Nursing Special Interest Subgroup – Observables Modelling Judith Warren, Susan Matney, Kathryn Hannah

Testing the Observables Model with Nursing Content 2013-10-06

Nursing Outcomes Indicators Concepts from the Catalog are in Four Categories: functional status therapeutic self-care (readiness for discharge) symptom management (pain, nausea, fatigue, dyspnea) safety (falls, pressure ulcers)

Process (evaluation done by S. Matney, K. Hannah and J. Warren) Created a spreadsheet with “Observable” attributes as headers (with definitions) Loaded nursing outcomes, chose six for initial model testing, completed all Mapped using Observables guidance document Met with D. Karlsson in Copenhagen Joined monthly Observable calls Identified patterns or heuristics for outcome observations

Observables Model Example TECHNIQUE Observation device WHAT SCALE UNITS DIRECT SITE PROPERTY TYPE INHERES IN ... HOW

Fully specifying an Observable There are 3 elements that define the observable: Property inheres in realization/location For each function there is a process Should we define functions in terms of processes Is Ability a property type or should we use Function?

Inheres in Homo sapiens (organism) 362077003

Function observables Functions have processes as realizations E.g. ability to walk has realization walking Do we need both functions and processes? ‘Towards’ is a realization What axis do the values come from Observable Qualifiers Is realization and towards the same thing

Technique Use Observation in the broadest possible meaning as Technique Classes that specify some aspect of the observation procedure, such as scale, units, technique, site, or informer

Informer Leave blank if we want users to post-coordinate Specify if we want to limit who can inform Patient Caregiver Patient and/or caregiver Responsible Person Subject of record

Bathing Observable entity and specifiedBy some (Patient status observation and observes some (Quality/Realizable and propertyType Function/Ability inheresIn Homo sapiens/Person and hasRealization some Bathing ) )

Recognition of changes in your body (symptoms) related to your illness Observable: Ability to recognize symptoms (700485008) Property type: observable (observable entity) (363884002) Inhere in Location: Homo sapiens (organism) 362077003 Process duration: current (qualifier value) Towards: Knowledge 371733000 Technique: evaluation procedure (procedure) 386053000 Informer: Patient Scale type: ORD

Able to adjust your regular activities when you experience body changes (symptoms) related to your illness Observable: Ability to self manage symptoms (700484007) Property type: Health related behavior (228272008) Inheres in location: Homo sapiens (organism) 362077003 Process duration: current (qualifier value) Towards: Knowledge 371733000 Techniques: evaluation procedure (procedure) 386053000 Informer: Patient Scale type: ORD

Walk in Room Observable: ability to walk in room Property type: Ability to perform a function/activity Inheres in location: Homo sapiens (organism) 362077003 Process duration: current (qualifier value) Towards: Technique: Mobility 363803005 Techniques: patient status observation (procedure) 103705002 Informer: Subject of record or other provider of history (ID 419358007) Scale type: ORD Result values: Dependent, Independent, Requires Assist….

Understand purpose of the medication Observable: Ability to verbalize understanding| 418907009| Property type: Knowledge (new concept) Inheres in location: Homo sapiens (organism) 362077003 Process duration: current (qualifier value) Towards: knowledge level (observable entity) 371733000 Technique: evaluation procedure (procedure) 386053000 Informer: Subject of record or other provider of history (ID 419358007)   Scale type: ORD        

Pain Intensity Observable: Pain Intensity 406127006 Property type: Perception Inheres in location: Homo sapiens (organism) 337915000 Process duration: current (qualifier value) Towards: Pain ?? Or comfort Technique: evaluation procedure (procedure) 386053000 Informer: Patient Scale type: ORD            

Discussion New Properties Function, Perception, Knowledge Towards: “...used to specify the third element of a relational quality...” Are functions relational qualities? A has realization object property? Technique Patient Stated - missing Patterns The properties above always inhere in the person (homo sapiens) Perception and knowledge are always stated by the patient

specified-by ○ observes ⊑ is-about Observable for qualities property type property types inheres in independent continuants (inherent) location Material entities is-about quality (inherent) ingredient substances towards Independent continuants observable entity relative to substances (rel-to) part of Independent continuants specified-by precondition Precondition values observation procedure observes scale scale types units units technique techniques direct site Material entities informer subjects specified-by ○ observes ⊑ is-about