Professor University of Salford, UK eHealth Programme Director Hardiker Pres.pdf · •eHealth is...

ICN - Advancing nursing and health worldwide www.icn.ch

Great nurses need great systems

Nicholas Hardiker RN PhD

Professor

University of Salford, UK

eHealth Programme Director

International Council of Nurses


(Great systems need great nurses)


Presentation Outline

• Motivation

• Background

• Practice

– Data capture, workflow, decision making, data reuse

• Questions


The world by land area


The world as proportion of young people

living with HIV


The world as proportion of nurses


The world by land area


The world as proportion of tuberculosis

cases


The world as proportion of nurses


Salford


• ‘…the workers of Salford live in dwellings in

which cleanliness and comfort are impossible’

Engels F (1845) Die Lage der arbeitenden Klasse in England


Hospital statistics

• ‘In attempting to arrive at the truth, I have

applied everywhere for information, but in

scarcely an instance have I been able to obtain

hospital records fit for any purposes of

comparison’ (p 176)

Nightingale F. Notes on Hospitals. 3rd Edition. London: Longman, Green,

Longman, Roberts, and Green, 1863


Better information

=

Better health care


Record keeping

• 'Today, the nursing shortage being what it is,

every effort should be made to utilize our nurses

to the utmost and not take their time with clerical

work of no immediate value'


1953

• 'Today, the nursing shortage being what it is,

every effort should be made to utilize our nurses

to the utmost and not take their time with clerical

work of no immediate value'

Gorby JH, Johnson LW. (1953) Nurses'

notes cost money—so why not simplify them and economize?

Modern hospital 81 (4):54-56.


eHealth (WHO 2011)

• eHealth is the use of information and

communication technologies (ICT) for health to,

for example, treat patients, pursue research,

educate students, track diseases and monitor

public health

http://www.who.int/topics/ehealth/en/


Examples

• Electronic patient records

• Telehealth and telecare

• Decision support systems and online knowledge

sources

• Web based patient information and personal

health records

• Social networking support groups

• etc.


‘eLife’

• The use of information and communication

technology in:

– Banking

– Retail

– Travel

– Entertainment

– Social engagement


Unrealistic expectations

• Cash machines (ATMs) have not improved my

financial status…


• …on demand TV has not made me like soap

operas more…


• …SatNavs have not make my journeys safer…


• …and online travel has not made the sun shine

on holiday…


• …but I could not live without them


A personal vision

• eHealth systems are in routine use to parallel

other aspects of contemporary life

• Data is available and routinely used/exploited for

the benefit of patients and those caring for them

• People are actively working on continually

improving how things are i.e. advancing together

the art/science of nursing informatics


The International Council of Nurses (ICN)

• A federation of more than130 national nurses

associations representing millions of nurses

worldwide

• Operated by nurses and leading nursing

internationally since 1899

• Its purpose is to represent nursing worldwide,

advancing the profession and influencing health

policy


ICN eHealth Programme

• Transforming nursing through the visionary

application of information and communication

technology

• Over 20 years in the making

• Announced at the ICN Conference 2011 in Malta

http://www.icn.ch/pillarsprograms/ehealth/


Why ICN eHealth?

• ICN informs, supports and advocates for nursing

and its members

• Worldwide proliferation of ICT

• ICT in health care provides new opportunities,

not least equity and improved access

• eHealth threads through ICN processes and

products


Connecting nurses

• A forum for expert healthcare professionals from

around the world to share their ideas, advice

and innovations

http://www.connecting-nurses.com


ICN Telenursing Network

• Global resource for sharing knowledge and

expertise around telehealth and telecare

http://www.icn.ch/networks/telenursing-network/


International Classification for Nursing

Practice (ICNP®)

• ICN has supported ICNP® since 1989

• A standardised terminology used to represent nursing diagnosis, intervention and outcome statements

• Available in 14 languages

• A related classification in the WHO Family of International Classifications

• Collaborative agreements in place with IHTSDO (SNOMED-CT) and Sabacare (CCC)

• Mappings to SNOMED CT, CCC, ICF, PNDS

• Migration pathway between ICNP and NANDA

http://www.icn.ch/pillarsprograms/international-

classification-for-nursing-practice-icnpr/


ICNP® Application &

Development

• Individual and collaborative research and

development projects

• ICN Accredited Centres for ICNP® Research &

Development

• Supporting practical use at point of care

– Translation activity

– Catalogue development

– Research into care planning

– Commercial agreements with software suppliers


Example 1: Workflow and decision

making

Focus Diagnostic

interventions Diagnosis Interventions


Example 2: Data reuse

Diagnosis Interventions Outcomes


Structure indicators

• Care hours per patient per day

• Dependency

• Nurse satisfaction


Process indicators Risk identification

Number of cases with a previously documented risk

that developed a specified problem in a given time

period

Number of cases that developed the problem in the

same time period

Did the identification of risk help to prevent a problem?


Outcome indicators Resolution of problems

Number of cases where a specified problem was

resolved and that had at least one documented

intervention in a given time period

Number of cases with the problem documented in the

same time period

Did our actions help to resolve a problem?


Outcome indicators Prevention of problems

Number of cases with a risk of a specified problem, that

did not develop that problem, and that had at least one

documented intervention in a specified time period

Number of cases with a risk of the problem in the same

time period

Did our actions help to prevent a problem?


Outcome indicators Achieving expected outcomes

Number of cases that achieved the expected outcome

for a specified problem and that had at least one

documented intervention in a given time period

Number of cases with the problem documented in the

same time period

Did our actions help to achieve an expected outcome?


Data requirements

• Risk

• Diagnosis

• Intervention

• Expected outcome

• Actual outcome


Key focal elements

• Adult care

– Falls, Dehydration, Pain, Aspiration

• Child care

– Breastfeeding, Malnutrition, Fear

• Women’s care

– Pregnancy, Parenting, Contraceptive use


Aspiration

• Risk for aspiration

– Risk identification, annually

• Actual aspiration

– Prevalence, bi-annual

• Care provider’s knowledge relating to aspiration

prevention

– Resolution of problem, annually


A B


SERVICE A SERVICE A

SERVICE A SERVICE A

SERVICE B SERVICE B

SERVICE A

SERVICE A SERVICE A

SERVICE B

SERVICE B SERVICE B

Epidemiological indicators: frequency


Risk

identification

Prevention

of problems


Achieving

expected

outcomes

Resolution

of problems


Summary

• A standard terminology (and a good

implementation) is important for:

– Data capture

– Supporting workflow

– Supporting decision making

– Data reuse

• Nursing is relatively new to this but is making

significant advances


Great systems need great nurses


Contacts

[email protected]

[email protected]

mailto:[email protected]




Professor University of Salford, UK eHealth Programme Director Hardiker Pres.pdf · •eHealth is...

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