professor university of salford, uk ehealth programme director hardiker pres.pdf · •ehealth is...
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ICN - Advancing nursing and health worldwide www.icn.ch
Great nurses need great systems
Nicholas Hardiker RN PhD
Professor
University of Salford, UK
eHealth Programme Director
International Council of Nurses
ICN - Advancing nursing and health worldwide www.icn.ch
(Great systems need great nurses)
ICN - Advancing nursing and health worldwide www.icn.ch
Presentation Outline
• Motivation
• Background
• Practice
– Data capture, workflow, decision making, data reuse
• Questions
ICN - Advancing nursing and health worldwide www.icn.ch
The world by land area
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
The world as proportion of young people
living with HIV
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
The world as proportion of nurses
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
The world by land area
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
The world as proportion of tuberculosis
cases
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
The world as proportion of nurses
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
Salford
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
• ‘…the workers of Salford live in dwellings in
which cleanliness and comfort are impossible’
Engels F (1845) Die Lage der arbeitenden Klasse in England
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
Hospital statistics
• ‘In attempting to arrive at the truth, I have
applied everywhere for information, but in
scarcely an instance have I been able to obtain
hospital records fit for any purposes of
comparison’ (p 176)
Nightingale F. Notes on Hospitals. 3rd Edition. London: Longman, Green,
Longman, Roberts, and Green, 1863
ICN - Advancing nursing and health worldwide www.icn.ch
Better information
=
Better health care
ICN - Advancing nursing and health worldwide www.icn.ch
Record keeping
• 'Today, the nursing shortage being what it is,
every effort should be made to utilize our nurses
to the utmost and not take their time with clerical
work of no immediate value'
ICN - Advancing nursing and health worldwide www.icn.ch
1953
• 'Today, the nursing shortage being what it is,
every effort should be made to utilize our nurses
to the utmost and not take their time with clerical
work of no immediate value'
Gorby JH, Johnson LW. (1953) Nurses'
notes cost money—so why not simplify them and economize?
Modern hospital 81 (4):54-56.
ICN - Advancing nursing and health worldwide www.icn.ch
eHealth (WHO 2011)
• eHealth is the use of information and
communication technologies (ICT) for health to,
for example, treat patients, pursue research,
educate students, track diseases and monitor
public health
http://www.who.int/topics/ehealth/en/
ICN - Advancing nursing and health worldwide www.icn.ch
Examples
• Electronic patient records
• Telehealth and telecare
• Decision support systems and online knowledge
sources
• Web based patient information and personal
health records
• Social networking support groups
• etc.
ICN - Advancing nursing and health worldwide www.icn.ch
‘eLife’
• The use of information and communication
technology in:
– Banking
– Retail
– Travel
– Entertainment
– Social engagement
ICN - Advancing nursing and health worldwide www.icn.ch
Unrealistic expectations
• Cash machines (ATMs) have not improved my
financial status…
ICN - Advancing nursing and health worldwide www.icn.ch
• …on demand TV has not made me like soap
operas more…
ICN - Advancing nursing and health worldwide www.icn.ch
• …SatNavs have not make my journeys safer…
ICN - Advancing nursing and health worldwide www.icn.ch
• …and online travel has not made the sun shine
on holiday…
ICN - Advancing nursing and health worldwide www.icn.ch
• …but I could not live without them
ICN - Advancing nursing and health worldwide www.icn.ch
A personal vision
• eHealth systems are in routine use to parallel
other aspects of contemporary life
• Data is available and routinely used/exploited for
the benefit of patients and those caring for them
• People are actively working on continually
improving how things are i.e. advancing together
the art/science of nursing informatics
ICN - Advancing nursing and health worldwide www.icn.ch
The International Council of Nurses (ICN)
• A federation of more than130 national nurses
associations representing millions of nurses
worldwide
• Operated by nurses and leading nursing
internationally since 1899
• Its purpose is to represent nursing worldwide,
advancing the profession and influencing health
policy
ICN - Advancing nursing and health worldwide www.icn.ch
ICN eHealth Programme
• Transforming nursing through the visionary
application of information and communication
technology
• Over 20 years in the making
• Announced at the ICN Conference 2011 in Malta
http://www.icn.ch/pillarsprograms/ehealth/
ICN - Advancing nursing and health worldwide www.icn.ch
Why ICN eHealth?
• ICN informs, supports and advocates for nursing
and its members
• Worldwide proliferation of ICT
• ICT in health care provides new opportunities,
not least equity and improved access
• eHealth threads through ICN processes and
products
ICN - Advancing nursing and health worldwide www.icn.ch
Connecting nurses
• A forum for expert healthcare professionals from
around the world to share their ideas, advice
and innovations
http://www.connecting-nurses.com
ICN - Advancing nursing and health worldwide www.icn.ch
ICN Telenursing Network
• Global resource for sharing knowledge and
expertise around telehealth and telecare
http://www.icn.ch/networks/telenursing-network/
ICN - Advancing nursing and health worldwide www.icn.ch
International Classification for Nursing
Practice (ICNP®)
• ICN has supported ICNP® since 1989
• A standardised terminology used to represent nursing diagnosis, intervention and outcome statements
• Available in 14 languages
• A related classification in the WHO Family of International Classifications
• Collaborative agreements in place with IHTSDO (SNOMED-CT) and Sabacare (CCC)
• Mappings to SNOMED CT, CCC, ICF, PNDS
• Migration pathway between ICNP and NANDA
http://www.icn.ch/pillarsprograms/international-
classification-for-nursing-practice-icnpr/
ICN - Advancing nursing and health worldwide www.icn.ch
ICNP® Application &
Development
• Individual and collaborative research and
development projects
• ICN Accredited Centres for ICNP® Research &
Development
• Supporting practical use at point of care
– Translation activity
– Catalogue development
– Research into care planning
– Commercial agreements with software suppliers
ICN - Advancing nursing and health worldwide www.icn.ch
Example 1: Workflow and decision
making
Focus Diagnostic
interventions Diagnosis Interventions
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
Example 2: Data reuse
Diagnosis Interventions Outcomes
ICN - Advancing nursing and health worldwide www.icn.ch
Structure indicators
• Care hours per patient per day
• Dependency
• Nurse satisfaction
ICN - Advancing nursing and health worldwide www.icn.ch
Process indicators Risk identification
Number of cases with a previously documented risk
that developed a specified problem in a given time
period
Number of cases that developed the problem in the
same time period
Did the identification of risk help to prevent a problem?
ICN - Advancing nursing and health worldwide www.icn.ch
Outcome indicators Resolution of problems
Number of cases where a specified problem was
resolved and that had at least one documented
intervention in a given time period
Number of cases with the problem documented in the
same time period
Did our actions help to resolve a problem?
ICN - Advancing nursing and health worldwide www.icn.ch
Outcome indicators Prevention of problems
Number of cases with a risk of a specified problem, that
did not develop that problem, and that had at least one
documented intervention in a specified time period
Number of cases with a risk of the problem in the same
time period
Did our actions help to prevent a problem?
ICN - Advancing nursing and health worldwide www.icn.ch
Outcome indicators Achieving expected outcomes
Number of cases that achieved the expected outcome
for a specified problem and that had at least one
documented intervention in a given time period
Number of cases with the problem documented in the
same time period
Did our actions help to achieve an expected outcome?
ICN - Advancing nursing and health worldwide www.icn.ch
Data requirements
• Risk
• Diagnosis
• Intervention
• Expected outcome
• Actual outcome
ICN - Advancing nursing and health worldwide www.icn.ch
Key focal elements
• Adult care
– Falls, Dehydration, Pain, Aspiration
• Child care
– Breastfeeding, Malnutrition, Fear
• Women’s care
– Pregnancy, Parenting, Contraceptive use
ICN - Advancing nursing and health worldwide www.icn.ch
Aspiration
• Risk for aspiration
– Risk identification, annually
• Actual aspiration
– Prevalence, bi-annual
• Care provider’s knowledge relating to aspiration
prevention
– Resolution of problem, annually
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
ICN - Advancing nursing and health worldwide www.icn.ch
A B
ICN - Advancing nursing and health worldwide www.icn.ch
SERVICE A SERVICE A
SERVICE A SERVICE A
SERVICE B SERVICE B
SERVICE A
SERVICE A SERVICE A
SERVICE B
SERVICE B SERVICE B
Epidemiological indicators: frequency
ICN - Advancing nursing and health worldwide www.icn.ch
Risk
identification
Prevention
of problems
ICN - Advancing nursing and health worldwide www.icn.ch
Achieving
expected
outcomes
Resolution
of problems
ICN - Advancing nursing and health worldwide www.icn.ch
Summary
• A standard terminology (and a good
implementation) is important for:
– Data capture
– Supporting workflow
– Supporting decision making
– Data reuse
• Nursing is relatively new to this but is making
significant advances
ICN - Advancing nursing and health worldwide www.icn.ch
Great systems need great nurses
ICN - Advancing nursing and health worldwide www.icn.ch
Contacts