Healthcare Informatics Theories and Policies
The paper explains the peculiarities of nursing terminologies utilization in the neonatal intensive care unit (NICU). The issues of accessibility, ubiquity, and urgency predispose the development of standardized terminology in the neonatal field of healthcare. On the way, American Nurse Association (ANA) serves the cornerstone of legislation and recognition of several terminologies that are commonly used in the nursing practice. In particular, North American Nursing Diagnosis Association International (NANDA-1), Nursing Intervention Classification (NIC), and Nursing Outcomes Classification (NOC) are the ones initiated for utilization in the neonatal intensive care unit (NICU). The terminologies are described to provide consistency in information and accessibility. Development of the languages should be provided by validation and concept assessment, cross-mapping, and feedbacks’ analysis. The meaningful use of the terminologies for operating electronic health records (HER) means the possibilities for interoperability and exchange of the information for computerized healthcare systems. The terminologies are found to contribute to the evidence-based practice. Altogether, the terminological field still requires to be unified to get the objective vision of the healthcare process.
Increasing demands for quality of healthcare reinforces the need for the permanent improvements of healthcare delivery and the information provided in the process. Nursing organizations in the U.S. have worked over several decades to generate professional vocabulary that will contribute to the significant use of healthcare informatics and its tools. Implementation of acknowledged modern nursing language in the healthcare informatics enables the system to be uniform, efficient, and understandable for all the members. Neonatal intensive care unit (NICU) is the one where valid and objective information distinguished with the help of the NANDA-1, NIC, and NOC terminologies can be determinant for neonates’ survival and adaptation. The direction toward holistic and evidence-based practice in NICU constitutes the background for broader implementation and further development of the standardized nursing languages.
Development of Terminologies
Documentation of treatment and outcomes of care serves the etalon for understanding the actions provided by healthcare staff. The Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009 has meant financial incentives for large-scale implementation of EHRs. The process, however, requires generation of consistent terminology. As a means, development of consistency suggests that information under codification with the help of specified terminology should correspond closely to the needs of NICU and parents. In particular, it should incorporate accessibility, ubiquity, longevity, and reusability. The issue of urgency shapes all the mentioned aspects while applied to the neonatal intensive care. Hence, using appropriate terminology while proceeding EHRs seems to be the only way positive outcomes and interventions.
ANA has become the primary authority body for juridical standardization of seven terminologies. Among them, NANDA-1 is considered to be the framework for nursing diagnoses in the form of domains and classes. NIC and NOC systems are developed for unifying interventions of the healthcare staff and the patient outcomes. All the terminologies are approved by the International Healthcare Community as the ones contributing to significant patient outcomes and enabling the interoperability of EHRs.
NANDA-1, NIC, and NOC terminologies are found the most common for NICU while enabling to comprise all the different contextual elements of nursing in the documentation records. Moon is convinced that using those three languages for the EHR proceeding results in the consistency of information provided. Timely nursing in intensive care units means another criterion for the development of standardized terminology. For these purposes, terminologies seem to be appropriate while maximizing the effect of codification in the EHR platforms.
Codification, labeling, and determination include enumerative approach as sufficient for the development of NANDA technology, while offers the multi-axial hierarchy of classes and domains. It means that for the each category or term, the name or label, appropriate definition, and related factors are determined. Taxonomy II serves the framework for NANDA, where all the categories are supposed to be of equal importance. Accordingly, nursing diagnoses within NANDA terminology are not hierarchically related. Still, it contributes to the accessibility and easiness for implementation. NIC and NOC languages are organized in a similar way. The first one also manifests in the taxonomy of classes and domains, while the second one is represented in the alphabetical list of definitions of patient outcomes and references.
The above-mentioned standardized nursing terminologies are widely captured in the nursing practice of NICU. The comprehensive set of NANDA-1, NIC and NOC constitutes closely connected options for generation of structured information in EHR. Only, the management of a large amount of data in the neonatal intensive care limits the extent of application. According to Juvé-Udina et al., NANDA-1 offers restricted options for integrating all the information loaded in EHRs. In order to cope with the terminology, specific methods should be involved for the incorporation into clinical environment.
Methods of Implementation
Expert consensus, concept analysis, and criterion validation in response to the specific content include the primary methods for application and assessment of NANDA-1, NIC and NOC terminologies. While the terminologies are often considered to be complex and abstract, the implementation should start from structuration of data in EHRs according to determined terminologies. For these purposes, the team of nurse professionals is designed to research their practice in response to the terminologies. The research activity results in the expert consensus in NICU, in addition to ANA recommendations.
The next method concerns the conceptual analysis of vocabulary that will fit the needs of specific healthcare. The list of selected diagnoses, interventions and outcomes is distinguished that are congruent with the applied neonatal concepts and theory. Moreover, the team of selected experts seeks for unambiguous concepts that are clear for the interpretation implies to the limited group of terms frequently used in neonatal intensive care. For instance, “impaired skin integrity, activity intolerance, sleep pattern disturbance, and parent role conflict” were named as commonly used and validated. Consistent use of terms involves cross-mapping and tests for the validity and reliability that determines the level of their inclusion. Besides, the implementation process is supported by the cost analysis and nurse training. All the features contribute to the next step of efficient utilization.
Meaningful Use of Terminologies
Utilization of several terminologies for the newborn screening enables to cover all the fields of nursing practice for interoperability. Datasets collected with the help of NANDA-1, NIC, and NOC terminology help to connect medical interventions with nursing outcomes that especially valuable in the case of newborns survival. In such a way, the evaluation of treatment process and the nurse significance can be fulfilled. Moon is convinced that behind the set of standardized terminologies, clinical data and diagnoses lose their significance and possibility of verification.
The importance of implementation outcomes of nursing languages in the novel clinical practice of neonatal intensive care can be seen through the efficacy of computerized algorithms and nursing documentation. For example, detection of medication administration errors (MAE) in NICU became apparent with the use of refined terms in EHR instead of incident reports. Changing nursing practice in response to growing requirements to the premature neonates’ support constitutes another measure of outcomes of implementation. The improved quality of documentation follows implementation of standardized languages in EHRs too, leading to enhanced nursing practice. Hence, the implementation process enables to distinguish benefits and barriers of application.
Benefits and Barriers
The above-mentioned terminologies as a whole contribute to the new era of healthcare with precise and prompt feedbacks between chains of the clinical treatment and patients/clients. NANDA, NIC, and NOC systems were recognized to be efficient because of their simplicity, interoperability, and reuse for theoretical research. Research by Moon argues the efficiency of the combination of those three terminologies for the meaningful use of EHR while constructing plans of care. Exchange with the data between specific care fields contributes the codified information to have the research value and reusability. While the broad spectrum of information is needed in NICU, including parent’s health histories, the unified combination of the nursing languages tend to be the right system that cover all the diversity of nursing actions and clinicians’ interventions.
Accordingly, continuity of care is another feature that relates to the benefits of implementation of terminologies. With the use of EHRs filled up with the consistent terminology, healthcare professionals become able to follow triggers, conditions, and interventions that result in positive or negative patient outcomes. The issue includes the assessment of costs spent for care and nurse staff that can be analyzed in the dynamics and comparison to the alternative clinical practices.
Still, the barriers for their implementation are related to the difficulties in training and critical thinking of nurses working with EHRs. Interpretation of the large set of domains, classes, and related factors constitute the challenges for nurses in the process of decision-making. The survey by Ellsworth, Lang, Pickering, and Herasevich indicates information overload in EHRs of NICU that still should be critically synthesized. Therefore, not all the data involved reflect the needs of all the healthcare members in NICU. On the way, generated clinical judgments require further validation and testing in clinical settings.
Hence, decision-making in NICU would benefit from one unified standard in the nursing languages. The plethora of information applied to modern healthcare system makes nursing professionals generate a standard in the terminology framework to cope with the diversity diagnoses and actions. Search for similarities among models offered before appears to be the trigger for local, national, and universal interoperability. In particular, a reference system that consists of nursing diagnoses and actions seems to be the one offering basic definitions while decomposing them into the simplest refined terms. The ISO 18104:2003 standard health informatics is considered the appropriate tool to refine and systematically assess the terms out of different models. In the light, evidence-based practice will serve as the main manifestation of the established standard in nursing terminology.
Nursing informatics, provided with standardized nursing terminologies, has become an essential part of modern healthcare. NICU refers to healthcare fields where critical care relies on the timely and accurate systematization of data originated from different sources. To incorporate all the nursing processes in the documentation of neonatal intensive care acknowledged nursing terminologies like NANDA-1, NIC, and NOC can be used. While comprising nursing diagnoses, interventions, and outcomes, the languages enable the meaningful use of data collected in EHRs. Development of the terminologies manifests in conceptual analysis, mapping, and research testing in NICU. The outcomes of implementation can be measures of the nursing care quality, efficiency of spent costs, and improvements in patient outcomes. Though complicated by the interpretation, unified system of NANDA-1, NIC, and NOC models contributes to the evidence-based practice.