A Unified Nursing Language System
Article Outline
As healthcare information systems (HIS) become more common around the world, the responsibility of nursing to take an integral role in the development and implementation of these systems looms large. Nurses can provide a great service to recipients of healthcare by ensuring that HIS represent all pertinent health data, including clinical nursing data, and—even more important—that the primary focus of HIS is always on the patient rather than the technology setting, payer, or service provider.1
A necessary element of any HIS is interoperability, or the ability to communicate and transfer data across systems. “Interoperable healthcare information enhances the quality of care for all Americans,”2 and fundamental to interoperability of HIS is standardized terminologies.3 Interoperability and standardization are necessary in the US, with its plethora of vendors and standards-development organizations, as well as in developing countries where systems are expanding. The HIS in developing countries are often acquired through donation and are, thus, disparate—introducing challenges to achieving interoperability.4
Given the strong movement toward HIS worldwide, a unified nursing language system is necessary to generate standardized, electronic, retrievable, client-level data that represent nursing practice.5 These data can be used to communicate, describe, and compare nursing practice. The resultant information and knowledge can facilitate clinical and administrative decision-making, contribute to the development of guidelines and benchmarks for best practice, and support the development of healthcare policies worldwide.
ICN & ICNP
The International Council of Nurses (ICN) is a federation of 129 national nurses’ associations. The ICN’s mission is to represent nursing worldwide, advancing the profession and influencing health policy.6 The ICN recognized the need for a global standard for nursing terminology and began work in 1989 toward an International Classification for Nursing Practice (ICNP).
The ICNP was developed and continues to evolve with the participation of informatics consultants and hundreds of nurses across the ICN member countries. In 2005, ICN released ICNP Version 1.0. The ICNP Version 1.0 is defined as a unified nursing language system and provides a standardized terminology to capture nursing practice at the point-of-care delivery, through representation of nursing diagnoses, interventions, and outcomes.7 The vision of ICNP is to be an integral part of the global information infrastructure, informing health care practice and policy to improve patient care worldwide.7
The need for ICNP
There are multiple nursing terminologies worldwide. The American Nurses’ Association has evaluated and recognized a number of nursing terminologies. Although there are clear disadvantages to multiple terminologies, such as the lack of interoperability, there also is a need for and potential benefit of multiple systems. It is clear that nursing specialties share concepts across their terminologies while, at the same time, have unique terminology needs. For example, nurses in a Community Health Department share some terminology with nurses in an Intensive Care Unit or Home Care, but they also would need unique concepts within each specialty area to best represent their practice. This also is the situation with nurses globally. There are both shared and unique nursing concepts across countries and cultural groups.
International Classification for Nursing Practice (ICNP) can play a major role in harmonizing concepts across the various terminologies. As a unified nursing language system, the purpose of ICNP is to facilitate cross-mapping of both local terms and concepts in existing nursing terminologies. This approach recognizes and supports the ongoing work of nursing terminologies (eg, NANDA, Omaha system, Clinical Care Classification), rather than creating yet another nursing terminology. International Classification for Nursing Practice (ICNP) acts as a reference terminology for nursing and identifies relationships among concepts within and across nursing terminologies. International Classification for Nursing Practice (ICNP) was developed in conformance with International Standards (eg, ISO Standard 18104:2003) to support the interoperability of nursing data regionally, nationally, and internationally. As an international standard, the ICNP can facilitate collection and analysis of nursing data across populations, health care settings, languages, and geographic regions.
Some countries have adopted a multi-disciplinary health care terminology, the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), as a national standard. Although the SNOMED-CT structure allows for convergence of nursing content from nursing terminologies,8 ICN believes that it is essential that the profession of nursing determines what constitutes the domain of nursing and the terminology representing this domain. The International Council of Nurses has been in discussion with SNOMED International to explore opportunities for collaboration.
Along with harmonizing concepts across clinical nursing specialties and across other health care disciplines, there is a need to improve shared meaning of concepts within nursing itself, across education, research, and practice. The current emphasis on evidence-based practice and globalization in health care all point to a greater need for a consistent and comprehensible way of describing the practice of nursing. To accelerate the reality of evidence-based practice, there needs to be a link between the clinical terminology used by nurses in practice and the nurse researchers’ terminology to describe practice. Linking research and practice terminology has become an important concern, and further work is needed to develop knowledge-based HIS.
There is the expectation that computer-aided clinical decision support will contribute to quality improvement, including improved client outcomes. To achieve this expectation, HIS should be designed with a clear understanding of the information needs of users and why data are being collected because, ultimately, these data should be used to influence the behavior of those responsible for and in control of improving health,9 including patients themselves, nurses and other health professionals, administrators, and policy-makers. International Classification for Nursing Practice (ICNP) will need to be dynamic and responsive to users’ needs, as HIS decision-support evolves.
Improving ICNP accessibility
Many efforts are underway to make the ICNP more accessible, including translations, ICNP Centres, and ICNP Catalogues. Four translations of the new Version 1.0 are completed and numerous others are underway. Some of the translation work is being conducted in the ICNP Centres. The International Council of Nurses is accrediting Centres that are focused on ICNP research and development. The ICNP Centres provide an infrastructure for ICNP activities and form the ICNP Consortium that meets every 2 years at the ICN Congress or ICN Conference.
The most recent version of ICNP is a complex, comprehensive tool including thousands of terms, their definitions, and relationships. For ease of use of ICNP Version 1.0, ICN is developing ICNP catalogues. These catalogues are subsets of the ICNP, including nursing diagnoses, interventions and outcomes for a specialty area or focus of practice. For example, the ICNP Catalogue on Promoting Dignified Dying will allow nurses providing end-of-life and palliative care to more readily integrate the ICNP into their practice. Another example is the Perioperative Nursing Data Set (PNDS), a product of the Association of Perioperative Registered Nurses (AORN).9 With a map of the PNDS to the ICNP, nurses using the PNDS in their practice can also benefit from being part of a larger unified nursing language system.
Implications for academy members
There are many opportunities to participate in ICNP activities:
The use of the ICNP in HIS worldwide can provide relevant clinical data to analyze and evaluate care; to support decision-making in practice, administration, and policy; and to generate new knowledge to improve care. International Classification for Nursing Practice provides an exciting opportunity to communicate and compare nursing worldwide. Some researchers may be interested in examining the important differences in nursing practice across the globe. Others may find it inspiring to use the ICNP to explore the similarities across nursing and the contributions of nursing to world health.10
References
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- United States Department of Health & Human Services. The Commission on Systemic Interoperability (2005) Report: Ending the Document Game. Available at: http://endingthedocumentgame.gov/report.html. Accessed on August 15, 2006.
- . An informatics infrastructure is essential for evidence-based practice. J Am Med Informatics. 2001;8:199–201
- . Third-world presents unique IT implementation challenges. Healthcare IT News. 2006;3:9
- . Global nursing language: making international nursing visible. J Prof Nurs. 2002;18:113–114
- International Council of Nurses. About ICN. Available at: www.icn.ch/abouticn.htm. Accessed on August 15, 2006.
- International Council of Nurses. International Classification for Nursing Practice-About ICNP® Available at: http://www.icn.ch/icnp_about.htm. Accessed on October 13, 2006.
- SNOMED International Nursing. Available at: http://www.snomed.org/clinical/nursing.html. Accessed on August 25, 2006.
- . Information is not only for managers. Bull World Health Organ. 2005;83:637
- Association of Perioperative Registered Nurses (n.d.). Perioperative Nursing Data Set. Available at: http://www.aorn.org/research/pnds.htm. Accessed on August 7, 2006.
PII: S0029-6554(06)00270-3
doi:10.1016/j.outlook.2006.09.009
