Nursing Knowledge Model
Susan Matney, MSN, PhD(c), RN-C, FAANInformaticist 3M Health Information SystemsChair SNOMED CT Nursing Special Interest GroupChair Clinical LOINC nursing Subcommittee
Nursing Knowledge: Big Data Research for Transforming Healthcare
Purpose
• Define knowledge model• Demonstrate nursing knowledge models
• Historical• Electronic
• Discuss the data and information required to support an electronic nursing knowledge model
Nursing Knowledge
Knowledge Translation: The exchange, synthesis and application of knowledge within a complex system.
Knowledge Transfer: A systematic approach to capture, collect and share tacit knowledge in order for it to become explicit knowledge.
Knowledge Model: The capture of knowledge in an electronic reusable format for the purpose of preserving, improving, sharing, aggregating and reapplying it.
Knowledge Translation: The exchange, synthesis and application of knowledge within a complex system.
Knowledge Transfer: A systematic approach to capture, collect and share tacit knowledge in order for it to become explicit knowledge.
Knowledge Model: The capture of knowledge in an electronic reusable format for the purpose of preserving, improving, sharing, aggregating and reapplying it.
The Nursing Process
Nursing Informatics DIKW Framework
ANA, 2007
CAUSES
REASON FOR
REASON
FOR
Care Plan Relationships (Happy Path
Health Concern
[mood EVN]
Goal [mood GOL]
Outcome Observation [mood EVN]
Intervention [mood: INT/ RQO/ etc.]
[mood: EVN]
SUPP
ORT
S
Observation [mood EVN]
RELATES TO
RELATES TO
IS COMPONENT OF
EVALUATES
Storyboard Example• Joe is a 24 year-old male quadriplegic admitted
to an inpatient unit from his home. During admission assessment, the nurse notes that he has no sensation from the shoulders down. He is confined to a wheelchair and requires two-person assist. His skin is occasionally moist. Joe reports that he is a “good eater” and is on a normal diet. The nurse completes the Braden Skin Scale score is 13. Further assessment by the nurse reveals skin is intact with no pressure ulcers.
Hx. SubjectiveFindings
Setting
Assessment
Observations
CAUSES
REASON FOR
REASON
FOR
Simple Skin Assessment (Happy Path)
Health Concerns:Impaired mobilityRisk for alteration
in skin Integrity
Goal: No skin breakdown
Outcome Observation
Interventions: Turn q 4 hours
Assess skin q shift
SUPP
ORT
S
Observations:Decreased SensationLimited MobilityBraden scale = 13
RELATES TO
RELATES TO
IS COMPONENT OF
EVALUATES
Interoperability using the DIKW Framework
Data
Skin Assessment
class Skin Inspection Detail
Pressure Ulcer Risk Assessment Item
Skin Inspection
- skin color :Skin Color- skin moistness :Skin Moistness- skin temperature :Skin Temperature- skin turgor :Skin Turgor
«enumeration»Skin Color
normal for ethnic group ashen cyanotic flushed jaundiced mottled pale
«enumeration»Skin Turgor
good elasticity (normal) poor, decreased elasticity tenting = not found
«enumeration»Skin Temperature
cool warm (normal) cold hot
«enumeration»Skin Moistness
normal moist diaphoretic clammy
«enumeration»Skin Condition
dry extremely dry normal friable
Interoperability using the DIKW Framework
Data
Terminology Coding
12
Type Text Terminology Code Fully Specified NameQuestion Skin Moisture LOINC 39129-2 Moisture:Type:PT:Skin:Nom::
Value Diaphoretic SNOMED CT 52613005 excessive sweating (finding)
Value Moist SNOMED CT 16514006 moist skin (finding)
Value Clammy SNOMED CT 102598000 clammy skin (finding)
Question Skin Temperature LOINC 44968-6Temperature:Type:PT:Skin:Ord:Palp
Value Consistent With Body Temperature SNOMED CT 297977002 Skin normal temperature (finding)
Value Warm SNOMED CT 102599008 warm skin (finding)
Value Cool SNOMED CT 427733005 cool skin (finding)
Question Skin Turgor LOINC 39109-4 Turgor:Imp:PT:Skin:Nom::
Value Good Elasticity (normal) SNOMED CT 297956000 skin turgor normal (finding)
Value Decreased Elasticity (Poor) SNOMED CT 425244000 decreased skin turgor (finding)
Value Tenting SNOMED CT 297957009 stretched skin (finding)
Key drivers in enabling knowledge model
Knowledge exists in paper - Care plans Knowledge exists in vended EHRs (non standardized) Structured Nursing Knowledge beginning to emerge (e.g.
Pressure Ulcer Models) Standardized terminology
SNOMED CT, LOINC, RxNORM, CPT, ICD-10-CM HIT standards
HL7, ONC, PHIN-VADS, VSAC
NURSING IS VISIBLE
Vision of the FutureVision of the Future
In Health Information Systems
NURSING DATA ARE AVAILABLE
To Promote Evidence-Based, Quality Nursing Practice
Questions?
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