Nurses

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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

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Acknowledgements

• Main study (In review)
• Effects of Using Standard Terms in Electronic
  Records on Nurses Power and Childrens 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

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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

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Driving Forces Use of NNN in School Settings

• Research-based standardized terms
• Describes
• Health promotion
• Health protection
• Management of problems
• Provides comprehensive nursing process data both
  decisions actions

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Driving Forces Use of NNN in School Settings

• Measures broad range of child family outcomes
• Relates outcomes to interventions
• Improves
• Communication
• Continuity of care

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Restraining Forces Use of NNN in School Settings

• Historically
• Data organized by medical diagnoses (MDx) tasks
• Nursing model for care generally invisible
• Low emphasis on documenting health promotion
  health protection
• Resistance to change historical patterns
• With familiarity of MDx, perception
  that EHR based on MDx easier to implement

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Restraining Forces Use of NNN in School Settings

1. Cost of purchasing licenses to use NNN
2. Paucity of research data to show the advantages
   of using NNN

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Research Questions

• Are there patterns of documentation that can be
  identified from health visit data?
• Are there differences in documentation patterns
  with and without use of NNN?
• Does the data support the advantages
• of using NNN?

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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

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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

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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

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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
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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
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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
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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

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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

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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

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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