icnp applications in nursing informatics 3rd telenurseid dissimination meeting in cee countries

Danish Institute for Health and Nursing Research. Fensmarkgade 3. 2200 Copenhagen N. Denmark.Phone +45 31394066. Email: DIHNR@DISS.DK

ICNP Applications in Nursing Informatics3rd TelenurseID Dissimination Meeting in CEE Countries

Prague October 2000

ICNP History,Current State

and Perspectives

Randi Annikki MortensenTelenurse Coordinator, ICNP Consultant

Director of The Danish Institute for Health and Nursing Research

Content:1. Introduction2. Design of ICNP:

A Unifying Framework anda Design for Expressive Power

2.1 Nursing Phenomena2.2 Nursing Actions2.3 Nursing Outcomes3. ICNP: A Tool for Practice and Research 4. Conclusion

Ward ID V % O % R % Total %

Nursing Diagnoses:1 11111 Physiological Functions 4 1 40 452 11112111 Acute Pain 5 23 4 323 1111211 Pain 3 3 14 204 1111182 Urinary Elimination 7 4 6 175 111113111 Fever 1 2 13 166 1111111211 Expectoration 10 0 1 116 111221213 Self Care: Hygiene 0 9 2 117 111212111 Lack of Knowledge 0 5 5 107 111116 Hydration 5 1 4 108 11112114 Consciousness 8 1 0 98 111119 Integument 0 1 8 99 111112 Circulation 5 2 1 810 111111 Respiration 7 0 0 710 111111115 Mobility ( Lower Extr.) 0 6 1 710 11111222 Low Blood Pressure 6 1 0 710 1111215 Nausea 0 1 6 7

Total 61 100 60 100 105 100 226 100

Ward ID V % O % R % Total %

Nursing phenomenon:

1 11111 Physiological Functions 4 7 1 2 40 38 45 20

2 11112111 Acute Pain 5 8 23 38 4 4 32 14

6 1111111211 Expectoration 10 16 0 0 1 1 11 5

Top 17 Nursing Interventions

nursing interventions

measuring pulse

describing faeces

measuring temperature

describing drip bag I

informing patient about diet

others

measuring blood pressure

wound care

describing drip bag II

washing patient

describing urine

describing hydration

consult physiotherapist

mobilizing patient

informing patient about diet

documenting wasteproducts

putting on tubes

Column 1 Column 2 Column 3 Column 4 Column 5 Column 6 Column 7 Column 8 Column 9 Column 101st day 2nd day 3rd day 4th day 5th day 6th day 7th day 8th day 9th day 10th day

3 2 1 1 2 2 2 #NUM! #NUM! #NUM!3 1.5 1 1 #NUM! #NUM! #NUM! #NUM! #NUM! #NUM!

3.5 3 3 2 2 2 #NUM! #NUM! #NUM! #NUM!

Degree of Acute Pain in Each of the Three Wards V,O and R

1 2 3 4 5 6 7 8 9 10

Days of Admission

f Seve

Series1

Series2

Series3

V:Intensiv afd.O:Routeop.kirur.afd.R:Onkol.afd.

Degree o f Acute Pain in Each o f the Three Wards V,O and R

1 2 3 4 5 6 7 8 9 10

Days of Admis s ion

Sé rie 1

Sé rie 2

Sé rie 3

NursingToday

The Construction of ICNP. As a Unifying Framework and a Design for

Expressive Power

Design:

Architecture

ICNP as a Unifying Framework i.e

a Reference Terminology

NandaHHCC NOC NIC

Data:Use of Existing Classification Systems

ICNP as a UnifyingFramework +Design for ExpressivePower

Use all ICNP Conceptsand combine NewICNP

Concepts

Data for Clinical Nursing Practice: Use of existing

Classifications Systems or create own Catalogs

HYPOTHESIS:HYPOTHESIS:Context ofDiscovery

Identificationthroughanalysis:

"Conceptdissection"

Context ofJustification

Validationthroughsynthesis:

"Concept- sutures"

ICNPICNP

Data:Existing Classification Systems

Folk-Guitar

ClassicalGuitar

Guitar

Grandpiano

Uprightpiano

Kettledrum

Basedrum

Musicalinstrument

Classifications are Concept Pyramids

1. nursing phenomena2. nursing actions

3. nursing outcomes

The 3 Classifications of ICNP:

Starters

Top term: CourseClasses:

Main Dish

Dessert

Starters Shrimps

Main Dish Lamb

Dessert Ice-cream

Menu of the dayNo choice of combinations

Starters Shrimps, Ham,Salad

Main Dish Lamb,Steak, Fish

Dessert Ice-cream, cake, fruit

A La Carte MenuFree choice of combinations

Judgement

Bearer

Top term: nursing phenomenonClasses:

FrequencyDuration

Topograhhy

Location

Likelihood

ICNP: Nursing Phenomena

Focus Coping

Judgement Enhanced

Bearer Family

FrequencyDuration

Topograhhy

Location

Likelihood Chance for

Axes:Action Types

Target

Top term: Nursing ActionClasses:

TimeTopographyLocationRouteBearer

Beta ICNP: Nursing Actions

Axes:Action Types Reducing

Target Anxiety

Mean Guided Imagery Technique

TimeTopographyLocationRouteBearer Individual

ICNP on the Net: www.telenurse.net

Design of ICNP betaArchitecture and Domain

1. Nursing Phenomenon:2. Nursing Actions

3. Nursing Outcomes

Classification of Nursing Phenomena

Focus Focus

Judgement

Bearer

FrequencyDuration

Topograhhy

Location

Likelihood

Focus Focus

Judgement

Bearer

FrequencyDuration

Topograhhy

Location

Likelihood

Is this anursing

phenomenon?

Molecules

Is this anursing

phenomenon?

Organs

Is this a nursing

phenomenon?

Functions

Is this anursing

phenomenon?

BrainFunctions

Is this anursing

phenomenon?

PersonsActions andReasons for Actions

Is this anursing

phenomenon?

Self ReliantActions

Is this anursing

phenomenon?

InterdependentActions

Is this anursing

phenomenon?

Is this anursing

phenomenon?

Nature

Is this a nursing

phenomenon?

Group Interdependent Actions

Self Reliant Actions Functions Organs

Molecules Atoms

Classification of Nursing Phenomena

Function Person

Individual Group

Hum an Being

Nature M an M ade

Environment

NursingPhenomena

Focus of Nursing PracticeFocus of Nursing Practice

Function Person

Function PersonNeeds Self CareV.Henderson D.Orem

Physical and the Humanities and theBiological Sciences: Social Sciences:Functional Health Human ReactionsConditions

Function Persone.g. Nutrition Self Care:Feeding

Urinary Incontinence Self Care:Toiletting Lactation BreastfeedingSpeech Communication

Sensations of the Body Reasons for ActionsPhysical Humanitieand Biological Sciences: and Social Sciences:Functional Human ReactionsHealth Conditions

Explaining Understanding

Sensations of the Body Reasons for ActionsPain SufferingIching CopingHunger ObsessionNausea PreoccupationVision PowerlessnessHearing Illusion

Reasons for Actions Actions (internal) (external)

Person

Self Reliant InterdependentActions Actions

Individual Group

Nursing Judgement:

Group Interdependent Actions

Self Reliant Actions Functions Organs

Molecules Atoms

A Nursing Diagnosis is a Nursing Phenomenon judged

Focus of Nursing: •Sensations•Sleep•Mobility•Respiration•Perspiration•Constipation•Peripheral Oedema•Consciousness

Nursing Judgement: •Sensation:Altered•Sleep:Disturbed•Mobility:Reduced•Breathing:Insufficient•Perspiration:Increased•Constipation:Yes•Peripheral Oedema:Yes•Consciousness:Reduced

Focus Focus Body Nutrition

JudgementJudgement Excess

Bearer

FrequencyDuration

Topography

Location

Likelihood

Beta ICNP: nursing phenomenon

Reasons for Actions

• Guilt•Loneliness•Coping• Hope

Reasons for Actions

•Guilt Yes•Loneliness Decreased •Coping Impaired• Hope Enhanced

Focus Focus Coping

JudgementJudgement Reduced

Bearer

FrequencyDuration

Topography

Location

Likelihood

Focus of Nursing:

•Self Esteem.•Self Care.•Self Control: Impulse•Tobacco Use.

Nursing Judgement:

•Self Esteem: High•Self Care: Not Deficient•Self Control: Impulse: Demonstrated•Tobacco Use: No

AxesFocus Focus Self Care

JudgementJudgement Adequate

Bearer

FrequencyDuration

Topography

Location

Likelihood

Focus of Nursing: •Socialising•Relating•Communication•Violence Directed at Others

Nursing Judgement: •Socialising: No Difficulty•Relating:Adequate•Violence Directed at Others: No•Communication: Achieved

AxesFocus Focus Communication

JudgementJudgement Increased

Bearer

FrequencyDuration

Topography

Location

Likelihood

Nursing Judgement: •Family:

AxesFocus Focus Family Planning

JudgementJudgement Adequate

Bearer

FrequencyDuration

Topography

Location

Likelihood

Nursing Judgement: •Nature:

AxesFocus Focus Water

JudgementJudgement Polluted

Bearer

FrequencyDuration

Topography

Location

Likelihood

Focus Focus JudgementJudgement

Bearer

FrequencyDuration

Topograhhy

Location

LikelihoodLikelihood

Nursing Judgement: •Chance for Altered Sensation•Risk for Disturbed Sleep•Chance for Reduced Mobility•Risk for Insufficient Breathing•Chance for Increased Perspiration•Risk for Constipation•Risk for Peripheral Oedema•Chance for Reduced Consciousness

Focus Body Nutrition

Judgement Excess

Bearer

FrequencyDuration

Topography

Location

Likelihood Risk for

Nursing Judgement:

•Chance for Self Esteem toa very high Degree•Risk for Self Care Deficit•Chance for demonstrated Self Control •Risk for Tobacco Use

Focus Hope

Judgement Enhanced

Bearer

FrequencyDuration

Topography

Location

Likelihood Chance for

Nursing Judgement: • Chance for desirable Parental Role•Risk for decreased Mother Child Attachment•Risk for neglected Breastfeeding•Risk for insufficient Infant Sucking

Nursing Judgement: Nutrition Excess Excess in Familyin Family

Focus Focus Hope

JudgementJudgement Enhanced

BearerBearer Family

FrequencyDuration

Topography

Location

LikelihoodLikelihood Chance for

ICNP: Nursing phenomenon

FocusFocus

JudgementJudgement

Bearer

Top term: Nursing phenomenonClasses:

FrequencyFrequency

Duration Duration

TopographyTopography

LocationLocation

Likelihood

Nursing Judgement: •Risk for Chronic Intermittend Pain in Back •Chance for increased• Mobility of right Arm•Risk for Iching of whole Body•Risk for Constipation in Colon

ICNP: Nursing phenomenon

FocusFocus Pain

JudgementJudgement Yes, to a very high degree

Bearer

Top term: Nursing phenomenonClasses:

FrequencyFrequency Often

Duration Duration Chronic

TopographyTopography Right

LocationLocation Arm

Likelihood

1. Nursing Phenomenon2. Nursing Actions

3. Nursing Outcomes

Breast Sw imming Craw l

Sw imming

Sprinting Jogging

Running

Exercising Sport

Classifications are Concept Pyramids

Classification of Nursing Actions

Observing Managing Performing Attending Informing

Action Types

Observing

Action Types

Observing Managing

Action Types

Observing Managing Performing

Action Types

Observing Managing Performing Attending

Observing Managing Performing Attending Informing

Action Types

Identifizieren

Erm itteln

Aufpassen

Bew erten

Beobachten

Organisieren

Versorgen

Verw alten

Putzen "Groom ing"

Baden,duschen

Bedecken

Ernähren Installieren

M anipulieren Aufb ieten

Stim ulieren Nähen

Lüften Vorbereiten

Aufb lasen Einfügen

Aufb ieten Herausnehm en

W echseln

Handeln

Beistehen

Behandeln

Vorbeugen

In Kontaktsein

Pflegen

Lehren

Führen

Beschreiben

In form ieren

Handlungstypen

Observing Managing Performing Attending Informingwhat? what? on what? to what? about?

Action Types

Observing Managing Performing Attending Informingwhat? what? on what? to what? about?using? using? using? using? using?

Action Types

Observing Managing Performing Attending Informingwhat? what? on what? to what? about?using? using? using? using? using?when? when? when? when? when?

Action Types

Observing Managing Performing Attending Informingwhat? what? on what? to what? about?using? using? using? using? using?when? when? when? when? when?where? where? where? where? where?

Action Types

Observing Managing Performing Attending Informingwhat? what? on what? to what? about?using? using? using? using? using?when? when? when? when? when?where? where? where? where? where?

for whom? for whom? to whom? whom?

Action Types

Axes:Action TypesAction Types

TargetTarget

TimeTopographyLocationRouteBeneficiary

Axes:Action TypesAction Types Preventing

TargetTarget Decubitus

TimeTopographyLocationRouteBeneficiary

Beta ICNP: nursing actions

Axes:Action TypesAction Types Attending to

TargetTarget Contact Lenses

TimeTopographyLocationRouteBeneficiaryBeneficiary Individual

Beta ICNP: nursing actions

1. Nursing Phenomenon2. Nursing Actions

3. Nursing Outcomes

Nursing Phenomena judged on a 5 point scale

are basis for measuring Nursing Outcomes

D O1 O2 O3 ........................................... On

Degree

5 ...to a very high degree

4 ...to a high degree

3 ...to some degree

2 ...to a lesser degree

1 ...no

D O1 O2 O3 ........................................... On

Degree

time-series

3 ...to some degree

1 ...no

Clinical nursing outcomesClinical nursing outcomes

Nursing outcomes arenursing diagnoses linked witha time interval interrupted by

a nursing interventionICNP and clinical nursing outcome:Diagnosis + Time interval = Outcome

Nursing Intervention

Focus Pain

Judgement Yes, to a high degree

Distribution

Top term: nursing phenomenaClasses:

FrequencyDuration

Topography

Location

Likelihood

ICNP: nursing phenomenonPoint in Time: 1

Axes:Action Types Administering

Target Medicine

TimeTopographyLocationRouteBeneficiary the individual

+ time intervalinterrupted by Nursing Intervention

Focus Pain

Judgement No

Distribution

FrequencyDuration

Topography

Location

Likelihood

ICNP: Nursing PhenomenonPoint in Time: 2

O1 O2 O3 ................................... On

NursingInterventions

Nursing Diagnoses

Diagnosis

PainTo a High Degree

time-series

O1 O2 O3 ................................... On

Nursing Diagnoses

Diagnosis

time-series

O1 O2 O3 ................................... On

Nursing Diagnoses

Diagnosis + Time interval =Outcome

Pain Notime-series

D O1 O2 O3 ........................................... On

Degree

time-series

Nursing Interventions

3 ...to some degree

1 ...no

The Nursing DomainThe Nursing Domain

Health- Human -Environment Nursing Practice

Human Being Environment Observing ManagingPerformingAttendingInforming

Individual Group Nature Manmade

Function Person Family Community

Nursing Research

Nursing Practice

Nursing Philosophy

Nursing Research

Nursing Practice

Nursing Philosophy

Nursing Research

Nursing Practice

Nursing Philosophy

Human Being

Individual

Function Person

Sensation Resoration SelfReliantActions

Actions

Function

Sensation Resoration

Nursing Research

Nursing PracticeRestSleep

Hypersomnia Insomnia Fatigue Exhaustion

Concepts and their attributes

Specific characteristics

Definition by genus et species.

ICNP Concepts

Definitions and Criteria:

SleepDefinition: Is a type of Restoration with the specific characteristics:Recurringlowering of bodily activitymarked by reduced consciousnessCriteria: not awake,not aware,immobile posture

Restoration

ICNP Concepts

Restoration

RestDefinition: Is a type of Restoration with the specific characteristics:Recurringlowering of bodily activity and immobile posture whileCriteria: awake and aware,

ICNP Concepts

Restoration Definition: Is a type of Function with the specific characteristics:Recurringlowering of bodily activityCriteria: mental and physical rejuvenation

RestDefinition: Is a type of Restoration with the specific characteristics:Recurringlowering of bodily activity and immobile posture whileCriteria: awake and aware,

ICNP: Surveillance of Peoples Need for Nursing Care-Clinical Nursing Outcome

Overview of Nursing Careand Resource Estimation

Thank You!

Focus Focus JudgementJudgement

Bearer

FrequencyDuration

Topograhhy

Location

Likelihood

The Combinatorial Design of ICNP can be used as:•Unifying Framework•Design for Expressive Power

Pyramids of concepts are many sided

Nursing Research

Nursing Practice

Nursing Philosophy

Human Being Environment Observing ManagingPerformingAttendingInforming

Individual Group Nature Manmade

Function Person Family Society

icnp applications in nursing informatics 3rd telenurseid dissimination meeting in cee countries

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