a long way throught data and terminologies

Transcription

1 A Bridge Between Data and Language, the Swiss Issues: NURSING data ISE Lausanne Alain Junger Bern From clinical practice to information system, a long way throught data and terminologies

2 Swiss health information system 26 autonomous cantons 26 health systems No central data production Many lobbies Economic restrictions Health policy Comparisons Coordination Many different information systems 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

3 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 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!

4 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, ) Conclusions of the 1 st part Need for a uniform nursing language to describe nursing phenomena and nursing 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)

5 Part 2 : business plan TP1: Project management TP2 : Classifications TP3 : CH-NMDS TP4: Data mining TP5: Information TP6 : Nat. and internat. coordination TP7: Normalisation Organigram Direction de projet NURSING data TP1 : Gestion opérationnelle TP2 -TP3 - Groupe national de terminologie et de données infirmières TP4 : Validation du modèle d exploitation des données TP5 : Information TP 7 : Préparation du système de normalisation TP2 : Groupe régional de terminologie infirmière (francophone) (GRTI) TP2 : Regionale Expertengruppe für Pflegefachsprache (REP) TP2 : Gruppo regionale per una terminologia infermieristica (GRTI) TP3 : Groupe d experts national pour le NMDS (GN-NMDS) TP 6 : Coordination Réseaux régionaux Regionale Netzwerke Reti regionali

6 NURSING data The conceptual framework Nursing Data Sets Nursing Phenomena Set Nursing Management/financial Set Patient Structure Prof. Nursing Intervention Set

7 Alain Junger/99 Version 2.0 Alain Junger/99 NURSING data in four models Facts A-State observed Clinical Environment Clinical Physiopathological Psychological Social status + resources - problems Diagnostic Nursing phenomena aspects, process objectives 5 Functions Interventions Outcomes B-Sate observed Les acteurs Etat de santé Autres Autres professions Analyse/fixe des Pat ient Patient objectifs Médecins Observe/ Médecin Infirmières décrit Des c ri ptif s spécifiques inf irmiers Agit Concern Object/data e Patient / Client Devient Emploi un nouvel état de santé Réalise/ applique Institution Modifie model Soins & traitements Séjourne/ Autres habite Traitements Induit Actes / interventions Travaille Prescrit/ demande Lieu Information flow Se Appartient Séjour situe Etape Episode Statistics of population NURSING data NMDS Data Statistical Data NDS Planification data Management aggregation reporting Management data Nursing records Clinical data Internal External Reality / practice Facts Alain Junger/99 Model of the clinical process Facts A-State observed Clinical status Diagnostic aspects, objectives Environment Physiopathological Psychological Social + resources - problems Nursing phenomena Interventions 5 Functions Outcomes B-State observed Alain Junger/99

8 Permanent concepts: Patient Care as an object Actor/professional Institution Point of care Episode Health status Interventions, actions The object: «care» Emploi Institution Les acteurs Autres professions Patient Médecins Infirmières Actors Organisation Travaille Réalise/applique Séjourne/ habite Prescrit/demande Analyse/fixe des objectifs Observe/décrit Agit Patient / Client Concerne Soins & traitements Autres Traitements Induit Actes / Interventions interventions Etat de santé Autres Patient Médecin Descriptifs spécifiques infirmiers Health status Modifie Devient un nouvel état de santé Séjour Etape Episode Appartient Lieu Place Se situe Episode Version 2.0 Alain Junger/99

9 Micro to macro Statistics Data Agregation Policy Management Clinical documentation Nursing process Linkage between data Hotellerie Physiothérapeute Finance Stat. Population NMDS NDS Nurs. Stat. Stat. Infirm. Dossier Documentation Soins Care Médecine

10 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) 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

11 NURSING data & other statistics Medical statistic Hospital statistic Long-term care statistic (Establishment) Future? NURSING data CH-NMDS What will we show and see?

12 Mais... Aber... Ma... But 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 electronic patient record

13 From data to terminologies From practice to concepts Practice Language Data Abstraction LEP/PRN

14 Phenomena / Diagnosis? Phenomena Aggregation Statistical Level Nursing Diagnosis 1 Target 1 Nursing Diagnosis 2 Target 2 Nursing Diagnosis 3 Target 3 Clinical Level Clinical Judgement Description Symptoms Description Clinical situation Future many years of data and research No known classification Classification characteristics Classification Classification characteristics Clinical definitions Clinical oriented definitions Typology = Gathering different Nursing diagnosis and other data (Hyperthermia, 86 years, pain,...) Hierarchical classification = Gathering nursing diagnosis with common characteristics (Nutritional state control, parenteral feeding, weight control = Care for nutritional troubles)? Phenomena

15 Health phenomenon Health aspect from one or many individuals justifying the nursing interventions Definition accepted at 82%, rejected by 5% Classification developments 1 Phase 1 June 2001 Sept Nov Febr Experts selection: 3 groups 3 languages 60 persons Course on basic terminology concepts Selection of nursing significant concepts for phenomena interventions Delphi I two lists per language Dead line for answers

16 Delphi questionnaire Speaking : Sent Received % French % German % Italian % Total % Delphi I & II I Other Nurse manager Nurse practitioner Nursing teacher Board nurse Other School Psychiatry Home care Long term care Hospital II Nurse Nurse Nursing Board Other manager practitioner teacher nurse Other School Psychiatry Home care Long term care Hospital

17 Classification developments 2 Phase II March 2002 May 2002 Results analysis Feedback Publication of the first version of the two lists translated in: French Italian German June 2001 Dead line for answers Test in 2003 Nursing phenomena Structure ICF (WHO) ANATOMICAL STRUCTURE ORGANIC FUNCTION ENVIRONMENTAL FACTORS ACTIVITY AND PARTICIPATION Content 50 items Qualifiers ICF 4 steps scale

18 Nursing interventions Structure ICF (WHO) Content 64 items Qualifiers Observe/survey/monitor Prevent Inform Teaching Advise/guide Assist/help/accompany Treat / act / intervene / supply Re-educate Future of NURSING data Theory Development Operational Research Engineering Nursing practice Future improvement NURSING data Future application

19 Information policy Ambitious information with modern tools Web site Restricted forum Regular publications in professional and other journals Communications, conferences, lectures Thank you for your attention and Looking forward to continue the discussion