Using the nursing minimum data set for the Netherlands (NMDSN) to illustrate differences in patient populations and variations in nursing activities.

RATIONALE: A nursing minimum data set (NMDS) provides data that are useful to legitimate nurses' contribution to healthcare. In Belgium and the US, such NMDS are operational, other countries are developing it, among which is the Netherlands. OBJECTIVE: To evaluate whether the nursing minimum data set for the Netherlands (NMDSN) is suitable to describe the diversity of patient populations and the variability of nursing care. METHODOLOGY: Using the NMDSN data collection forms, patient data were collected from 15 different hospital wards. During one week, nurses manually completed the NMDSN list for every patient. The data analysis methodology from the Belgian MVG was used, including ridit analysis and graphs. RESULTS: The NMDSN includes items related to hospital, patient demographics, medical condition, nursing process, nursing phenomena, nursing interventions, outcomes of nursing care, and complexity of care. There were 686 individual patients in the study, while for the data analysis their 2090 patient days in the hospital were used. Frequencies of nursing phenomena, nursing activities and results of care were calculated, transformed into ridit scores, and presented graphically as 'fingerprints'. CONCLUSION: The set of NMDSN items allows illustrating the diversity of patient populations, and variation in nursing care by means of 'fingerprints'.

Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items.

Development of the Nursing Minimum Data Set for the Netherlands (NMDSN): identification of categories and items Rationale Currently, there is no systematic collection of nursing care data in the Netherlands, while pressure is growing from the profession, policy-makers and society to justify the contribution of nursing and its costs. A nursing minimum data set can provide data to demonstrate nursing's contribution to health care as it can be used to describe the diversity of different patient populations and the variability of nursing activities, and to calculate the associated nursing workload. Objective To identify categories and items for inclusion in the Nursing Minimum Data Set for the Netherlands. Design A multimethod, exploratory approach was used. This included interviews, document analysis, consensus rounds, seeking validation in the literature, and drawing up lists of most frequently occurring patient problems, interventions and outcomes of care. Eight hospitals, with a total of 16 wards, participated in the study. Results Relevant categories and items emerged after analysis and grouping of the material and included: five hospital-related items, six patient demographics items, seven medical condition items, 10 nursing process items, 24 patient problems, 32 nursing interventions, four outcomes of nursing care, and three complexity of care items. Almost every item could be located in the existing documentation systems, the lists of patient problems, outcomes and interventions, or in the literature. Conclusion A set of categories and items of nursing data has been identified. The content validity of this set is partly supported by its consistency with the literature, findings from practice and the judgement of potential users. Nursing outcomes need further development. The data set will be tested in practice to find out whether the categories and items are useful, and whether they can be minimized.

A comparison of nursing minimal data sets.

It is often argued that Nursing Minimal Data Sets (NMDSs) have advantages for the nursing profession. The NMDSs that have been developed and applied in some countries have many features in common, but there are differences in purpose, content, sampling, collection approach, and developmental stage as well. This paper examines the advantages and disadvantages of data sets of nursing practice, and the differences and similarities of five national and international NMDS systems. The purpose is to apply this information toward an NMDS initiative in the Netherlands. Future initiatives in NMDS development should include international coordination.

Criteria for nursing information systems as a component of the electronic patient record. An international Delphi study.

In many countries nurses lack an adequate tool to assist in determining the essentials of an information policy in health care institutions and to outline the nursing component of the electronic patient record. In the United States criteria exist for systems that support the nursing process and for the electronic patient record, and the United Kingdom has the disposal of an Information Management and Technology Strategy that includes nursing information. The objective of this study was to determine international criteria for nursing information systems when such systems become part of the electronic patient record. Using the Delphi methodology, criteria for nursing information systems development, content, structure, and use are established by an international panel of 36 experts in three succeeding rounds. Most criteria gained consensus and are useful for application in practice for development of information policy and information systems for nursing. Eventually, the list of criteria will be included in a nursing information reference model. Nursing will benefit from the application of the reference model and the criteria to develop adequate information and communication technology.

Can we solve current problems with nursing information systems?

Dutch nurses are confronted with health care information systems quite often. However, they do not take full advantage of electronic support for their care activities and professional development. The nursing process is often considered the core of nursing care delivery and guides the documentation of care. Currently, this process can be supported electronically. However, the actual use of nursing information systems (NISs) in the Netherlands is limited to a few sites. Therefore, it is timely to analyse the problems that exist in the development and use of NISs and to look for solutions to solve them. This paper proposes both the nursing information reference model (NIRM), and structured discussions for a proper course of action in the development and use of NISs.

Nursing information in electronic patient records: criteria established in a Delphi study.

Nursing lacks an adequate tool to assist in determining the essential components of an information policy in health care institutions, and to outline the nursing component of the electronic patient record. The objective of this study was to determine the criteria to which a nursing information system, and its developmental process, should comply with, when such system is part of an electronic patient record system. Using the Delphi methodology, criteria for nursing information systems were determined by an international panel of 36 experts in three succeeding rounds. Most criteria gained consensus and are very useful for use in practice for those involved in nursing system development. Eventually the list of criteria will be included in a nursing information reference model. Nursing will benefit from the application of the reference instrument and criteria to express their information needs and to develop adequate information technology.

Description of a comprehensive research project to develop a reference model for nursing information systems.

This paper describes a comprehensive research project in progress that aims to develop a Nursing Information Reference Model. The study consists of several components. Together these components should lead to the production of the reference model. At the time of submission of this paper several components of the study are finished. After describing the scope of the study as a whole, individual components will be presented. An overview will also be offered of those parts that are still under development.

[Towards congruence in nursing information provision in The Netherlands]. / Naar een samenhang in de verpleegkundige informatievoorziening in Nederland.

Few reliable data are available about nursing care in the Netherlands, whereas pressure from society to support the contributions of the discipline of nursing to health care delivery increases. This paper presents an information model to support analytical access to nursing labour and services. This model, the nursing information reference model (Dutch acronym 'VIRM') focuses on the structure to achieve congruence between data from the primary process of nursing care and data derived from that process for clinical practice, management, research, and policy purposes. The model is based on the 'collect-once/use-often' principle of data collection and management, which emphasizes single collection and registration through the patient record for multiple subsequent uses and purposes. In this paper core elements of the VIRM are being discussed. Determination of data from the primary process of nursing care to be provided for certain aims is currently being conducted by the Dutch Nursing Minimum Data Set (VMDNS) initiative. The article at issue should be understood as a starting point in the discussion about the development of a Nursing Minimum Data Set in the Netherlands.

Classification systems in nursing: formalizing nursing knowledge and implications for nursing information systems.

The development of nursing information systems (NIS) is often hampered by the fact that nursing lacks a unified nursing terminology and classification system. Currently there exist various initiatives in this area. We address the question as to how current initiatives in the development of nursing terminology and classification systems can contribute towards the development of NIS. First, the rationale behind the formalization of nursing knowledge is discussed. Next, using a framework for nursing information processing, the most important developments in the field of nursing on formalization, terminology and classification are critically reviewed. The initiatives discussed include nursing terminology projects in several countries, and the International Classification of Nursing Practice. Suggestions for further developments in the area are discussed. Finally, implications for NIS are presented, as well as the relationships of these components to other sections of an integrated computerized patient record.