Standardized terminologies are terms that can be used universally to communicate different concepts. Standardized terminologies are important in the storage and sharing of information so as to maximize on its utility. The development of standardized nursing terminologies (SNTs) came about as part of an effort to effectively manage information and the nursing field (Hardiker et al, 2000). There are various benefits of having standardized nursing terminologies as part of standardization in information management. They include, among others, enhanced effectiveness in communication among nurses and other stakeholders in healthcare provision, better data collection and evaluation of outcomes in nursing care, ensuring that nursing interventions are more visible, and improving standards of care adherence (Kleinbeck, 2002).
The importance of information in the field of healthcare cannot be overemphasized. Healthcare policies are formulated based on the analysis of data to understand the current state of affairs (Kleinbeck, 2002). The advancement of technology has facilitated better and more information management techniques, which should potentially improve the hypotheses on which such policies are made. Since the 1970s, milestones have been made in the storage, access, and processing of information, especially with the advent of computerized technology. This information is however stored in a variety of way and using different methods. Standardized nursing terminologies attempt to ease the access and processing of data by using widely accepted and practiced in data management.
These terminologies were formally introduced in the late 1980s and early 1990s. Most nursing terminologies were based on controlled vocabulary, which is a set of terms that are widely used to refer to various conditions or treatments (Hardiker et al., 2000). Controlled vocabulary has often been specified on lists, but given the large number of information which the nurses have to deal with, this would mean that the records would have to be very large. Moreover, the terminologies used may sometimes be vague, or may not imply the same issue limiting their multidisciplinary application. Various lists and classifications exist, on multiple specialties and scopes of expertise, but none of them is comprehensive enough to be universally usable. The introduction of SNTS sought to solve these and other challenges.
There are various challenges in coming up with standard terminology. First, it would have to meet all users needs, which is more theoretical than practically achievable. It is also extremely difficult to get all stakeholders to agree on a single terminology (Kleinbeck, 2002). So far, there are seven SNTs that are approved by the American Nursing Association (ANA). They are North American Nursing Diagnosis Association (NANDA) system (1992), Nursing intervention Classification (NIC) system (1992), Nursing Outcome Classification (NOC) system (1997), Omaha System (1992), Clinical Care Classification (CCC/HHCC) system (1992), Perioperative Nursing Data Sets (PNDS) (1999) and 2ICNP (2000). While all these terminologies are specific to nursing, the present various differences and challenges some of which have been earlier mentioned. The first three terminologies only cover one nursing item from the data set the US nursing minimum data set (NMDS) each, while the latter four each cover the three NMDS. The NMDS are nursing problem, intervention and outcome. This study dwell more on the nature and application of PNDS.
The PNDS was designed and created by the Association of periOperative Registered Nurses, whose board remains its sole custodians to date. The objective was to create a national database and language that would serve exhaustively, the needs in the perioperative nursing (Hardiker et al, 2000). In the PNDS, data elements are used to classify data sets whereby specific codes have been assigned to properly defined diagnostic terms as well as interventions and outcomes. The PNDs was first published in 1999, six years after its development first began.
Various benefits have been attributed to this system; the single most important is the exposition of the role of perioperative nursing in healthcare. Since it first became operational, data analysis has been more efficient and precise, which has facilitated many resultant functions such as more efficient nursing care evaluation (ONH, 2017). For clinicians, there have been various implications. Firstly, nursing documentation has been standardized easing operations. Clinical research has also been significantly facilitated, which enables the formulation of effective policies. There has also been an improvement in the quality of patient care as a result.
PNDS has also had an impact in the management of healthcare processes and practice. Clinical outcomes can now be accurately measured and recorded, and levels of effectiveness can be compared to the financial statistics (Hardiker et al., 2000). For the first time, it has been possible to correlate cost to quality accurately. PNDS have therefore facilitated the management and allocation of costs. The high level of reliability of the data that is recorded under this SNT allows for evidence-based research to be carried out determining how best to improve practices and offer the best care to patients (Kleinbeck, 2002). The PNDs are reviewed periodically by the AORN for updates to ensure currency.
J. Cimino attempted to compile a list of the desiderata which controlled medical vocabularies must strive to satisfy if system developers are going to use such to build standardized systems. They are characteristics of a standardized system which would theoretically address all challenges that currently exist and cater to the needs of all stakeholders (Cimino, 1998). This is especially important in the context of digital applications and computer-assisted data recording and analysis.
Firstly, the vocabulary used should be multipurpose. It should allow versatile usage depending on the person who is using the system (Cimino, 1998). The system should also be structured in such a way that content can be added easily. The addition of information should, however, be controlled and approaches used, and circumstances in which content is to be added should be particular. The material should also not be vague, ambiguous, or redundant (Cimino, 1998). Vagueness may occur when terms fail to correspond to any meaning, ambiguity, when terminologies correspond to multiple meanings, while redundancy may arise when different vocabularies correspond to one definition.
Concept permanence is a characteristic whereby the content added should not be deleted. This is to protect the data that has been stored in the past. Deletion or altering of material may compromise of the information that may have been stored previously (Cimino, 1998). This desideratum relates to the concept of graceful evolution, whereby the system created should be able to evolve with the changes in its user's needs without compromising on the data that is stored in it. That essentially means that it should be able to allow the data stored in the past to maintain its relevance.
A hierarchical arrangement may also necessary as it eases in the navigation and usage of the system (Peterson & Kleiner, 2011). Poly-hierarchies or strict hierarchies may be used depending on the context of the content (Cimino, 1998). Various researchers have also argued in favor of formal definitions, proposing that terms must have an explanation that is drawn from the relationships that can be deduced within their classification. There is also a consensus that the designation not elsewhere classified should be omitted, although it is not possible to create a system that has a fully complete domain. Also, multiple granularities should be recognized (Cimino, 1998). This allows for different users to be able to use the system comfortably. For instance, surgeons may want to use more specific terms than general practitioners do.
There are various ways in which the PNDS seeks to qualify all the desiderata that Cimino proposes. For instance, the concepts have unique nonsemantic concept identifiers which assist in identification. For example, acute pain is awarded the identifier X38 (Peterson & Kleiner, 2011). Secondly, content can be added to the terminology whenever it is under review. It is reviewed periodically by the AORN board, the latest study of which was in 2012. The study presents an opportunity for new concepts in the field of perioperative nursing to be added and any outdated ideas to be retired. This also indicates that notions are not deleted from the system. This allows all data that has ever been managed using the terminology to maintain its utility (Peterson & Kleiner, 2011).
The multipurpose nature of the PNDS terminology is also evident, whereby it also contains terms and concepts which may be used to describe postoperative care. However, these need to be increased, as most of the words are for the intra-operative context (ONH, 2017). The PNDS uses a hierarchical system that allows for abstraction whereby more specific elements are classified under the more general term. The classification system has also been edited to ease the nurse's responsibility further. For instance, blood transfusions are organized under the general classification of fluids infusions.
Strategic Action Plan
The utility of the PNDS spreads across the board as far as the entire medical and management staff is concerned. The first group of stakeholders would predictably be the nurses, more specifically, the perioperative nurses. The AORN expressly states that the vocabulary should not be used as a standard of care. However, even as a guideline, it is an invaluable asset to the nurses (Peterson & Kleiner, 2011). Firstly, all operating rooms should be able to utilize this terminology as a tool. This would necessitate the installation of software on which the language has been coded. A challenge at this moment arises, whereby different healthcare facilities use different software vendors, thereby ending up with different variants of software. In this respect, the AORN should contract a trusted software developer to develop a standardized version of the PNDS that should be supplied to the healthcare providers (Kelley, 2016). The PNDS also has the potential to transform service delivery in nursing care. The AORN should continue evaluating its ability to facilitate information management efficiently, to allow the collection of the most relevant data. This data will be used for research which finally promotes policy formulation (ONH, 2017).
Another group of interest would be the doctors involved in intra-operative activities. The terminology is useful to these doctors because it allows for the recording of the operative processes which would allow for these processes to be analyzed. Data analyzed could reveal inefficiencies on which improvements could be made (McGonigle, 2017). The doctors should also play their part in offering insight on ways in which the PNDS should be improved in order to function better.
The third group of interest would be the managers of the healthcare providing institutions. The PNDS data should be analyzed and the findings presented for better planning. There are numerous aspects of preparation that would interest hospital management, such as logistical analysis, cost accounting, and financial forecasting. This enables better functionality between different departments in a hospital. It also allows the hospital management to monitor the efficiency and effectiveness of activities and processes within their organizations. The PNDS is also a facilitator of modeling and policing decisions...
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