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NNN02/april 2002
A Bridge Between Data and Language, the Swiss Issues: NURSING dataAlain Junger
Lausanne Bernhttp://www.hospvd.ch/ise/nursingdata
ISE ����
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
From clinical practice to information system,
a long way throught data and terminologies
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Swiss health information system
� 26 autonomouscantons
� 26 health systems � No central data
production � Many lobbies� Economic
restrictions
� Health policy� Comparisons� Coordination
Many differentinformation systems
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Federal laws
� Federal Law on statistics (1992)� Federal Law on health insurance (1994)
Since 1998, compulsory collecting of data for
Statistics Economy/Management
Federal Law on data protection
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
What is NURSING data ?
� The future nursing information system for Switzerland
� An add-on for the health information system
� An information system for pricing nursing care
� It covers:Acute care, Long term care, Home care
and Psychiatry care
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Why NURSING data ?
� To standardize nursing information� To layout the foundations for nursing
data comparability� To determine a nursing data set� To coordinate the swiss effort with
international developments
To show nursing makes a difference!
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
How NURSING data came to life ?
� 1998: political decision gave green light� 1999: Nursing information model ready� 2000: proposals for the future,
a global and pragmatic solution� 2001: phase 2 and extension of the
partnership:(federal administration, insurance, professional associations, providers,…)
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Conclusions of the 1st part
Need for a uniform nursing language to describe nursing phenomena andnursing interventions
� Definition of relevant concepts
� Choice of a standardised language for data collection and treatment
� Coordination on international level
� Ability for nurses to work in natural or «home» language
� Use of technical developments(informatics)
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Part 2 : business plan
2001 2002 2003 2004 2005TP1: Project management
TP2 : Classifications
TP3 : CH-NMDS
TP4: Data mining
TP5: Information
TP6 : Nat. and internat. coordination
TP7: Normalisation
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Organigram
Direction de projet NURSING data
TP 7 : Préparation du système de normalisation
TP4 : Validation du modèle d’exploitation des données
TP 6 : Coordination
TP5 : Information
TP1 : Gestion opérationnelle
TP2 -TP3 - Groupe national de terminologie et de données infirmières
TP2 : Gruppo regionale per una terminologia
infermieristica (GRTI)
TP2 : Regionale Expertengruppe für
Pflegefachsprache (REP)
TP2 : Groupe régional de terminologie infirmière (francophone) (GRTI)
TP3 : Groupe d’experts national pour le NMDS
(GN-NMDS)
Réseaux régionaux Regionale Netzwerke Reti regionali
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
NURSING data The conceptual framework
…
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Nursing Data Sets
Nursing
Management/financial
Set
Nursing Phenomena
Set
NursingIntervention
Set
Patient
Prof.
Structure
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
NURSING data in four models
Management reporting
NMDS
Facts
NDS
Management data
Planification data
Statistics of population
Reality / practice
Statistical Data
NURSING data
Inte
rna
lEx
tern
al
Alain Junger/99
Clinical dataNursing records
A-State observed
Physiopathological Psychological Social
Environment
Diagnosticaspects,objectives
Nursing phenomena
+ resources- problems
Interventions
Outcomes
Facts
Clinicalstatus
B-Sate observed
5 Functions
Alain Junger/99
Observe/décrit
Lieu
Institution
Emploi
Patient /Client
Travaille
Séjourne/habite
Analyse/fixe desobjectifs
Modifie
Devientun nouvel
état de santé
Version 2.0Alain Junger/9 9
Autres
Descriptifsspécifiquesinf irmiers
Médecin
PatientAutres professions
PatientMédecins
Inf irmières
Les acteurs
AgitConcern
e
Induit
Prescrit/demande
Appartient
Etat de santé
Réalise/applique
SéjourEtape
Episode
Sesitue
AutresTraitements
Actes /interventions
Soins & traitements
Dataaggregation
Clinicalprocess Object/data
model
Informationflow
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Model of the clinical process
A-State observed
Physiopathological Psychological Social
Environment
Diagnosticaspects,objectives
Nursing phenomena
+ resources- problems
Interventions
Outcomes
Facts
Clinicalstatus
B-State observed
5 Functions
Alain Junger/99
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
� Patient� Actor/professional� Institution� Point of care� Episode� Health status� Interventions, actions
Permanent concepts:
Care as an object
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
The object: « care »
Observe/décrit
Lieu
Institution
Emploi
Patient /Client
Travaille
Séjourne/habite
Analyse/fixe des objectifs
Modifie
Devientun nouvel
état de santé
Version 2.0Alain Junger/99
Autres
Descriptifsspécifiquesinfirmiers
Médecin
PatientAutres professions
PatientMédecins
Infirmières
Les acteurs
Agit
Concerne
Induit
Prescrit/demande
Appartient
Etat de santé
Réalise/applique
SéjourEtape
Episode
Se situe
AutresTraitements
Actes /interventions
Soins & traitements
ActorsHealth status
Organisation
Place
Interventions
Episode
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Micro to macro
Nursing process
Data
Agr
egat
ion
Statistics
Policy
Management
Clinical documentation
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Linkage between data
Soins
Méd
ecin
e
Physiothérapeute
Fina
nce
Stat.Population
NMDS
NDS
Stat. Infirm
.
Dossier
Hotellerie
CareDocumentationNurs. Stat.
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
CH-NMDS - 1
� Patient� ID Number*� Date of birth*� Sex*� Region of residence*
� Episode� Date of entry � Date of exit� Number of intern transfer� Hospital:In Operating Theater; Intensive
care (Y/N)� Long term care:With Hospitalization (Y/N)
� Place� Type** link with medical and
administrative statistics
� Health status� Medical diagnoses*� Nursing phenomena� Caracteristics of the
phenomena� Outcomes related to the
phenomena
� Interventions� Interventions � Frequency, contribution of
social network, home assistance
� Overall intensity of the episode (class, length of required or dispensed care)
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
CH-NMDS - 2
� Nurse� ID Number� Nationality� Diploma� Year of qualification
� Activity� Function � Date of engagement� Date of resignation� Work rate
� Firm Information (year)� Total number of
working hours of temporary workers (Nursing)
� Total number of working hours of temporary workers(Other)
� Total number of working hours for a full time worker
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
NURSING data & other statistics
Medicalstatistic
Hospitalstatistic
Long-termcare
statistic(Establishment)
NURSING data CH-NMDS
Future ?
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
What will we show and see ?
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
�Mais...�Aber...
� Ma ...– But
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Terminology: what for ?
Specificity of Switzerland:
� Four national languages� No common professional language� No compatibility between systems in use
• Workload measure, measure of given care• measure of needs, staffing, …
� Rapid development of electronicpatient record
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
From data to terminologiesFrom practice to concepts
Practice
Abstraction
Dat
aLa ngu ag e
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
LEP/PRN
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
ClinicalLevel
StatisticalLevel
Clinical situation
NursingDiagnosis 3
Target 3
NursingDiagnosis 2
Target 2
NursingDiagnosis 1
Target 1
ClinicalJudgement
Description DescriptionSymptoms
?
Phenomena
Aggregation
Phenomena � /� Diagnosis
Description Description
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Hierarchical classification=
Gathering nursing diagnosis with commoncharacteristics
(Nutritional state control, parenteral feeding, weightcontrol = Care for nutritional troubles)
Noknown
classificationClassification
Clinical definitionsClinical oriented
definitions
Futuremany years of data and research
Classificationcharacteristics
Classificationcharacteristics
?
Typology=
Gathering different Nursingdiagnosis and other data
(Hyperthermia, 86 years, pain, ...)
Phenomena
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Health phenomenon
Health aspect from one or many individuals justifying the
nursing interventions
Definition accepted at 82%,rejected by 5%
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Classification developments 1
June 2001
Expertsselection:3 groups3 languages60 persons
Sept. 2001
Course on basic terminologyconcepts
Selection ofnursing significant concepts forphenomenainterventions
Nov. 2001
Delphi Itwo listsper language
Febr. 2001
Dead linefor answers
Phase 1
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Delphi questionnaire
Speaking : Sent Received %
French 46 32 70%German 50 37 74%Italian 55 40 73%Total 151 109 72%
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Delphi I & II
OtherNurse manager
Nurse practitioner
Nursing teacher
Board nurse
Other 9 10 19School 2 1 10 13Psychiatry 5 2 1 1 9Home care 3 6 9Long term care 4 6 2 12Hospital 5 24 7 2 12 50
112
OtherNurse manager
Nurse practitioner
Nursing teacher
Board nurse
Other 14 10 2 26School 2 1 8 11Psychiatry 5 2 1 1 9Home care 2 5 1 3 11Long term care 2 6 2 10Hospital 2 22 5 2 11 42
22 49 9 12 17 109
I
II
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Classification developments 2
March 2002 May 2002
Results analysis FeedbackPublicationof the firstversion of thetwo lists translated in:•French•Italian•German
June 2001
Dead linefor answers
Phase II
Testin
2003
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Nursing phenomena
ICF 4 steps scale
50 itemsICF (WHO)�ANATOMICAL STRUCTURE�ORGANIC FUNCTION�ENVIRONMENTAL FACTORS�ACTIVITY AND PARTICIPATION
QualifiersContentStructure
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Nursing interventions
�Observe/survey/monitor�Prevent�Inform�Teaching�Advise/guide�Assist/help/accompany�Treat / act / intervene / supply�Re-educate
64 itemsICF (WHO)
QualifiersContentStructure
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Future of NURSING data
Theory
Development
Operational
Research
Engineering
Nursingpractice
NURSING data
Futureimprovement
Futureapplication
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Information policy
Ambitious information with modern tools � Web site
http://www.hospvd.ch/public/ise/nursingdata/
� Restricted forum� Regular publications in professional and
other journals� Communications, conferences, lectures
NNN02/april 2002http://www.hospvd.ch/ise/nursingdata
Thank youfor your attention
and Looking forward
to continue the discussion