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

Quantifying care coordination using natural language processing and domain-specific ontology

OBJECTIVE

This research identifies specific care coordination activities used by Aging in Place (AIP) nurse care coordinators and home healthcare (HHC) nurses when coordinating care for older community-dwelling adults and suggests a method to quantify care coordination.

METHODS

A care coordination ontology was built based on activities extracted from 11,038 notes labeled with the Omaha Case management category. From the parsed narrative notes of every patient, we mapped the extracted activities to the ontology, from which we computed problem profiles and quantified care coordination for all patients.

RESULTS

We compared two groups of patients: AIP who received enhanced care coordination (n=217) and HHC who received traditional care (n=691) using 128,135 narratives notes. Patients were tracked from the time they were admitted to AIP or HHC until they were discharged. We found that patients in AIP received a higher dose of care coordination than HHC in most Omaha problems, with larger doses being given in AIP than in HHC in all four Omaha categories.

CONCLUSIONS

'Communicate' and 'manage' activities are widely used in care coordination. This confirmed the expert hypothesis that nurse care coordinators spent most of their time communicating about their patients and managing problems. Overall, nurses performed care coordination in both AIP and HHC, but the aggregated dose across Omaha problems and categories is larger in AIP.

Nursing informatics: decades of contribution to health informatics

OBJECTIVES

In this paper we present a contemporary understanding of "nursing informatics" and relate it to applications in three specific contexts, hospitals, community health, and home dwelling, to illustrate achievements that contribute to the overall schema of health informatics.

METHODS

We identified literature through database searches in MEDLINE, EMBASE, CINAHL, and the Cochrane Library. Database searching was complemented by one author search and hand searches in six relevant journals. The literature review helped in conceptual clarification and elaborate on use that are supported by applications in different settings.

RESULTS

Conceptual clarification of nursing data, information and knowledge has been expanded to include wisdom. Information systems and support for nursing practice benefits from conceptual clarification of nursing data, information, knowledge, and wisdom. We introduce three examples of information systems and point out core issues for information integration and practice development.

CONCLUSIONS

Exploring interplays of data, information, knowledge, and wisdom, nursing informatics takes a practice turn, accommodating to processes of application design and deployment for purposeful use by nurses in different settings. Collaborative efforts will be key to further achievements that support task shifting, mobility, and ubiquitous health care.

Mapping evidence-based guidelines to standardized nursing terminologies

The purpose of this study was to explore how evidence-based practice recommendations for adults with depression were represented in two standardized nursing terminologies. A qualitative concept analysis was used to answer the research question. Concepts were extracted from the recommendations and matched to two standardized nursing terminologies through lexical and semantic concept mapping techniques. Study findings included variability in the lexical mapping to the standardized terminologies. The ability to map semantically was greater than lexical mapping, but the majority of these were partial matches. Findings also raised concerns about the potential for ambiguity of data retrieved when using standardized terminology.

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.

Sistemas de classificação de enfermagem e sua aplicação na assistência: revisão integrativa de literatura

O objetivo deste estudo foi buscar evidências sobre o uso de sistemas de classificação de enfermagem na assistência, por meio de revisão integrativa da literatura. Com a busca nas bases LILACS e PubMed, com as palavras-chave classificação, enfermagem, padronizado, sistema, linguagem, selecionaram-se 38 artigos. Encontraram-se cinco sistemas de classificação principais implementados nos serviços: de diagnósticos de enfermagem (da North American Nursing Diagnosis Association International), intervenções de enfermagem (Nursing Interventions Classification), resultados de enfermagem (Nursing Outcomes Classification), a Classificação Internacional para a Prática de Enfermagem e a Classificação Internacional das Práticas de Enfermagem em Saúde Coletiva. Os artigos abordaram aspectos relacionados à implementação, avaliação, educação continuada e validação de termos relacionados aos sistemas de classificação. Há benefícios para a assistência com a implementação desses sistemas, com melhora da assistência, da qualidade das informações e da organização do serviço.

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.

The adequacy of ICNP version 1.0 as a representational model for electronic nursing assessment documentation

OBJECTIVES

The purpose of this study was to evaluate the adequacy of the International Classification of Nursing Practice (1) (ICPN) Version 1.0 as a representational model for nursing assessment documentation.

DESIGN AND MEASUREMENTS

To identify representational requirements of nursing assessments, the authors mapped key concepts and semantic relations extracted from standardized and local nursing admission assessment documentation forms/templates and inpatient admission assessment records to the ICNP. Next, they expanded the list of ICNP semantic relations with those obtained from the admission assessment forms/templates. The expanded ICNP semantic relations were then validated against the semantic relations identified from an additional set of admission assessment records and a set of 300 randomly selected North American Nursing Diagnosis Association defining characteristic phrases. The concept coverage of the ICNP was evaluated by mapping the concepts extracted from these sources to the ICNP concepts. The UMLS Methathesaurus was then used to map concepts without exact matches to other American Nursing Association (ANA) recognized terminologies.

RESULTS

The authors found that along with the 30 existing ICNP semantic relations, an additional 17 are required for the ICNP to function as a representational model for nursing assessment documentation. Eight hundred and five unique assessment concepts were extracted from all sources. Forty-three percent of these unique assessment concepts had exact matches in the ICNP. An additional 20% had matches in the ICNP classified as narrower, broader, or "other." Of the concepts without exact matches in the ICNP, 81% had exact matches found in other ANA recognized terminologies.

CONCLUSIONS

The broad concept coverage and the logic-based structure of the ICNP make it a flexible and robust standard. The ICNP provides a framework from which to capture and reuse atomic level data to facilitate evidence-based practice.

Classificações de enfermagem: mapeamento entre termos do foco da prática

Devido às mudanças estruturais das classificações: CIPE®beta 2, versão 1.0 e CIPESC®, este estudo descritivo tem como objetivo construir um mapeamento entre os termos do foco da prática, identificando semelhanças e diferenças. A CIPE® 1.0 em relação à beta 2 apresenta: 41% dos termos novos; 33% idênticos; 4% com conceito ampliado; 12% modificados; 8% diferentes; e 2% conceituados apenas na beta 2. A CIPE® 1.0 em relação à CIPESC® apresenta: 79% são novos; 8% idênticos; 1% ampliado; 5% modificados; 4% diferentes; e 3% sem conceito. Houve dificuldades oriundas do processo de tradução e editoração da CIPE® 1.0 e da inexistência de conceitos em alguns termos da CIPESC®. Este trabalho desencadeará um processo de validação dos termos não equivalentes.

Modeling the distribution of Nursing Effort using structured Labor and Delivery documentation

Our study objectives included the development and evaluation of models for representing the distribution of shared unit-wide nursing care resources among individual Labor and Delivery patients using quantified measurements of nursing care, referred to as Nursing Effort. The models were intended to enable discrimination between the amounts of care delivered to patient subsets defined by attributes such as patient acuity. For each of five proposed models, scores were generated using an analysis set of 686,402 computerized nurse-documented events associated with 1093 patients at three hospitals during January and February 2006. Significant differences were detected in Nursing Effort scores according to patient acuity, care facility, and in scores generated during shift change versus non-shift change hours. The development of nursing care quantification strategies proposed in this study supports outcomes analysis by establishing a foundation for measuring the effect of patient-level nursing care on individual patient outcomes.

What nurses do: use of the ISO Reference Terminology Model for Nursing Action as a framework for analyzing MICU nursing practice patterns

This study utilized the ISO RTM for Nursing Action as a model to decompose nursing actions and as a framework for analyzing the practice patterns of nurses working in a medical intensive care unit (MICU). Observations were made in a 25-bed MICU and nursing actions recorded in terms of model attributes. 1013 actions were observed; decomposed into the ISO RTM categories, they represented 68 distinct actions, 166 targets, 6 recipients of care, 81 means, 16 routes and 115 sites. The most frequent actions were 'assessing' (19.1%) and 'documenting' (10.5%). The most frequent target was 'medication' (8.5%) and the most frequent recipient of care was 'patient' (94.1%). Data revealed nurses perform, yet do not document all actions. Thus in this setting, the existing documentation system does not adequately represent all aspects of nursing practice. The ISO RTM permits evaluation of the depth and breadth of nursing care by identifying all nursing actions.

Conceptual knowledge acquisition in biomedicine: A methodological review

The use of conceptual knowledge collections or structures within the biomedical domain is pervasive, spanning a variety of applications including controlled terminologies, semantic networks, ontologies, and database schemas. A number of theoretical constructs and practical methods or techniques support the development and evaluation of conceptual knowledge collections. This review will provide an overview of the current state of knowledge concerning conceptual knowledge acquisition, drawing from multiple contributing academic disciplines such as biomedicine, computer science, cognitive science, education, linguistics, semiotics, and psychology. In addition, multiple taxonomic approaches to the description and selection of conceptual knowledge acquisition and evaluation techniques will be proposed in order to partially address the apparent fragmentation of the current literature concerning this domain.

An ontological approach to support the description of nursing practice in Japan with the ICNP

BACKGROUND

With increasing computerization of nursing records in Japan, standardization of nursing terminology is becoming imperative. Although some efforts have been made to formalize description of nursing practice in Japan with the International Classification of Nursing Practice (ICNP), lack of effective description tools has impacted negatively on the initiatives.

PURPOSE

To develop and evaluate an ontological approach that could be used to facilitate the description of nursing practice in Japan with the ICNP.

METHODOLOGY

An ontology-based support system was developed using Protégé-2000, mainly by the following three steps: (1) representing a standard classification of nursing practice (the Nursing Master) in Japan; (2) representing a Japanese version of the ICNP; (3) designing an ontology-based framework. A heuristic matching algorithm was developed to automatically match the action labels in the Nursing Master with the terms of the eight axes of the ICNP Nursing Actions Classification. A preliminary evaluation was performed to examine the usefulness of the system.

RESULTS

High hit rate was shown on the ICNP axes ActionType, Target, and Location. The evaluation indicated that 51.7+/-5.8% (mean+/-S.D.) of the action labels with only one action type were properly matched, and that in 80+/-4% (mean+/-S.D.) of action labels with more than one action type, at least one valid action type was matched correctly.

CONCLUSION

The ontology-based approach using a frame-based knowledge representation system (e.g., Protégé-2000) is useful for supporting the formal description of nursing practice in Japan with the ICNP.

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.

Nursing process outcome linkage research: issues, current status, and health policy implications

BACKGROUND

The use of large clinical datasets to assess the effectiveness of health care is of growing interest in continuing efforts to understand the impact of healthcare costs on quality. Correspondingly, there is a greater need to define and measure outcomes that are sensitive to nursing interventions. However, concerns exist about the ability to amass and use large clinical nursing datasets to assess the effectiveness of nursing interventions. Some nursing studies have used large clinical datasets to examine patterns of nursing diagnoses, interventions, and outcomes. Among patient populations, however, systematic effectiveness studies of nursing process and outcome linkages at the individual nurse and patient level of analysis are essentially nonexistent. This is largely the result of slow development of nursing classifications, reference terminologies, and reference information standards. Nursing information systems have an unprecedented potential for documentation of nursing practice, as well as the accumulation and analysis of large clinical datasets, to improve nursing performance, increase nursing knowledge, and provide data and information necessary for nursing to participate in the formulation of healthcare policy.

OBJECTIVES

A literature search shows that a common framework is beginning to evolve that represents nursing's essential information, eg, the Nursing Minimum Data Set, Management Minimum Data Set, and several standardized nursing languages. Extensive research and other initiatives have produced 1) nursing languages and reference terminologies that span healthcare settings; 2) information models; and 3) standards for datasets supporting information systems. A number of issues remain, however, that concern the development of uniform nursing datasets, definitions of outcomes, quality of nursing data, information system design, and methods of data analysis. We review nursing process outcome research, clarify issues inherent in nursing effectiveness research, and discuss implications for nursing and health policy.

Mapeamento das ações de enfermagem do CIPESC às intervenções de enfermagem da NIC

Termos utilizados num instrumento do projeto de Classificação Internacional da Prática em Saúde Coletiva (CIPESC) no Brasil foram analisados à luz das intervenções de enfermagem estabelecidas na Classificação de Intervenções de Enfermagem (NIC) para determinar se elas podiam representar a prática de enfermagem no Brasil. Um processo de três passos foi empregado para fazer a ligação entre os termos e uma análise descritiva foi conduzida. Concluiu-se que a NIC pode ser útil no Brasil.

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.

Nursing informatics in Korea

The use of computers in the Korean healthcare system began in the late 1970s to expedite insurance reimbursements when the national health insurance system was introduced. Their application in nursing came much later because the insurance fee schedule does not include nursing services. This article explores the history and activities of nursing informatics in Korea in professional organization, education, research, clinical practice, and professional outreach. Suggestions are given on meeting the challenges of information technology for nursing in Korea.