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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
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(Great systems need great nurses)
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Presentation Outline
• Motivation
• Background
• Practice
– Data capture, workflow, decision making, data reuse
• Questions
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The world by land area
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The world as proportion of young people
living with HIV
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The world as proportion of nurses
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The world by land area
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The world as proportion of tuberculosis
cases
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The world as proportion of nurses
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Salford
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• ‘…the workers of Salford live in dwellings in
which cleanliness and comfort are impossible’
Engels F (1845) Die Lage der arbeitenden Klasse in England
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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
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Better information
=
Better health care
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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'
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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.
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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/
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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.
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‘eLife’
• The use of information and communication
technology in:
– Banking
– Retail
– Travel
– Entertainment
– Social engagement
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Unrealistic expectations
• Cash machines (ATMs) have not improved my
financial status…
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• …on demand TV has not made me like soap
operas more…
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• …SatNavs have not make my journeys safer…
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• …and online travel has not made the sun shine
on holiday…
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• …but I could not live without them
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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
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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
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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/
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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
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Connecting nurses
• A forum for expert healthcare professionals from
around the world to share their ideas, advice
and innovations
http://www.connecting-nurses.com
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ICN Telenursing Network
• Global resource for sharing knowledge and
expertise around telehealth and telecare
http://www.icn.ch/networks/telenursing-network/
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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/
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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
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Example 1: Workflow and decision
making
Focus Diagnostic
interventions Diagnosis Interventions
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Example 2: Data reuse
Diagnosis Interventions Outcomes
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Structure indicators
• Care hours per patient per day
• Dependency
• Nurse satisfaction
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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?
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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?
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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?
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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?
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Data requirements
• Risk
• Diagnosis
• Intervention
• Expected outcome
• Actual outcome
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Key focal elements
• Adult care
– Falls, Dehydration, Pain, Aspiration
• Child care
– Breastfeeding, Malnutrition, Fear
• Women’s care
– Pregnancy, Parenting, Contraceptive use
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Aspiration
• Risk for aspiration
– Risk identification, annually
• Actual aspiration
– Prevalence, bi-annual
• Care provider’s knowledge relating to aspiration
prevention
– Resolution of problem, annually
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A B
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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
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ICN - Advancing nursing and health worldwide www.icn.ch
Risk
identification
Prevention
of problems
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ICN - Advancing nursing and health worldwide www.icn.ch
Achieving
expected
outcomes
Resolution
of problems
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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
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ICN - Advancing nursing and health worldwide www.icn.ch
Great systems need great nurses
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ICN - Advancing nursing and health worldwide www.icn.ch
Contacts