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25th InternationalNursing Research Congress
Hong Kong,27 July 2014
Objectives Development Organising principle and structure Systematic further development Evidence base
European Nursing care PathwaysGiving Nursing a Language
Sebastian Kraus(RN, B.A., cand M.Sc.)
A classification is an organisational system based on the principle of class formation. A classification structure is a listing of terms or concepts represented in a hierarchical structure.
The sorting of different nursing phenomena or concepts in groups, classes, categories (resulting from the organisationaccording to criteria and types of features), can be called a nursing classification.
Nursing classification and organization system
What is ENP?
Reference: HIMSS 2006
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A major challenge:(Dis)Orientation within the nursing process
Aims of ENP
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Structured illustration of the nursing process in the context of documentation in a standardized professional language
Aims of ENP
Support of the communication process
Support of processes and transitional care
Support of performance transparency in nursing
Structuring of the current nursing knowledge
Support of quality development, nursing staff calculation and outcome measurement
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References: Figosky & Downey 2006, Bartholomeyczik 2000, Bates et al. 2003, Titler et al. 2005, Gordon 2001, Gordon 2010, Johnson 2006
Outline of the ENP history
1989: Beginning of the inductive development "Nursing performance can be
practically illustrated with a standardized terminology."
1994: First publication of the catalogue Containing nursing problems, outcomes and interventions
1996: Representation of the ENP catalogue in IT
1998: Establishment of a research department Continuous further development in projects with end users and through
literature analyses
from 2000: evidence-based development (validation studies, cross-mapping, systematic reviews, ...)
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ENP... as a nursing classification system for a total of seven groups
Division into three sections
The structure of ENP
Pictures: www.istockphoto.com
ENP... as pre-combination of the elements of this nursing classification system
ENP... as practice guidelinesdeveloped from the pre-combination
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Nursing problems / phenomena
Characteristics
Etiologies
Resources
Nursing objectives
Interventions
Intervention specifications
Seven groups: components
ENP classifies... across sectors!
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ENP pre-combined
Nursing problem (P) + Etiologies
Characteristics/Symptoms
or
- Nursing diagnosis
The patient is impaired in verbal communication due to motor aphasia (Broca's aphasia)
Impaired verbal communication Motor aphasia(Broca's aphasia)
Picture: P. Vaclavek (www.fotolia.com)
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Characteristics/Symptoms Strongly pronounced
agrammatism
Strongly halting speech flow
Uses commonplace phrases
Uses meaningless phrases and/or stereotypes
…
Reference points of the nursing diagnoses in ENP
The patient is impaired in verbal communication due to motor aphasia (Broca's aphasia)
Etiologies
Pathophysiologic causes Degenerative process of the brain Congenital vascular malformations ...
Disease-related causes Cerebral vascular accident Encephalitis …
Individual
Specification (here: etiology)
Nursing problem / phenomenon
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Result: practice guidelines for decision-making
Nursing diagnoses
Characteristics/Symptoms
Etiologies
Nursing objectives
Interventions
Detailed instructions
Resources
Scales
References Indexation
Illustration of the nursing process in the form of a care pathwayrepresenting the current knowledge, individualized for each patient!
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Normativetime values
The structure of ENP: Summary
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Topics are organized from general to specific
On each hierarchy level a further distinguishing feature is added
Concepts are assigned to exactly one generic term
ENP: a monohierarchical classification system
Groups (7)
Domains (4)
Classes (21)
Categories (135)
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ENP: a monohierarchical classification system
Domain Class Category SubcategoryFunctional/physiological area
Personal hygiene/clothing
Self-care deficit washing
Self-care deficit oral hygiene
Self-care deficit hair care
Self-care deficit dressing
Respiration Ineffective self-cleansing function of the respiratory tract
Insufficient respiration The patient has insufficient respiration due to dyspnoea
Risk of respiration insufficiency The patient is ventilated, there is a risk of insufficient respiration
Risk of suffocation The patient has serous foamy sputum associated with acute dyspnea, there is insufficient respiration
Risk of aspiration …
Risk of atelectasis/pneumonia
Risk of impaired respiration postoperatively
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Group: Nursing problems / phenomena
Current status: scope and evidence level of ENP
Terms/concepts of the group
Itemsv2.5
Items v2.6
Items v2.7
Itemsv2.9 (new)
Nursing diagnoses 521 542 548 552
Characteristics / Symptoms 2230 2719 2905 3984
Etiologies 1799 2282 2426 3526
Ressources 379 457 473 648
Nursing objectives 1435 1683 1724 1852
Nursing interventions 2494 2511 2558 2615
Intervention specifications 3652 4285 4461 4797
Systematic literature-based revision of about 1/5 of all practice guidelines Growing number of ENP validation studies (completed and in progress): Implementation and evaluation in nursing practice Securing content and criteria validity
Cross-mapping, expert rating Student theses
References: Baltzer et al. 2006, Kossaibati & Berthou 2006, Del Negro 2012, Berger 2010, Schmitt 2010, Wieteck 200814 of 19
Each item has a unique and unchangeable ID number!
Each systematically revised nursing diagnoses is supported by a definition:
New elements since 2014
The patient is impaired in verbal communication due to motor aphasia (Broca's aphasia)
Impaired or lacking ability to actively participate in verbal communication after completion of language acquisition due to a central speech disorder with
the lack of grammatical structures in the sentence structure as a leading symptom.
(DGN 2012, Wehmeyer et al. 2006, ICNP Aphasia [10002438],ICF Communicating with - receiving - spoken messages [d310], ICF Speaking [d330])
The revision history and the level of evidence (based on NANDA-I) is shown for the respective ENP nursing diagnosis:
Revision history: 1991, 1994, 2004, 2008, 2014
ENP practice guideline ENP nursing diagnosisLevel of evidence: LoE 3.2 LoE 3.2
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Systematic further development today
Analysis of user databases
New scientific findings (studies, guidelines,
etc.)
Practice projects with institutions
Findings of previous ENP validation studies
Feedback from end users
European Nursing care Pathways (ENP), starting version
Influencing factors on the further development
Elements of the systematic further development
a. Determination of the topics to be revised
b. Determination of a revision strategy
c. Systematic literature review and analysis
d. Revision of the ENP catalogue and consensus
e. Validation of the additions/changes/deletions
European Nursing care Pathways (ENP), new version
Systematic translation of ENP (English, Italian, French)
Hypotheses for nursing research
Current topics in public health
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References: Wieteck 2007, Wieteck 2004, Berger 2010
Limits of ENP
ENP can (and should) not replace the nurses expert knowledge
ENP is not complete: i.e about 23% of the NANDA-I nursing diagnoses can not be illustrated with ENP About 18% of formulations in nursing care plans had to be added individually (2007)
Currently, there are only a few validation studies which include a review of an entire practice guideline
The operationalized scales for outcome measurement are partly not yet validated (e.g. own developments)
ENP is not yet tested in some areas in practical use (e.g. recovery room, operating theatres, neonatal intensive care unit)
Not all important questions for management, research and educationcan be answered from the data obtained with ENP
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Development of a new system to specify the levels of evidence (in cooperation with NANDA-I)
Systematic revision of all nursing diagnoses and practice guidelines
Supporting the international implementation and use of ENP
Networking and exchange
Establishment of strategies and concepts for analyzing the data generated with ENP
What is next?
A look into the future
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References
Bartholomeyczik, S. (2000). Pflegediagnosen aus einer Perspektive der Pflegewissenschaft. In: Etzel, B. S. (Ed.), Pflegediagnosen und die Internationale Klassifikaton Pflegerischer Praxis (ICNP Beta-Version). Entwicklung in der Diskussion. Stuttgart, Berlin, Köln: Kohlhammerverlag, pp. 53-70.
Baltzer, M., Baumberger, M., & Wieteck, P. (2006). Pilotprojekt LEP Nursing 3/ENP. Abschlussbericht. Retrieved from: http://download.recom-verlag.de/pdf/Abschlussbericht%20Projekt%20ENP_LEP3.pdf (Accessed: 28.05.2014)
Bates, D. W. et al. (2003). A Proposal for Electronic Medical Records in U.S. Primary Care. JAMIA, Journal of the American Medical Informatics Association, 10(1), pp. 1-10.
Berger, S. (2010). Kriteriumsvalidität von ENP. Abbildung von individuell formulierten Pflegeprozessplanungenmit der standardisierten Pflegefachsprache ENP. Kassel: Recom Verlag.
Del Negro, L. (2012). Confronto dell’impatto di due sistemi di classificazione di diagnosi infermieristica, obiettivi/risultato e interventi, sugli studenti d’infermieristica. University of L’Aquila, Department of Internal Medicine and Public Health, PhD in Nursing Science.
Deutsche Gesellschaft für Neurologie. (2012). Rehabilitation aphasischer Störungen nach Schlaganfall. In H.-C. Diener, H. Ackermann & Deutsche Gesellschaft für Neurologie Kommission Leitlinien (Eds.), Leitlinien fürDiagnostik und Therapie in der Neurologie (5th ed.). Stuttgart [u.a.]: Thieme, pp. 1087-1095.
Figoski, M. R. & Downey, J. (2006). Facility Charging and Nursing Intervention Classification (NIC): The New Dynamic Duo. Nursing Economic, 24(2), pp. 102-111, 115.
Gordon, M. (2010). Manual of nursing diagnoses (12th ed.). St. Louis, Mosby Verlag.
References
Gordon, M. (2001). Handbuch Pflegediagnosen. Das Buch zur Praxis. München; Jena: Urban & Fischer Verlag.
(HIMSS) Healthcare Information and Management Systems Society. (2006). HIMSS. Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations. Ohio: HIMSS Healthcare Information and Management Systems Society.
(ICNP) International Council of Nurses. (2013). Aphasia [10002438]. Retrieved from http://icnp.stemos.com/index.php/en/2013/viewer/show/uid/10002438 (Accessed: 20.05.2014).
Johnson, M. (2006). NANDA, NOC and NIC linkages : nursing diagnoses, outcomes, & interventions. St. Louis, Mo.: Mosby/Elsevier.
Kossaibati, S. & Berthou, A. (2006). Konzeption und Pilotierung der Einführung von ENP an den Spitälernund Kliniken des Kantons St. Gallen -Schlussbericht: Institut de santé et d`economie (ISE).
Schmitt, A. (2010). Kriteriumsvaliditätsprüfung von ENP auf einer neonatologischen Intensivstation. PR-Internet, 12(4), pp. 224-232.
Titler, M. et al. (2005). Cost of hospital care for elderly at risk of falling. Nurs Econ, 23(6), pp. 290-306, 279.
Wehmeyer, M., Grötzbach, H., & Kiermeier, S. (2006). Aphasie. Wege aus dem Sprachdschungel (3. ed.). [Berlin]: Springer.
Wieteck, P. (2008). Furthering the development of standardized nursing terminology through an ENP®-ICNP®
cross-mapping. International Nursing Review, 55(3), pp. 296-304.
References
Wieteck, P. (2007). Validitätsprüfung ausgewählter Bestandteile der ENP® (European Nursing care Pathways). ENP - ein Instrument zur prozessorientierten, fallbezogenen und handlungsbegründenden Pflegeprozessdokumentation. Dissertation, University of Witten/Herdecke, Witten.
Wieteck, P. (2004). Sekundäranalyse auf inhaltliche Vollständigkeit der ENP®. In P. Wieteck (Ed.), ENP -European Nursing care Pathways Standardisierte Pflegefachsprache zur Abbildung von pflegerischen Behandlungspfaden. Leistungstransparenz und Qualitätssteuerung im Gesundheitswesen. Bad Emstal: RECOM Verlag, pp. 1157-1169.
World Health Organization (WHO). (2001). International Classification of Functioning, Disability and Health (ICF): Communicating with - receiving - spoken messages [d310]. Retrieved from http://apps.who.int/classifications/icfbrowser/Browse.aspx?code=d310&hsr=1 (Accessed: 20.05.2014).
World Health Organiszation (WHO). (2001). International Classification of Functioning, Disability and Health (ICF): Speaking [d330]. Retrieved from http://apps.who.int/classifications/icfbrowser/Browse.aspx?code=d330&hsr=1 (Accessed: 20.05.2014).
