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

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!

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,…)

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

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

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

Questions

• What do Nursing ?• Why ?• How ?• Where ?• Whish cost ?To:

CompareCoordinate and Plan

Finance

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)

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

How ?

Clinical process

Data Language

ConceptsMemory

Information

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

What ?: Nursing data set

Nursing Management/financial

Set

Nursing Phenomena

Set

NursingIntervention

Set

Patient

Prof.

Structure

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

NURSING data & other statistics

Medicalstatistic

Hospitalstatistic

Long-termcare

statistic(Establishment)

NURSING data CH-NMDS

Future ?

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

From data to terminologiesFrom practice to concepts

Practice

Abstraction

Dat

aLanguage

Semanticrules

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

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

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)

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

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

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

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

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

ICF - WHO

Interactions between the components of ICF

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

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

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

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

Future of NURSING data

Theory

Development

Operational

Research

Engineering

Nursingpractice

NURSING data

Futureimprovement

Futureapplication

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

Thank youfor your attention

and Looking forward

to continue the discussion

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

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

Nursing phenomenon

Health aspect from one or many individuals justifying the nursing interventions

(NURSING data)

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

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

Nursing Intervention

Set of actions organised to reach a Nursing goal

(NURSING data)

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

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

AJ. MIE2002, http://www.hospvd.ch/ise/nursingdata/

LEP/PRN

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