Why do we need standardised languages?
With the move to computerising health information, standardisation of health terminologies started with medical diagnosis. Such standardised terminologies expanded to allow for professional activities, interactions, interventions and other concepts of care delivery to be understood and used within the electronic environment, especially used in the electronic patient record.
With the policy approach in England to become paperless by 2018, the drive for EPRs is growing exponentially. As such there is now a need to use standardised terminologies to capture information in a way, which is meaningful and reportable.
Fundamentally, Dame June Clark & Professor Norma Lang emphasized the importance of standardised nursing terminology and taxonomy. Furthermore, Clark and Lang stated that, “If you can’t name it, you can not 1) Control, 2) Finance, 3) Research, 4) Teach, and 5) Put in policy. [i]
What is a Nursing language?
Nursing languages, are in effect concepts of care that describes the work that nurses do and the impact of that work. As such, nursing languages allow for:
- Nursing diagnosis, i.e. problems that affect the person living a normal life or function as best they can, for example risk of developing a pressure ulcer
- Nursing interventions such as assessment, care delivered and other elements such as education, support & counselling. An example would be Repositioning of the patient, assessment of fragile skin, education why repositioning is necessary
- Nursing outcomes the aspects of care which nursing directly contributes to, such as relief of pain, prevention of pressure ulcer development.
As we further develop nursing documentation, care plans, integrated pathways of care which will be captured electronically, using a nursing language allows of these concepts to be analysed, used to facilitate resource requirements and identify trends.
What is a Standardised Nursing Language?
A standardised nursing language takes the language nursing use in effect to describe what they are doing. It allows to use agreed terms which describe:
- Nursing assessments,
- Administration of medication, wound care and other nursing interventions & procedures
- Coordinate & manage care
- Deliver care
- Capture data to support research
- Describe nursing outcomes
It captures it in a standardised way and then ‘machine’ codes it so that it can be used for further purposes.
Internationally there are a number of specific nursing languages or terminologies that code the phrase in a way that allows information to be used to understand what happens, data reporting, resource implications and enable us to articulate nursing in ac and standardised way. They support education, research and can be mapped to evidence based work.
Because nursing is international, and the US & North America has led the journey, many evolved from there, these include:
- NANDA International (NANDA‐ I)
• Nursing Interventions Classification (NIC)
• Nursing Outcomes Classification (NOC)
• Clinical Care Classification System (CCC)
• The Omaha System
• Perioperative Nursing Data Set (PNDS)
• International Classification for Nursing Practice (ICNP)
• Logical Observation Identifiers Names and Codes (LOINC)
• Nursing Minimum Data Sets (NMDS)
• Nursing Management Minimum Data Sets (NMMDS)
• ABC Codes
As well as nursing languages there are standardised nomenclature that encompass many of the above to have a uniform language. One of the main ones in use in the UK is:
- Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT)
As technology advances there are other ways of capturing information outside of standardised terminologies, by using artificial intelligence to ‘read’ both structured and unstructured information in electron patient records, using semantic searching will allow enhanced flexibility. This while not new is emerging in the UK. Such approached are often called natural language processing will emerge as the next way to understand what [nursing] is doing. Until then we have to consider do we need a generic standardised language in care e.g. SNOMED-CT or a specific standardised nursing language. Whichever approach, the fact remains, without a way to capture what nursing is, we truly will not be able to articulate robustly what nursing is doing and risk loosing resources and influences the wider health agenda.
[i] Clark, J., & Lang, N.M. (1992). Nursing’s next advance: An international classification of nursing practice. International Nursing Review, 39, 109-111
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