Toward Integrating a Common Nursing Data Set in Home Care to Facilitate Monitoring Outcomes Across Settings

Abstract

The purpose of our research is to identify a realistic subset of North American Nursing Diagnosis Association (NANDA), Nursing Outcome Classification (NOC), and Nursing Interventions Classification (NIC) terms specific to the home care (HC) setting. A subset of 89 NOC outcomes were identified for study in HC through a baseline survey. Three research assistants then observed the care of 258 patients to whom the 89 NOC outcomes applied and recorded the associated NANDA and NIC terms. Follow-up surveys and focus groups were conducted with the nurses and research assistants. There were 81 different NANDA and 226 NIC labels used to describe study patients’ care. Only 36 of the 89 NOC labels studied were deemed clinically useful for HC. We found that expert opinion about terminology usage before actual experience under practice conditions is unreliable.

Nursing diagnoses in a home-based program: cross-mapping and NANDA-I Taxonomy

“…The mean age was 66.8 years; among the individuals, 55% were female and the highest prevalence was of circulatory system diseases. These data are corroborated by other international studies (6)(7)(8)(9) . Globally, demographic and epidemiological changes have taken place, and Brazil follows these trends, such as the increase in the number of elderly people and the phenomenon of feminization of aging, due to women's longer life expectancy (14)(15) .…”

“…The Activity/rest domain was the one that presented the highest frequency of ND titles, and the most prevalent diagnosis was Impaired physical mobility, for which the most recurrent factors were neuromuscular impairment and altered cognitive function, and defining characteristics: reduction in range of motion, difficulty to turn around and reduction in gross motor skills. This domain and diagnosis were also identified with prevalence in other studies (6)(7)(8)(9) , with patients with a similar profile.…”

“…In the Elimination and change domain, the diagnosis of impaired urinary elimination was identified, which was related to multiple causes and evidenced by the defining feature of urinary incontinence. Like other studies (6)(7)(8) , this diagnosis was commonly found in patients in HC. In these patients, changes in the genitourinary system are relevant (18) .…”

“…Data collection took an average of 1 hour and 30 minutes. A systematized instrument was developed, based on a literature review (6)(7)(8)(9) , containing sociodemographic and clinical characterization variables. It is noteworthy that the selection process of the instrument of data collection occurred, through the appreciation of specialists who evaluated its quality and relevance, and all the suggested changes were adhered to and the final instrument was consolidated by consensus.…”

Standardized Nursing Languages Essential for the Nursing Workforce

“…The HANDS utilizes the standardized nursing terminologies of NANDAI, NOC, and NIC to represent nursing diagnoses, outcomes, and interventions respectively. The HANDS can be connected to any EHR and utilized as the coordination of care or care planning component (Dunn-Lopez & Keenan, 2010;Keenan, 2004Keenan, Falan, Heath, & Treder, 2003a;Keenan, Stocker, Barakauskas, Johnson, Maas, Moorhead, & Reed, 2003b;Keenan, Stocker, Barkauskas, Treder, & Heath, 2003c;Keenan, Stocker, Barkauskas, Treder, & Heath, 2003d;Keenan, Barkauskas, Johnson, Maas, Moorhead, Reed, 2003e;Keenan, Stocker, Geo-Thomas, Soporkar, Barkauskas, & Lee, 2002;Keenan & Yakel, 2005). The HANDS achieves the three levels of interoperability recommended for full interoperability by Health Level 7s EHR Interoperability Work Group (2007) to ensure data captured using HANDS is valid and reliable across all systems that use HANDS.…”