Download - Korean hospice nursing interventions using the Nursing Interventions Classification system: A comparison with the USA

Research Article

Korean hospice nursing interventions using the NursingInterventions Classification system: A comparisonwith the USA

Sung-Jung Hong, PhD, RN1 and Eunjoo Lee, PhD, RN2

1Department of Nursing, Semyung University, Jecheon and 2College of Nursing, Research Institute of Nursing Science,Kyungpook National University, Daegu, Korea

Abstract In this study, nursing interventions used by hospice nurses in Korea were identified and compared with coreinterventions selected by US end-of-life care nurses in order to determine similarities and differences betweenthe two nations regarding such care. Data were collected from the electronic medical records of 353 hospicepatients admitted to a tertiary hospital in Korea over a period of two years. First, extracted narrativeinterventions were mapped onto the Nursing Interventions Classification for comparison with interventionsselected by nurses in the USA. A total of 56,712 intervention statements were mapped onto 147 NursingInterventions Classification interventions. Hospice nurses in Korea performed more nursing interventions inthe physiological basic domain, compared to nurses in the USA. The most frequently-used interventions inKorea were related to patient pain management. Among 47 core Nursing Interventions Classification inter-ventions used in the USA, only 18 were used by Korean nurses in this study. This study highlights culturaldifferences in hospice care nursing interventions between the two countries.

Key words end of life care, hospice nurse, hospice nursing practice, Nursing Interventions Classification.

INTRODUCTION

Although nurses have always been an integral part of thehealthcare system, and often provide important direct care,their contributions have largely been invisible, becausenursing notes are narrative with an understructured format;therefore, aggregation and analysis are difficult (Bulecheket al., 2008). In addition, important information regardingnursing care has been underrepresented in communicatinghealthcare data, research, and education. Therefore, there isa pressing need to identify core, essential data and to thenperform systematic collection of that data in an easily-retrievable and comparable format that can be incorporatedinto national databases in the nursing profession (Delaney &Huber, 1996).

Standardized nursing languages (SNL) were launched inorder to meet this need, and currently, the American NursingAssociation recognizes terminologies for a nursing practiceinformation infrastructure (ANA, 2008). One of the SNL, theNursing Interventions Classification (NIC), is a comprehen-sive standardized classification of interventions performed

by nurses; its purpose is to assist in efforts to describe theuniqueness of nurses compared with other healthcare pro-viders, and to articulate their contributions to the health ofpatients (Bulechek et al., 2008). To date, the NIC has beenimplemented in nursing information systems at national, aswell as international levels in order to describe and capturethe interventions performed by nurses (Haugsdal & Scherb,2003). Recent studies using the NIC in Korea were conductedin diverse nursing practice care settings (Oh et al., 2001; Yonget al., 2001; Kwon & Park, 2002; Lee & Park, 2002; Oh &Park, 2002; Choi et al., 2003; Park & Jung, 2005; Cho & Kim,2008; Hong et al., 2011). All of these studies reportedthat the NIC is applicable for use in describing nursingpractice in Korea. However, the NIC has not been used byhospice nurses.

Cancer, the number one cause of adult death in Korea,imposes an enormous emotional and financial burden onKorean society, and the number of cancer patients is rapidlyincreasing. Because of this trend, a special law to finance andprovide reimbursement for cancer treatments was passed bythe Korean legislature in 2006 (Yong et al., 2006). In addition,in response to social pressure to improve the quality ofnursing care for hospice patients, a specialized program wasdeveloped for hospice nurses at the master level in 2004 (Ohet al., 2007). Thus, hospice and end-of-life care are receivingsignificant interest and attention in Korea (Kyung et al.,2010).

Correspondence address: Eunjoo Lee, College of Nursing, Research Institute ofNursing Science, Kyungpook National University, 101 Dongin-dong, Jung-gu, Daegu700-422, Korea. Email: [email protected] 12 March 2013; revision received 13 November 2013; accepted 24November 2013

bs_bs_banner

Nursing and Health Sciences (2014), ••, ••–••

© 2014 Wiley Publishing Asia Pty Ltd. doi: 10.1111/nhs.12120

mailto:[email protected]

Given these developments, the identification of NIC inter-ventions for hospice nursing will be valuable. These data willprovide empirical evidence to guide practice decisions thatwill promote high-quality hospice nursing care outcomes andeffectiveness (Lunney, 2006). The data will also be helpful tohospice nurses in describing the work they perform, so thatthe contribution of nursing care can be measured and valued.In addition, the identification of NIC interventions forhospice nursing in Korea to compare with those of othercountries, will be helpful in the effort to understand patternsof nursing interventions. This is a step toward the identifica-tion of culturally-sensitive care in hospice nursing in Korea.

The purposes of the study were: (i) to identify interven-tions performed by hospice nurses in Korea and then to mapthem onto NIC interventions; (ii) to compare NIC interven-tions performed by Korean nurses with NIC interventionsselected by members of the American End of Life CareNursing (AELCN) organization. Through this process, wewill be able to identify similarities and differences in nursinginterventions between Korean hospice nurses and AELCNnurses.

Background

NIC

The current healthcare system demands data and informa-tion on how effectively and economically healthcare profes-sionals contribute to health and quality-of-life of patients.Nurses must demonstrate which interventions in their prac-tice provide the most cost-effective and efficient health carecompared to interventions by other healthcare professionals(Simpson, 2003). However, without describing what nursesdo and studying ways to make nursing more cost-effectiveand efficient, that is not possible (Johnson et al., 2005). Beingable to describe these nursing interventions in a standardizedlanguage is a first step.

Prior to the development of the NIC, there was no stand-ardized classification and coding system for describing treat-ments administered by nurses. The project was initiated in1987, with the aim to assist in efforts to describe the unique-ness of nurses compared with other healthcare providers(Bulechek et al., 2008). It has been continuously updated andrevised with ongoing feedback and review from clinicalnurses and researchers in all settings. The sixth edition, pub-lished in 2013, includes more than 12,000 activities, which aregrouped into a three-level taxonomy for ease of use: sevendomains, 30 classes, and 554 interventions.The seven domainsare physiological basic, physiological complex, behavior,safety, family, health system, and community (Bulechek et al.,2013).

The NIC has been linked with nursing diagnoses and out-comes developed by the North American Nursing DiagnosisAssociation and Nursing Outcomes Classification, respec-tively (Moorhead et al., 2008). As a multidisciplinary view,the NIC is mapped onto SNOMED CT, a comprehensivehealthcare reference terminology that provides a frameworkfor the integration of concepts and languages from otherhealthcare disciplines (Campbell et al., 1997; SNOMED CT,

2002). These linkages facilitate the understanding and usageof nursing languages by diverse health professionals, and theyenhance interoperability among healthcare professions(Zollo & Huff, 2000; Zeng et al., 2002).

The NIC has been adopted by hundreds of healthcareorganizations, and used in care plans, competency evalua-tions, and nursing-education programs. It has been translatedinto 12 different languages, including Korean, and has beenused in many countries, including Brazil, Canada, Denmark,England, France, Germany, Iceland, Japan, Korea, Spain,Switzerland, and the Netherlands (Bulechek et al., 2013).Although using standardized language to identify andcompare nursing interventions and their effects on patientoutcomes is at an early stage at the international level, it willbe studied more actively in the near future.

Nursing care quality and SNL

Electronic health record (EHR) systems are being imple-mented worldwide, with the goal being that their use will leadto improved quality and reduced medical costs (Park &Hardiker, 2009). EHR enable nurses to provide virtual docu-mentation of the core nursing elements in the nursing infor-mation system and store them in databases. To achieve thesegoals, standardized classifications with coding systems withinthe EHR are a key and fundamental factor, because they canfacilitate the capture, storage, and retrieval of clinical infor-mation in documentation systems and databases (Haugsdal& Scherb, 2003).

By collecting data and using databases in informationsystems, nurses can systemically analyze the treatments theyperform and the resulting patient outcomes, and can identifywhich interventions work best for a given population ofpatients or set of problems.This will improve nursing care forspecific populations, and the nursing profession will gain rec-ognition for its contribution to patient outcomes.

Nurses need to use databases for the systemic collectionand analysis of patient diagnoses, nursing interventions, andthe resulting patient outcomes. Based on this information,they can determine which nursing interventions work best fora given group of diagnoses or a population. By doing this,nursing research will be energized, and can effectively influ-ence the decision-making about nursing-related healthcarepolicies (Plowfield et al., 2005).

The Hospice model in Korea

Hospice nursing in Korea was started in 1965 by Catholicnuns, and the first hospice educational program for nurseswas started in 1979 (Kang, 2010). Most hospitals in Koreaprovide hospice care to terminally-ill patients in an effort tohelp control their pain and symptoms, or for those whosefamily members are exhausted or in crisis and in need ofrespite. In the main in Korea, hospice care is delivered usingone of the following four models: (i) the hospice unit withina hospital model; (ii) the inpatient scattered-bed consultativemodel; (iii) the free-standing model; or (iv) the hospicehome-care model (Lee et al., 2008).

2 S-J. Hong and E. Lee

© 2014 Wiley Publishing Asia Pty Ltd.

Of the hospice care provided for inpatients (i–iii), thehospice unit within a hospital and the inpatient scattered-bedconsultative models (i and ii) are used for patients who havealready been admitted to a hospital and are dying. In hospiceunits within a hospital, care is usually provided by certifiedhospice nurses, or nurses who have advanced training inhospice care. Inpatient scattered-bed consultative care is pro-vided by a team of nurses who specialize in hospice care.Admission to one of these units is dependent on bed avail-ability in the hospital. The free-standing hospice model (iii)provides hospice care through an independently-ownedhospice center, and might include both home hospice servicesand an inpatient care facility. The inpatient facility provideshospice care for patients who require medical services notsuitable for a home setting. In the hospice home care model(iv), care is provided in a patient’s home. The type of hospicecare services provided depends on the patient’s needs andpreferences. Most home care agencies and independently-owned hospice programs offer home hospice services.Although a nurse provides specialized nursing care for aterminally-ill patient in a home hospice program, the maincaregiver is usually a family member of the patient. Somefamily members are trained by the nurse to provide much ofthe hands-on care to the patients (Lee et al., 2008).

METHODS

Research design and participants

This study used a descriptive design to identify the natureand types of nursing interventions performed by nurses in ahospital hospice unit. Data were collected from the electronicnursing records of 353 hospice patients who were admitted toa tertiary hospital, and were either discharged or died follow-ing end-of-life care between January 2009 and December2010.

Instrument

NIC

The instrument used in this study was based on the fifthedition of the NIC (Bulechek et al., 2008), which is catego-rized according to seven domains, 30 classes, and 542 inter-ventions; each intervention has its own definition and uniquenumeric code.

Core intervention list of the AELCN

The development of the AELCN core interventions listwas performed by the Iowa Interventions Project Team(Bulechek et al., 2008). The AELCN core intervention listwas developed and finalized based on input, discussion, andfeedback from members of the AELCN, and then carefullyreviewed by the project investigators and staff of the IowaInterventions Project. Members of the AELCN identified 46interventions as core interventions.

Human participants

Kyungpook University Hospital institutional review boardapproval was obtained prior to the collection of the studydata. In addition, the purposes and procedures of thestudy were reviewed by the administrative office, andapproved by the hospital where the data were collected.The purpose of the study was also explained to the directorof the nursing department of the hospital. The patientshad already given their consent, because all patients admit-ted to the hospital provide informed consent for use oftheir de-identified demographic, diagnostic, and treatmentinformation recorded in electronic medical records inresearch. This consent process has been required by medicallaw for every inpatient throughout Korea since September2011.

Data collection

Data were downloaded from the electronic nursing docu-mentation system of the hospice care unit of KyungpookUniversity Hospital, with encryption of patients’ personalinformation, and compiled in an Excel file. Kyungpook Uni-versity Hospital, a tertiary hospital located in Daegu, SouthKorea, contains more than 850 beds. This hospice unit, whichwas established as a hospital-based hospice service in April2009 as a way to provide the best possible quality of life forterminally-ill patients, serves as a model for tertiary and otherhospitals, due to governmental efforts to develop a nationalhospice system in Korea.

All documented nursing statements were extracted andcategorized according to nursing assessments, nursing diag-noses, nursing outcomes, and nursing evaluations, and thenaccording to the meaning of each statement within each ofthese categories. A total of 140,369 nursing statements wereextracted, 56,712 of which were related to interventions oractivities only. These statements were used in this study. Theselection of statements on nursing interventions and activi-ties was performed independently by two researchers whohad experience with SNL. After the independent selectionof statements on nursing interventions and activities, thestatements were compared with one another, and 92%agreement was found between the researchers. The 56,712statements were then mapped onto the interventions listedin the fifth edition of the NIC, resulting in 147 different NICinterventions.

The mapping process was performed by three researcherswho had extensive knowledge, as well as research experience,using NIC. For mapping the statements onto NIC interven-tions, it was necessary to confirm that each extracted state-ment matched the definition, as well as activities of an NICintervention. Each researcher independently performedmapping of nursing statements onto NIC labels, and thesemappings were compared among the researchers. The origi-nal inter-rater reliability was between 80% and 85%. Wherediscrepancies existed, the context was reviewed, and therewas extensive discussion until 100% agreement was reachedamong the researchers.

Korean hospice nursing practice 3


Data analysis

Data were analyzed using SPSS (version 18.0; SPSS, Chicago,IL, USA). Descriptive statistics, such as frequencies and per-centages, were used to identify the demographic characteris-tics of the hospice patients. NIC utilization rates werecalculated using frequency and percentages. Frequencies andpercentages were used for comparison with core NIC inter-ventions identified by the AELCN. In order to make the datacomparison easier to understand, the interventions selectedin both countries were displayed and categorized accordingto the classes and domains of the NIC taxonomy structure.

RESULTS

Classification of nursing records

The nursing records of 353 patients consisted of assessments,diagnoses, planning, interventions, and evaluations. Thetotal number of statements was 140,369. There were 10,624nursing-assessment statements, 10,624 nursing-planningstatements, 57,629 nursing-intervention statements, and62,872 nursing-evaluation statements.

Documented intervention classification according tothe NIC taxonomic structure

The results of an analysis showed that only 56,712 of 57,629nursing statements were mapped onto 147 NIC interventions(Table 1). Thus, 917 nursing-intervention statements werenot mapped with NIC interventions. All of these 56,712statements were categorized according to the NIC taxonomicstructure, resulting in six domains and 24 classes.

Approximately 35% of the nursing-intervention state-ments belonged to the physiological basic domain, followedby the physiological complex (26.7%), safety (19%),behavioral (15.63%), health system (3.58%), and family(0.43%) domains. The NIC community domain was notselected (Table 2). The most often used classes of interven-tion statements were risk management (19%) and physicalcomfort promotion (18.98%), followed by drug management(15.18%), patient teaching (11.89%), and immobility man-agement (9.36%). the other classes included less than 5% ofthe nursing-intervention statements.

Comparison of core interventions between Korea andthe USA

A comparison between the interventions most frequentlyselected by Korean hospice nurses and core nursing interven-

tions identified by members of AELCN is shown in Table 3.In order to compare the data of Korean hospice nurses withthose of US nurses, the same number of interventions wasselected from Korean data. Eighteen interventions (32%)were selected by nurses from both countries. Among thesimilarities and differences in the use of nursing interventionsobserved between the two countries, Korean nurses selectedfour interventions related to medication and six related toteaching, while no interventions related to medication orteaching were selected by nurses in the USA.

Comparison of core interventions between the twocountries using NIC taxonomy

The core interventions of the two countries were then cat-egorized according to the classes and domains of the NICtaxonomic structure (Table 4). The interventions selected byKorean nurses belonged to 21 classes and six domains,whereas the interventions selected by members of theAELCN in belonged to 17 classes and six domains. The classmost frequently selected by Korean nurses was patient edu-cation (6 interventions, 13%), followed by drug management(5 interventions, 10.9%). the most frequently-selected classin the USA was coping assistance (14 interventions, 34.4%),followed by health system mediation (5 interventions,10.9%).

Korean nurses performed more interventions in the physi-ological basic, and physiological complex, and safety domainsthan nurses in the USA. However, the behavioral, family, andhealth system domains were more often selected by nurses inthe USA than by Korean nurses.

DISCUSSION

SNL contributes to the accumulation of evidence-basedhospice nursing practice using data retrieved from ENRsystems; therefore, the utilization of SNL, such as the NIC, byhospice nurses is very important. This study identified actualnursing interventions performed for terminally-ill patients byhospice nurses in Korea. Comparisons were then made withthe core interventions selected by the AELCN. Thus, thisstudy broadens the possibilities for the utilization of SNL forthe quantification of hospice care. In addition, the study pro-vides an important transcultural reflection of hospice nursingpractice. This process could be the first step to the identifica-tion of similarities and differences in hospice nursing practicebetween the two countries. In the future, it could provide animportant opportunity to improve the quality of hospice carein both countries.

Table 1. Classification of narrative nursing statements in the electronic nursing record

Total narrativenursing statements

Nursing-assessmentstatements

Nursing-planningstatements

Nursing-interventionstatements

Statements mapped ontothe Nursing Interventions

ClassificationNursing-evaluation

statements

140,369 9244 10,624 57,629 56,712 62,872



In this study, 56,712 nursing-intervention statements weremapped with the NIC; these 56,712 nursing statements fit intothe 147 NIC interventions and belonged to 21 classes and sixdomains. In an analysis of paper charts of discharged patientswith end-stage cancer who were admitted to a hospice unitand to general units, respectively, in a tertiary hospital, Roet al. (2002) found 121 and 103 different NIC interventions.Choi and Jang (2005) found that 190 different NIC interven-tions were used in a paper chart for terminal-stage cancerpatients admitted to a tertiary hospital. Therefore, thenumbers of NIC interventions used for hospice patientsranged between approximately 100 and 200. This couldreflect how hospice nurses need to be equipped with knowl-edge and skills for the performance of a variety of interven-tions in order to provide quality nursing care to terminally-illpatients.

In this study, hospice nurses in Korea selected most of theinterventions in the physiological basic domain, followed bythe physiological complex domain. However, among theseven domains in the NIC taxonomic structure, interventionsfrom five domains were rarely selected. Similarly, Choi andJang (2005) reported that interventions from the physiologi-cal basic domain were most frequently performed by nursesfor terminal cancer patients, followed the physiologicalcomplex domain; whereas, in the research reported by Roet al. (2002), nurses performed interventions for terminalcancer patients from the physiological complex domain, fol-lowed by the physiological basic domain. The findings fromall three of these studies indicated that Korean nurses focus

more on providing physiological care, rather than otheraspects of care, to terminally-ill patients.

In accordance with the results described, in this study, thetop 10 most commonly-performed interventions for hospicepatients were pain management, analgesic administration,medication administration: intravenous, bed rest care, vitalsigns monitoring, teaching: procedure/treatment, environ-ment management: comfort, medication administration: oral,teaching: prescribed medication, and emotional support. Inthe study reported by Ro et al. (2002), more than 90% ofhospice nurses reported that they performed interventions,such as medication administration (95.5% of the nurses),fluid management (95.5%), fluid monitoring (95.1%), urinaryelimination management (93.3%), nutritional monitoring(93.4%), and nutrition therapy (93%). Choi and Jang (2005)reported that vomiting management, pain management,surveillance, respiratory monitoring, and fluid monitoringwere the most commonly-documented interventions forterminally-ill patients. All of these studies showed thathospice nurses in Korea were focused on providing moreinterventions for the relief of physical symptoms than onthose related to emotional and psychosocial aspects ofterminally-ill patients.

Why do Korean nurses perform more interventions fromthe physiological domain compared to nurses in the USA?One of the reasons might be due to the shortage of nurses inKorea. The staffing ratio in Korea is much lower: the numberof registered nurses per 1000 patients in the USA is 10.8;however, that in Korea was 4.5, less than that of the USA, and

Table 2. Domains and classes of interventions mapped onto the Nursing Interventions Classification

Domains n % Classes n (%)

Physiological basic 19,657 34.66 Activity and exercise management 108 (0.19)Elimination management 751 (1.32)Immobility management 5,307 (9.36)Nutrition support 1,207 (2.13)Physical comfort promotion 10,763 (18.98)Self-care facilitation 1,521 (2.68)

Physiological complex 15,140 26.70 Drug management 8,608 (15.18)Electrolyte and acid-base management 701 (1.24)Neurological management 646 (1.14)Perioperative care 10 (0.02)Respiratory management 1,764 (3.11)Skin/wound care 2,209 (3.90)Thermoregulation 549 (0.97)Tissue perfusion management 653 (1.15)

Behavioral 8,866 15.63 Behavioral therapy 322 (0.57)Communication enhancement 2 (0)Coping assistance 1,530 (2.70)Patient education 6,742 (11.89)Psychological comfort promotion 270 (0.48)

Safety 10,774 19.0 Risk management 10,774 (19.00)Family 244 0.43 Lifespan care 244 (0.43)Health system 2,031 3.58 Health system management 313 (0.55)

Health system mediation 1,370 (2.42)Information management 348 (0.61)

Total 56,712 100 56,712 (100)



below the average number of registered nurses (8.4) in theOrganization for Economic Cooperation and Developmentcountries (OECD Factbook, 2011). Task-oriented workassignments prescribed by physicians, and those providingbasic physiological nursing care, have taken priority overinterventions based on psychosocial aspects, resulting in rela-tively less time to provide the psychosocial aspects of nursingcare.

This study also compared the use of interventions betweenKorean and US hospice nurses. The data suggest clear simi-larities and differences in nursing practices between thetwo countries. Eighteen interventions were the same onesselected in both countries. US nurses selected interventionsthat are more focused on psychosocial aspects than physicalaspects. For example, anticipatory guidance, decision makingsupport, forgiveness facilitation, grief work facilitation, pres-ence, religious ritual enhancement, spiritual support, and

Table 3. Comparison of core nursing interventions betweenKorean and US nurses

Korean nurses US nurses

Activity therapy Active listeningAdmission care Analgesic administrationAnalgesic administration Anticipatory guidanceAnxiety reduction Anxiety reductionBed rest care Bed rest careBleeding precautions Bowel managementBowel management Caregiver supportCoping enhancement Case managementDying care Constipation/impaction

managementEmotional support Coping enhancementEnvironmental management:

comfortDecision-making support

Examination assistance Delirium managementFamily involvement promotion Dying careFever treatment Emotional supportFluid/electrolyte management Energy managementIncident reporting Environmental managementMassage Family integrity promotionMedication administration Family involvement promotionMedication administration:

intravenousFinancial resource assistance

Medication administration: oral Fluid/electrolyte managementMedication reconciliation Forgiveness facilitationNausea management Grief work facilitationNeurological monitoring Healthcare information

exchangeNutrition management Health system guidanceNutrition therapy Multidisciplinary care

conferenceOxygen therapy Neurological monitoringPain management Nutrition managementPass facilitation Pain managementPositioning Patient rights’ protectionPressure management PositioningRespiratory monitoring PresenceSkin care: topical treatments Pressure managementSkin surveillance Religious ritual enhancementSleep enhancement Reminiscence therapySupport system enhancement Respiratory monitoringSurveillance Respite careSurveillance: safety Self-care assistanceTeaching: disease process Skin surveillanceTeaching: individual Sleep enhancementTeaching: prescribed

activity/exerciseSpiritual support

Teaching: prescribed diet Support system enhancementTeaching: prescribed medication Telephone consultationTeaching: procedure/treatment TouchTotal parental nutrition

administrationUrinary elimination

managementVital signs monitoring Values clarificationWound care: closed drainage Visitation facilitation

Note: US data are from the Iowa Interventions Project Team(Bulechek et al., 2008).

Table 4. Comparisons of core interventions between Korean andUS nurses by Nursing Interventions Classification domains andclasses

Korean nurses US nursesn (%) n (%)

ClassActivity and exercise management 0 1 (2.2)Elimination management 1 (2.2) 3 (6.5)Immobility management 2 (4.3) 3 (6.5)Nutrition support 2 (4.3) 0Physical comfort promotion 4 (8.7) 1 (2.2)Self-care facilitation 1 (2.2) 2 (4.3)Electrolyte and acid-base

management1 (2.2) 1 (2.2)

Drug management 5 (10.9) 1 (2.2)Neurological management 1 (2.2) 1 (2.2)Respiratory management 2 (4.3) 1 (2.2)Skin/wound management 4 (8.7) 2 (4.3)Thermoregulation 1 (2.2) 0Tissue perfusion management 1 (2.2) 0Behavioral therapy 1 (2.2) 0Communication enhancement 0 1 (2.2)Coping assistance 4 (8.7) 14 (30.4)Patient education 6 (13.0) 0Psychological comfort promotion 1 (2.2) 1 (2.2)Crisis management 0 0Risk management 3 (6.5) 2 (4.3)Lifespan care 1 (2.2) 4 (8.7)Health system mediation 2 (4.3) 5 (10.9)Health system management 1 (4.3) 0Information management 2 (4.3) 4 (8.7)Total 46 (100) 46 (100)

DomainsPhysiological basic 11 (23.9) 10 (21.7)Physiological complex 15 (32.6) 6 (13.0)Behavioral 12 (26.1) 16 (34.8)Safety 3 (6.5) 2 (4.3)Family 1 (2.2) 4 (8.7)Health system 4 (8.7) 8 (17.4)Total 46 (100) 46 (100)



values clarification were selected by the AELCN, whileKorean nurses in this study selected only coping enhance-ment, dying care, emotional support, and support systemenhancement as psychosocial interventions.

In addition, Korean nurses focused more on interventionsrelated to patient education, such as teaching: prescribedmedication, teaching: procedure/treatment, and teaching:prescribed diet. However, there are no teaching-related inter-ventions on the US core intervention list. Why do Koreannurses provide more interventions for patient teaching thantheir counterparts? In Korea, one family member alwaysstays with the patient. Therefore, due to the shortage ofnurses, some interventions are delegated to, and performedby, family members of patients. This kind of informal car-egiver is very popular in Korean hospitals, with the exceptionof the intensive care unit. Some interventions are delegatedto informal caregivers; therefore, interventions related toteaching might be needed.

A list of nursing interventions specific to hospice nursing inKorea was identified in this study.This list can be used for theeducation and training of newly-hired nurses in hospice units,and in the competency examination for the career laddersystem. This process can also be used to define the roles ofhospice nurses, and increase the autonomy of nurses workingin hospice units. By identifying the core interventions accord-ing to each specialty, we were able to determine which inter-ventions were more cost-effective and provide betteroutcomes for patients with fewer resources. This process ulti-mately benefits patients by use of research-based data, as wellas nurses, by visualizing the contribution of nurses to patientoutcomes.

However, among 57,629 nursing-intervention statements,56,712 (98.4%) were mapped into the NIC, thus, 917 (1.6%)nursing-intervention statements were not mapped with theNIC. The very high mapped rate of nursing interventions inthe study with the NIC might suggest that the NIC can beused to describe nursing interventions for terminally-illpatients in Korea. However, 917 nursing statements mightbe unique or culturally-sensitive interventions specific tohospice care settings in Korea. This requires further investi-gation. Thus, a comparison of nursing interventions interna-tionally is valuable, because nurses should understandcultural diversity in order to offer their services in the 21stcentury global society.

Limitations of the study related to the data-collectionmethods; Korean data were collected from the ENR system,while US data were selected by members of the AELCN.Thisthreatens the external validity of the results, and a moreconsistent data-collection method will be needed for futurestudies. Comprehensive and complete documentation bynurses in hospitals using a nursing process model is a com-pulsory requirement for hospitals in order to obtain hospitalaccreditation in Korea.Thus, nurses in Korea, especially thoseworking in tertiary hospitals, receive education and trainingin the importance of regular documentation. However, thereis a possible gap between actual nursing interventions per-formed for hospice patients and interventions documented inthe ENR by nurses. In addition, with the ease of documenta-tion due to use of the ENR, there is always a chance of

overdocumenting interventions performed by nurses. For allof these reasons, careful consideration is needed when inter-preting the results of this study.

Conclusion

The data in this study contribute to knowledge regardingnursing interventions related to hospice care, especially corenursing interventions for patients at the end of their lives.Theuse of a standardized language, such as NIC, provides a toolfor comparison of Korean and American hospice nursinginterventions. This type of information is expected to beuseful in understanding how to improve hospice care, deter-mination of costs for hospice nursing, and the standardizationof nursing interventions. This study provides a direct com-parison between end-of-life nursing practices in Korea andthe USA, and suggests future transcultural comparisons ofnursing practice patterns.

The identification of nursing interventions using a standardterminology, such as the NIC, rather than with a narrativedescription for each specialty, is a fundamental and essentialstep toward facilitating the exchange of data. The results ofthis study can be used in the development of more user-friendly ENR systems in Korea. This aggregation of data isone way to ensure the visibility of the contribution of hospicenurses to health outcomes for patients. In addition, it will behelpful in building nursing knowledge and delineating theunique roles of hospice nurses as a profession. For thesereasons, continuous dissemination of the NIC will be neces-sary, and leaders, researchers, and educators should make aneffort to incorporate this terminology into practice in Korea.

In addition, this study demonstrated the applicability ofthe NIC to hospice nursing in Korea. The identified coreinterventions list can be utilized in the clinical practice ofnurses by providing valuable information for use in thedevelopment of hospice nurse-orientation programs, educa-tion, and training, and maintaining competencies of hospicenurses.

ACKNOWLEDGMENTS

This work was supported by the National Research Founda-tion of Korea Grant funded by the Korean Government(NRF- 2013S1A5A2A03044389).

CONTRIBUTIONS

Study Design: EL, SJH.Data Collection and Analysis: SJH.Manuscript Writing: EL.

REFERENCES

American Nurses Association. Scope and Standards of Nursing Infor-matics Practice. Washington, DC: American Nurses Publishing,2008.

Bakken S, Cashen MS, Mendonca EA, O’Brien A, Zieniewicz J.Representing nursing activities within a concept-oriented termi-nological system: evaluation of a type definition. J. Am. Med.Inform. Assoc. 2000; 7: 81–90.



Bulechek GM, Butcher HK, Dochterman JM (eds). Nursing Inter-ventions Classification (NIC) (5th edn). St. Louis, MO: Mosby,2008.

Bulechek GM, Butcher HK, Dochterman JM (eds). Nursing Inter-ventions Classification (NIC) (6th edn). St. Louis, MO: Mosby,2013.

Campbell J, Carpenter P, Sneiderman C, Cohn S, Chute C, Warren J.Phase II evaluation of clinical coding schemes: completeness, tax-onomy, mapping, definitions, and clarity. J. Am. Med. Inform.Assoc. 1997; 4: 238–251.

Cho EJ, Kim NC. Validation of major nursing diagnosis-outcome-intervention (NANDA-NOC-NIC) Linkage for adult surgerypatients of post anesthetic care unit. J. Korean Clin. Nurs. Res.2008; 14: 141–151.

Choi JY, Jang KS. Comparison of cancer nursing interventionsrecorded in nursing notes with nursing interventions perceived bynurses of an oncology unit-patient with terminal cancer. J. KoreanAcad. Nurs. 2005; 35: 441–450.

Choi JY, Kim HS, Park MS. A correlation study of perceived impor-tance of nursing interventions with performance frequency in psy-chiatric nursing units using the 3rd NIC. J. Korean Acad. Nurs.2003; 33: 95–103.

Delaney C, Huber D. A Nursing Management Minimum Data Set(NMMDS): A Report of An Invitational Conference. Chicago, IL:American Organization of Nurse Executives, 1996.

Haugsdal CS, Scherb CA. Using the nursing interventions classifica-tion to describe the work of the nurse practitioner. J. Am. Acad.Nurse Pract. 2003; 15: 87–94.

Hong SJ, Lee SH, Kim HS. Analysis of nursing interventions per-formed by gynecological nursing unit nurses using the nursinginterventions classification. J. Women Health Nurs. 2011; 17: 275–284.

Johnson M, Bluechek G, Butcher H et al. NANDA, NOC and NICLinkages (2nd edn). St. Louis, MO: Mosby, 2005.

Kang J. A Basic Study for Hospice and Palliative Care Traner’sEducation Program Development. Seoul: Ewha Womans Univer-sity, 2010.

Kwon MS, Park KS. Analysis of the nursing interventions performedby orthopedic surgery unit using NIC. J. Korean Acad. Nurs. Adm.2002; 8: 655–667.

Kyung MH, Jang YM, Han KH, Yun YH. Current status and activa-tion plan of hospice palliative care in Korea-based on hospicepalliative care facilities survey. Korean J. Hosp. Palliat. Care 2010;13: 143–152.

Lee K, Joo J, Kim J, Kim K. Current status and challenge of hospicepalliative care I. Korean J. Hosp. Palliat. Care 2008; 11: 196–205.

Lee YY, Park KO. Analysis of core interventions of operating roomusing nursing intervention room nurses. J. Korean Acad. Nurs.Adm. 2002; 8: 361–372.

Lunney M. Stress overload: a new diagnosis. Int. J. Nurs. Terminol.Classif. 2006; 17: 165–175.

Moorhead S, Johnson M, Maas M, Swanson E. Nursing OutcomesClassification (NOC) (5th edn). St. Louis, MO: Mosby, 2008.

OECD Factbook. Economic, environmental and social statistics.2011. [Cited 10 May 2013.] Available from URL: http://dx.doi.org/10.1787/888932508091.

Oh KS, Kim KMJ, Kim KS et al. Educational issues and strategies toimprove APN education. J. Korean Acad. Nurs. 2007; 37: 801–809.

Oh MS, Park KS. Analysis of the nursing interventions performed byneurosurgery unit using NIC. J. Korean Acad.Adult Nurs. 2002; 14:265–275.

Oh W, Suk MH, Yoon YM. A survey of the nursing interventionsperformed by neonatal nursing unit nurses using the NIC. KoreanJ. Child Health Nurs. 2001; 7: 161–178.

Park HA, Hardiker N. Clinical terminologies: a solution for semanticinteroperability. J. Korean Soc. Med. Inform. 2009; 15: 1–11.

Park OY, Jung MS. Analysis of the nursing interventions performedin the medical & surgical units and the health insurance cost itemsbased on the NIC. J. Korean Acad. Nurs. Adm. 2005; 11: 449–467.

Plowfield LA, Hayes ER, Hall-Long B. Using the Omaha system todocument the wellness needs of the elderly. Nurs. Clin. North Am.2005; 40: 817–829.

Ro YJ, Han SS, Yong JS, Song MS, Hong JU. A comparison ofnursing interventions with terminal cancer patient in a hospiceunit and general unit. J. Korean Acad. Adult Nurs. 2002; 14: 543–553.

Simpson RL. What’s in a name? The taxonomy and nomenclaturepuzzle, Part 2. Nurs. Manage. 2003; 34: 12–16.

SNOMED CT. Modeler’s Handbook. Northfield, IL: SNOMEDInternational, 2002.

Yong JS, Kim NC, Kang JH. Development of nursing interventionstandards for home hospice patients. J. Korean Acad. Adult Nurs.2006; 18: 102–114.

Yong JS, Ro YJ, Han SS, Kim MJ. A comparision between home carenursing interventions for hospice and general patients. J. KoreanAcad. Nurs. 2001; 31: 897–911.

Zeng Q, Cimino JJ, Zou KH. Providing concept-oriented views forclinical data using a knowledge-based system: an evaluation. J.Am.Med. Inform. Assoc. 2002; 9: 294–305.

Zollo KA, Huff SM. Automated mapping of observation codes usingextensional definitions. J. Am. Med. Inform. Assoc. 2000; 7: 586–592.



http://dx.doi.org/10.1787/888932508091

http://dx.doi.org/10.1787/888932508091

Download - Korean hospice nursing interventions using the Nursing Interventions Classification system: A comparison with the USA

Top Related