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Lee JY, Park J, Choi H, Oh EG. Nursing Variables Predicting Readmissions in Patients With a High Risk: A Scoping Review. Comput Inform Nurs 2024:00024665-990000000-00213. [PMID: 39093059 DOI: 10.1097/cin.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Unplanned readmission endangers patient safety and increases unnecessary healthcare expenditure. Identifying nursing variables that predict patient readmissions can aid nurses in providing timely nursing interventions that help patients avoid readmission after discharge. We aimed to provide an overview of the nursing variables predicting readmission of patients with a high risk. The authors searched five databases-PubMed, CINAHL, EMBASE, Cochrane Library, and Scopus-for publications from inception to April 2023. Search terms included "readmission" and "nursing records." Eight studies were included for review. Nursing variables were classified into three categories-specifically, nursing assessment, nursing diagnosis, and nursing intervention. The nursing assessment category comprised 75% of the nursing variables; the proportions of the nursing diagnosis (25%) and nursing intervention categories (12.5%) were relatively low. Although most variables of the nursing assessment category focused on the patients' physical aspect, emotional and social aspects were also considered. This study demonstrated how nursing care contributes to patients' adverse outcomes. The findings can assist nurses in identifying the essential nursing assessment, diagnosis, and interventions, which should be provided from the time of patients' admission. This can mitigate preventable readmissions of patients with a high risk and facilitate their safe transition from an acute care setting to the community.
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Affiliation(s)
- Ji Yea Lee
- Author Affiliations: College of Nursing, Ajou University (Ms Lee), Suwon; and College of Nursing, Yonsei University (Ms Park and Dr Oh), Seoul, South Korea; College of Nursing, University of Illinois Chicago (Ms Choi); and Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University (Dr Oh); Yonsei Evidence-Based Nursing Centre of Korea: A Joanna Briggs Institute Affiliated Group (Dr Oh); and Institute for Innovation in Digital Healthcare, Yonsei University (Dr Oh), Seoul, South Korea
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Giap TTT, Park M, Bui LK. A comprehensive picture of using standardized nursing languages in long-term care systems: An integrative review. Int J Nurs Knowl 2024. [PMID: 38951041 DOI: 10.1111/2047-3095.12478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/30/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE This integrative review was conducted to provide a comprehensive picture of the use of standardized nursing languages (SNLs) in long-term care (LTC) systems. METHODS A comprehensive search was performed with terminological variants of "standardized terminology" and "long-term care" in eight electronic databases up to December 2021. Eligible studies were further identified by screening the reference lists of publications that met the inclusion criteria. The quality of the included studies was appraised using the Joanna Briggs Institute checklists. The study findings were organized into themes, which represent the focus of the study. FINDINGS Eighty-one publications that studied 12 SNLs in 17 countries are presented in this review. The Omaha System, NANDA-I, NIC, and NOC were the most common SNLs. Study foci were classified into five themes: evaluating the applicability of 10 SNLs (n = 22), characterizing nursing care using six SNLs (n = 16), developing core sets and tools based on seven SNLs (n = 15), documenting nursing care by using four SNLs (n = 14), and implementing intervention programs based on six SNLs (n = 14). CONCLUSIONS AND IMPLICATIONS FOR NURSING SNLs can be used for various purposes, and the available evidence supports the expansion of their utilization. Further studies should continue to identify gaps in the existing versions of SNLs to reflect the LTC nursing process in multiple societies. Additionally, the successful use of SNLs requires background knowledge of nursing informatics; therefore, preparation should be started in the nursing curriculum and continued in healthcare facilities, including LTC settings. These research findings will assist healthcare managers, researchers, and policymakers in the LTC field in effectively utilizing SNLs.
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Affiliation(s)
- Thi-Thanh-Tinh Giap
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Myonghwa Park
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Linh Khanh Bui
- College of Nursing and Midwifery, Griffith University, Brisbane, Australia
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Gligor LE, Rusu H, Domnariu CD, Müller-Staub M. The quality of nursing diagnoses, interventions, and outcomes in Romanian nursing documentation measured with the Q-DIO: A cross-sectional study. Int J Nurs Knowl 2024; 35:298-307. [PMID: 37691395 DOI: 10.1111/2047-3095.12446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
PURPOSE To assess the quality of the nursing process in Romania by evaluating nursing documentations with the quality of diagnoses, interventions and outcomes (Q-DIO) measurement instrument. METHODS A quantitative cross-sectional research design was employed using probabilistic sampling to select nursing documentations from a Romanian university hospital. The data were analyzed using the Q-DIO measurement instrument. FINDINGS Low quality levels of nursing process documentation were found. The Q-DIO subscale "Nursing diagnoses as process" (assessment) revealed a mean = 1.36 (SD 0.52) of maximum 2. Nurses collected lots of data but did not use these to state nursing diagnoses. "Nursing diagnoses as product" showed inaccurate diagnoses; mean = 1.24 (SD 0.48) of maximum 4. Nursing interventions were planned and documented, but their impact on the etiology of nursing diagnoses was low; mean = 0.76 (SD 0.18). The quality of nursing outcomes mean was 0.57 (SD 0.29). Nurses failed making connections between nursing assessment, diagnoses, interventions, and outcomes, and standardized nursing languages (SNLs) were not used. Statistically significant differences were found among all Q-DIO sub-concepts except for "Nursing diagnoses as process." CONCLUSIONS The documentation was structured but did not support the nursing process and its documentation, and SNLs were not implemented. There was an underutilization of data to state nursing diagnoses, and nursing interventions were mostly ineffective, leading to low nursing outcomes. IMPLICATIONS FOR NURSING PRACTICE This study provides new insights on the nursing process and its documentation in Romania and a baseline for future research. Policymakers, administrators, and educators should consider educating nurses to use standardized nursing languages and apply the Advanced Nursing Process.
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Affiliation(s)
- Laura Elena Gligor
- Faculty of Medicine, Dental Medicine and Nursing Department, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Horațiu Rusu
- Faculty of Social Sciences and Humanities, Centre for Social Research, Lucian Blaga University of Sibiu, Sibiu, Romania
- Romanian Academy, Research Institute for Quality of Life, Bucharest, Romania
| | - Carmen Daniela Domnariu
- Faculty of Medicine, Dental Medicine and Nursing Department, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Maria Müller-Staub
- Pflege PBS (Nursing Projects, Consulting, Research), Wil, Switzerland
- Research and Innovation Group in Health Care and Nursing, Hanze University, Groningen, The Netherlands
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Camilo Ferreira R, Dunn-Lopez K, Moorhead S, Zuchatti BV, Pereira PC, M Duran EC. Using interoperable nursing care data to improve outcomes for multiple traumas patients with Impaired Physical Mobility. J Clin Nurs 2024; 33:2562-2577. [PMID: 38597302 DOI: 10.1111/jocn.17140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/23/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
AIM(S) To demonstrate how interoperable nursing care data can be used by nurses to create a more holistic understanding of the healthcare needs of multiple traumas patients with Impaired Physical Mobility. By proposing and validating linkages for the nursing diagnosis of Impaired Physical Mobility in multiple trauma patients by mapping to the Nursing Outcomes Classification (NOC) and Nursing Interventions Classification (NIC) equivalent terms using free-text nursing documentation. DESIGN A descriptive cross-sectional design, combining quantitative analysis of interoperable data sets and the Kappa's coefficient score with qualitative insights from cross-mapping methodology and nursing professionals' consensus. METHODS Cross-mapping methodology was conducted in a Brazilian Level 1 Trauma Center using de-identified records of adult patients with a confirmed medical diagnosis of multiple traumas and Impaired Physical Mobility (a nursing diagnosis). The hospital nursing free-text records were mapped to NANDA-I, NIC, NOC and NNN linkages were identified. The data records were retrieved for admissions from September to October 2020 and involved medical and nursing records. Three expert nurses evaluated the cross-mapping and linkage results using a 4-point Likert-type scale and Kappa's coefficient. RESULTS The de-identified records of 44 patients were evaluated and then were mapped to three NOCs related to nurses care planning: (0001) Endurance; (0204) Immobility Consequences: Physiological, and (0208) Mobility and 13 interventions and 32 interrelated activities: (6486) Environmental Management: Safety; (0840) Positioning; (3200) Aspiration Precautions; (1400) Pain Management; (0940) Traction/Immobilization Care; (3540) Pressure Ulcer Prevention; (3584) Skincare: Topical Treatment; (1100) Nutrition Management; (3660) Wound Care; (1804) Self-Care Assistance: Toileting; (1801) Self-Care Assistance: Bathing/Hygiene; (4130) Fluid Monitoring; and (4200) Intravenous Therapy. The final version of the constructed NNN Linkages identified 37 NOCs and 41 NICs. CONCLUSION These valid NNN linkages for patients with multiple traumas can serve as a valuable resource that enables nurses, who face multiple time constraints, to make informed decisions efficiently. This approach of using evidence-based linkages like the one developed in this research holds high potential for improving patient's safety and outcomes. NO PATIENT OR PUBLIC CONTRIBUTION In this study, there was no direct involvement of patients, service users, caregivers or public members in the design, conduct, analysis and interpretation of data or preparation of the manuscript. The study focused solely on analysing existing de-identified medical and nursing records to propose and validate linkages for nursing diagnoses.
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Affiliation(s)
- Raisa Camilo Ferreira
- School of Nursing, State University of Campinas, Campinas, SP, Brazil
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
- Coordination for the Improvement of Higher Education Personnel (CAPES), Campinas, SP, Brazil
| | - Karen Dunn-Lopez
- Center for Nursing Classification & Clinical Effectiveness, College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Sue Moorhead
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Lövestam E, Orrevall Y, Boström AM. Individual and contextual factors in the Swedish Nutrition Care Process Terminology implementation. HEALTH INF MANAG J 2024; 53:94-103. [PMID: 36254749 PMCID: PMC11067422 DOI: 10.1177/18333583221133465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Standardised terminologies and classification systems play an increasingly important role in the continuous work towards high quality patient care. Currently, a standardised terminology for nutrition care, the Nutrition Care Process (NCP) Terminology (NCPT), is being implemented across the world, with terms for four steps: Nutrition Assessment (NA), Nutrition Diagnosis (ND), Nutrition Intervention (NI) and Nutrition Monitoring and Evaluation (NME). OBJECTIVE To explore associations between individual and contextual factors and implementation of a standardised NCPT among Swedish dietitians. METHOD A survey was completed by 226 dietitians, focussing on: (a) NCPT implementation level; (b) individual factors; and (c) contextual factors. Associations between these factors were explored through a two-block logistic regression analysis. RESULTS Contextual factors such as intention from management to implement the NCPT (OR (odds ratio) ND 15.0, 95% Confidence Interval (CI) 3.9-57.4, NME 3.7, 95% CI 1.1-13.0) and electronic health record (EHR) headings from the NCPT (OR NI 3.6, 95% CI 1.4-10.7, NME 3.8, 95% CI 1.1-11.5) were associated with higher implementation. A positive attitude towards the NCPT (model 1 OR ND 3.8, 95% CI 1.5-9.8, model 2 OR ND 5.0, 95% CI 1.4-17.8) was also associated with higher implementation, while other individual factors showed less association. CONCLUSION Contextual factors such as intention from management, EHR structure, and pre-defined terms and headings are key to implementation of a standardised terminology for nutrition and dietetic care. IMPLICATIONS FOR PRACTICE Clinical leadership and technological solutions should be considered key areas in future NCPT implementation strategies.
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Affiliation(s)
- Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Sweden
| | - Ylva Orrevall
- Department of Biosciences and Nutrition, Karolinska Institutet, Sweden
- Clinical Nutrition, Women’s Health and Allied Health Professionals, Karolinska University Hospital, Sweden
| | - Anne-Marie Boström
- Inflammation and Aging, Nursing Unit Aging, Karolinska University Hospital, Sweden
- Research and Development Unit, Stockholms Sjukhem, Sweden
- Department of Neurobiology, Care Science and Society, Division of Nursing, Karolinska Institutet, Sweden
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Laukvik LB, Lyngstad M, Rotegård AK, Fossum M. Utilizing nursing standards in electronic health records: A descriptive qualitative study. Int J Med Inform 2024; 184:105350. [PMID: 38306850 DOI: 10.1016/j.ijmedinf.2024.105350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The electronic health record (EHR), including standardized structures and languages, represents an important data source for nurses, to continually update their individual and shared perceptual understanding of clinical situations. Registered nurses' utilization of nursing standards, such as standardized nursing care plans and language in EHRs, has received little attention in the literature. Further research is needed to understand nurses' care planning and documentation practice. AIMS This study aimed to describe the experiences and perceptions of nurses' EHR documentation practices utilizing standardized nursing care plans including standardized nursing language, in the daily documentation of nursing care for patients living in special dementia-care units in nursing homes in Norway. METHODS A descriptive qualitative study was conducted between April and November 2021 among registered nurses working in special dementia care units in Norwegian nursing homes. In-depth interviews were conducted, and data was analyzed utilizing reflexive thematic analysis with a deductive orientation. Findings Four themes were generated from the analysis. First, the knowledge, skills, and attitude of system users were perceived to influence daily documentation practice. Second, management and organization of documentation work, internally and externally, influenced motivation and engagement in daily documentation processes. Third, usability issues of the EHR were perceived to limit the daily workflow and the nurses' information-needs. Last, nursing standards in the EHR were perceived to contribute to the development of documentation practices, supporting and stimulating ethical awareness, cognitive processes, and knowledge development. CONCLUSION Nurses and nursing leaders need to be continuously involved and engaged in EHR documentation to safeguard development and implementation of relevant nursing standards.
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Affiliation(s)
- Lene Baagøe Laukvik
- Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, PO Box 509, NO-4898 Grimstad, Norway.
| | | | | | - Mariann Fossum
- University of Agder, Department of Health and Nursing Science, Faculty of Health and Sport Sciences, Grimstad, Norway.
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Macieira TGR, Yao Y, Marcelle C, Mena N, Mino MM, Huynh TML, Chiampou C, Garcia AL, Montoya N, Sargent L, Keenan GM. Standardizing nursing data extracted from electronic health records for integration into a statewide clinical data research network. Int J Med Inform 2024; 183:105325. [PMID: 38176094 PMCID: PMC11018263 DOI: 10.1016/j.ijmedinf.2023.105325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/06/2023] [Accepted: 12/24/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Care plans documented by nurses in electronic health records (EHR) are a rich source of data to generate knowledge and measure the impact of nursing care. Unfortunately, there is a lack of integration of these data in clinical data research networks (CDRN) data trusts, due in large part to nursing care being documented with local vocabulary, resulting in non-standardized data. The absence of high-quality nursing care plan data in data trusts limits the investigation of interdisciplinary care aimed at improving patient outcomes. OBJECTIVE To map local nursing care plan terms for patients' problems and goals in the EHR of one large health system to the standardized nursing terminologies (SNTs), NANDA International (NANDA-I), and Nursing Outcomes Classification (NOC). METHODS We extracted local problems and goals used by nurses to document care plans from two hospitals. After removing duplicates, the terms were independently mapped to NANDA-I and NOC by five mappers. Four nurses who regularly use the local vocabulary validated the mapping. RESULTS 83% of local problem terms were mapped to NANDA-I labels and 93% of local goal terms were mapped to NOC labels. The nurses agreed with 95% of the mapping. Local terms not mapped to labels were mapped to the domains or classes of the respective terminologies. CONCLUSION Mapping local vocabularies used by nurses in EHRs to SNTs is a foundational step to making interoperable nursing data available for research and other secondary purposes in large data trusts. This study is the first phase of a larger project building, for the first time, a pipeline to standardize, harmonize, and integrate nursing care plan data from multiple Florida hospitals into the statewide CDRN OneFlorida+ Clinical Research Network data trust.
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Affiliation(s)
- Tamara G R Macieira
- Department of Family, Community and Health System Science, College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610, United States.
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610, United States
| | - Cassie Marcelle
- University of Florida Health Information Technology, 3011 SW Williston Rd, Gainesville, FL 32608, United States
| | - Nathan Mena
- University of Florida Health, 1600 SW Archer Rd, Gainesville, FL 32608, United States
| | - Mikayla M Mino
- College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610, United States
| | - Trieu M L Huynh
- College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610, United States
| | - Caitlin Chiampou
- College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610, United States
| | - Amanda L Garcia
- College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610, United States
| | - Noelle Montoya
- University of Florida Health, 1600 SW Archer Rd, Gainesville, FL 32608, United States
| | - Laura Sargent
- University of Florida Health, 1600 SW Archer Rd, Gainesville, FL 32608, United States
| | - Gail M Keenan
- Department of Family, Community and Health System Science, College of Nursing, University of Florida, PO Box 100197, Gainesville, FL 32610, United States
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Pu S, Peng H, Li Y, Huang X, Shi Y, Song C. Development of standardized nursing terminology for the process documentation of patients with chronic kidney disease. Front Nutr 2024; 11:1324606. [PMID: 38362106 PMCID: PMC10867265 DOI: 10.3389/fnut.2024.1324606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/17/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction European Nursing care Pathways (ENP) is a professional care language that utilizes software to map care processes and utilize the data for research purposes, process control, and personnel requirement calculations. However, there is a lack of internationally developed terminology systems and subset specifically designed for the nutritional management of CKD. The aim of this study was to create a subset of the standardized nursing terminology for nutrition management in patients with chronic kidney disease (CKD). Materials and methods According to the guidelines for subset development, four research steps were carried out: (i) Translation of version 3.2 of the ENP (chapter on kidney diseases) and understanding of the framework structure and coding rules of the ENP; (ii) Identification of relevant six-dimensional nursing terms; (iii) Creation of a framework for the subset; (iv) Review and validation by experts. Results A subset for CKD nutritional care was created as part of this project, comprising 630 terms, with 17 causal relationships related to nursing diagnoses, 115 symptoms, 31 causes, 34 goals/outcomes, 420 intervention specifications and 13 resources, including newly developed care terms. All terms within the subset have been created using a six-step maintenance procedure and a clinical standard pathway for nutrition management in the SAPIM mode. Implications for nursing practice This terminology subset can facilitate standardized care reports in CKD nutrition management, which is used to standardize nursing practice, quantify nursing, services, guidance on care decisions, promoting the exchange and use of CKD nutrition data and serve as a reference for the creation of standardized subset of nursing terminology in China.
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Affiliation(s)
- Shi Pu
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongmei Peng
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yang Li
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xia Huang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yu Shi
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Caiping Song
- President Office, The Second Affiliated Hospital of Army Medical University (Third Military Medical University), Chongqing, China
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Johnson EA, Dudding KM, Carrington JM. When to err is inhuman: An examination of the influence of artificial intelligence-driven nursing care on patient safety. Nurs Inq 2024; 31:e12583. [PMID: 37459179 DOI: 10.1111/nin.12583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 01/18/2024]
Abstract
Artificial intelligence, as a nonhuman entity, is increasingly used to inform, direct, or supplant nursing care and clinical decision-making. The boundaries between human- and nonhuman-driven nursing care are blurred with the advent of sensors, wearables, camera devices, and humanoid robots at such an accelerated pace that the critical evaluation of its influence on patient safety has not been fully assessed. Since the pivotal release of To Err is Human, patient safety is being challenged by the dynamic healthcare environment like never before, with nursing at a critical juncture to steer the course of artificial intelligence integration in clinical decision-making. This paper presents an overview of artificial intelligence and its application in healthcare and highlights the implications which affect nursing as a profession, including perspectives on nursing education and training recommendations. The legal and policy challenges which emerge when artificial intelligence influences the risk of clinical errors and safety issues are discussed.
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Affiliation(s)
- Elizabeth A Johnson
- Mark & Robyn Jones College of Nursing, Montana State University, Bozeman, Montana, USA
| | - Katherine M Dudding
- Department of Family, Community, and Health Systems, UAB School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jane M Carrington
- Department of Family, Community and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA
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Martin CL, Austin RR, Alexander S, Britt-Lalich M, Lee K, Monsen KA. Discovering Patterns in the Corpus of Omaha System Evidence-Based Guidelines: A Descriptive Visualization Analysis. Comput Inform Nurs 2024; 42:1-10. [PMID: 38194509 DOI: 10.1097/cin.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Christie L Martin
- Author Affiliations: School of Nursing, University of Minnesota (Drs Martin, Austin, and Monsen, and Ms Britt-Lalich), Minneapolis; College of Nursing, The University of Alabama in Huntsville (Dr Alexander); and University of Missouri (Dr Lee), Columbia
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Wagner CM, Jensen GA, Lopes CT, Mcmullan Moreno EA, Deboer E, Dunn Lopez K. Removing the roadblocks to promoting health equity: finding the social determinants of health addressed in standardized nursing classifications. J Am Med Inform Assoc 2023; 30:1868-1877. [PMID: 37328444 PMCID: PMC10586041 DOI: 10.1093/jamia/ocad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023] Open
Abstract
Providing 80% of healthcare worldwide, nurses focus on physiologic and psychosocial aspects of health, which incorporate social determinants of health (SDOH). Recognizing their important role in SDOH, nurse informatics scholars included standardized measurable terms that identify and treat issues with SDOH in their classification systems, which have been readily available for over 5 decades. In this Perspective, we assert these currently underutilized nursing classifications would add value to health outcomes and healthcare, and to the goal of decreasing disparities. To illustrate this, we mapped 3 rigorously developed and linked classifications: NANDA International (NANDA-I), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) called NNN (NANDA-I, NIC, NOC), to 5 Healthy People 2030 SDOH domains/objectives, revealing the comprehensiveness, usefulness, and value of these classifications. We found that all domains/objectives were addressed and NNN terms often mapped to multiple domains/objectives. Since SDOH, corresponding interventions and measurable outcomes are easily found in standardized nursing classifications (SNCs), more incorporation of SNCs into electronic health records should be occurring, and projects addressing SDOHs should integrate SNCs like NNN into their ongoing work.
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Affiliation(s)
- Cheryl Marie Wagner
- Nursing Interventions Classification, College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Gwenneth A Jensen
- Division of Nursing, Sanford Health System, Sioux Falls, South Dakota, USA
| | - Camila Takáo Lopes
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Erica Deboer
- Division of Nursing, Sanford Health System, Sioux Falls, South Dakota, USA
| | - Karen Dunn Lopez
- Center for Nursing Classification and Clinical Effectiveness, College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Dunn Lopez K, Heermann Langford L, Kennedy R, McCormick K, Delaney CW, Alexander G, Englebright J, Carroll WM, Monsen KA. Future advancement of health care through standardized nursing terminologies: reflections from a Friends of the National Library of Medicine workshop honoring Virginia K. Saba. J Am Med Inform Assoc 2023; 30:1878-1884. [PMID: 37553233 PMCID: PMC10586049 DOI: 10.1093/jamia/ocad156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 07/22/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVE To honor the legacy of nursing informatics pioneer and visionary, Dr. Virginia Saba, the Friends of the National Library of Medicine convened a group of international experts to reflect on Dr. Saba's contributions to nursing standardized nursing terminologies. PROCESS Experts led a day-and-a-half virtual update on nursing's sustained and rigorous efforts to develop and use valid, reliable, and computable standardized nursing terminologies over the past 5 decades. Over the course of the workshop, policymakers, industry leaders, and scholars discussed the successful use of standardized nursing terminologies, the potential for expanded use of these vetted tools to advance healthcare, and future needs and opportunities. In this article, we elaborate on this vision and key recommendations for continued and expanded adoption and use of standardized nursing terminologies across settings and systems with the goal of generating new knowledge that improves health. CONCLUSION Much of the promise that the original creators of standardized nursing terminologies envisioned has been achieved. Secondary analysis of clinical data using these terminologies has repeatedly demonstrated the value of nursing and nursing's data. With increased and widespread adoption, these achievements can be replicated across settings and systems.
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Affiliation(s)
- Karen Dunn Lopez
- Division of Acute and Critical Care, The University of Iowa, College of Nursing, Iowa City, IA, USA
| | | | | | | | | | - Greg Alexander
- Columbia University, School of Nursing, New York, NY, USA
| | | | - Whende M Carroll
- Healthcare Information Management and Systems Society (HIMSS), Chicago, IL, USA
| | - Karen A Monsen
- University of Minnesota School of Nursing, Minneapolis, MN, USA
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Monsen KA, Heermann L, Dunn-Lopez K. FHIR-up! Advancing knowledge from clinical data through application of standardized nursing terminologies within HL7® FHIR®. J Am Med Inform Assoc 2023; 30:1858-1864. [PMID: 37428893 PMCID: PMC10586043 DOI: 10.1093/jamia/ocad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
Health Level 7®'s (HL7) Fast Healthcare Interoperability Resources® (FHIR®) is leading new efforts to make data available to healthcare clinicians, administrators, and leaders. Standardized nursing terminologies were developed to enable nursing's voice and perspective to be visible within the healthcare data ecosystem. The use of these SNTs has been shown to improve care quality and outcomes, and to provide data for knowledge discovery. The role of SNTs in describing assessments and interventions and measuring outcomes is unique in health care, and synergistic with the purpose and goals of FHIR. FHIR acknowledges nursing as a discipline of interest and yet the use of SNTs within the FHIR ecosystem is rare. The purpose of this article is to describe FHIR, SNTs, and the potential for synergy in the use of SNTs with FHIR. Toward improving understanding how FHIR works to transport and store knowledge and how SNTs work to convey meaning, we provide a framework and examples of SNTs and their coding for use within FHIR solutions. Finally, we offer recommendations for the next steps to advance FHIR-SNT collaboration. Such collaboration will advance both nursing specifically and health care in general, and most importantly, improve population health.
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Affiliation(s)
- Karen A Monsen
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Laura Heermann
- Logica, Salt Lake City, Utah, USA
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
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Cho I, Cho J, Hong JH, Choe WS, Shin H. Utilizing standardized nursing terminologies in implementing an AI-powered fall-prevention tool to improve patient outcomes: a multihospital study. J Am Med Inform Assoc 2023; 30:1826-1836. [PMID: 37507147 PMCID: PMC10586045 DOI: 10.1093/jamia/ocad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES Standardized nursing terminologies (SNTs) are necessary to ensure consistent knowledge expression and compare the effectiveness of nursing practice across settings. This study investigated whether SNTs can support semantic interoperability and outcoming tracking over time by implementing an AI-powered CDS tool for fall prevention across multiple EMR systems. MATERIALS AND METHODS The study involved 3 tertiary academic hospitals and 1 public hospital with different EMR systems and nursing terms, and employed an AI-powered CDS tool that determines the fall risk within the next hour (prediction model) and recommends tailored care plans (CDS functions; represented by SNTs). The prediction model was mapped to local data elements and optimized using local data sets. The local nursing statements in CDS functions were mapped using an ICNP-based inpatient fall-prevention catalog. Four implementation models were compared, and patient outcomes and nursing activities were observed longitudinally at one site. RESULTS The postimplementation approach was practical for disseminating the AI-powered CDS tool for nursing. The 4 hospitals successfully implemented prediction models with little performance variation; the AUROCs were 0.8051-0.9581. The nursing process data contributed markedly to fall-risk predictions. The local nursing statements on preventing falls covered 48.0%-86.7% of statements. There was no significant longitudinal decrease in the fall rate (P = .160, 95% CI = -1.21 to 0.21 per 1000 hospital days), but rates of interventions provided by nurses were notably increased. CONCLUSION SNTs contributed to achieving semantic interoperability among multiple EMR systems to disseminate AI-powered CDS tools and automatically track nursing and patient outcomes.
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Affiliation(s)
- Insook Cho
- Nursing Department, Inha University, Incheon, Republic of Korea
- Division of General Internal Medicine, The Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Jiseon Cho
- Department of Nursing, National Health Insurance Service Ilsan Hospital, Gyeonggi-do, Republic of Korea
| | - Jeong Hee Hong
- Department of Nursing, Samsung Medical Center, Seoul, Republic of Korea
| | - Wha Suk Choe
- Department of Nursing, Inha University Hospital, Incheon, Republic of Korea
| | - HyeKyeong Shin
- Graduate School, Nursing Department, Inha University, Incheon, Republic of Korea
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Peltonen LM, O'Connor S, Conway A, Cook R, Currie LM, Goossen W, Hardiker NR, Kinnunen UM, Ronquillo CE, Topaz M, Rotegård AK. Nursing Informatics' Contribution to One Health. Yearb Med Inform 2023; 32:65-75. [PMID: 38147850 PMCID: PMC10751119 DOI: 10.1055/s-0043-1768738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
OBJECTIVES To summarise contemporary knowledge in nursing informatics related to education, practice, governance and research in advancing One Health. METHODS This descriptive study combined a theoretical and an empirical approach. Published literature on recent advancements and areas of interest in nursing informatics was explored. In addition, empirical data from International Medical Informatics Association (IMIA) Nursing Informatics (NI) society reports were extracted and categorised into key areas regarding needs, established activities, issues under development and items not current. RESULTS A total of 1,772 references were identified through bibliographic database searches. After screening and assessment for eligibility, 146 articles were included in the review. Three topics were identified for each key area: 1) education: "building basic nursing informatics competence", "interdisciplinary and interprofessional competence" and "supporting educators competence"; 2) practice: "digital nursing and patient care", "evidence for timely issues in practice" and "patient-centred safe care"; 3) governance: "information systems in healthcare", "standardised documentation in clinical context" and "concepts and interoperability", and 4) research: "informatics literacy and competence", "leadership and management", and "electronic documentation of care". 17 reports from society members were included. The data showed overlap with the literature, but also highlighted needs for further work, including more strategies, methods and competence in nursing informatics to support One Health. CONCLUSIONS Considering the results of this study, from the literature nursing informatics would appear to have a significant contribution to make to One Health across settings. Future work is needed for international guidelines on roles and policies as well as knowledge sharing.
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Affiliation(s)
- Laura-Maria Peltonen
- Department of Nursing Science, University of Turku and Turku University Hospital, Finland
| | - Siobhan O'Connor
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester, UK
| | - Aaron Conway
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada
| | - Robyn Cook
- Epsilon Informatics Ltd, United Kingdom and Australia
| | - Leanne M. Currie
- Leanne M. Currie, School of Nursing, University of British Columbia, Canada
| | | | | | - Ulla-Mari Kinnunen
- Department of Health and Social Management, University of Eastern Finland, Finland
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Chae S, Oh H, Da Costa Ferreira Oberfrank N, Schulman-Green D, Moorhead S, Swanson EA. Linking nursing outcomes classification to the self- and family management framework. J Adv Nurs 2023; 79:832-849. [PMID: 36424724 PMCID: PMC10099907 DOI: 10.1111/jan.15503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/09/2022] [Accepted: 10/01/2022] [Indexed: 11/27/2022]
Abstract
AIM Establish linkages between components of the Self- and Family Management Framework and outcomes of the Nursing Outcomes Classification to evaluate the comprehensiveness of outcomes addressing self- and family management in the Nursing Outcomes Classification. DESIGN Descriptive study. METHODS Experts conducted a six-step process to establish linkages: (1) preliminary mapping of all relevant nursing outcomes to the framework; (2) development of checklists for team members serving as 'identifiers' and 'reviewers'; (3) mapping all relevant nursing outcomes to the framework; (4) final agreement on mapped outcomes; (5) establishment of inter-rater reliability; and (6) discussion of findings with authors of the Self- and Family Management Framework. RESULTS Three hundred and sixty-three nursing outcomes were identified as related to the management of chronic disease across all components of the framework: outcomes related to patient self-management (n = 336), family functioning (n = 16) and family caregivers (n = 11). CONCLUSION The Nursing Outcomes Classification outcomes comprehensively address self-management, and, less so, family functioning, and caregivers. IMPLICATIONS Established linkages can be used by nurses to track and support patient and family management outcomes across the care continuum. PATIENT OR PUBLIC CONTRIBUTION Linking standardized nursing outcomes to the Self- and Family Management Framework can assist in goal setting and measurement of nursing care during chronic disease management. This work can help describe to funders, policy makers and others invested in health care reform the specific contributions of nurses to self- and family management of chronic disease. IMPACT This paper demonstrates the linkages between components of the Self- and Family Management Framework and Nursing Outcomes Classification outcomes. The results of this study offer the opportunity to quantify the impact of nursing care and enhance nursing practice for patients with chronic conditions as well as contribute to developing Nursing Outcomes Classification outcomes that consider self-management processes.
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Affiliation(s)
- Sena Chae
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Hyunkyoung Oh
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Dena Schulman-Green
- New York University, Rory Meyers College of Nursing, New York, New York, USA
| | - Sue Moorhead
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
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Tomotaki A, Iwamoto T, Yokota S. Research Types and New Trends on the Omaha System Published From 2012 to 2019: A Scoping Review. Comput Inform Nurs 2022; 40:531-537. [PMID: 35929744 DOI: 10.1097/cin.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Omaha System is a popular and standard term used in community health. This scoping review aimed to update the research types and identify new usage trends for the Omaha System through articles published between 2012 and 2019. The bibliography databases PubMed, CINAHL, Scopus, PsycInfo, Ovid, and ICHUSHI and the Omaha System's Web site were used to search for publications. Research articles published between 2012 and 2019 that included "Omaha System" in the title or abstract and were written in English or Japanese were included in this review. After excluding duplicate articles, 305 articles were screened and 82 were included in our analysis. There was a median of 10.3 articles per year. The percentages for each type of use of the Omaha System to "analyze client problem," "analyze clinical process," "analyze client outcomes," and "advanced classification research" were 18.3%, 12.2%, 23.2%, and 4.9%, respectively. The reclassification of the type "others" (41.5%) included "use the Omaha System data for assessment for other than clients," "use the Omaha System data as structured data," "encode by the Omaha System code," "adopt the OS framework," "clinical information system," and "literature review." This newly reclassified category will help capture future research trends using the Omaha System.
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Affiliation(s)
- Ai Tomotaki
- Author Affiliations: Informatics, National College of Nursing (Dr Tomotaki), Japan; WyL. Inc and Omaha System Japan (Mr Iwamoto); and Faculty of Medicine, The University of Tokyo, Tokyo, Japan (Dr Yokota)
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Dos Santos FC, Macieira TG, Yao Y, Hunter S, Madandola OO, Cho H, Bjarnadottir RI, Dunn Lopez K, Wilkie DJ, Keenan GM. Spiritual Interventions Delivered by Nurses to Address Patients' Needs in Hospitals or Long-Term Care Facilities: A Systematic Review. J Palliat Med 2022; 25:662-677. [PMID: 35085471 PMCID: PMC8982123 DOI: 10.1089/jpm.2021.0578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction: Despite increasing evidence of the benefits of spiritual care and nurses' efforts to incorporate spiritual interventions into palliative care and clinical practice, the role of spirituality is not well understood and implemented. There are divergent meanings and practices within and across countries. Understanding the delivery of spiritual interventions may lead to improved patient outcomes. Aim: We conducted a systematic review to characterize spiritual interventions delivered by nurses and targeted outcomes for patients in hospitals or assisted long-term care facilities. Methodology: The systematic review was developed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and a quality assessment was performed. Our protocol was registered on PROSPERO (Registration No. CRD42020197325). The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to June 2020. Results: We screened a total of 1005 abstracts and identified 16 experimental and quasi-experimental studies of spiritual interventions delivered by nurses to individuals receiving palliative care or targeted at chronic conditions, such as advanced cancer diseases. Ten studies examined existential interventions (e.g., spiritual history, spiritual pain assessment, touch, and psychospiritual interventions), two examined religious interventions (e.g., prayer), and four investigated mixed interventions (e.g., active listening, presence, and connectedness with the sacred, nature, and art). Patient outcomes associated with the delivery of spiritual interventions included spiritual well-being, anxiety, and depression. Conclusion: Spiritual interventions varied with the organizational culture of institutions, patients' beliefs, and target outcomes. Studies showed that spiritual interventions are associated with improved psychological and spiritual patient outcomes. The studies' different methodological approaches and the lack of detail made it challenging to compare, replicate, and validate the applicability and circumstances under which the interventions are effective. Further studies utilizing rigorous methods with operationalized definitions of spiritual nursing care are recommended.
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Affiliation(s)
- Fabiana Cristina Dos Santos
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Tamara G.R. Macieira
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Samantha Hunter
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Olatunde O. Madandola
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Hwayoung Cho
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Ragnhildur I. Bjarnadottir
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | | | - Diana J. Wilkie
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Gail M. Keenan
- Department of Family, Community, and Health System Science, College of Nursing, University of Florida, Gainesville, Florida, USA
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Macieira TGR, Yao Y, Keenan GM. Use of machine learning to transform complex standardized nursing care plan data into meaningful research variables: a palliative care exemplar. J Am Med Inform Assoc 2021; 28:2695-2701. [PMID: 34569603 DOI: 10.1093/jamia/ocab205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this article was to describe a novel methodology for transforming complex nursing care plan data into meaningful variables to assess the impact of nursing care. We extracted standardized care plan data for older adults from the electronic health records of 4 hospitals. We created a palliative care framework with 8 categories. A subset of the data was manually classified under the framework, which was then used to train random forest machine learning algorithms that performed automated classification. Two expert raters achieved a 78% agreement rate. Random forest classifiers trained using the expert consensus achieved accuracy (agreement with consensus) between 77% and 89%. The best classifier was utilized for the automated classification of the remaining data. Utilizing machine learning reduces the cost of transforming raw data into representative constructs that can be used in research and practice to understand the essence of nursing specialty care, such as palliative care.
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Affiliation(s)
- Tamara G R Macieira
- Department of Family, Community and Health Systems Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, USA
| | - Gail M Keenan
- Department of Family, Community and Health Systems Science, College of Nursing, University of Florida, Gainesville, Florida, USA
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Zhang X, Li Y, Li H, Zhao Y, Ma D, Xie Z, Sun J. Application of the OMAHA System in the education of nursing students: A systematic review and narrative synthesis. Nurse Educ Pract 2021; 57:103221. [PMID: 34649129 DOI: 10.1016/j.nepr.2021.103221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 09/14/2021] [Accepted: 09/26/2021] [Indexed: 11/26/2022]
Abstract
AIM The aim of this systematic review was to synthesize evidence on the application of the Omaha System in the education of nursing students and to provide advice for educators to apply the Omaha System to practice and research effectively and meaningfully. BACKGROUND It is a necessary part of nursing education to provide students with informatics experience. The Omaha System is a standardized nursing terminology designed to enhance practice, documentation, and information management. DESIGN A systematic review and narrative synthesis. METHODS Studies from eight databases (PubMed, Web of Science, Embase, CINAHL, PsycINFO, China Biology Medicine disc, CNKI, Wanfang Data) were systematically retrieved. Twenty-three articles were found and synthesized. RESULTS Existing studies showed that the Omaha System was mainly applied in student community practice as a tool for guiding practice and collecting information, and the practice data were used by educators to analyse the outcomes of nursing education. Recently, the Omaha System was introduced into the classroom environment and achieved positive results in terms of teaching. Students' feedback on the use of the Omaha System was generally positive. CONCLUSIONS The Omaha System can be an active teaching and learning tool for nursing education, and further research is needed to explore and realize its potential in the field of education.
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Affiliation(s)
- Xu Zhang
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
| | - Yijing Li
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
| | - Huanhuan Li
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
| | - Yingnan Zhao
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
| | - Dongfei Ma
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
| | - Zongting Xie
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
| | - Jiao Sun
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun 130021, Jilin, People's Republic of China.
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Jenkins ML. Health IT advances for the 21st century. J Am Assoc Nurse Pract 2021; 34:405-409. [PMID: 34014897 DOI: 10.1097/jxx.0000000000000613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT The United States is working toward a value-based health care system in which reimbursement will be based on quality outcomes rather than on Current Procedural Terminology payment codes. Health data will be more easily shared, and patients will have more control of their records. Health information technology advances in the federal 21st Century Cures Act follow earlier related legislation and regulation that moved clinical care and research forward. Policy analysis of the Cures Act is presented following the three phases of the Longest model (2010): formation, implementation, and modification. With the passage of the Cures Act and promulgation of its final rules, the formation phase is complete. The implementation phase has begun. Modification may occur, based on the evaluation of key deliverables over time. Advanced practice nurses are well-suited to the use of electronic tools to share data with patients and other providers. New competencies, tools, and infrastructure are needed for advanced practice nurses to fully participate in value-based health care. Full implementation of the 21st Century Cures Act with the use of coded concepts in standardized nursing terminologies will provide an ideal foundation for strong patient-centered care, population health, and reimbursement that takes advanced nursing practice into account.
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Affiliation(s)
- Melinda L Jenkins
- Nursing Informatics Specialty, School of Nursing, Rutgers University, Newark, New Jersey
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Fennelly O, Grogan L, Reed A, Hardiker NR. Use of standardized terminologies in clinical practice: A scoping review. Int J Med Inform 2021; 149:104431. [PMID: 33713915 DOI: 10.1016/j.ijmedinf.2021.104431] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/20/2021] [Accepted: 02/19/2021] [Indexed: 12/13/2022]
Abstract
AIM To explore the use and impact of standardized terminologies (STs) within nursing and midwifery practice. INTRODUCTION The standardization of clinical documentation creates a potential to optimize patient care and safety. Nurses and midwives, who represent the largest proportion of the healthcare workforce worldwide, have been using nursing-specific and multidisciplinary STs within electronic health records (EHRs) for decades. However, little is known regarding ST use and impact within clinical practice. METHODS A scoping review of the literature was conducted (2019) across PubMed, CINAHL, Embase and CENTRAL in collaboration with the Five Country Nursing and Midwifery Digital Leadership Group (DLG). Identified studies (n = 3547) were reviewed against a number of agreed criterion, and data were extracted from included studies. Studies were categorized and findings were reviewed by the DLG. RESULTS One hundred and eighty three studies met the inclusion criteria. These were conducted across 25 different countries and in various healthcare settings, utilising mainly nursing-specific (most commonly NANDA-I, NIC, NOC and the Omaha System) and less frequently local, multidisciplinary or medical STs (e.g., ICD). Within the studies, STs were evaluated in terms of Measurement properties, Usability, Documentation quality, Patient care, Knowledge generation, and Education (pre and post registration). As well as the ST content, the impact of the ST on practice depended on the healthcare setting, patient cohort, nursing experience, provision of education and support in using the ST, and usability of EHRs. CONCLUSION Employment of STs in clinical practice has the capability to improve communication, quality of care and interoperability, as well as facilitate value-based healthcare and knowledge generation. However, employment of several different STs and study heterogeneity renders it difficult to aggregate and generalize findings.
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Affiliation(s)
- Orna Fennelly
- Insight Centre for Data Analytics, University College Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - Loretto Grogan
- Office of the Nursing and Midwifery Services Director, Health Service Executive (HSE), Ireland.
| | - Angela Reed
- Northern Ireland Practice & Education Council for Nursing and Midwifery, Northern Ireland.
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Macieira TGR, Yao Y, Smith MB, Bian J, Wilkie DJ, Keenan GM. Nursing Care for Hospitalized Older Adults With and Without Cognitive Impairment. Nurs Res 2020; 69:116-126. [PMID: 31972847 PMCID: PMC7050380 DOI: 10.1097/nnr.0000000000000402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presence of cognitive impairment (CI) among hospitalized older adults (aged 85 years and older) could interfere with the identification and treatment of other important symptoms experienced by these patients. Little is known, however, about the nursing care provided to this group. Contrasting the nursing care provided to patients with and without CI may reveal important insights about symptom treatment in the CI population. OBJECTIVE The aim of this study was to examine the relationship of CI to nursing care provided and length of stay for hospitalized older adults using standardized nursing data retrieved from electronic health records. METHODS We conducted a comparative secondary data analysis. A data set of standardized nursing plan of care data retrieved from electronic health record data of nine units at four hospitals was analyzed. The plan of care data for this study were previously transformed into one of eight categories (family, well-being, mental comfort, physical comfort, mental, safety, functional, and physiological care). Fisher exact tests were used to compare the differences in the nursing care for hospitalized older adults with and without CI. Mixed-effects models were used to examine associations of patient's cognitive status and nursing care, and cognitive status and length of stay. RESULTS We identified 4,354 unique patients; 746 (17%) had CI. We observed that older adults with CI were less likely to receive physical comfort care than those without CI for seven of nine units. Older adults' cognitive status was associated with the delivery of mental comfort care. In addition, a worsening in cognitive status was associated with an increase in length of stay for older adults with CI. DISCUSSION Older adults with CI appeared to be undertreated for symptoms of pain when compared to those without CI across units. There is a need for further research to improve symptom recognition and management for this population. The presence of CI was associated with variation in nursing care provided and length of stay. Future studies that include the analysis of nursing data merged with elements stored in the electronic health record representing the contributions of other health professions are expected to provide additional insights into this gap.
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Affiliation(s)
- Tamara G R Macieira
- Tamara G. R. Macieira, PhD, BSN, is Postdoctoral Fellow, University of Florida College of Nursing, Gainesville. Yingwei Yao, PhD, is Research Associate Professor, Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville. Madison B. Smith, PhD, BSN, RN, is Diabetes Nurse Clinician, Department of Pediatrics, University of Florida College of Medicine, Division of Endocrinology, Gainesville. Jiang Bian, PhD, MS, is Associate Professor, Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville. Diana J. Wilkie, PhD, RN, FAAN, is Professor and Prairieview Trust-Earl and Margo Powers Endowed Professor, Department of Biobehavioral Nursing Science, University of Florida College of Nursing, and Director, Academic Center of Excellence in Palliative Care Research and Education, Gainesville, Florida. Gail M. Keenan, PhD, RN, FAAN, is Professor and Annabel Davis Jenks Endowed Chair for Teaching and Research in Clinical Nursing Excellence, Department of Family, Community and Health Systems Science, University of Florida College of Nursing, Gainesville
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Towards implementing SNOMED CT in nursing practice: A scoping review. Int J Med Inform 2020; 134:104035. [DOI: 10.1016/j.ijmedinf.2019.104035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/20/2019] [Accepted: 11/22/2019] [Indexed: 01/24/2023]
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