The document discusses the benefits of using the International Classification of Nursing Practice (ICNP) as the preferred terminology for nursing practice and documentation in Ireland. It argues that ICNP is well-suited as it allows for standardized nursing terminology that can be integrated into electronic health records across settings. The author draws on their experience as both a nurse and informatics lecturer in supporting ICNP. They believe ICNP will optimally represent Irish nursing practice while facilitating health data integration and quality care focused on patient outcomes.

1. 1
Why
I
like
the
International
Classification
of
Nursing
Practice
Dr
Pamela
Hussey,
School
of
Nursing
&
Human
Sciences,
DCU.
HISINM
25th
November
2015
Workshop
Deliverable
Introduction
When
we
talk
about
health
and
social
care
transformation
in
Ireland,
the
expectation
for
nursing
is
to
inform
new
configurations
of
health
records
that
can
work
well
across
different
settings.
Particularly
in
regard
to
delivering
a
quality
orientated
health
service
focused
on
better
patient
outcomes.
At
this
conference
you
will
hear
much
debate
on
eHealth,
new
technologies
and
new
solutions.
Examples
may
include
how
can
we
deliver
access
to
electronic
referral
patient
data
to
enhance
continuity
of
care.
But
when
we
strip
the
discussion
back
to
a
local
context
and
embedding
technologies
into
practice
what
nurses
need
to
reflect
upon
can
be
summarized
into
two
short
sentences:
How
can
we
use
information
and
communications
technology
to
provide
better
care
to
our
patients?
And
How
can
we
best
use
our
resources
wisely
to
deliver
this
care?
Today
HISINM
instigate
an
important
debate.
It
is
our
intention
to
facilitate
and
contribute
to
eHealth
Ireland
and
to
do
this
we
need
to
consider
what
nursing
terminology
to
use
in
future
electronic
health
records.
We
start
this
discourse
by
recognizing
that
knowledge
production
is
always
situated
in
context,
therefore
for
idealistic
and
pragmatic
reasons
nurses
in
Ireland
need
a
language
classification
that
can
be
integrated
into
health
records
and
which
can
optimally
represent
the
context
of
Irish
nursing
practice.
Twenty
first
century
health
care
dominated
by
patient
outcomes
and
quality
indicators
is
increasingly
seen
as
the
yardstick
from
which
healthcare
is
funded
and
measured.
With
the
introduction
of
Individual
health
identifier
in
September
of
this
year,
it
is
now
the
case
of
when
we
integrate
rather
than
if
health
data
will
be
integrated
and
accessible
from
differing
service
providers.
Nursing
will
form
part
of
this
integration
and
so
in
the
foreseeable
future
nursing
documentation
practices
relating
to
patient
care
will
no
longer
be
separate
but
rather
recorded
and
integrated
into
electronic
health
records
(EHR).
Outputs
from
this
resource
will
not
only
be
used
for
individual
care
delivery
but
will
be
used
to
provide
views
and
summaries
that
will
in
part
define
the
nursing
contribution
to
service
delivery.
As
part
of
the
transitioning
process,
nursing
documentation
in
healthcare
will
need
to
identify
and
use
a
nursing
classification
or
terminology
resource.
Briefly,
the
identified
terminology
will
include
three
specific
components
a
nursing
diagnosis
(problem
identification
or
potential
for
a
problem)
a
nursing
intervention
(an
action
or
activity)
and
a
nursing
outcome
(often
described
as
a
goal
that
the
care
plan
has
been
developed
to
achieve).
Each
of
the
above
concepts
will
include
a
defined
term
and
an
associated
numerical
code
or
a
concept
identity
number.
There
are
many
approaches
that
we
can
adopt
to
integrate
nursing
records
into
future
electronic
health
records.
Indeed
some

2. 2
services
have
already
begun
this
transition,
for
clarity
it
is
therefore
timely
for
us
to
have
a
national
debate
on
what
is
the
best
available
evidence
to
inform
decision
making
on
this
important
topic.
As
a
nurse
with
a
clinical
background
for
20
years
and
an
informatics
lecturer,
I
propose
we
consider
the
International
Classification
of
Nursing
Practice
as
the
preferred
terminology
for
practice
development
and
nursing
in
Ireland.
I
present
this
brief
paper
from
both
personal
experience,
and
international
perspectives
considering
why
I
believe
that
ICNP
is
the
preferred
terminology
of
choice
for
Irish
nurses.
I
have
organized
my
thoughts
under
three
points
to
support
this
position.
1. The
purpose
of
a
nursing
terminology
using
ICNP
as
an
example
2. ICNP
as
a
global
nursing
terminology
classification
3. My
personal
experience
of
using
ICNP
in
education
and
research
1.
The
purpose
of
a
nursing
terminology
So
what
is
the
purpose
of
a
nursing
terminology?
Its
primary
function
is
to
ensure
that
the
nursing
contribution
is
represented
in
an
Electronic
Health
Record
commonly
referred
to
as
an
EHR.
ICNP
as
a
product
of
the
International
Council
of
Nurses
(ICN)
is
an
agreed
terminology,
or
dictionary
of
terms,
that
enables
nurses
to
describe
and
report
their
practice
in
a
systematic
way.
The
resulting
information
is
used
to
support
care
and
effective
decision-­‐making,
in
addition
to
informing
nursing
education
and
health
policy.
Celebrating
its
25th
anniversary
in
2014,
ICNP
has
a
proven
track
record
of
successful
implementations
and
is
translated
into
seventeen
different
languages
across
the
globe.
Nursing
as
a
profession
provides
a
dual
role
in
health
service
delivery.
We
practice
both
independently
and
as
part
of
the
multi
disciplinary
team,
I
believe
that
ICNP
is
best
aligned
to
represent
nursing
care
in
both
of
these
roles,
and
in
this
context,
ICNP
can
be
used
to
build
new
tributaries
of
knowledge
to
support
and
provide
sustainability
to
the
profession.
It
is
my
firm
belief
that
some
of
the
nursing
activities
we
engage
with
are
not
unique
and
that
the
essential
holistic
care
that
we
provide
while
critical
to
our
patients
health
state
is
vulnerable
as
a
consequence.
Our
best
approach
today
is
to
proactively
lead
on
defining
the
core
information
relating
to
our
practice
for
inclusion
in
EHR,
such
an
approach
will
galvanize
the
profession
from
additional
rationalization
of
existing
scant
resources.
It
is
naïve
for
us
to
think
that
we
can
continue
to
be
isolated
in
our
approach
to
practicing
and
documenting
care,
the
profession
of
nursing
is
evolving.
This
is
evident
with
recent
developments
in
strategic
planning
in
the
HSE
and
DoH
as
it
considers
expansion
of
the
ANP,
CNS
and
Case
Manager
roles
as
part
of
the
MDT
in
the
Irish
health
service.
But
let
us
not
forget
we
have
historically
been
champions
of
change
particularly
when
we
have
provided
insight
on
problem
identification
and
potential
solutions
in
service
delivery.
eHealth
Ireland
therefore
presents
us
with
an
opportunity
to
lead
on
(or
at
least
take
a
proactive
role
in)
transitioning.
Let
not
our
lack
of
knowledge
on
this
important
topic
of
terminology
become
a
reason
for
non
engagement
or
worse
still
abandoning
decisions
to
others
who
may
not
have
the
insight
to
understand
the
implications
of
what
is
required.
There
is
therefore
both
a
practical
and
urgent
need
for
nursing
to
meaningfully
contribute
with
ideas
and
solutions
for

3. 3
health
care
transition.
New
configurations
of
health
records
will
be
developed
as
part
of
these
emerging
roles
of
ANP,
and
CNS
requiring
core
concept
identification
for
inclusion
as
part
of
the
new
records.
ICNP
provides
an
easily
accessible
resource
for
this
configuration
development.
It
is
I
believe
comprehensive,
flexible
and
continually
updated
to
reflect
the
broad
and
changing
requirements
of
nursing
practice.
It
is
free
for
non-­‐
commercial
users
and
is
available
for
you
to
view
on
line
from
the
ICNP
Browser.
The
ICNP
team
has
also
invested
in
mapping
to
electronic
health
record
terminology
related
resources
such
as
SNOMED
CT.
Reviewing
the
codes
in
SNOMED
CT,
the
ICNP
team
have
paired
over
500
concepts
within
the
two
terminologies
transforming
ICNP-­‐encoded
data
to
the
related
SNOMED
CT
codes.
Additional
collaborative
work
with
the
World
Health
Organisation
and
SNOMED
CT
governing
group
has
also
resulted
in
new
nursing
content
for
the
International
Classification
of
Health
Interventions
and
SNOMED
Clinical
Terms.
While
medical
administrators
configure
rationalization
plans,
ICNP
provides
a
scaffold
to
align
nursing
interests
globally
and
provides
a
starting
point
for
nurses
in
Ireland
to
connect
with
existing
networks
of
nurses
through
the
International
Congress
of
Nursing.
ICNP
therefore
provides
opportunities
to
create
a
nursing
discourse
for
evolving
nursing
roles
to
participate
with
eHealth
Ireland
and
beyond.
2.
ICNP
is
a
global
nursing
terminology
classification
ICNP
has
for
many
years
been
a
member
of
the
World
Health
Organisation
family
of
classifications,
this
is
really
important
point
for
you
to
take
into
consideration.
ICNP
therefore
offers
the
profession
in
Ireland
the
best
approach
to
evolve
in
line
with
international
best
practice.
To
date
on
the
International
circuit,
ICNP
has
commercial
agreements
in
Portugal,
Brazil,
Canada,
Norway
and
Poland.
Selecting
Portugal
as
an
example,
I
will
briefly
outline
how
ICNP
contributes
to
service
improvement.
In
Portugal,
93.1%
of
public
hospitals
or
hospital
centers
use
systems
that
are
based
on
ICNP,
and
in
the
community
setting
in
primary
care,
91%
of
the
348
health
centers
across
Portugal
also
use
the
Health
Ministry’s
nursing
information
system
which
is
based
on
ICNP.
Since
integration
of
ICNP
recent
evidence
from
OECD
reports
claim
that
the
primary
care
system
in
Portugal
is
performing
well
against
other
OECD
countries.
Figures
on
avoidable
hospitalization
are
amongst
the
best
in
OECD
countries
and
recent
reforms
have
been
successful
in
improving
accessibility
efficiency
quality
and
continuity
of
care.
OECD
also
report
this
year
that
there
is
an
increase
in
satisfaction
of
both
professionals
and
citizens
in
Portugal
in
primary
care
which
is
also
worthy
to
note.
At
an
international
level
ICNP
engages
in
the
development
of
accreditation
centers
with
the
creation
of
catalogues
that
can
also
be
disseminated
for
uptake
and
use
across
different
nations.
ICNP
Catalogues
can
be
described
as
nursing
data
subsets
for
specified
health
concerns
which
address
a
practical
need
in
building
health
information
systems
with
all
the
benefits
of
using
a
unified
nursing
language.
ICNP
catalogues
can
be
used
as
an
accessible
reference
for
nurses
in
their
particular
care
setting.
Catalogues
devised
by
ICNP
are
listed
on
their
website
and
the
link
is
included
here
as
a
reference
to
this
short
paper.
The
resource
includes
catalogues
relating
to
community
nursing,
palliative
care,
and
paediatric
pain
management.
A
key
goal
of
the
catalogues
is
to
provide
a

4. 4
systematic
approach
for
retrievable
data
about
healthcare
worldwide.
3.
Personal
experience
of
using
ICNP
for
education
and
research
Finally
I
conclude
with
a
short
account
of
my
personal
experience
of
using
ICNP
over
the
past
fifteen
years.
My
interest
in
concepts
and
terminology
arose
from
my
role
as
an
academic
when
I
started
to
teach
nursing
informatics
in
the
School
of
Nursing
and
Human
Sciences
in
DCU
in
2002.
At
this
time
I
included
sessions
on
a
number
of
nursing
terminology
systems
including
ICNP.
Anecdotal
student
feedback
in
class
workshops
reported
consistently
that
ICNP
was
the
preferred
terminology
over
a
five
year
time
frame,
particularly
from
practicing
and
experienced
nurses
who
were
completing
a
top
up
bachelor
of
nursing
degree
called
the
BNS.
The
practicing
nurses
came
from
a
number
of
division’s
mental
health,
intellectual
disability,
paediatrics,
and
general
nursing,
so
I
am
confident
that
these
students
provided
me
with
a
certain
degree
of
clinical
pragmatism
when
using
the
classification
for
documenting
care
plans
in
class.
As
part
of
my
research
I
also
invested
time
in
mapping
the
Irish
Nursing
Minimum
Dataset
to
ICNP
and
found
the
process
of
searching
and
retrieving
core
concepts
from
the
ICNP
browser
both
easy
to
complete
and
practical
in
its
approach.
Access
and
support
from
ICNP
was
never
an
issue,
and
over
time
as
the
versions
of
ICNP
were
updated
the
ICNP
browser
presented
state
of
the
art
free
access
to
the
resource
online.
Finally
I
completed
a
mapping
in
my
PhD
work
on
development
of
a
referral
for
transition
between
services
using
the
Canadian
health
outcomes
for
better
information
and
care
and
also
mapped
this
to
ICNP
successfully.
This
work
continues
today
within
the
HSE.
Conclusion
The
future
for
nursing
terminology
needs
to
be
based
on
evidence,
consensus
of
expert
opinion,
with
due
consideration
given
for
potential
utility
in
the
Irish
context.
I
believe
that
ICNP
as
a
resource
provides
the
best
scope
for
the
dual
role
that
nurses
in
Ireland
practice
within,
and
will
continue
to
develop
to
meet
requirements
to
make
eHealth
Ireland
a
reality.
What
is
known
by
the
profession
is
shaped
by
how
it
has
come
to
be
known.
We
now
need
to
be
constructive
and
creative
in
our
approach.
I
believe
that
ICNP
can
support
nurses
in
Ireland
to
nurture
and
maintain
what
it
is
that
we
know
about
holistic
care
situated
in
context,
so
as
we
transition
to
deliver
nursing
terminology
we
can
create
new
configurations
that
can
work
across
different
settings.
Settings
that
are
messy,
include
numerous
interpretations
and
include
many
perspectives
can
use
ICNP
to
configure
health
records
to
retrieve
important
data.
ICNP
as
a
globally
recognized
terminology
system
provides
the
springboard
for
nurses
in
Ireland
to
devise
datasets
that
present
our
situated
knowledge
to
inform
twenty
first
century
integrated
healthcare
in
Ireland.
References
1. International
Classification
of
Nursing
Practice
(ICNP)
Online
Resource
Available
from
http://www.icn.ch/
Accessed
09th
November
2015
2. OECD
(2015),
OECD
Reviews
of
Health
Care
Quality:
Portugal
2015:
Raising
Standards,
OECD
Publishing,
Paris.
Online
Resource
Available
from
http://dx.doi.org/10.1787/9789264225985-­‐en