1	Nursing Terminologies: An introduction Anne Casey Royal College of Nursing, UK Member, NHS Clinical Information Standards Board Member, SNOMED International Editorial Board
2	Overview Nursing and healthcare terminologies Requirements Current and future developments Messages: Many requirements, many terminologies: need for standards Collaboration in development How do you know which one is ‘fit for your purpose’?
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5	Terminologies in Context
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7	A clinical terminology…. Structured set of terms (labels) representing concepts relevant to clinical practice: concept representation May include definitions: clinical definitions e.g. NANDA defining characteristics semantic definitions to support use in computer systems May have additional features to support use in computer systems e.g. codes
8	Nursing Terminologies Agreed, defined, structured sets of terms which represent the phenomena of concern to nurses: patient conditions, states, behaviors and concerns nursing diagnoses nursing interventions outcomes of care.
9	Need for Nursing Terminologies 1. To be able to discuss, teach and research nursing 2. To share and compare information about practice: monitoring quality and developing new knowledge 3. To include nursing concepts in computer systems 4. To help ensure the visibility of nursing in health service data for planning, funding, policy etc. Communicating using a common language
10	Discussing, teaching, researching, sharing and comparing practice: Example Does distraction help children cope with procedural pain? What is procedural pain? How is it measured in children? What is coping? How is it measured in children? What is distraction? Does it include play preparation? Guided imagery? Hypnosis? REQUIREMENT: defined (paediatric) nursing diagnoses and interventions with validated measures
11	Planning, Funding & Policy: Example Does the ratio of qualified / unqualified nurses make a difference to patient outcomes? 2002 US study: Outcomes measured as incidence of adverse events such as diagnosis of pneumonia, urinary infection, DVT etc (ICD-9 coded). REQUIREMENT: 1. Classification (with definitions) of types of nurses 2. Classification of patient outcomes (not only adverse events?)
12	Terminology in Electronic Systems: 1 Small scale, local nursing record system also used to audit nursing practice. REQUIREMENT: Coded list of terms for patient problems / nursing diagnosis, interventions and outcomes Could be locally developed, based on existing terminologies such as NIC, ICNP
13	Terminology in Electronic Systems: 2 Facility-wide (national) multi-disciplinary records with electronic transfer of records and data transfer to national repositories REQUIREMENT Comprehensive, multi-disciplinary terminology, with interface and reference properties, mapped to classifications SNOMED Clinical Terms (www.snomed.org)
14	‘…structured…’ List Alphabetical list Hierarchical structure Multi-axial, hierarchical structure
15	Examples of structures Diagnoses listed by Gordon’s Functional Patterns Intervention administration of drug administration of insulin administration of aspirin
16	Semantic definition Used by terminologist, not by clinician Defines the concept according to its relationships with other concepts in the terminology Example: Administration of insulin Is_A Intervention
17	Examples of structures Diagnoses listed by Gordon’s Functional Patterns Intervention administration of drug administration of insulin administration of aspirin
18	Terminologies have different Content for different purposes
19	Terminologies have different Structures for different purposes
20	Some Existing Terminologies: International: WHO family of classifications (ICD, ICF, ICPC) ICNP SNOMED Clinical Terms US Nursing - in international use NANDA, NIC, NOC Omaha, Home Health Care Classification National nursing e.g. VIPS Sweden, Specialist / Local / Vendor terminologies within datasets, guidelines, systems etc
21	How do Datasets relate to terminologies? Dataset: two or more data items (field names and value types) selected for a purpose. The allowable value set may be specified as a particular terminology.
22	Current and future developments Maintenance and development of existing terminologies What are the gaps? Who should fill the gaps? How? Terminology standards
23	The Need for Standards Differences between individual clinical terminologies prevent direct comparison and exchange of information Hardiker et al, 2000 Comparability and Interoperability
24	The overall aim Good quality data and information that can be: shared - communicated with the meaning retained and understood by all (including the patient) compared - ‘like with like’ In order to: support effective, evidence-based care support management and financing influence policy
25	Terminology Standards in context
26	The terminology is a small piece!
27	Conclusions 1. Nursing language shares many common elements with other health care languages and with the everyday language of patients. 2. Formal nursing and clinical terminologies are essential tools for nursing practice, education, research and management. 3. Many different nursing terminologies exist to reflect the many requirements and the diverse nature of nursing. 4. Nursing must work collaboratively to identify gaps in terminology provision and focus developments to meet essential requirements.
28	Getting involved Awareness, dissemination, ACENDIO Education Research / testing Terminology development Terminology standards development and testing