Watch your language

Recently on Twitter, a discussion started about basic nursing care. In fact, the discussion debated our use of adjectives to describe nursing care.  Adjectives such as ‘basic’, ‘fundamental’, ‘modern’, necessarily don’t add value, and in fact often adversely diminish the value and imagery of nursing.

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It’s now in our ‘psyche’ to articulate nursing care in such a way. A search on Google brings up over 4.6m entries with ‘basic nursing care’. There are over 3,000 scholarly articles on Google Scholar alone, Pubmed has 82 articles;  Amazon has an amazing 167 textbooks with this in the title or the description; Medline has 34 articles with all three words or under 300 with basic nursing.

So, I ask, where has this need to justify the “care” we as nurses give to patient come from? It I believe,  is now becoming a professional obsession in nursing to put some ill-fitting adjective to describe care, which no other care professions rarely, if ever does.

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While we are focussing on adjectives, we are ignoring the real value of true nursing ‘language’, or let’s be honest, the lack of standardised nursing terminology in England. Many will say we don’t need it, we have the ‘nursing process’, we have care plans. They miss the point.

Standardised [nursing] languages are now essential, especially as we are moving to Electronic Patient Records (EPRs) and electronic environments. The policy direction to move to paperless/ working means that these systems need to have agreed ways through common phrases and languages which ensures the agreed (standard) phrase is coded in such a way it can then be used by the system and understood by the system when it reports and provides information.

Through the documentation entered in the EPR not only will one be able to record what has happened and report from this, e.g. numbers of falls, numbers of patients with risk of patient harm factors such as breakdown in skin etc,. By adopting an agreed standardised nursing language or terminology, one can then see the relationships between ’cause and effect’, because not only are the activities ‘coded’, as those activities use the agreed terms which describe what nurses do, but also associates the ‘doing’ and the ‘doer’, against the outcome and impact of care given.

Nursing needs a standardised nursing language to ensure the voice of nursing is heard

Let’s put this into context. Take two ward areas, with similar patient profiles, same skill mix and numbers of beds. Ward X uses a standardised nursing language, such as NANDA, NIC or NOC these being just three of over 12 standardised nursing languages (SNL). Ward X records activity and complies with policy, Ward Y uses freetext in its system and also a poorer skill-mix of nurses despite having the same establishment as Ward X. The result is:

  • Ward Y’s outcomes are poorer than X
  • Ward X’s data is easier to capture and report on
  • Ward Y’s data is there but more time is needed to analyse and understand
  • Difficulty to associate cause and effect between the different outcomes
  • Ward X’s staff use the standardised nursing language to articulate the care they give, use nursing diagnosis and interventions & classification in a systematic logical and appropriate way
  • But if Ward Y’s healthcare assistant had been using a SNL the system would have known that s/he was one as ‘Healthcare assistant’ is a classification in SNOMED-CT 224577009

 Impact to the future

Most health systems uses some form of coding this supports both for payment & classification of demand, usage etc. In England ICD10 is the classification for health diagnosis and moving towards SNOMED-CT which is a broader based multi-professional and encompassing  classification where different coding systems use this commonly language, it also incorporates standardised nursing languages such as NANDA / NIC & NOC.

So why is this an issue? Now that systems are starting to use standardised languages, there are now APIs (interfaces)  coming out known as SMART APIs – in effect ensuring that interoperability between different systems is able to happen. This is done through the use of standardised nursing language so when one system talks about a Grade II pressure ulcer they other does too.

The risk is if nursing does not adopt a standardised nursing language, and all we talk about is basic, fundamental care; just using adjectives, we miss the opportunity for the future. Nursing is a science and being a science the profesison needs to apply the accpted standardised nursing language so that systems can aggregate the information by classification, describe, articulate and report so that information is provided to effective change and better outcomes

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