Alison Wallis, Clinical Advisor Putting Scottish Community Nurses on the Map

Agenda  What’s it about?  Why terminology?  Mapping process and progress  What’s next?

What’s it about? Development of a catalogue of standardised community nursing terms for use in electronic patient records:  Collaboration between Scottish Government Health Directorates, ISD & International Classification of Nursing Practice (ICNP).  Development of a web-based collaborative tool. Aims:  Support communication within community nursing and across other disciplines.  Provide a consistent terminology for nurses to articulate what they do.  Facilitate description, comparison, and reuse of data to improve care.

Community Nursing Census  April 2008 – National, one day census  Filled information gap about community nursing  Provided information to support service redesign, workload management and policy decisions  Tested a national minimum dataset for community nursing which could be embedded in electronic records to provide secondary information  Provided source terms for nursing problems and interventions for mapping to a recognised terminology

Why Standardise? Think of ways you have used standardisation  at home?  on the move?  at work?

Why Standardise Terminology? “In comparing the deaths of one hospital with those of another, any statistics are justly considered absolutely valueless which do not give the age, the sexes, and the diseases of all the cases.” Florence Nightingale, 1860 “The need for cost-effectiveness and accountability for quality in care demand descriptions and organization of data on nursing care.” Clark & Lang, 1992 “The availability of standardized nursing data can advance knowledge by enabling the study of health problems across populations, settings, and caregivers and by linking nursing diagnoses with interventions and outcomes.” McCloskey & Bulechek, 1992

Why Standardise Terminology? ICD 10 OPCS 4 READ Snomed CT ICF NANDA, NIC, NOC Omaha ICNP

International Classification of Nursing Practice  Flexibility – new items can be submitted to the ICNP for addition to the classification.  Comprehensive and adaptable –can express nursing diagnoses, interventions, and outcomes.  Transferability –other terminologies can be mapped to ICNP (e.g. SNOMED CT)  Comparability – international classification facilitates comparison with other countries.

Mapping Process Nursing Problems Nursing Interventions Categorised lists Categorised lists CENSUS Catalogue of Community Nursing Catalogue of Community Nursing SnowCloud Scottish terms Scottish terms ICNP

Mapping Process Method:  C-Space launched, April 2009  developed by SnowCloud  password protected  will host other catalogue developments in future  Editorial Group formed, May 2009  practising community nurses  project manager  NMAHP eHealth Clinical Lead  ICN staff  Nursing Problem & Intervention Mapping via C-Space  Invitations to participate and validate mappings, Aug 2009  individual clinicians  professional organisations  clinical networks  lead professionals  universities

Mapping Process

Challenges:  Clinicians  Yawn Factor !  Not familiar with terminology  Lack of time to participate  Hesitant about participating online  ICNP  Locating matching terms  Trans Atlantic translation & communication  Different models of health  Emerging models in Scotland  C-Space  Scottish Census group first users  Complex process for online media  Requires time to participate

Mapping Process Status:  142 nursing problems  164 nursing interventions

Mapping Process Mapping Issues:  Granularity  Ambiguity Examples: Nursing Problem Attention Seeking Disease Prevention Vulnerable Child Nursing Interventions Case Conference Toilet Training (child) Financial/ Employment support

What’s Next?  Complete mapping – new ICNP terms for no/ partial matches  Promote use of ICNP in community nursing systems  Support ‘Shifting the Balance of Care’  Support Modernising Community Nursing  Support new models of care delivery  Categorise terms to support high level reporting  Identify missing problems/ interventions  Outcomes???  Ongoing catalogue maintenance by ICNP

Any Questions??