Amy Coenen

International Classification for Nursing Practice (ICNP): Most-frequently Asked Questions

The International Classification for Nursing Practice (ICNP) is a collaborative project under the auspices of the International Council of Nurses. The alpha version ia available online for comment in preparation for the release of the beta version in 1999. The authors answer the most-frequently asked questions about the ICNP and encourage nurses in the United States to participate in the revision by sending comments and suggestions to the American Nurses Association. n JAMIA. 1998;5:335 - 336.

Development of terminology subsets using ICNP

PURPOSE For healthcare terminologies to provide coverage of a domain, many have evolved into very large and complex sets, creating a challenge for implementation. The International Classification of Nursing Practice (ICNP) Version 2 has over 2800 concepts. Thus, development of terminology subsets is considered as a potential solution to facilitate implementation. METHOD Based on early efforts to develop ICNP Catalogues, or clinically relevant subsets of the terminology, a process model was developed based on the ICNP life cycle. The steps involved in developing a subset are (a) identifying client(s) and health priority, (b) gathering terms and concepts relevant to a given priority, (c) mapping the identified concepts to the ICNP terminology, (d) modeling new concepts, (e) finalizing a Catalogue, and (f) disseminating the Catalogue. RESULTS The ICNP model was applied to subset development resulting in three ICNP Catalogues: (a) Partnering with Patients and Families to Promote Adherence to Treatment, (b) Palliative Care for Dignified Dying, and (c) Canadian Health Outcomes for Better Information and Care. Although the three Catalogues were very different in the focus of health priority addressed, there are overlapping concepts across the Catalogues ranging from 1.0 to 14.2%. CONCLUSION The ICNP process model for Catalogue development can be used by other terminology developers and potentially assist in the creation of subset of ICNP to be used at the electronic health record interface. Further research is needed to address challenges and implications for testing and applications of terminology subsets.

Globalization and advances in information and communication technologies: The impact on nursing and health

Globalization and information and communication technology (ICT) continue to change us and the world we live in. Nursing stands at an opportunity intersection where challenging global health issues, an international workforce shortage, and massive growth of ICT combine to create a very unique space for nursing leadership and nursing intervention. Learning from prior successes in the field can assist nurse leaders in planning and advancing strategies for global health using ICT. Attention to lessons learned will assist in combating the technological apartheid that is already present in many areas of the globe and will highlight opportunities for innovative applications in health. ICT has opened new channels of communication, creating the beginnings of a global information society that will facilitate access to isolated areas where health needs are extreme and where nursing can contribute significantly to the achievement of “Health for All.” The purpose of this article is to discuss the relationships between globalization, health, and ICT, and to illuminate opportunities for nursing in this flattening and increasingly interconnected world.

Nursing interventions to promote dignified dying in four countries

PURPOSE/OBJECTIVES To describe nursing interventions to promote dignified dying as identified by nurses in four countries. DESIGN Cross-sectional survey design. SETTING Hospitals and clinics in Ethiopia, India, Kenya, and the United States. SAMPLE A convenience sample of 560 nurses who cared for dying patients in Ethiopia (n = 14), India (n = 229), Kenya (n = 36), and the United States (n = 281). METHODS Nurses who agreed to participate completed the International Classification for Nursing Practice Dignified Dying Survey. Responses to an open-ended survey question about the interventions nurses use to promote dignified dying were analyzed qualitatively. MAIN RESEARCH VARIABLES Nursing interventions. FINDINGS The Dignity-Conserving Care Model provided a framework to analyze nursing interventions used to promote dignified dying. Although some variation was found in the interventions used, nurses from all four countries identified interventions representing each of the three major categories of the model: illness-related concerns, a dignity-conserving repertoire, and a social-dignity inventory. CONCLUSIONS Nurses identified the holistic nature of the dying experience and the multiple interventions needed to promote dignity for dying patients and their family members. Palliative care is an area of practice that crosses healthcare settings, specialties, countries, and cultures. IMPLICATIONS FOR NURSING This study begins to identify specific interventions for future research and applies the Dignity-Conserving Care Model to further understand dignified dying from an international nursing perspective.

Collaborative Efforts for Representing Nursing Concepts in Computer- based Systems: International Perspectives

Current nursing terminology efforts have converged toward meeting the demand for a reference terminology for nursing concepts by building on the foundation of existing interface and administrative terminologies and by collaborating with terminology efforts across the spectrum of health care. In this article, the authors illustrate how collaboration is promoting convergence toward a reference terminology for nursing by briefly summarizing a wide range of exemplary activities. These include: 1) the International Classification of Nursing Practice (ICNP) activities of the International Council of Nurses (ICN), 2) work in Brazil and Korea that has contributed to, and been stimulated by, ICNP developments, 3) efforts in the United States to improve understanding of the different types of terminologies needed in nursing and to promote harmonization and linking among them, and 4) current nursing participation in major multi-disciplinary standards initiatives. Although early nursing terminology work occurred primarily in isolation and resulted in some duplicative efforts, the activities summarized in this article demonstrate a tremendous level of collaboration and convergence not only in the discipline of nursing but in multi-disciplinary standards initiatives. These efforts are an important prerequisite for ensuring that nursing concepts are represented in computer-based systems in a manner that facilitates multi-purpose use at local, national, regional, and international levels.

Development of the nursing problem list subset of SNOMED CT

OBJECTIVE To create an interoperable set of nursing diagnoses for use in the patient problem list in the EHR to support interoperability. DESIGN Queries for nursing diagnostic concepts were executed against the UMLS Metathesaurus to retrieve all nursing diagnoses across four nursing terminologies where the concept was also represented in SNOMED CT. A candidate data set was retrieved and included the nursing diagnoses and corresponding SNOMED CT concepts from the UMLS Metathesaurus. The team members identified the concepts that met the semantic selection criteria for inclusion in the nursing problem list. RESULTS 1320 concepts were returned in the initial UMLS Metathesaurus query of nursing diagnostic concepts. Further analysis was conducted to identify those nursing diagnostic concepts mapped to SNOMED CT and duplicate concepts were removed resulting in 591 unique UMLS Metathesaurus concepts. The query extracted all concepts from two of the nursing terminologies that contained interventions and outcomes. After cleaning the dataset, the final count of SNOMED CT concepts in the nursing problem list subset is 369. CONCLUSIONS The problem list is a key component of the patient care and has been acknowledged as critical by the EHR Meaningful Use criteria. Nursing diagnoses on the problem list are foundational for constructing a nursing care plan. A multidisciplinary patient problem list will facilitate communication and evaluation of the contribution of nursing care to the patients clinical care experiences and outcomes.

Semantic mappings and locality of nursing diagnostic concepts in UMLS

One solution for enhancing the interoperability between nursing information systems, given the availability of multiple nursing terminologies, is to cross-map existing nursing concepts. The Unified Medical Language System (UMLS) developed and distributed by the National Library of Medicine (NLM) is a knowledge resource containing cross-mappings of various terminologies in a unified framework. While the knowledge resource has been available for the last two decades, little research on the representation of nursing terminologies in UMLS has been conducted. As a first step, UMLS semantic mappings and concept locality were examined for nursing diagnostic concepts or problems selected from three terminologies (i.e., CCC, ICNP, and NANDA-I) along with corresponding SNOMED CT concepts. The evaluation of UMLS semantic mappings was conducted by measuring the proportion of concordance between UMLS and human expert mappings. The semantic locality of nursing diagnostic concepts was assessed by examining the associations of select concepts and the placement of the nursing concepts on the Semantic Network and Group. The study found that the UMLS mappings of CCC and NANDA-I concepts to SNOMED CT were highly concordant to expert mappings. The level of concordance in mappings of ICNP to SNOMED CT, CCC and NANDA-I within UMLS was relatively low, indicating the need for further research and development. Likewise, the semantic locality of ICNP concepts could be further improved. Various stakeholders need to collaborate to enhance the NLM knowledge resource and the interoperability of nursing data within the discipline as well as across health-related disciplines.

Interpretation of an international terminology standard in the development of a logic-based compositional terminology

PURPOSE Version 1.0 of the International Classification for Nursing Practice (ICNP) is a logic-based compositional terminology. International Organization for Standardization (ISO) 18104:2003 Health Informatics-Integration of a reference terminology model for nursing is an international standard to support the development, testing and implementation of nursing terminologies. METHODS This study examines how ISO 18104:2003 has been interpreted in the development of ICNP Version 1.0 by identifying mappings between ICNP and the ISO standard. Representations of diagnostic and interventional statements within ICNP are also analyzed according to the requirements mandated by the ISO standard. RESULTS All structural components of ISO 18104:2003 i.e. semantic categories, semantic domains, qualifiers and semantic links are represented either directly or in interpreted form within ICNP. The formal representations within ICNP of diagnostic and interventional statements meet the requirement of the ISO standard. CONCLUSIONS The findings of this study demonstrate that ICNP Version 1.0 conforms to ISO 18104:2003. More importantly perhaps, this study provides practical examples of how components of a terminology standard might be interpreted and it examines how such a standard might be used to support the definition of high-level schemata in developing logic-based compositional terminologies.

Toward harmonising WHO International Classifications: a nursing perspective

The WHO Family of International Classifications (FIC) provides a suite of health classifications to promote data exchange and comparisons worldwide. The International Classification of Functioning, Disabilities and Health (ICF) and the International Classification for Nursing Practice (ICNP) are part of WHO-FIC. This study was designed to examine to what extent the ICF and ICNP could be mapped to facilitate unambiguous communication across health settings and professionals. A total of 946 concepts from ICF were mapped to ICNP primitive concepts. Lexical matches generated by machine were examined to find false positive or additional semantic equivalence. Although the semantic mapping increased the number of exact and partial matches by 13%, only less than half of ICF concepts (46%) were able to be mapped to ICNP concepts. ICF concepts were more granular than ICNP concepts in the area of human functioning and body structures. Major challenges in mapping the two classifications resulted from differences in the terminology structure, concept representation and content specificity. A reference terminology model was useful to the mapping effort. The study findings support ongoing advancement in the area of harmonisation of healthcare terminologies. Applications that blend the use of ICF and ICNP concepts in practice should be further tested.

A quality improvement model for healthcare terminologies

A number of controlled healthcare terminologies and classification systems have been developed for specific purposes, resulting in variations in content, structure, process management, and quality. A terminology quality improvement (TQI) model or framework would be useful for various stakeholders to guide terminology selection, to assess the quality of healthcare terminologies and to make improvements according to an agreed standard. A TQI model, thus, was formulated based on a review of the literature and existing international standards developed for healthcare terminologies. The TQI model, adapted from Donabedians approach, encompasses structure, process, and outcome components in relation to a terminology life cycle--change request, editing, and publication. Multi-dimensional quality outcome measures also were identified in the areas of terminology content, modeling structure, mapping, and process management. A case study was developed to validate the TQI model using the International Classification for Nursing Practice (ICNP). The TQI model represented the complexity of activities involved in terminology quality management. The ICNP case study demonstrated both the applicability of the TQI model and the appropriateness of the criteria identified in the TQI model: openness and responsiveness, clarity and reproducibility, understandability, accessibility and usability, interoperability, and quality of documentation. The applicability of the TQI model was validated using ICNP. While ICNP exhibits many of the desirable characteristics of contemporary terminologies, the case study identified a need for further work on ICNP policy and on documentation.