Nursing Classification Systems
Necessary but not Sufficient for Representing “What Nurses Do” for Inclusion in Computer-based Patient Record Systems
- Affiliations of the authors: Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA (SBH, CNM); CareCentric Solutions, Inc., Duluth, GA (CNM)
- Correspondence and reprints: Suzanne Bakken Henry, RN, DNSc, FAAN, Box 0608, University of California, San Francisco, San Francisco, CA 94143-0608. E-mail: nursing%sue_henry{at}ccmail.ucsf.edu
- Received 23 December 1996
- Accepted 24 January 1997
Abstract
Our premise is that from the perspective of maximum flexibility of data usage by computer-based record (CPR) systems, existing nursing classification systems are necessary, but not sufficient, for representing important aspects of “what nurses do.” In particular, we have focused our attention on those classification systems that represent nurses' clinical activities through the abstraction of activities into categories of nursing interventions. In this theoretical paper, we argue that taxonomic, combinatorial vocabularies capable of coding atomic-level nursing activities are required to effectively capture in a reproducible and reversible manner the clinical decisions and actions of nurses, and that, without such vocabularies and associated grammars, potentially important clinical process data is lost during the encoding process. Existing nursing intervention classification systems do not fulfill these criteria. As background to our argument, we first present an overview of the content, methods, and evaluation criteria used in previous studies whose focus has been to evaluate the effectiveness of existing coding and classification systems. Next, using the Ingenerf typology of taxonomic vocabularies, we categorize the formal type and structure of three existing nursing intervention classification systems—Nursing Interventions Classification, Omaha System, and Home Health Care Classification. Third, we use records from home care patients to show examples of lossy data transformation, the loss of potentially significant atomic data, resulting from encoding using each of the three systems. Last, we provide an example of the application of a formal representation methodology (conceptual graphs) which we believe could be used as a model to build the required combinatorial, taxonomic vocabulary for representing nursing interventions.
Footnotes
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Supported by NR3874, Representing Nursing Concepts for Computer-Based Systems, S. B. Henry, Principal Investigator. The data were provided by NR02215, Quality of Nursing Care of People with AIDS, W. L. Holzemer, Principal Investigator. An earlier version of this article was presented at the 1996 AMIA Fall Symposium.
