Home Maintenance
  • Readiness for Enhanced Community Coping
  • Hopelessness
  • Ineffective Breathing Pattern
  • Risk for infection
  • Relocation Stress Syndrome
  • Decisional Conflict
  • Acute Confusion
  • Effective Breast Feeding

13
Why NDx?
  • Human responses are complex
  • Research findings r.t. high risk of inaccuracy
  • 1966 series of studies
  • 1970s series of studies
  • 1980-2001 Influencing factors
  • Clinician knowledge, abilities other
  • Task difficulty level
  • Situational factors, e.g., agency policies

14
Why NDx?
  • Interpretations/diagnoses
  • foundation for NRxs NSPOs
  • Low accuracy can lead to
  • harm to patient/family
  • wasted time energy
  • absence of positive outcomes
  • patient/family dissatisfaction
  • Basis for quality of nursing care
  • Accountability to HC consumers
  • Expand knowledge of health

15
NANDA I
  • History, 1973-present
  • Research-based submissions
  • Systematic approval process
  • International involvement
  • NDxs widely used
  • Publish every 2 years, latest 2009
  • Recognized by significant organizations (ICD,
    HL7, ANA, ICN, ACENDIO, AENTDE, others)

16
NANDA Taxonomy II
  • 7 axes (concept, time, unit of care, age, health
    status, descriptor, topology)
  • 206 diagnoses, definitions, descriptions
  • Problems
  • Risk states
  • Health promotion
  • Wellness/Strengths
  • 13 Domains, 2-6 classes in each domain
  • Coded for EHR integrated with International
    Health Terminology Standards Development
    Organization (IHTSDO)

17
NIC (Nursing Interventions Classification NRxs)
  • NRxs are treatments performed by nurses based on
    clinical judgment knowledge in order to achieve
    positive pt. outcomes
  • Purposes of naming Consider appropriateness,
    communicate with others for continuity, relate to
    NDxs and NSPOs

18
NIC Examples
  • Acid-Base Management
  • Active Listening
  • Community Disaster Preparedness
  • Coping Enhancement
  • Exercise Promotion
  • Health Education
  • Family Integrity Promotion
  • Health Education
  • Health Policy Monitoring
  • Surveillance
  • Presence
  • Social Support Enhancement

19
NIC
  • Hx Interventions described in numerous
    literature sources
  • In 1987, NIC research group started to identify
    standardize literature-based info
  • Funded by NIH, NINR for 7 yrs
  • 1st ed. 1992 2nd ed. 1996
  • 3rd ed. 2000, 4th ed. 2004, 5th ed. 2008
  • Coded for EHR integrated with IHTSDO, formerly
    SNOMED CT

20
NIC (2008)
  • 542 interventions, definitions, descriptions
  • 7 Domains 30 Classes
  • 1. Physiologic Basic (6 classes)
  • 2. Physiologic Complex (8 classes)
  • 3. Behavioral (6 classes)
  • 4. Safety(2 classes)
  • 5. Family (3 classes)
  • 6. Health System (3 classes)
  • 7. Community (2 classes)

21
NOC (Nursing-Sensitive Patient Outcomes NSPOs
Classification)
  • NSPOs define general pt. states, behaviors or
    perceptions that are influenced by sensitive to
    NRxs and can be measured as variables
  • Purpose of Naming Determine the quality and
    effectiveness of nursing care

22
NOC Examples
  • Caregiver Homecare Readiness
  • Knowledge Illness Care
  • Social Support
  • Mobility level
  • Risk Control Drug Use
  • Neglect Recovery
  • Activity Tolerance
  • Self Care Hygiene
  • Dialysis Access Integrity
  • Wound Healing Primary Intention
  • Acceptance Health Status
  • Symptom Control

23
NOC
  • Existing approaches
  • Goal statements not quantifiable
  • Not comparable across localities
  • Not sensitive to changes in nursing care
  • 1991- NOC research group started
  • 7 yrs funding by NIH/NINR
  • 1st ed 1996, 2nd ed. 2000, 3rd ed. 2004,
  • 4th ed. 2008
  • Coded for EHR integrated with IHTSDO

24
NOC (2008)
  • 385 outcomes, definitions, descriptions
  • 7 Domains, 29 Classes
  • 1. Functional Health (4 classes)
  • 2. Physiologic Health (10 Classes)
  • 3. Psychosocial Health (4 Classes)
  • 4. Health Knowledge Behavior (4 Cl.)
  • 5. Perceived Health (2 Classes)
  • 6. Family Health (3 Classes)
  • 7. Community Health (2 Classes)

25
NOC Principles
  • Neutral terms, variables
  • 17 five point scales
  • 1 (least desirable) to 5 (most desirable)
  • Ex Knowledge Medication,
  • None 1, Limited 2, Moderate 3, Substantial
    4, Extensive 5
  • Other scales
  • Very weak to very strong
  • None to Complete
  • Not At All to A Great Extent
  • Not Adequate to Totally Adequate
  • Extensive to None

26
New Directions
  • Common structure for the 3 systems, partially
    funded by the NLM
  • Goal Improve
  • 1) integration of three systems
  • 2) ease of use
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