Nursing Knowledge Model

Susan Matney, MSN, PhD(c), RN-C, FAANInformaticist 3M Health Information SystemsChair SNOMED CT Nursing Special Interest GroupChair Clinical LOINC nursing Subcommittee

Nursing Knowledge: Big Data Research for Transforming Healthcare

Purpose

• Define knowledge model• Demonstrate nursing knowledge models

• Historical• Electronic

• Discuss the data and information required to support an electronic nursing knowledge model

Nursing Knowledge

Knowledge Translation: The exchange, synthesis and application of knowledge within a complex system.

Knowledge Transfer: A systematic approach to capture, collect and share tacit knowledge in order for it to become explicit knowledge.

Knowledge Model: The capture of knowledge in an electronic reusable format for the purpose of preserving, improving, sharing, aggregating and reapplying it.

Knowledge Translation: The exchange, synthesis and application of knowledge within a complex system.

Knowledge Transfer: A systematic approach to capture, collect and share tacit knowledge in order for it to become explicit knowledge.

Knowledge Model: The capture of knowledge in an electronic reusable format for the purpose of preserving, improving, sharing, aggregating and reapplying it.

The Nursing Process

Nursing Informatics DIKW Framework

ANA, 2007

CAUSES

REASON FOR

REASON

FOR

Care Plan Relationships (Happy Path

Health Concern

[mood EVN]

Goal [mood GOL]

Outcome Observation [mood EVN]

Intervention [mood: INT/ RQO/ etc.]

[mood: EVN]

SUPP

ORT

S

Observation [mood EVN]

RELATES TO

RELATES TO

IS COMPONENT OF

EVALUATES

Storyboard Example• Joe is a 24 year-old male quadriplegic admitted

to an inpatient unit from his home. During admission assessment, the nurse notes that he has no sensation from the shoulders down. He is confined to a wheelchair and requires two-person assist. His skin is occasionally moist. Joe reports that he is a “good eater” and is on a normal diet. The nurse completes the Braden Skin Scale score is 13. Further assessment by the nurse reveals skin is intact with no pressure ulcers.

Hx. SubjectiveFindings

Setting

Assessment

Observations

CAUSES

REASON FOR

REASON

FOR

Simple Skin Assessment (Happy Path)

Health Concerns:Impaired mobilityRisk for alteration

in skin Integrity

Goal: No skin breakdown

Outcome Observation

Interventions: Turn q 4 hours

Assess skin q shift

SUPP

ORT

S

Observations:Decreased SensationLimited MobilityBraden scale = 13

RELATES TO

RELATES TO

IS COMPONENT OF

EVALUATES

Interoperability using the DIKW Framework

Data

Skin Assessment

class Skin Inspection Detail

Pressure Ulcer Risk Assessment Item

Skin Inspection

- skin color :Skin Color- skin moistness :Skin Moistness- skin temperature :Skin Temperature- skin turgor :Skin Turgor

«enumeration»Skin Color

normal for ethnic group ashen cyanotic flushed jaundiced mottled pale

«enumeration»Skin Turgor

good elasticity (normal) poor, decreased elasticity tenting = not found

«enumeration»Skin Temperature

cool warm (normal) cold hot

«enumeration»Skin Moistness

normal moist diaphoretic clammy

«enumeration»Skin Condition

dry extremely dry normal friable

Interoperability using the DIKW Framework

Data

Terminology Coding

12

Type Text Terminology Code Fully Specified NameQuestion Skin Moisture LOINC 39129-2 Moisture:Type:PT:Skin:Nom::

Value Diaphoretic SNOMED CT 52613005 excessive sweating (finding)

Value Moist SNOMED CT 16514006 moist skin (finding)

Value Clammy SNOMED CT 102598000 clammy skin (finding)

Question Skin Temperature LOINC 44968-6Temperature:Type:PT:Skin:Ord:Palp

Value Consistent With Body Temperature SNOMED CT 297977002 Skin normal temperature (finding)

Value Warm SNOMED CT 102599008 warm skin (finding)

Value Cool SNOMED CT 427733005 cool skin (finding)

Question Skin Turgor LOINC 39109-4 Turgor:Imp:PT:Skin:Nom::

Value Good Elasticity (normal) SNOMED CT 297956000 skin turgor normal (finding)

Value Decreased Elasticity (Poor) SNOMED CT 425244000 decreased skin turgor (finding)

Value Tenting SNOMED CT 297957009 stretched skin (finding)

Key drivers in enabling knowledge model

Knowledge exists in paper - Care plans Knowledge exists in vended EHRs (non standardized) Structured Nursing Knowledge beginning to emerge (e.g.

Pressure Ulcer Models) Standardized terminology

SNOMED CT, LOINC, RxNORM, CPT, ICD-10-CM HIT standards

HL7, ONC, PHIN-VADS, VSAC

NURSING IS VISIBLE

Vision of the FutureVision of the Future

In Health Information Systems

NURSING DATA ARE AVAILABLE

To Promote Evidence-Based, Quality Nursing Practice

Questions?

samatney@mmm.com