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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
NURSING data : context and choices of the nursing Swiss experience
The XVIIth International Congress of the European Federation for Medical Informatics
Alain JungerAnne Berthou
ISE
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Why NURSING data ?
• To standardize nursing information• To layout the foundations for nursing data
comparability• To determine a nursing data set• To coordinate the swiss effort with
international developments
To show how nursing makes the difference!
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
How NURSING data came to life ?
• 1998: political decision gave green light• 1999: Nursing information model ready• 2000: proposals for the future,
a global and pragmatic solution• 2001: phase 2 and extension of the
partnership:(federal administration, insurance, professional associations, providers,…)
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Context : Diversity
• 26 autonomous cantons• 26 health systems • No central data production• At the nursing level:
– No common language• Professional• Common
– No common tools – No standards – Hospital, home, long term, psychiatric sectors
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Features of the project
• Not a scientific research• Driven by political and
professional authorities• Tight time and resource
budget • Links with the medical (ICD-
10) and administrative languages
• Compatibility (nat. and int.)
Use ofexisting
informationsystems
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Questions
• What do Nursing ?• Why ?• How ?• Where ?• Whish cost ?To:
CompareCoordinate and Plan
Finance
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
The choice between two solutions
Hum
an re
sour
ces c
ost
for e
duca
tion
High
Low
Technological investmentsLow High
One instrument for the country
No standards
„Optimal“ solution (Minimal cost)
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
How ?
Clinical process
Data Language
ConceptsMemory
Information
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
What ?: Nursing data set
Nursing Management/financial
Set
Nursing Phenomena
Set
NursingIntervention
Set
Patient
Prof.
Structure
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
NURSING data & other statistics
Medicalstatistic
Hospitalstatistic
Long-termcare
statistic(Establishment)
NURSING data CH-NMDS
Future ?
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
From data to terminologiesFrom practice to concepts
Practice
Abstraction
Dat
aLanguage
Semanticrules
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Micro to macro
Nursing process
Data
Agr
egat
ion
Statistics
Policy
Management
Clinical documentation
See Goosens W., 1997
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
The object: « care »
Observe/décrit
Lieu
Institution
Emploi
Patient /Client
Travaille
Séjourne/habite
Analyse/fixe des objectifs
Modifie
Devientun nouvel
état de santé
Version 2.0Alain Junger/99
Autres
Descriptifsspécifiquesinfirmiers
Médecin
PatientAutres professions
PatientMédecins
Infirmières
Les acteurs
Agit
Concerne
Induit
Prescrit/demande
Appartient
Etat de santé
Réalise/applique
SéjourEtape
Episode
Se situe
AutresTraitements
Actes /interventions
Soins & traitements
ActorsHealth status
Organisation
Place
Interventions
Episode
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
CH-NMDS – 1 (continuous)
• Patient– ID Number*– Date of birth*– Sex*– Region of residence*
• Episode– Date of entry – Date of exit– Hospital:In Operating Theater; Intensive
care (Y/N)– Long term care:With Hospitalization (Y/N)
• Place– Type** link with medical and administrative
statistics
Health statusMedical diagnoses*Nursing phenomena
InterventionsInterventionsFrequency, contribution of social network, home assistanceOverall intensity of the episode (class, length of required or dispensed care)
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
CH-NMDS – 2 (yearly)
• Nurse– ID Number– Nationality– Diploma– Year of qualification
• Activity– Function – Date of engagement– Date of resignation– Work rate
Firm Information Total number of working hours of temporary workers (Nursing)Total number of working hours of temporary workers(Other)Total number of working hours for a full time worker
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Model of the clinical process
A-Sta te observed
Physiopa thologica l Psychologica l Socia l
Environment
Diagnosticaspects,objectives
Nursing phenomena
+ resources- problems
Interventions
Outcomes
Facts
Clinica lsta tus
B-Sa te observed
5 Functions
Alain Junger/99
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Health phenomenon
Target
Target
TargetTarget
Target TargetTarget
Target
Intervention 1Target + Verb
Intervention 2Target + Verb
Intervention
Intervention
Intervention Intervention
Intervention
Intervention
Intervention
Intervention Intervention
Nursingphenomena
Phenomena Health + qualification aspect (scale)
TargetPhenomenonActionIntervention
Nursingphenomena
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
TerminologyNURSING data & Iso model
is perspective on
is applied to
focus
timing
site
subject of information
judgement
degree potentiality acuity timing
dimension
has site
has subject of information
is applied to
action
timing
target
subject of care
has site
has means
acts on
has subject of care
means
has route
route
site
CH-NMDS
CH-NMDS
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
ICF - WHO
Interactions between the components of ICF
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Nursing phenomena
ICF 4 step scale
50 itemsICF (WHO)•ANATOMICAL STRUCTURE•ORGANIC FUNCTION•ENVIRONMENTAL FACTORS•ACTIVITY AND PARTICIPATION
JudgmentFocusStructure
A Risk B RessourceC Problem
a MILD problem (slight, low,…) 5-24 %b MODERATE problem (medium, fair,...) 25-49 %c SEVERE problem (high, extreme, …) 50-95 %d COMPLETE problem (total,…) 96-100 %e not specified
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Nursing interventions
•Observe/survey/monitor•Prevent•Inform•Teaching•Guide•Assist•Act•Rehabilitate•Managed
68 items
Target
ICF (WHO)•ANATOMICAL STRUCTURE•ORGANIC FUNCTION•ENVIRONMENTAL FACTORS•ACTIVITY AND PARTICIPATION
Action (ICNP)TargetStructure
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Present
March 2002 May 2002
Results analysis FeedbackPublicationof the firstversion of thetwo lists translated in:•French•Italian•German
June 2001
Dead linefor answers
Phase II
Testin
2003
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Future of NURSING data
Theory
Development
Operational
Research
Engineering
Nursingpractice
NURSING data
Futureimprovement
Futureapplication
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Thank youfor your attention
and Looking forward
to continue the discussion
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Nursing information system(s)
Many systemsWorkload measurePersonnel staffing Measure of given careMeasure of needs Electronic patient record
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Nursing phenomenon
Health aspect from one or many individuals justifying the nursing interventions
(NURSING data)
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
ClinicalLevel
StatisticalLevel
Clinical situation
NursingDiagnosis 3
Target 3
NursingDiagnosis 2
Target 2
NursingDiagnosis 1
Target 1
ClinicalJudgement
Description DescriptionSymptoms
?
Phenomena
Aggregation
Phenomena / Diagnosis
Description Description
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Nursing Intervention
Set of actions organised to reach a Nursing goal
(NURSING data)
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Health phenomenon (2)
Hierarchical classification=
Gathering nursing diagnosis with commoncharacteristics
(Nutritional state control, parenteral feeding, weightcontrol = Care for nutritional troubles)
Noknown
classificationClassification
Clinical definitionsClinical oriented
definitions
Futuremany years of data and research
Classificationcharacteristics
Classificationcharacteristics
?
Typology=
Gathering different Nursingdiagnosis and other data
(Hyperthermia, 86 years, pain, ...)
Phenomena
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
The limits of my language mean the limits of my own world.
Les limites de mon langage signifient les limites de mon propre monde.
[ Ludwig Wittgenstein, Logician and Austrian philosopher ]
Extract of Tractatus logico-philosophicus
Thank You for Your attention
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
LEP/PRN
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AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/
Classification developments 1
June 2001
Expertsselection:3 groups3 languages60 persons
Sept. 2001
Course on basic terminologyconcepts
Selection ofnursing significant concepts forphenomenainterventions
Nov. 2001
Delphi Itwo listsper language
Febr. 2001
Dead linefor answers
Phase 1