Transcript Nurses’ Use of Standard Terms In Electronic Records With

Nurses’ Use of Standard Terms In
Electronic Records With and
Without NNN
Margaret Lunney, RN, PhD
Professor, College of Staten Island (CSI)
Linda Fiore, RN, MA
Assistant Director of Nursing
New York City Dept of Health & Mental
Hygiene
Acknowledgements
Main study (In review):
– Effects of Using Standard Terms in Electronic Records on Nurses’
Power and Children’s Health Outcomes
Main Study Co-Investigators:
– Laurence Parker, PhD
– Roberta Cavendish, RN, PhD
– Joyce Pulcini, RN, PhD
Main study partially funded by:
– NINR, NIH, 1R15NR04870, $107, 700
– CSI Foundation & President Marlene Springer, $15,000
– Professional Software for Nurses, $14,000
Background
CHANGE from paper to electronic health
records (EHR)
CHN specialty-nursing care in school
settings
Decisions re: software to purchase
Many vendors, Medical model approaches
Will EHR include sufficient nursing data?
– Driving Forces
– Restraining Forces
Driving Forces:
Use of NNN in School Settings
1. Research-based standardized terms
2. Describes:
Health promotion
Health protection
Management of problems
3. Provides comprehensive nursing
process data; both decisions & actions
Driving Forces:
Use of NNN in School Settings
4. Measures broad range of child & family
outcomes
5. Relates outcomes to interventions
6. Improves:
Communication
Continuity of care
Restraining Forces:
Use of NNN in School Settings
1. Historically:
–
–
–
Data organized by medical diagnoses (MDx) & tasks
Nursing model for care generally invisible
Low emphasis on documenting health promotion & health
protection
2. Resistance to change historical patterns
3. With familiarity of MDx,
perception that
EHR based on MDx easier to implement
Restraining Forces:
Use of NNN in School Settings
4. Cost of purchasing licenses to use NNN
5. Paucity of research data to show the
advantages of using NNN
Research Questions
1. Are there patterns of documentation that
can be identified from health visit data?
2. Are there differences in documentation
patterns with and without use of NNN?
3. Does the data support the advantages
of using NNN?
Study Methods
Qualitative & quantitative analyses of 12
nurses’ documentation
Health visits with 220 children, ~1300
contacts
6 nurses used standard terms of vendor
6 nurses used NNN + vendor terms
Investigators independently analyzed data
Methods to support credibility, dependability,
confirmability, transferability
Findings
Q 1: Documentation patterns evident:
– Type of care provided
Primarily health promotion & health protection
(~80%)
Management of therapeutic regimens (~10%)
Management of health problems (~10%)
– # of standard terms used per visit varied
widely among nurses, e.g., 1 vs. 10 Rxs
– Poor documentation of outcomes, i.e., 9/12
schools little to no outcome data
– Some errors implied in use of terms
Findings
Q2 & 3: Comparison of two groups:
Group that used NNN:
– Data better illustrated a nursing model for care
– Data were more comprehensive, e.g.,
Used 44 NDxs; 93 NIC Interventions, 33 NOC
Outcomes
Vendor terms
– Data better reflected specialty emphasis on
health promotion & health protection
– Data showed diversity & complexity of practice
High Frequency NANDA Diagnoses
Nursing diagnosis
Freq.
# Nurses
Knowledge Deficits
Health Seeking Behavior
Risk of injury & other risk dxs
Pain
Self Concept, RFE
Decisional Conflict
Self Esteem Disturbance
Decision making, RFE
207
70
62
8
37
35
30
22
5/6
5/6
5/6
5/6
3/6
3/6
3/6
3/6
High Frequency NIC Interventions
Intervention
Freq.
# Nurses
Active Listening
Counseling
Teaching: Group
Health Education
Environmental Mgt: Safety
Behavior Modification
Calming Technique
Anger Control Assistance
255
134
86
79
76
68
50
42
4/6
6/6
5/6
4/6
3/6
5/6
4/6
5/6
High Frequency NOC Outcomes
Outcomes
Freq. # of Nurses
Safety Behavior: Personal
Knowledge: Health Behaviors
Play Participation
Role Performance
Aggression Control
Information Processing
Knowledge: Diet
Knowledge: Health Promotion
81
81
46
44
39
39
38
29
3/6
2/6
3/6
3/6
2/6
2/6
2/6
4/6
Discussion:
Documentation Patterns
Data (both groups) illustrated complexity &
diversity of school-based nursing
Wide variety of charting patterns r.t. “pilot”
test, did not set specific expectations
Inadequate use of outcomes r.t. new way
of thinking; additional education needed
Errors in use of terms-education needed
Discussion:
Use of NNN vs. Vendor Terms
Data better represented:
– Nursing model for care (holism, health,
caring)
– Health Promotion
– Health Protection
– Management of acute and chronic problems
Use of NNN + vendor terms contributed to:
– Redundancy
– Inconsistent use of terms
Implications/Conclusions
Computerized documentation can
effectively represent school-based nursing
With use of NNN, omit vendor terms
With use of NNN, agencies need to plan:
Decision making re: preferred use of terms
Ongoing data evaluation, e.g., monthly
Systematic feedback to nurses
Ongoing education of nurses
Implications/Conclusions
Facilitate driving forces for use of NNN:
– Health-related perspective
– Comprehensive terms needed to represent
school-based nursing
– National and international recognition of terms
Minimize the restraining forces, e.g.,
– Research data needed
Promote purchase of software with NNN