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: [email protected]

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

0

500

1000

1500

2000

2500

3000

3500

1

nursing interventions

nu

mb

er

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

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10

Days of Admission

Degre

e o

f Seve

rity

Series1

Series2

Series3

VO!R

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

0

1

2

3

4

5

1 2 3 4 5 6 7 8 9 10

Days of Admis s ion

Deg

ree o

f S

ev

erit

y

Sé rie 1

Sé rie 2

Sé rie 3


NursingToday

ICNP

NEWS






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

Expressive Power

Design:

Architecture

Dom

ain


ICNP as a Unifying Framework i.e

a Reference Terminology

ICNP

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

ICNP


HYPOTHESIS:HYPOTHESIS:Context ofDiscovery

Identificationthroughanalysis:

"Conceptdissection"

Context ofJustification

Validationthroughsynthesis:

"Concept- sutures"

ICNPICNP

??

Data:Existing Classification Systems


ICNP


Folk-Guitar

ClassicalGuitar

Guitar

Grandpiano

Uprightpiano

Piano

Kettledrum

Basedrum

Drum

Musicalinstrument

Classifications are Concept Pyramids


1. nursing phenomena2. nursing actions

3. nursing outcomes

The 3 Classifications of ICNP:


Axes

Starters

Top term: CourseClasses:

Main Dish

Dessert

Menu


Axes

Starters Shrimps


Main Dish Lamb

Dessert Ice-cream

Menu of the dayNo choice of combinations


Axes

Starters Shrimps, Ham,Salad


Main Dish Lamb,Steak, Fish

Dessert Ice-cream, cake, fruit

A La Carte MenuFree choice of combinations


Axes

Focus

Judgement

Bearer

Top term: nursing phenomenonClasses:

FrequencyDuration

Topograhhy

Location

Likelihood

ICNP: Nursing Phenomena


Axes

Focus Coping

Judgement Enhanced

Bearer Family


FrequencyDuration

Topograhhy

Location

Likelihood Chance for



Axes:Action Types

Target

Top term: Nursing ActionClasses:

Mean

TimeTopographyLocationRouteBearer

Beta ICNP: Nursing Actions


Axes:Action Types Reducing

Target Anxiety


Mean Guided Imagery Technique

TimeTopographyLocationRouteBearer Individual



ICNP on the Net: www.telenurse.net


ICNP on the Net: www.telenurse.net






Design of ICNP betaArchitecture and Domain

IC

NP


1. Nursing Phenomenon:2. Nursing Actions

3. Nursing Outcomes



Classification of Nursing Phenomena


Axes

Focus Focus

Judgement

Bearer


FrequencyDuration

Topograhhy

Location

Likelihood



Axes

Focus Focus

Judgement

Bearer


FrequencyDuration

Topograhhy

Location

Likelihood



Atoms

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?


Group

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


Axes

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


Axes

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


Axes

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


Axes

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


Axes

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


Axes

Focus Focus Hope

JudgementJudgement Enhanced

BearerBearer Family


FrequencyDuration

Topography

Location

LikelihoodLikelihood Chance for



ICNP: Nursing phenomenon

Axes

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

Axes

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


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


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


Mean

TimeTopographyLocationRouteBeneficiary



Axes:Action TypesAction Types Preventing

TargetTarget Decubitus


Mean

TimeTopographyLocationRouteBeneficiary

Beta ICNP: nursing actions


Axes:Action TypesAction Types Attending to

TargetTarget Contact Lenses


Mean

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


Axes

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


Mean

TimeTopographyLocationRouteBeneficiary the individual

+ time intervalinterrupted by Nursing Intervention


Axes

Focus Pain

Judgement No

Distribution


FrequencyDuration

Topography

Location

Likelihood

ICNP: Nursing PhenomenonPoint in Time: 2


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

NursingInterventions

Nursing Diagnoses

5

4

3

2

1

Diagnosis

PainTo a High Degree

time-series


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


Nursing Diagnoses

5

4

3

2

1

Diagnosis


time-series


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


Nursing Diagnoses

5

4

3

2

1

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


a

Concepts and their attributes

C1

C4

C3C2

ab

d

a

dfj

n

b

C5bdg

k

a

o

a

C6ceh

lp

C7

mqi

ce

a

e

ca


a

Specific characteristics

C1

C4

C3C2

ab

d

a

dfj

n

b

C5bdg

k

a

o

C6

aceh

lp

C7

mqi

ce

a

e

ca


a

Definition by genus et species.

C1

C4

C3C2

ab

d

a

dfj

n

b

C5bdg

k

a

o

a

C6ceh

lp

C7

mqi

ce

a

e

ca


ICNP Concepts

Definitions and Criteria:

A

B C

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


A

B C


Restoration

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


ICNP Concepts


A

B C


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!


Axes

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




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ICNP Applications in Nursing Informatics 3rd TelenurseID Dissimination Meeting in CEE Countries

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