Clinical use of nursing classifications: How are nursing. Hospital Information Infrastructure? t Torbjørg Meum, PhD student, University of Tromsø

Transcription

1 Clinical use of nursing classifications: How are nursing classification integrated in the Hospital Information Infrastructure? t Torbjørg Meum, PhD student, University of Tromsø

2 Introduction and background Hospital Information Systems, Hospital Information Infrastructure and Electronic Patient Record What is the difference? One difference is standardization the different element of an infrastructure are integrated through standardized interfaces. (Monteiro, Hanseth) Nursing classification as an Information Infrastructure. Increased interest t in nursing classification after the implementation ti of EPR The Norwegian Nursing Organization recommends a standardized language to describe nursing Nursing classifications have to support different needs and different purposes and shared by a large community of practice Challenges accociated with management of classification system It is a challenge and a negotiation between flexibility, control and comparability. lkj1

3 Slide 2 lkj1 trade off? Liv Karen Johannesen;

4 From international classification to local practice NANDA (North American Nursing Diagnosis Association) 155 Diagnosis Clinical judgement about individual, family or community responses to actual or potential health problems/life processes (North American Nursing Diagnosis Association, 1997) Translated to Norwegian Integrated into the DIPS EPR system

5 NIC (Nursing Intervention Classification) NIC is a comprehensive standardized classification of interventions that nurses perform. It is developed at the University of Iowa and consist of a list of 514 interventions. It is translated to Norwegian and integrated into the DIPS EPR system

6 ICNP (International Classification of Nursing Practice) Developed by the International Counsil of Nursing Reference terminology a concept-oriented terminology in contrast to an interface terminology Recently translated into Norwegian The Norwegian Nursing Organization has recently recommended the use of ICNP in Norwegian EPR systems.

7 The development of a structured and standardized clinical language for nursing is of major importance to the profession of nursing for both practice and science. (June Clarke, 2001) It is important to establish a common nursing language for describing nursing practice. (ICN, 1996) It is important to make the practice of nursing visible in the Hospital Information Infrastructure It is also important to be able to compare across different sites No classification system may specify the complexity of what is represented. Some degree of control is required to get the work done, for most of the people, most of the time. (Bowker and Star, 2000) A manageable classification system works in practice, is not too finegrained and fits with the ways work is organized. It is a trade off between visibility, comparability and control

8 Method Department of Special Psychiatry (APP) at the University hospital of Northern Norway (UNN). APP started to use the electronic nursing documentation, included nursing classifications in The main motivation to use classifications was to improve the language in the documentation Participant observation, semi-structured interviews, informal discussions and participation in internal project meetings. (Documentation Project)

9 Transformation of NANDA and NIC into Transformation of NANDA and NIC into the EPR system

10 The new nursing document. T NANDA The new document displays the actual care plan, so it s

11 To edit a NANDA diagnosis.. i C A NANDA

12 Visibility and control The care plans have become an important actor as a communication tool at the department and the quality of the nursing documentation has improved The first year after the implementation it was mandatory to use NANDA, but after a year it was voluntary. An evaluation of the use of NANDA was conducted by two super users in They compared the use of NANDA and free text diagnosis During the first year only 6% was free text but after a year it has increased to 42% A document analysis showed that 70% of the free text diagnosis was similar or equal to NANDA. This finding is supported by the observation study and the interviews Lack of classification to describe some psychiatric conditions and observation of medicament treatment

13 Strange/unfamiliar language in some of the classification. Sensory/Perceptual Alterations Anxiety

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15 TM1 They have managed to visualise the work that they do, but.. Is it because of the classification? Is it because of the care plan? Is it because of the two super users? The answer is a combination of social and technical issues

16 Slide 14 TM1 Torbjørg Træland Meum;

17 Further work Continue my field study in Tromsø Document analysis Field study at a hospital in Southern Norway Follow the development of ICNP in Norway