Nursing Classification Systems: Necessary but not Sufficient for Representing "What Nurses Do" for Inclusion in Computer-based Patient Record Systems

Abstract

Our premise is that from the perspective of maximum flexibility of data usage by computer-based record (CPR) systems, existing nursing classification systems are necessary, but not sufficient, for representing important aspects of "what nurses do." In particular, we have focused our attention on those classification systems that represent nurses' clinical activities through the abstraction of activities into categories of nursing interventions. In this theoretical paper, we argue that taxonomic, combinatorial vocabularies capable of coding atomic-level nursing activities are required to effectively capture in a reproducible and reversible manner the clinical decisions and actions of nurses, and that, without such vocabularies and associated grammars, potentially important clinical process data is lost during the encoding process. Existing nursing intervention classification systems do not fulfill these criteria. As background to our argument, we first present an overview of the content, methods, and evaluation criteria used in previous studies whose focus has been to evaluate the effectiveness of existing coding and classification systems. Next, using the Ingenerf typology of taxonomic vocabularies, we categorize the formal type and structure of three existing nursing intervention classification system--Nursing Interventions Classification, Omaha System, and Home Health Care Classification. Third, we use records from home care patients to show examples of lossy data transformation, the loss of potentially significant atomic data, resulting from encoding using each of the three systems. Last, we provide an example of the application of a formal representation methodology (conceptual graphs) which we believe could be used as a model to build the required combinatorial, taxonomic vocabulary for representing nursing interventions.

Interpretation of an international terminology standard in the development of a logic-based compositional terminology

“…Prior to the development of ICNP® Version 1, several terminology experts had already recognized the need for a more formal foundation for nursing terminologies [7,8]. ISO 18104:2003 provided at least part of that foundation by exposing the semantics embedded within nursing diagnostic and interventional terms.…”

Nursing informatics: yesterday, today and tomorrow

“…These two vocabularies are further classified according to the HHCC of Care Components, which consists of 20 care components. The 20 care components have been tested and proven to be statistically valid and reliable classes, and found by Henry & Mead (1997) to be 99% compliant. The 20 care component classes are used as the framework for documenting home care and/or ambulatory care services based on the nursing process (Saba 1997).…”

The Experience of an Information System for Nursing Practice

“…It was developed as an attempt to fill a gap in the standardization of language to improve the quality of care and provide a structure for information globalization 24 by ensuring the availability of uniform nursing data for several purposes. 26,27 A nursing phenomenon is an aspect of health relevant to nursing practice, and a diagnosis is a label assigned by a nurse who relates the focus of nursing interventions to the decision on a diagnosis. This classification aims to be an integral part of the infrastructure of information documenting the practice of global healthcare and health policy to improve patient care.…”