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Why I like ICNP - Pamela Hussey

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This short paper has been written by Dr Pamela Hussey, School of Nursing and Human Sciences, Dublin City University in support of the adoption of ICNP within Ireland.

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Why I like ICNP - Pamela Hussey

  1. 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.   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.   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.   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  Accessed  09th  November  2015     2. OECD  (2015),  OECD  Reviews  of  Health  Care  Quality:  Portugal  2015:   Raising  Standards,  OECD  Publishing,  Paris.  Online  Resource  Available   from­‐en