Structural validation of nursing terminologies

Embedding Nursing Interventions into the World Health Organization's International Classification of Health Interventions (ICHI)

OBJECTIVE

The International Classification of Health Interventions, currently being developed, seeks to span all sectors of the health system. Our objective was to test the draft classification's coverage of interventions commonly delivered by nurses, and propose changes to improve the utility and reliability of the classification for aggregating and analyzing data on nursing interventions.

MATERIALS AND METHODS

A 2-phase content mapping method was used: (1) three coders independently applied the classification to a dataset comprising 100 high-frequency nursing interventions; (2) the coders reached consensus for each intervention and identified reasons for initial discrepancies.

RESULTS

A consensus code was found for 80 of the 100 source terms; for 34% of these, the code was semantically equivalent to the source term, and for 64% it was broader. Issues that contributed to discrepancies in Phase 1 coding results included concepts in source terms not captured by the classification, ambiguities in source terms, and uncertainty of semantic matching between "action" concepts in source terms and classification codes.

DISCUSSION

While the classification generally provides good coverage of nursing interventions, there remain a number of content gaps and granularity issues. Further development of definitions and coding guidance is needed to ensure consistency of application.

CONCLUSION

This study has produced a set of proposals concerning changes needed to improve the classification. The novel method described here will inform future health terminology and classification content coverage studies.

Advanced Nursing Process quality: Comparing the International Classification for Nursing Practice (ICNP) with the NANDA-International (NANDA-I) and Nursing Interventions Classification (NIC)

AIMS AND OBJECTIVES

To assess the quality of the advanced nursing process in nursing documentation in two hospitals.

BACKGROUND

Various standardised terminologies are employed by nurses worldwide, whether for teaching, research or patient care. These systems can improve the quality of nursing records, enable care continuity, consistency in written communication and enhance safety for patients and providers alike.

DESIGN

Cross-sectional study.

METHODS

A total of 138 records from two facilities (69 records from each facility) were analysed, one using the NANDA-International and Nursing Interventions Classification terminology (Centre 1) and one the International Classification for Nursing Practice (Centre 2), by means of the Quality of Diagnoses, Interventions, and Outcomes instrument. Quality of Diagnoses, Interventions, and Outcomes scores range from 0-58 points. Nursing records were dated 2012-2013 for Centre 1 and 2010-2011 for Centre 2.

RESULTS

Centre 1 had a Quality of Diagnoses, Interventions, and Outcomes score of 35·46 (±6·45), whereas Centre 2 had a Quality of Diagnoses, Interventions, and Outcomes score of 31·72 (±4·62) (p < 0·001). Centre 2 had higher scores in the 'Nursing Diagnoses as Process' dimension, whereas in the 'Nursing Diagnoses as Product', 'Nursing Interventions' and 'Nursing Outcomes' dimensions, Centre 1 exhibited superior performance; acceptable reliability values were obtained for both centres, except for the 'Nursing Interventions' domain in Centre 1 and the 'Nursing Diagnoses as Process' and 'Nursing Diagnoses as Product' domains in Centre 2.

CONCLUSION

The quality of nursing documentation was superior at Centre 1, although both facilities demonstrated moderate scores considering the maximum potential score of 58 points. Reliability analyses showed satisfactory results for both standardised terminologies.

RELEVANCE TO CLINICAL PRACTICE

Nursing leaders should use a validated instrument to investigate the quality of nursing records after implementation of standardised terminologies.

Usability of the Clinical Care Classification System for Representing Nursing Practice According to Specialty

This study examined the ability of the Clinical Care Classification system to represent nursing record data across various nursing specialties. The data comprised nursing care plan records from December 1998 to October 2008 in a medical center. The total number of care plan documentation we analyzed was 2 060 178, and we used a process of knowledge discovery in datasets for data analysis. The results showed that 75.42% of the documented diagnosis terms could be mapped using the Clinical Care Classification system. However, a difference in nursing terminology emerged among various nursing specialties, ranging from 0.1% for otorhinolaryngology to 100% for colorectal surgery and plastic surgery. The top five nursing diagnoses were identified as knowledge deficit, acute pain, infection risk, falling risk, and bleeding risk, which were the most common health problems in an acute care setting but not in non-acute care settings. Overall, we identified a total of 21 established nursing diagnoses, which we recommend adding to the Clinical Care Classification system, most of which are applicable to emergency and intensive care specialties. Our results show that Clinical Care Classification is useful for documenting patient's problems in an acute setting, but we suggest adding new diagnoses to identify health problems in specialty settings.

A preliminary study on the use of clinical care classification in nursing documentation data sets

This study analyzed and organized the content coverage of the clinical care classification (CCC) system to represent nursing record data in a medical center in Taiwan. The nursing care plan was analyzed using the process of knowledge discovery in the data set. The nursing documentation was mapped based on the full list of nursing diagnoses and interventions available using the CCC system. The result showed that 75.45% of the documented diagnosis terms can be mapped using the CCC system. A total of 21 established nursing diagnoses were recommended for inclusion in the CCC system. The results also showed that 30.72% of assessment/monitor tasks and 31.16% of care/perform tasks were provided by nursing professionals, whereas manage/refer actions accounted for 15.36% of the tasks involved in nursing care. The results showed that the CCC system is a suitable clinical information system for the majority of nursing care documentation, and is useful for determining the patterns in nursing practices.

Building a bridge for nursing education and clinical care in Taiwan--using action research and Confucian tradition to close the gap

BACKGROUND

Nursing workplaces in Taiwan are unable to retain talent. An examination of this problem has revealed that the causes of this phenomenon are that nursing education fails to cultivate the skills that meet workplace requirements and that there are gap between nursing education and clinical practice.

OBJECTIVES

This paper is an action research that aims is to design educational programs that can close the gap between nursing education and clinical practice in Taiwan.

DESIGN

In this action research project, 4 action cycles were used to design educational programs including concept mapping and focused discussion strategies.

SETTINGS

Participants were invited to join the research in three teaching hospitals and one university.

PARTICIPANTS

Two groups of participants, student nurses (SN) and nursing staff personnel (NS), were sampled and invited to participate in the research.

METHODS

Participant observation, focus groups, and qualitative interviews were used to collect data. Qualitative data were not only profiled by content analysis, but they were also compared continuously between the two groups as well as between the 4 cycles.

RESULTS

The qualitative data collected for the 135 participants were analysed. The themes of an effective nursing program were summarized.

CONCLUSIONS

Many fundamental values of traditional Chinese education have gradually faded due to the Westernization of education. In this study, we discovered that Western educational models may play a critical role in improving traditionally taught nursing education programs.

“Does One Size Fit All?” Exploring the Cultural Applicability of NANDA Nursing Diagnoses to Chinese Nursing Practice

East Asia has historically unique concepts of health and well-being and thus is an appropriate setting for exploring the multicultural applicability of the North American Nursing Diagnosis Association’s Nursing Diagnoses (NANDA ND) system. This study aimed to explore how NANDA ND affect the growth and quality of professional nursing from the perspective of Taiwanese nurses. Grounded theory was employed in this interview-based investigation of 53 Taiwan-licensed nursing professionals at various hospitals in Taiwan. Data were analyzed using constant comparative analysis until theoretical saturation was reached. The core concept, Struggling with (the NANDA ND notion that) One Size Fits All, emerged after ongoing analysis of the effects of NANDA ND on good nursing, patient welfare, and professional development. The preliminary theoretical framework developed from this study provides evidence that NANDA ND may be incompatible with the cultural beliefs of the traditional Chinese health care setting in Taiwan, which emphasize holistic harmony and balance.

Mapping the Diagnosis Axis of an Interface Terminology to the NANDA International Taxonomy

Background. Nursing terminologies are designed to support nursing practice but, as with any other clinical tool, they should be evaluated. Cross-mapping is a formal method for examining the validity of the existing controlled vocabularies. Objectives. The study aims to assess the inclusiveness and expressiveness of the nursing diagnosis axis of a newly implemented interface terminology by cross-mapping with the NANDA-I taxonomy. Design/Methods. The study applied a descriptive design, using a cross-sectional, bidirectional mapping strategy. The sample included 728 concepts from both vocabularies. Concept cross-mapping was carried out to identify one-to-one, negative, and hierarchical connections. The analysis was conducted using descriptive statistics. Results. Agreement of the raters' mapping achieved 97%. More than 60% of the nursing diagnosis concepts in the NANDA-I taxonomy were mapped to concepts in the diagnosis axis of the new interface terminology; 71.1% were reversely mapped. Conclusions. Main results for outcome measures suggest that the diagnosis axis of this interface terminology meets the validity criterion of cross-mapping when mapped from and to the NANDA-I taxonomy.

Uma visão da produção científica internacional sobre a classificação internacional para a prática de enfermagem

A Classificação Internacional para a Prática de Enfermagem (CIPE®) é um sistema classificatório que visa padronizar uma linguagem universal para Enfermagem. Este artigo propõe identificar os estudos desenvolvidos no âmbito mundial abordando a CIPE®, categorizando-os segundo suas finalidades. Trata-se de uma revisão de literatura, em base de dados da Biblioteca Virtual em Saúde, pelo o termo "ICNP", com abrangência até 2009. Foram encontrados 124 artigos; 65 analisados, cujo conteúdo foi agrupado em nove categorias: abordagens gerais; aplicabilidade à prática; avaliação de classificações; experiências com recursos computacionais; desenvolvimento e inclusão de termos; abordagem sobre sistemas classificatórios; uso para ancorar a construção de declarações de enfermagem; traduções; e outros. Verificou-se que poucos trabalhos apresentam projetos ou avaliam resultados de aplicações práticas da CIPE®; a maioria aborda aspectos conceituais ou realiza comparações com outras classificações. Diversos trabalhos concluem sobre a adequação e relevância da CIPE®, mas apontam a necessidade de aperfeiçoamento.

Implications for Nursing Research and Generation of Evidence

A sound informatics infrastructure is essential to optimise the application of evidence in nursing practice. A comprehensive review of the infrastructure and associated research methods is supported by an extensive resource of references to point the interested reader to further resources for more in depth study. Information and communication technology (ICT) has been recognized as a fundamental component of applying evidence to practice for several decades. Although the role of ICT in generating knowledge from practice was formally identified as a nursing informatics research priority in the early 1990s (NINR Priority Expert Panel on Nursing Informatics, 1993), it has received heightened interest recently. In this chapter, the authors summarize some important trends in research that motivate increased attention to practice-based generation of evidence. These include an increased emphasis on interdisciplinary, translational, and comparative effectiveness research; novel research designs; frameworks and models that inform generation of evidence from practice; and creation of data sets that include not only variables related to biological and genetic measures, but also social and behavioral variables. The chapter also includes an overview of the ICT infrastructure and informatics processes required to facilitate generation of evidence from practice and across research studies: (1) information structures (e.g., re-usable concept representations, tailored templates for data acquisition), (2) processes (e.g., data mining algorithms, natural language processing), and (3) technologies (e.g., data repositories, visualization tools that optimize cognitive support). In addition, the authors identify key knowledge gaps related to informatics support for nursing research and generation of evidence from practice.

A review of auditing methods applied to the content of controlled biomedical terminologies

Although controlled biomedical terminologies have been with us for centuries, it is only in the last couple of decades that close attention has been paid to the quality of these terminologies. The result of this attention has been the development of auditing methods that apply formal methods to assessing whether terminologies are complete and accurate. We have performed an extensive literature review to identify published descriptions of these methods and have created a framework for characterizing them. The framework considers manual, systematic and heuristic methods that use knowledge (within or external to the terminology) to measure quality factors of different aspects of the terminology content (terms, semantic classification, and semantic relationships). The quality factors examined included concept orientation, consistency, non-redundancy, soundness and comprehensive coverage. We reviewed 130 studies that were retrieved based on keyword search on publications in PubMed, and present our assessment of how they fit into our framework. We also identify which terminologies have been audited with the methods and provide examples to illustrate each part of the framework.

Modeling a terminology-based electronic nursing record system: An object-oriented approach

OBJECTIVE

The aim of this study was to present our perspectives on healthcare information analysis at a conceptual level and the lessons learned from our experience with the development of a terminology-based enterprise electronic nursing record system - which was one of components in an EMR system at a tertiary teaching hospital in Korea - using an object-oriented system analysis and design concept.

METHODS

To ensure a systematic approach and effective collaboration, the department of nursing constituted a system modeling team comprising a project manager, systems analysts, user representatives, an object-oriented methodology expert, and healthcare informaticists (including the authors). A rational unified process (RUP) and the Unified Modeling Language were used as a development process and for modeling notation, respectively.

RESULTS

From the scenario and RUP approach, user requirements were formulated into use case sets and the sequence of activities in the scenario was depicted in an activity diagram. The structure of the system was presented in a class diagram.

CONCLUSION

This approach allowed us to identify clearly the structural and behavioral states and important factors of a terminology-based ENR system (e.g., business concerns and system design concerns) according to the viewpoints of both domain and technical experts.

Cross-Mapping Between Three Terminologies With the International Standard Nursing Reference Terminology Model

PURPOSE

The International Standards Organization's (ISO) International Standard IS 18104 should assist the nursing profession to integrate their terminologies into computer systems and healthcare reference terminologies. The purpose of this study is to cross-map between different terminologies; that is, to determine if concepts in one terminology are similar to concepts in another terminology.

METHODS

The ISO standard was used to test the degree to which three terminologies could be cross-mapped to each other. Concepts and terms were selected, their equivalence determined by experts, and the specific concepts were dissected or broken down to their constituent parts.

RESULTS

Based on experts' selections from the three classifications, equivalent concepts were identified. Those concepts deemed equivalent were dissected, thus revealing whether the components of the nursing diagnostic concepts such as focus, judgment, and other attributes of the ISO standard matched. Based on the dissection of each diagnosis, the decision was made whether mapping was possible or not.

CONCLUSIONS

The dissection revealed that several nursing diagnostic concepts can easily be interchanged, while others cannot or can be mapped only for specific purposes (e.g., clinical or aggregate use). This implies that for some concepts it does not matter which terminology is used, and in other cases it does because of different meanings.

Mutual enhancement of diverse terminologies

The purpose of this study was to map the North American Nursing Diagnosis Association (NANDA) nursing diagnoses to the International Classification for Nursing Practice Version 1.0 (ICNP) and to compare the resulting representations and relationships to those within SNOMED Clinical Terms (CT). Independent reviewers reached agreement on 25 (i.e. 64%) of the 39 parent-child relationships identified via the mappings between NANDA entities. Other parent-child relationships were more questionable and are in need of further discussion. This work does not seek to promote one terminology over any other. Rather, this collaborative effort has the potential to mutually enhance all three terminologies involved in the study: ICNP, SNOMED CT and NANDA. In doing so it provides an example of the type of collaborative effort that is needed to facilitate the development of tools to support interoperability at a global level.

Introduction and development of NCP using ICNPR in Pakistan

BACKGROUND

Traditionally, nursing care has been described as performing nursing tasks and often focused on nurses carrying out doctors' orders. In many countries of the world, including Pakistan, nurses do not document care in a standardized manner. Because of this limitation many health administrators, policy makers, and consumers make inadequate assumptions about nursing work, often regarding nurses as any other 'health care technician' who can be easily replaced by more economical health care workers.

PURPOSE

To overcome this problem, standardized documentation is being introduced into the Aga Khan University School of Nursing and hospital, Aga Khan Health Services, Public Health School in Karachi, and government colleges of nursing, using the International Classification for Nursing Practice (ICNP). The purpose of this paper is to highlight the process of introducing and developing standardized nursing care plans (NCP) using ICNP in Pakistan.

PROCESS

The process for introducing ICNP consists of four components, including administrative planning, development, teaching and training, and testing. Subsets of the ICNP for (i) maternity: antenatal, postnatal and natal care; and (ii) cardiology were developed using standardized NCPs. The subsets were developed by nurse experts and introduced at the testing sites. The testing will be conducted as a pilot project. Findings from the pilot will be used to continue and expand standardized nursing documentation using the ICNP across Pakistan.

CONCLUSION

Through this project, nurses, midwives and lady health visitors (midwives, vaccinator and health educators) will test standardization of documentation and begin to evaluate efficiency and effectiveness of clinical practice.

Developing terminology for documenting perioperative nursing interventions

OBJECTIVE

To develop terminology for documenting perioperative nursing interventions.

METHOD

Nursing documentation of 250 patients was explored by content analysis. The study was conducted to validate further the Perioperative Nursing Data Set (PNDS) in Finland. The data included 3442 terms that were clustered into 104 nursing interventions. A Delphi-panel (N=5) evaluated the relevance of each term on a scale from 1 to 4. The structure of each nursing intervention was checked to meet the minimum requirements of the ISO reference terminology model for nursing action concepts. Finally, the nursing interventions were compared with the original PNDS-interventions.

RESULTS

The Delphi-panel accepted 98 nursing interventions with Content Validity Index from 0.88 to 1.0. Of the 133 nursing interventions in the PNDS, 60% (n=80) were covered by nursing interventions identified in this study. A notable portion of the nursing interventions related to preventive aspects of perioperative care and the patients' coping with perioperative experience.

CONCLUSION

The findings supported the need for cross-cultural validation of a nursing language prior to clinical implementation. The ISO reference terminology model is recommended as framework in constructing concepts for nursing interventions in a regular form.

Mapping parish nurse documentation into the nursing interventions classification: a research method

Mapping, or linking like terms that represent the same concept, is a research method increasingly used for testing the reliability and validity of standardized taxonomies. For mapping to be useful, it is critical that the procedure is reliable. One way to maximize reliability is to develop standardized mapping procedures, or rules to follow when linking the terms. This article will present a standardized mapping procedure method in a study that mapped narrative parish nurse documentation (170 health records, 1607 interactions) into the Nursing Interventions Classification (NIC), yielding an intercoder reliability kappa of 0.92. The mapping process identified conceptual issues in the NIC, which also are presented. Because the NIC is included in the Systematic Nomenclature of Medicine of Clinical Terms (SNOMED CT), these conceptual issues raised data aggregation issues in SNOMED CT. Those issues are also presented.

A novel view on information content of concepts in a large ontology and a view on the structure and the quality of the ontology

Semantic distance and semantic similarity are two important information retrieval measures used in word sense disambiguation as well as for the assessment of how relevant concepts are with respect to the documents in which they are found. A variety of calculation methods have been proposed in the literature, whereby methods taking into account the information content of an individual concept outperform those that do not. In this paper, we present a novel recursive approach to calculate a concept's information content based on the information content of the concepts to which it relates. The method is applicable to extremely large ontologies containing several million concepts and relationships amongst them. It is shown that a concept's information content as calculated by this method provides additional information with respect to an ontology that cannot be approximated by hierarchical edge-counting or human insight. In addition, it is suggested that the method can be used for quality control within large ontologies and that it can give you an impression on the structure and the quality of the ontology.

Representing critical care data using the clinical care classification

Concept-oriented terminologies require the user to combine terms, making them awkward for their direct use as a documentation tool. Therefore, classification systems are needed to serve as interface terminologies between the user and the reference terminology used to organize the computer database system. Whether nursing classification systems provide sufficient granularity to adequately capture nursing practice is controversial. In addition, no nursing classification systems have been designed specifically for or evaluated in the critical care setting. The purpose of this study was to evaluate the ability of the Clinical Care Classification (CCC) to represent data in an intensive care setting and to provide recommendations for the expansion of this classification for its use in critical care documentation.

A term extraction tool for expanding content in the domain of functioning, disability, and health: proof of concept

Among the challenges in developing terminology systems is providing complete content coverage of specialized subject fields. This paper reports on a term extraction tool designed for the development and expansion of terminology systems concerned with functioning, disability, and health. Content relevant to this domain is the emphasis of the foci and targets of many nursing terminologies. We extend previously published term extraction algorithms by applying two filters. The first filter is based on the raw frequency of the content words in the lexical string under consideration. The second filter applies the notion of a complete syntactic node to discover relevant noun or verb phrases. While we report on a limited corpus (30,607 words comprising 4103 terms from 60 dismissal note summaries), the recall, precision, and F-measures we observed are encouraging and suggest continued development and testing of the tool is merited.

The Nursing Terminology Summit Conferences: a case study of successful collaboration for change

The Nursing Terminology Summit, a series of invitational conferences and ongoing collaboration, has played both initiating and contributing roles to bring about a second-order change in the development and integration of standards for nursing terminology. What factors enabled this success? What factors made change difficult? This paper examines the structure and process of the Nursing Terminology Summit using concepts, principles, theories, and strategies identified in Lorenzi and Riley [Organizational Aspects of Health Informatics: Managing Technological Change, Springer, 1995]. As a case study, this critical analysis offers practical lessons for informaticians in managing change across disciplinary, organizational, and national boundaries.

Evaluation of the draft international standard for a reference terminology model for nursing actions

PURPOSE

The purpose of this study was to evaluate the draft ISO reference terminology model (RTM) for nursing actions. Nursing RTM models attempt to include concepts that are universally represented in nursing documentation to improve the depiction of nursing practice in computerized systems.

METHOD

Content analysis was used to decompose interventions into words and phrases, which were then mapped to the six model categories used to represent nursing actions in the draft ISO RTM. The decomposition of interventions was applied to nurses' documentation of pain interventions entered into a clinical information system.

FINDINGS

Consistent with the ISO standard requirements, all (100.00%) of the interventions contained an <action> word or phrase and a <<target>>. Additional findings are discussed in relation to earlier studies of terminology models.

CONCLUSIONS

It is recommended that terminology and information system developers consider this model in their ongoing system development, evaluation, maintenance, and revisions. Further evaluation of the ISO RTM for nursing will contribute to the goals of this specific model and the harmonization and integration with other health care models.

Determining sources for formal nursing terminology systems

OBJECTIVE

The purpose of this study is to assess the relative merits of aspects--labels or informal definitions--of traditional nursing terminology systems as the foundational sources for target formal nursing terminology systems.

DESIGN

This study builds upon and compares the findings of two previous experiments in which formal terminology systems, one based on informal definitions, the other based on labels, were developed under the GALEN approach and used to generate hierarchies of nursing interventions drawn from the Nursing Interventions Classification.

MEASUREMENTS

The two generated hierarchies were compared to see whether, and to what extent, they captured a test set of hierarchical relationships implicit within and derived from the Nursing Interventions Classification. An analysis of the relevant conceptual representations was carried out in those cases where a hierarchical relationship from the test set was absent from either of the generated hierarchies.

RESULTS

The hierarchy generated from the formal terminology system based on informal definitions contained none of the test set of hierarchical relationships. Reasons included structural differences between conceptual representations; different levels of specificity; and deficiencies within the formal terminology system itself. The hierarchy generated from the formal terminology system based on labels contained all but one of the test set. The reason for the one absence was inconsistent usage within source and target.

CONCLUSIONS

While it may be possible to derive formal terminology systems from informal definitions for nursing interventions, the inherent complexity within those informal definitions brings into question the utility of such systems. This study demonstrates that it may be more productive to base formal nursing terminology systems on labels, simpler sources with limited discursive content and a higher degree of consistency.

Integrating nursing diagnostic concepts into the medical entities dictionary using the ISO Reference Terminology Model for Nursing Diagnosis

OBJECTIVE

The purposes of the study were (1) to evaluate the usefulness of the International Standards Organization (ISO) Reference Terminology Model for Nursing Diagnoses as a terminology model for defining nursing diagnostic concepts in the Medical Entities Dictionary (MED) and (2) to create the additional hierarchical structures required for integration of nursing diagnostic concepts into the MED.

DESIGN AND MEASUREMENTS

The authors dissected nursing diagnostic terms from two source terminologies (Home Health Care Classification and the Omaha System) into the semantic categories of the ISO model. Consistent with the ISO model, they selected Focus and Judgment as required semantic categories for creating intensional definitions of nursing diagnostic concepts in the MED. Because the MED does not include Focus and Judgment hierarchies, the authors developed them to define the nursing diagnostic concepts.

RESULTS

The ISO model was sufficient for dissecting the source terminologies into atomic terms. The authors identified 162 unique focus concepts from the 266 nursing diagnosis terms for inclusion in the Focus hierarchy. For the Judgment hierarchy, the authors precoordinated Judgment and Potentiality instead of using Potentiality as a qualifier of Judgment as in the ISO model. Impairment and Alteration were the most frequently occurring judgments.

CONCLUSIONS

Nursing care represents a large proportion of health care activities; thus, it is vital that terms used by nurses are integrated into concept-oriented terminologies that provide broad coverage for the domain of health care. This study supports the utility of the ISO Reference Terminology Model for Nursing Diagnoses as a facilitator for the integration process.

Evaluation of patient records as part of developing a nursing care classification

The aim of the study was to evaluate the content of nursing care records and the usefulness of the instrument used for their evaluation. The evaluation involved 70 patient records from seven acute special care inpatient units. The evaluation instrument used was based on Phaneuf's Nursing Audit as further developed by Lukander. The nursing records in all the care units evaluated was very good or good. However, some deficiencies were found, for instance, regarding patient teaching and recording patients' own opinions. The method proved adequate for evaluating the content of patient records.

Testing the generalizability of the ISO model for nursing diagnoses

The purpose of this study was to explore whether the ISO reference terminology model for nursing diagnoses could be generalized to the MDS data set that, like nursing terminologies standardizes expressions of the concepts within and relevant to the domain of nursing practice. We first constructed paraphrased expressions of the rubrics from the data set. Next we dissected those expressions into the reference model domains of focus and judgment, recorded any qualifiers required for either domain, and semantic links required to represent associative relations. Our findings demonstrate that the ISO model for nursing diagnoses is generalizable to the MDS data set, however expansions to the model are required if the model is to be used to represent objects rather than terms.

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.

Submitting terms to the International Classification for Nursing Practice (ICNPR)

The purpose of this article was to illustrate how nurses can contribute to the development and improvement of the International Classification for Nursing Practice (ICNP). It provides researchers and students with an example of how to submit terms to the ICNP Programme for review. The article provides a brief general background on the ICNP and explains the process of how to identify and develop nursing phenomena and actions. It continues to describe the method of validating new terms, reviewing the literature to support it and how to submit the term to the International Council of Nurses (ICN). Examples are provided.

Collaborative efforts for representing nursing concepts in computer-based systems: international perspectives

Current nursing terminology efforts have converged toward meeting the demand for a reference terminology for nursing concepts by building on the foundation of existing interface and administrative terminologies and by collaborating with terminology efforts across the spectrum of health care. In this article, the authors illustrate how collaboration is promoting convergence toward a reference terminology for nursing by briefly summarizing a wide range of exemplary activities. These include: 1) the International Classification of Nursing Practice (ICNP) activities of the International Council of Nurses (ICN), 2) work in Brazil and Korea that has contributed to, and been stimulated by, ICNP developments, 3) efforts in the United States to improve understanding of the different types of terminologies needed in nursing and to promote harmonization and linking among them, and 4) current nursing participation in major multi-disciplinary standards initiatives. Although early nursing terminology work occurred primarily in isolation and resulted in some duplicative efforts, the activities summarized in this article demonstrate a tremendous level of collaboration and convergence not only in the discipline of nursing but in multi-disciplinary standards initiatives. These efforts are an important prerequisite for ensuring that nursing concepts are represented in computer-based systems in a manner that facilitates multi-purpose use at local, national, regional, and international levels.