Nursing Language Research Articles

A Conceptual Model for Nursing Information

This Conceptual Model for Nursing Information describes the core activities of nursing, the collection of information about these activities, and argues that these activities must be described using standardized nursing languages. Relevant literature, both national and international, was reviewed and summarized. A maximum data set for nursing was developed. In the United Kingdom, a new and radical approach to the process of nursing is required; one that demonstrates that nursing is the decision-making that takes place in all core activities of nursing. Unless nurses have a clear view of what the profession requires from technological solutions for the recording of nursing activities, less than optimal solutions will be forced upon the profession.

Testing the Q-DIO as an Instrument to Measure the Documented Quality of Nursing Diagnoses, Interventions, and Outcomes

To describe pilot testing of Quality of Diagnoses, Interventions and Outcomes (Q-DIO), an instrument to measure quality of nursing documentation. Instrument testing was performed using a random, stratified sample of 60 nursing documentations representing hospital nursing with and without implementation of standardized nursing language (30 for both strata) in a Swiss General Acute Hospital. Internal consistency and intrarater and interrater reliabilities were tested. Through item analyses, the grades of difficulty and the discrimination validity of items were evaluated. Internal consistency of nursing diagnoses as process produced Cronbach's alpha .83; nursing diagnoses as product .98; nursing interventions .90; and nursing-sensitive patient outcomes .99. With Kappas of .95, the intrarater and interrater reliabilities were good. Criteria for the grades of difficulty of items and discrimination validity were well met. The results of this study suggest that Q-DIO is a reliable instrument to measure the documentation quality of nursing diagnoses, interventions, and outcomes. Further testing of Q-DIO in other settings is recommended.

Standardized Nursing Language: What Does It Mean for Nursing Practice?

Use of a standardized nursing language for documentation of nursing care is vital both to the nursing profession and to the bedside/direct care nurse. The purpose of this article is to provide examples of the usefulness of standardized languages to direct care/bedside nurses. Currently, the American Nurses Association has approved thirteen standardized languages that support nursing practice, only ten of which are considered languages specific to nursing care. The purpose of this article is to offer a definition of standardized language in nursing, to describe how standardized nursing languages are applied in the clinical setting, and to explain the benefits of standardizing nursing languages. These benefits include: better communication among nurses and other health care providers, increased visibility of nursing interventions, improved patient care, enhanced data collection to evaluate nursing care outcomes, greater adherence to standards of care, and facilitated assessment of nursing competency. Implications of standardized language for nursing education, research, and administration are also presented.

Utilizing the Perioperative Nursing Data Set in a Surgical Setting

The Perioperative Nursing Data Set (PNDS) is the standardized nursing language for documentation by perioperative nurses. The usage of this language is the essential framework for documentation standardization in the operating room. This article explores 2 specific patient outcomes and how the usage of the PNDS helps guide actions taken by registered nurses in the operating room. Furthermore, this article gives a brief overview of the history of the PNDS, and how this language helps improve nursing outcomes and promotes the profession of nursing.

Putting policy into practice: pre‐ and posttests of implementing standardized languages for nursing documentation

To describe the change in documentation of the nursing process in all inpatient wards in a 900-bed university hospital. Major research question was what are the differences between before and after implementation of documentation policy related to the steps of the nursing process? Implementation of standardized languages has been shown to be difficult to accomplish in clinical practice. Patients are the source of data and their conditions, responses and well-being should be reflected in the nursing record. As such, nursing documentation can create the premises for the development of new knowledge in nursing and the improvement of nursing performance and can provide data and information necessary for nursing researchers to evaluate the quality of interventions and participate in the formulation of healthcare policy. This study is part of longitudinal project to prepare nurses for electronic documentation within the interdisciplinary health record and to improve documentation of nursing using standardized languages. A cross-sectional study design was used: a pretest (n = 355 nursing records) for baseline status of nursing documentation, an intervention and a post-test (n = 349 nursing records) to obtain data on nursing documentation. The year-long intervention comprised planned work in groups, and educational and supporting efforts. A statistically significant improvement was found in the use of Functional Health Patterns for documentation of nursing assessment, NANDA for nursing diagnoses and Nursing Interventions Classification for nursing interventions in documentation of daily nursing care for inpatients. At all organizational levels intervention aimed at putting policy regarding documentation into clinical practice considerably improved daily use of standardized nursing languages. Relevance to clinical practice. Nurses need to use standardized language to document patient care data in the electronic health record and to demonstrate contributions to nursing care.

THE IMPORTANCE OF LANGUAGE FOR NURSING: DOES IT CONVEY COMMONALITY OF MEANING AND IS IT IMPORTANT TO DO SO

Objective: Language is the medium by which communication is both conveyed and received. To understand and communicate meaning it is necessary to examine the theoretical basis of word conceptualisation. The determinants of understanding language however are somewhat elusive and idiosyncratic by nature. This paper will examine briefly the development of language and how language is used in the health care setting, while recognising that nursing is an internationally recognised profession. Setting: In nursing, language is used to facilitate quality care and inform and educate recipients of that care. In today’s somewhat litigious society, it is essential that what is transmitted is commonly interpreted by nurses and patients alike. Questions are posed relating to an elitist language for nurses and its placement for communicating with other health care professionals. Primary argument: Through exploring language with a small group of nurses, this paper alludes to consumer expectations; how nurses use a common language; and where and when they move toward a more elitist communication. The paper examines consumer expectations of health care communication and how it facilitates consumer choice and the quality care agenda. Conclusion: Communication for the nursing profession poses a challenge as there are differing requirements for specific situations. Nurses acknowledge that language facilitates commonality of understanding and hence meaning. An elitist language when communicating with other health professionals does exist within specialist units, though where commonality of language ends and an elite language begins is difficult to determine. Language does elicit power and authority when educating and communicating with patients while proving difficult in the context of international global nursing requirements.

Building a personal health record from a nursing perspective

Objective A complex set of needs—increased accessibility to and interest in health information, more respect for patients’ rights, advanced information technologies, and pressure to seek cost-effective healthcare delivery—made the personal health record (PHR) necessary. Nursing, as essential to healthcare, must be represented in a PHR, but few studies have explored the nurse's role in the development and expansion of the PHR. The aim of this project was to design and develop an Internet-based PHR, IowaPHR, in order to demonstrate how nursing can be integrated into the PHR. Methods In addition to the common features of the PHR as detailed by previous studies, IowaPHR contains the following innovations: (1) the information embraces major community health concerns; (2) an interactive feature—the self-assessment and feedback field—was created by transforming a standardized nursing language into appropriate questions adjusted for consumer vocabulary level; and (3) a user-friendly interface was equipped with trends in health conditions and a diary function. This PHR was then evaluated by experts in terms of content, ease of navigation, time needed to complete tasks, ability to find desired information, and site presentation. Results In the evaluation of this PHR, experts assigned high scores to four items. Completion of the tasks took an average of 16.25 min. Conclusion Allowing self- or caregivers to observe health conditions through completion of the questions on our PHR will precisely address clinic visitors’ health problems, assist in planning interventions, and promote education of and empowerment for health care. This PHR will provide a new way for nursing informatics to enhance the capacity of nursing in consumer health and to make a difference in the larger context of health informatics.

Nursing Interventions Classification in Systematized Nomenclature of Medicine Clinical Terms

The Systemized Nomenclature of Medical Clinical Terms, or SNOMED-CT, was developed to create a comprehensive clinical healthcare reference terminology. Standardized nursing language concepts and terminologies recognized by the American Nurses Association have been added to SNOMED-CT and include the NANDA's Taxonomy II, NIC, NOC, the Omaha System, and CCC. The relationship link between terminologies and SNOMED-CT is provided in a mapping table, which identifies the source terminology. The purpose of this study is to examine the validity of the cross-mapping between the source system (NIC) and the target system (SNOMED-CT) using the methodology developed by Lu and colleagues to detect misassigned concepts. Knowledge representation concepts in the NIC and SNOMED-CT systems were compared using expert human judgment. Of 514 NIC concepts, 14 (2.7%) were identified as misassigned in SNOMED-CT. Two inappropriate representations of concepts were discovered in NIC. Results and recommendations were given to NIC and to SNOMED-CT.

Application of Orem's Self‐Care Deficit Theory and Standardized Nursing Languages in a Case Study of a Woman with Diabetes

This paper aims to illustrate the process of theory-based nursing practice by presenting a case study of a clinical nurse specialist's assessment and care of a woman with type 2 diabetes. Orem's self-care deficit theory and standardized nursing language, NANDA, NIC (Nursing Interventions Classification), and NOC (Nursing Outcomes Classification), guided assessment and the identification of outcomes and interventions related to the client's management of diabetes. Theory-based nursing care and standardized nursing language enhanced the client's ability to self-manage the chronic illness: diabetes. Nursing theory and standardized nursing language enhance communication among nurses and support a client's ability to self-manage a chronic illness.

Viewpoint: Use of King's Conceptual System, Nursing Informatics, and Nursing Classification Systems for Global Communication

To propose a common nursing language for communication among members of the nursing community worldwide. The Taxonomy of Nursing Practice, nursing informatics literature, King's Theory of Goal Attainment applied to the nursing process. Several milestones in nursing in the 20th century indicated the need for a universal language for nursing. The nursing process provides a method for synthesis of nursing data, information, and knowledge and is congruent with Imogene King's Theory of Goal Attainment. The authors advocate for a common nursing language (nursing classification and terminology systems) that would unify nurses worldwide. Supported by nursing theory and technology, global communication would be enhanced for nurses and the interdisciplinary teams of which they are a part. Use of Imogene King's Conceptual System and Theory of Goal Attainment and the nursing specialty of Nursing Informatics are examples of nursing theory and technology to frame global communication.

Elementary School Nurse Interventions: Attendance and Health Outcomes

Regular school attendance is a necessary part of the learning process; student absenteeism has a direct association with poor academic performance. School nurses can influence student attendance. This study describes the impact of school nurse interventions on student absenteeism and student health. A retrospective review of 240 randomly selected elementary student health folders and attendance records was conducted. School nurses were involved with 75% of high-absence students as compared to 66% of low-absence students; they were also more involved with students who had previously identified health conditions. There were no referrals to the school nurse for absenteeism and school nurse interventions were not targeted to attendance, despite 17% of students missing 11 or more school days. Nursing documentation was sparse and primarily task related. Few records contained entries of nursing diagnoses, interventions, or outcomes. Of the 134 interventions provided, only 56 (41.2%) had some information about the condition outcome, but it was insufficient to determine the effectiveness of nursing interventions. Furthermore, the record system did not support the collection of standard information for interventions or outcomes from which effectiveness could be determined. Recommendations include establishment of an attendance referral policy and improved documentation systems, including the use of standardized nursing language to demonstrate student outcomes.

Elementary School Nurse Interventions: Attendance and Health Outcomes

Regular school attendance is a necessary part of the learning process; student absenteeism has a direct association with poor academic performance. School nurses can influence student attendance. This study describes the impact of school nurse interventions on student absenteeism and student health. A retrospective review of 240 randomly selected elementary student health folders and attendance records was conducted. School nurses were involved with 75% of high-absence students as compared to 66% of low-absence students; they were also more involved with students who had previously identified health conditions. There were no referrals to the school nurse for absenteeism and school nurse interventions were not targeted to attendance, despite 17% of students missing 11 or more school days. Nursing documentation was sparse and primarily task related. Few records contained entries of nursing diagnoses, interventions, or outcomes. Of the 134 interventions provided, only 56 (41.2%) had some information about the condition outcome, but it was insufficient to determine the effectiveness of nursing interventions. Furthermore, the record system did not support the collection of standard information for interventions or outcomes from which effectiveness could be determined. Recommendations include establishment of an attendance referral policy and improved documentation systems, including the use of standardized nursing language to demonstrate student outcomes.

Patterns of Nursing Intervention Use Across 6 Days of Acute Care Hospitalization for Three Older Patient Populations

The purpose was to (a) identify frequently used nursing interventions, and (b) describe patterns of interventions used for each of the three patient groups. This secondary data analysis used data from an academic medical center where the Nursing Interventions Classification (NIC) was used to electronically document nursing care. Descriptive statistics describe the types, frequencies, and patterns of NIC interventions delivered to three older acute care populations. Four NIC treatments were frequently used in all patient groups. There were also NIC treatments and patterns of treatments that were unique to each group. Using standardized nursing language in electronic medical records (EMRs) enables data extraction and analysis. Data extracted from EMRs provides nurse administrators with a tool to guide decisions regarding nurse staffing, education, evaluation, and resource allocation.

A Cross‐Cultural Analysis of Dignified Dying

To describe the characteristics of dignified dying and other terminology nurses used to describe this phenomenon in Ethiopia, India, Kenya, and the United States (US). A cross-sectional descriptive survey with a convenience sample of nurses who cared for dying patients in Ethiopia (n=14), India (n=229), Kenya (n=36), and the US (n=281). Data were collected between 2002 and 2004. Nurses were recruited to complete the ICNP Dignified Dying survey, which consists of demographic information, 2 open-ended questions, and 14 questions about characteristics of dignified dying. The 14 characteristics on the dignified dying scale reliably measured dignified dying, with a Cronbach's alpha coefficient of .91. All characteristics were rated as representative of dignified dying, with content validity scores ranging from .62 to .77. Factor analysis yielded a two-factor solution, which accounted for 53% of the variance. Findings of this study contribute to the ongoing development of the International Classification of Nursing Practice (ICNP) regarding the nursing phenomenon of dignified dying. The ICNP a unified nursing language system, is used to promote and facilitate scholarly exchange among nurses across countries.

Clients Served and Services Provided by Academic Nurse-Managed Centers

Currently, no national database for academic nurse-managed centers (ANMCs) exists. These primary care services remain somewhat invisible in the policy and reimbursement areas of the American primary care system and, consequently, are undersupported. The purpose of this article is to describe client and service data from a national study of ANMCs. A cross-sectional survey design was used to collect data from ANMC directors. Usable data were received from 64 centers. ANMCs in the sample were relatively small in terms of patients and volume. Client and service profiles demonstrated variation, which seemed to be reflective of needs relative to populations and communities served. Nearly half of the ANMCs responding served clients of all ages, with services representing the breadth of primary care (i.e., health maintenance and management of minor acute and common chronic illnesses). Evidence of community-focused care was also noted. The reported use of standardized nursing language was low. Standardized medical taxonomies were more commonly used, with International Classification of Diseases, Ninth Revision being the most common. ANMCs provide a small but substantial amount of primary care services in communities served. Findings indicated a need for ANMCs to improve the documentation of their contributions through the use of standardized taxonomies to provide aggregated reporting for policy and research purposes.

The Benefits of Standardized Nursing Languages in Complex Adaptive Systems Such as Hospitals

Paperwork is a major source of frustration for hospital nurses and takes valuable time away from patient care. Studies indicate that nurses spend an estimated 13% to 28% of total shift time documenting. The growth in documentation requirements for nurses can, in part, be attributed to an exponential rise in health system complexity. Authors explore the documentation of nursing care plans from a complex adaptive system perspective and then analyze the utility of adopting a standardized nursing language. An actual case history of a nursing unit's attempt to reduce complexity, improve completion time, and increase staff satisfaction in care planning by adopting a standardized nursing language is provided to emphasize a practical application.

Nursing Interventions and Other Factors Associated With Discharge Disposition in Older Patients After Hip Fractures

The research on hip fractures has been focused on surgical procedures for hip fracture repair; little is known about the contribution of nursing interventions to outcomes. To investigate factors, including nursing interventions, associated with the discharge destination of an older patient population hospitalized for a fractured hip or an elective hip procedure. Nursing interventions used during the hospitalized period are identified. A design model composed of patient characteristics; clinical conditions; nursing unit characteristics; and medical, pharmacy, and nursing interventions related to the outcome of discharge disposition was tested using generalized estimating equations analysis. A total of 116 variables were examined in a sample of 569 hospitalizations from 524 patients aged 60 years and older admitted for treatment of a hip fracture or elective hip procedure in one tertiary care agency over a 4-year period. Data were obtained retrospectively from five clinical databases. Fifty-four percent of the population was discharged to a location other than to home. The predictors of discharge to home were a younger age, admission from home, and having a spouse, as well as receipt of intravenous solutions, diagnostic ultrasound, a lower number of medications, and moderate use of the nursing intervention of bathing. The identification of nursing interventions indicates that those who received routine nursing care for this condition returned home while those who required interventions for complications or prevention of complications were discharged to an institution. Using a standardized nursing language with the hospital's information system can provide nurses and others with information that demonstrates the contribution of nursing care to outcomes, including the outcome of discharge to home.

Using NANDA, NIC, and NOC (NNN) Language for Clinical Reasoning With the Outcome‐Present State‐Test (OPT) Model

To analyze the degree to which standardized nursing language was used by baccalaureate nursing students completing Outcome-Present State-Test (OPT) model worksheets in a clinical practicum. METHODS. A scoring instrument was developed and 100 worksheets were retrospectively analyzed. NANDA nursing diagnoses were correctly stated in 92% of the OPT models. Nursing Outcomes Classification (NOC) outcomes were explicitly stated in 22%, and implied in 72%. Interventions matched appropriate Nursing Interventions Classification (NIC) activities in 61%. NANDA, NIC, and NOC (NNN) language was used inconsistently by students in this sample. If NNN language is to advance nursing knowledge, its promotion, representation in curriculum development, and active use is necessary. Educational research is needed on the facilitators and barriers to NNN language use.

Nursing Diagnoses in a Brazilian Intensive Care Unit

To identify the nursing diagnoses and their most frequent related factors or risk factors in patients admitted to an intensive care unit (ICU). Descriptive cross-sectional study with information from 991 admissions to an ICU during a 6-month period. Sixteen nursing diagnoses resulting from hospitalization were most frequently identified; six had percentages greater than 40% with 29 related/risk factors. The resulting averages were 6.9 diagnoses per hospitalization and 1.2 related/risk factors per nursing diagnoses. The nursing diagnoses identified seemed to be common to the clinical practice of nursing and their fundamental related/risk factors to precise clinical judgment, thus providing a basis for interventions for a desired outcome. The findings have contributed to the development of the standardized nursing language usage in Brazilian nursing practices.

Promoting standardized nursing language using an electronic medical record system

Paper-based medical record systems are becoming obsolete with the advent of electronic medical record (EMR) systems. With EMRs, patient data can be accessed instantly, patients can be tracked intelligently, and safeguards can help prevent medical errors. By integrating a universal nursing language, such as the Perioperative Nursing Data Set (PNDS), into EMR systems, nurses can document the nursing care they give to patients. This allows nurses to show the value of their role in the OR, promote nursing, and explain how their actions help meet National Patient Safety Goals. The transition to an EMR system for Jackson Health System, Miami, is discussed, including integration of the PNDS into the EMR system.