A Bridge Between Data and Language, the Swiss Issues: NURSING … · NNN02/april 2002 A Bridge...

NNN02/april 2002

A Bridge Between Data and Language, the Swiss Issues: NURSING dataAlain Junger

Lausanne Bernhttp://www.hospvd.ch/ise/nursingdata

ISE ��

NNN02/april 2002http://www.hospvd.ch/ise/nursingdata

From clinical practice to information system,

a long way throught data and terminologies


Swiss health information system

� 26 autonomouscantons

� 26 health systems � No central data

production � Many lobbies� Economic

restrictions

� Health policy� Comparisons� Coordination

Many differentinformation systems


Federal laws

� Federal Law on statistics (1992)� Federal Law on health insurance (1994)

Since 1998, compulsory collecting of data for

Statistics Economy/Management

Federal Law on data protection


What is NURSING data ?

� The future nursing information system for Switzerland

� An add-on for the health information system

� An information system for pricing nursing care

� It covers:Acute care, Long term care, Home care

and Psychiatry care


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 nursing makes a difference!


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,…)


Conclusions of the 1st part

Need for a uniform nursing language to describe nursing phenomena andnursing interventions

� Definition of relevant concepts

� Choice of a standardised language for data collection and treatment

� Coordination on international level

� Ability for nurses to work in natural or «home» language

� Use of technical developments(informatics)


Part 2 : business plan

2001 2002 2003 2004 2005TP1: Project management

TP2 : Classifications

TP3 : CH-NMDS

TP4: Data mining

TP5: Information

TP6 : Nat. and internat. coordination

TP7: Normalisation


Organigram

Direction de projet NURSING data

TP 7 : Préparation du système de normalisation

TP4 : Validation du modèle d’exploitation des données

TP 6 : Coordination

TP5 : Information

TP1 : Gestion opérationnelle

TP2 -TP3 - Groupe national de terminologie et de données infirmières

TP2 : Gruppo regionale per una terminologia

infermieristica (GRTI)

TP2 : Regionale Expertengruppe für

Pflegefachsprache (REP)

TP2 : Groupe régional de terminologie infirmière (francophone) (GRTI)

TP3 : Groupe d’experts national pour le NMDS

(GN-NMDS)

Réseaux régionaux Regionale Netzwerke Reti regionali


NURSING data The conceptual framework

…


Nursing Data Sets

Nursing

Management/financial

Set

Nursing Phenomena

Set

NursingIntervention

Set

Patient

Prof.

Structure


NURSING data in four models

Management reporting

NMDS

Facts

NDS

Management data

Planification data

Statistics of population

Reality / practice

Statistical Data

NURSING data

Inte

rna

lEx

tern

al

Alain Junger/99

Clinical dataNursing records

A-State observed

Physiopathological Psychological Social

Environment

Diagnosticaspects,objectives

Nursing phenomena

+ resources- problems

Interventions

Outcomes

Facts

Clinicalstatus

B-Sate observed

5 Functions

Alain Junger/99

Observe/décrit

Lieu

Institution

Emploi

Patient /Client

Travaille

Séjourne/habite

Analyse/fixe desobjectifs

Modifie

Devientun nouvel

état de santé

Version 2.0Alain Junger/9 9

Autres

Descriptifsspécifiquesinf irmiers

Médecin

PatientAutres professions

PatientMédecins

Inf irmières

Les acteurs

AgitConcern

e

Induit

Prescrit/demande

Appartient

Etat de santé

Réalise/applique

SéjourEtape

Episode

Sesitue

AutresTraitements

Actes /interventions

Soins & traitements

Dataaggregation

Clinicalprocess Object/data

model

Informationflow


Model of the clinical process

A-State observed

Physiopathological Psychological Social

Environment

Diagnosticaspects,objectives

Nursing phenomena

+ resources- problems

Interventions

Outcomes

Facts

Clinicalstatus

B-State observed

5 Functions

Alain Junger/99


� Patient� Actor/professional� Institution� Point of care� Episode� Health status� Interventions, actions

Permanent concepts:

Care as an object


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


Micro to macro

Nursing process

Data

Agr

egat

ion

Statistics

Policy

Management

Clinical documentation


Linkage between data

Soins

Méd

ecin

e

Physiothérapeute

Fina

nce

Stat.Population

NMDS

NDS

Stat. Infirm

.

Dossier

Hotellerie

CareDocumentationNurs. Stat.


CH-NMDS - 1

� Patient� ID Number*� Date of birth*� Sex*� Region of residence*

� Episode� Date of entry � Date of exit� Number of intern transfer� Hospital:In Operating Theater; Intensive

care (Y/N)� Long term care:With Hospitalization (Y/N)

� Place� Type** link with medical and

administrative statistics

� Health status� Medical diagnoses*� Nursing phenomena� Caracteristics of the

phenomena� Outcomes related to the

phenomena

� Interventions� Interventions � Frequency, contribution of

social network, home assistance

� Overall intensity of the episode (class, length of required or dispensed care)


CH-NMDS - 2

� Nurse� ID Number� Nationality� Diploma� Year of qualification

� Activity� Function � Date of engagement� Date of resignation� Work rate

� Firm Information (year)� 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


NURSING data & other statistics

Medicalstatistic

Hospitalstatistic

Long-termcare

statistic(Establishment)

NURSING data CH-NMDS

Future ?


What will we show and see ?


�Mais...�Aber...

� Ma ...– But


Terminology: what for ?

Specificity of Switzerland:

� Four national languages� No common professional language� No compatibility between systems in use

• Workload measure, measure of given care• measure of needs, staffing, …

� Rapid development of electronicpatient record


From data to terminologiesFrom practice to concepts

Practice

Abstraction

Dat

aLa ngu ag e


LEP/PRN


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


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


Health phenomenon

Health aspect from one or many individuals justifying the

nursing interventions

Definition accepted at 82%,rejected by 5%


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


Delphi questionnaire

Speaking : Sent Received %

French 46 32 70%German 50 37 74%Italian 55 40 73%Total 151 109 72%


Delphi I & II

OtherNurse manager

Nurse practitioner

Nursing teacher

Board nurse

Other 9 10 19School 2 1 10 13Psychiatry 5 2 1 1 9Home care 3 6 9Long term care 4 6 2 12Hospital 5 24 7 2 12 50

112

OtherNurse manager

Nurse practitioner

Nursing teacher

Board nurse

Other 14 10 2 26School 2 1 8 11Psychiatry 5 2 1 1 9Home care 2 5 1 3 11Long term care 2 6 2 10Hospital 2 22 5 2 11 42

22 49 9 12 17 109

I

II


Classification developments 2

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


Nursing phenomena

ICF 4 steps scale

50 itemsICF (WHO)�ANATOMICAL STRUCTURE�ORGANIC FUNCTION�ENVIRONMENTAL FACTORS�ACTIVITY AND PARTICIPATION

QualifiersContentStructure


Nursing interventions

�Observe/survey/monitor�Prevent�Inform�Teaching�Advise/guide�Assist/help/accompany�Treat / act / intervene / supply�Re-educate

64 itemsICF (WHO)

QualifiersContentStructure


Future of NURSING data

Theory

Development

Operational

Research

Engineering

Nursingpractice

NURSING data

Futureimprovement

Futureapplication


Information policy

Ambitious information with modern tools � Web site

http://www.hospvd.ch/public/ise/nursingdata/

� Restricted forum� Regular publications in professional and

other journals� Communications, conferences, lectures


Thank youfor your attention

and Looking forward

to continue the discussion

A Bridge Between Data and Language, the Swiss Issues: NURSING … · NNN02/april 2002 A Bridge...

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