Nursing Special Interest Subgroup – Observables Mapping Susan Matney, RN, MSN, PhD(c), FAAN Chair Nursing SIG

Nursing Special Interest Group (SIG) ‘…a community of practice for the nursing profession, supporting worldwide nursing participation in the development, validation, uptake, implementation, and correct use of SNOMED CT and related products.’ sufficient and appropriate terminology content to support nursing requirements guidance about the use of SNOMED CT and related products in nursing settings

Main activities Evaluation of content for specific uses / in response to issues raised Content development process [Request submission] Implementation support ‘products’ Mapping and subset development - Early stages Guidance materials – nursing user priority or nursing specific audience (not duplicating general materials) [Educational materials]

International Classification for Nursing Practice (ICNP®) A standardised terminology used to represent nursing diagnoses, interventions and outcomes Available in 14 languages Formally modeled in OWL and use of auto-reasoner and Protégé annotations A formal infrastructure that facilitates cross-mapping and allows output in multiple formats A related classification in the WHO Family of International Classifications Harmonisation agreements in place with IHTSDO (SNOMED-CT)

ICNP Maps approved for release for – Public Good http://www.ihtsdo.org/fileadmin/user_upload/Docs_01/Press_Releases/20112701-IHTSDO-NLM-press.pdf

http:// 2013-10-06

Process (evaluation done by myself, K. Hannah and J. Warren) Created a spreadsheet with “Observable” attributes as headers (with definitions) Loaded nursing outcomes, chose six for modeling Initially mapped using Observables guidance document Met with D. Karlsson in Copenhagen Modeled six Identified patterns or heuristics for outcome observations

Nursing Outcomes Indicators Concepts in Four Categories: functional status therapeutic self-care (readiness for discharge) symptom management (pain, nausea, fatigue, dyspnea) safety (falls, pressure ulcers) 2013-10-06

Sample Measure NAUSEA - Assess for last 24 hours 0. No nausea 1. Mild nausea: occasionally experienced but does not interfere with eating and/or activities 2. Moderate nausea: interferes somewhat with eating and/or some activities most days 3. Severe nausea: interferes daily with eating and/or activities 4. Incapacitating: remains in bed part of each day due to nausea and interferes with eating and activities 2013-10-06

Outcome concept modeling (spreadsheet) Observable SCT code | PT Property Type Inheres in   Towards Bathing 284797005 | ability to perform bathing activity function (observable entity) Homo sapiens (organism) current (qualifier value) skin hygiene (observable entity) Walking 282097004 |ability to walk| mobility (observable entity) Toilet use 284906000 | ability to use toilet ability to perform toileting activities (observable entity) Pain Intensity 406127006 | pain intensity | perception, function (observable entity) level of physical comfort (observable entity) Nausea New term submitted - nausea level Knowledge of medications currently taking 405112004 | knowledge level: medication Knowledge (new concept) knowledge level (observable entity) Understand purpose of the medication 418907009|Ability to vaerbalize understanding

Discussion New Properties Function, Perception, Knowledge Towards We discuss this being a goal but decided not. Review what we did. Technique Patient Stated - missing Patterns The properties above always inhere in the person (homo sapien) Perception and knowledge is always stated by the patient 2013-10-06