Description of COVID-19 patients and mapping nursing data to ICNP 2021 reference set in SNOMED CT.

AIM: To describe nursing care of COVID-19 patients with International Classification for Nursing Practice (ICNP) 2019, ICNP 2021 reference set, and Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT). BACKGROUND: From the beginning of the COVID-19 pandemic, nurses have realised the importance of documenting nursing care. INTRODUCTION: It is important to recognise how real nursing data match the ICNP reference set in SNOMED CT as that is the terminology to be used in Iceland. METHODS: A descriptive study with two methods: (a) statistical analysis of demographic and coded clinical data identified and retrieved from Electronic Health Record (EHR) and (b) mapping of documented nursing diagnoses and interventions in EHRs into ICNP 2019, ICNP 2021 and SNOMED CT 2021. RESULTS: The sample consisted of all (n = 91) adult COVID-19 patients admitted to the National University Hospital between 28 February and 30 June 2020. Nurses used 62 different diagnoses and 79 interventions to document nursing care. Diagnoses and interventions were best represented by SNOMED CT (85.4%; 100%), then by ICNP 2019 version (79.2%; 85%) and least by the ICNP 2021 reference set (70.8; 83.3%). Ten nursing diagnoses did not have a match in the ICNP 2021 reference set. DISCUSSION: Nurses need to keep up with the development of ICNP and submit to ICN new terms and concepts deemed necessary for nursing practice for inclusion in ICNP and SNOMED CT. CONCLUSION: Not all concepts in ICNP 2019 for COVID-19 patients were found to have equivalence in ICNP 2021. SNOMED CT-preferred terms cover the description of COVID-19 patients better than the ICNP 2021 reference set in SNOMED CT. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Through the use of ICNP, nurses can articulate the unique contribution made by the profession and make visible the specific role of nursing worldwide.

Accuracy, completeness and comprehensiveness of information on pressure ulcers recorded in the patient record.

AIM: To describe the accuracy, completeness and comprehensiveness of information on pressure ulcers documented in patient records. DESIGN AND SETTING: A cross-sectional descriptive study performed in 29 wards at a university hospital in Iceland. The study included skin assessment of patients and retrospective audits of records of patients identified with pressure ulcers. PARTICIPANTS: A sample of 219 patients was inspected for signs of pressure ulcers on 1 day in 2008. Records of patients identified with pressure ulcers were audited (n = 45) retrospectively. RESULTS: The prevalence of pressure ulcers was 21%. Information in patient records lacked accuracy, completeness and comprehensiveness. Only 60% of the identified pressure ulcers were documented in the patient records. The lack of accuracy was most prevalent for stage I pressure ulcers. CONCLUSIONS: The purpose of documentation to record, communicate and support the flow of information in the patient record was not met. The patient records lacked accuracy, completeness and comprehensiveness, which can jeopardise patient safety, continuity and quality of care. The information on pressure ulcers in patient records was found not to be a reliable source for the evaluation of quality in health care. To improve accuracy, completeness and comprehensiveness of data in the patient record, a systematic risk assessment for pressure ulcers and assessment and treatment of existing pressure ulcers based on evidence-based guidelines need to be implemented and recorded in clinical practice. Health information technology, including the electronic health record with decision support, has shown promising results to facilitate and improve documentation of pressure ulcers.

Developing and testing inter-rater reliability of a data collection tool for patient health records on end-of-life care of neurological patients in an acute hospital ward.

AIM: Develop and test a data collection tool-Neurological End-Of-Life Care Assessment Tool (NEOLCAT)-for extracting data from patient health records (PHRs) on end-of-life care of neurological patients in an acute hospital ward. DESIGN: Instrument development and inter-rater reliability (IRR) assessment. METHOD: NEOLCAT was constructed from patient care items obtained from clinical guidelines and literature on end-of-life care. Expert clinicians reviewed the items. Using percentage agreement and Fleiss' kappa we calculated IRR on 32 nominal items, out of 76 items. RESULTS: IRR of NEOLCAT showed 89% (range 83%-95%) overall categorical percentage agreement. The Fleiss' kappa categorical coefficient was 0.84 (range 0.71-0.91). There was fair or moderate agreement on six items, and moderate or almost perfect agreement on 26 items. CONCLUSION: The NEOLCAT shows promising psychometric properties for studying clinical components of care of neurological patients at the end-of-life on an acute hospital ward but could be further developed in future studies.

Content and completeness of care plans after implementation of standardized nursing terminologies and computerized records.

The nursing process and standardized nursing terminologies are essential elements to structure nursing documentation in daily nursing information management. The aim of this study was to describe sustainability and whether and how standardized nursing terminologies, in handwritten versus preprinted versus computerized nursing care plans, changed the content and completeness of documented nursing care. Three audits of patient records were performed: a pretest (n = 291) before a yearlong implementation of standardized nursing terminologies in nursing care plans followed by two posttests: (1) 3 weeks after implementation of nursing terminologies (n = 299) and (2) 22 months after implementation of nursing terminologies and 8 months after implementation of a computerized system (n = 281) in a university hospital. Content and completeness of documented nursing care improved after implementation of standardized nursing terminologies. Documentation of nursing care plans, signs and symptoms, related factors, and nursing interventions increased, whereas mean number of nursing diagnoses per patient did not change between audits. Computerized nursing care plans had the biggest impact, with more variety of nursing diagnoses and increased documentation of signs and symptoms, related factors, and nursing interventions. The use of standardized nursing terminologies improved nursing content in the nursing care plans. Moreover, computerized nursing care plans, in comparison with handwritten and preprinted care plans, increased documentation completeness.

The prevalence and characteristics of yoga or meditation users in Iceland: Results of a national health survey.

BACKGROUND: Use of yoga or meditation has increased decisively in recent years. Factors associated with the use of yoga and meditation are not well understood. The aim was to focus on the relationship of yoga and meditation to sociodemographic background, religiosity, healthcare-related attitudes, mental and physical health, and physician visits. MATERIALS AND METHODS: This study builds on data from a national health survey of a random sample of Icelandic adults, aged 18-75 (n = 1599; response rate of 58%). RESULTS: The overall use of yoga or meditation reached 19.3% in 2015. This is an increase of 12.5% points over a nine-year period. The increase was much greater for women. Yoga or meditation use was positively related to the female gender, younger age, higher levels of education, and not belonging to a religious denomination. It was also positively related to higher anxiety, previous visits to a physician, and a positive attitude toward CAM services, but it was negatively related to having chronic medical conditions. CONCLUSION: Increased use of yoga or meditation may reflect public interest in Icelander's self-care and health promotion. Further studies are needed to better understand the predictors and effects of yoga and meditation.

Impact of technology-based patient education on modifiable cardiovascular risk factors of people with coronary heart disease: A systematic review.

OBJECTIVE: To collect evidence on what types of technology and content are most effective in helping people with coronary heart disease (CHD) to change their modifiable cardiovascular risk factors. METHODS: A literature search was performed to find relevant studies published between 1 January 2008 and 31 December 2018 in PubMed, CINAHL, PROQUEST and Scopus databases. Selected outcomes were risk factors (exercise, diet, blood pressure, blood sugar, cholesterol, body mass index, tobacco use). The quality of the studies was evaluated according to Joanna Briggs Institute Reviewers Manual Checklists for risk for bias, TIDieR for quality of interventions, and PRISMA statement for presenting results. RESULTS: Eighteen quantitative (17 RCT´s and one quasi-experimental) studies were included. Patient education delivered through telephone, text messaging, webpages, and smartphone applications resulted in significant changes in some risk factors of people with CHD. Sufficient descriptions of the content and intervention methods were lacking. CONCLUSION: Patient education delivered with technology can help people with CHD to modify their risk factors. There is a need for better descriptions of the content and delivery of educational interventions in studies. PRACTICE IMPLICATIONS: Patient education needs to be delivered with technological solutions that best support the multidimensional needs of CHD patients.

Models, standards and structures of nursing documentation in European countries.

The use of standardized nursing languages varies between and even within different European countries. Standardization of a nursing language is a demanding process which requires substantial methodological and technological knowledge as well as cultural experience in terminology development work. A survey was carried out to describe the current state of art of the use of models, standards and structures in nursing documentation. A web-based questionnaire was targeted to members of the Association for Common European Nursing Diagnoses, Interventions and Outcomes (ACENDIO). Replies were received from 17 countries in Europe. Results show that the nursing process is the model most often used to structure nursing documentation in Europe. Many standardized nursing terminologies are used in Europe but general use in nursing is still lacking which makes access to nursing data an obstacle. In more than 60% of the institutions in the countries that replied were nursing data not stored and could therefore not be retrieved. These results should be a major concern to nurses in Europe. This relates to the lack of use of standards in use of nursing terminologies and information systems. Standardization activities in existing and evolving networks in Europe, as well as in other parts of the world, need to be enhanced. As a European platform, ACENDIO can play a role in these standardization activities and should develop its role accordingly.

National eHealth Implementation: Country Experience.

A national eHealth strategy is presumed to empower health professionals, patients and citizens to increase patient safety and quality of health care delivery. A national eHealth infrastructure encompassing a secure HealthNet, interconnected electronic health records, e-prescriptions, a national medication database and a patient portal has been implemented in Iceland. The timely and secure access to patient information by health professionals through a single portal, independent of where the patient received care, is expected to increase continuity of care, decrease duplication of data and tests, increase efficiency, increase cost effectiveness and benefit citizens in several ways. The eHealth strategy needs to be evaluated using comparable indicators.

From capturing nursing knowledge to retrieval of data from a data warehouse.

The purpose of the project was to capture nursing data and knowledge, represent it for use and re-use by retrieval from a data warehouse, which contains both clinical and financial hospital data. Today nurses at LUH use standardized nursing terminologies to document information related to patients and the nursing care in the EHR at all times. Pre-defined order sets for nursing care have been developed using best practice where available and tacit nursing knowledge has been captured and coded with standardized nursing terminologies and made explicit for dissemination in the EHR. All patient-nursing data is permanently stored in a data repository. Core nursing data elements have been selected for transfer and storage in the data warehouse and patient-nursing data are now captured, stored, can be related to other data elements from the warehouse and be retrieved for use and re-use.

A survey of nursing documentation, terminologies and standards in European countries.

A survey was carried out to describe the current state of art in the use of nursing documentation, terminologies, standards and education. Key informants in European countries were targeted by the Association for Common European Nursing Diagnoses, Interventions and Outcomes (ACENDIO). Replies were received from key informants in 20 European countries. Results show that the nursing process was most often used to structure nursing documentation. Many standardized nursing terminologies were used in Europe with NANDA, NIC, NOC and ICF most frequently used. In 70% of the countries minimum requirements were available for electronic health records (EHR), but nursing not addressed specifically. Standards in use for nursing terminologies and information systems were lacking. The results should be a major concern to the nursing community in Europe. As a European platform, ACENDIO can play a role in enhancing standardization activities, and should develop its role accordingly.

Nursing specialty knowledge as expressed by standardized nursing languages.

PURPOSE: To describe how nursing specialty knowledge is demonstrated in nursing records by use of standardized nursing languages. METHODS: A cross-sectional review of nursing records (N = 265) in four specialties. FINDINGS: The most common nursing diagnoses represented basic human needs of patients across specialties. The nursing diagnoses and related interventions represented specific knowledge in each specialty. Sixty-three nursing diagnoses (nine appeared in four specialties) and 168 nursing interventions were used (24 appeared in four specialties). CONCLUSIONS: Findings suggest that standardized nursing languages are capable of distinguishing between specialties. Further studies with large data sets are needed to explore the relationships between nursing diagnoses and nursing interventions in order to make explicit the knowledge that nurses use in their nursing practice. PRACTICE IMPLICATIONS: Nursing data in clinical practice must be stored and retrievable to support clinical decision making, advance nursing knowledge, and the unique perspective of nursing.

[Access to own health information and services on the Internet by disability pensioners and other citizens]. / Adgangur öryrkja og annarra thegna ad eigin heilbrigdisupplýsingum og thjónustu á netinu.

OBJECTIVE: To study Icelandic citizens' perception, attitude and preferences regarding access to own health information and interactive services at the State Social Security Institute of Iceland (SSSI). Hypotheses regarding differences between disability pensioners and other citizens were put forward. MATERIAL AND METHODS: A descriptive mail survey was performed with a random sample from the Icelandic population, 1400 individuals, age 16 to 67, divided into two groups of 700 each: (1) persons entitled to disability pension (2) other citizens in Iceland. The questionnaire consisted of 56 questions, descriptive statistics were used and Chi square for comparison with 95% as confidence level of significance. Response rate was 34.9%. RESULTS: Perception of rights to access own's health information was significantly higher by pensioners than other citizens. Attitude concerning impact of access was in general positive, with pensioners significantly more positive about effectiveness, perception of health, communication and decisions owing to services, access at SSSI, maintaining health records and controlling access. CONCLUSIONS: The study, the first of its kind in Iceland, supports previous research. The results, as well as foreign models of research projects, are recommended to be used for evolution of electronic health services and researching employees' viewpoints. Future research in Iceland should address the impact of interactive health communication on quality of life, health and services' efficiency.

Putting policy into practice: pre- and posttests of implementing standardized languages for nursing documentation.

AIMS AND OBJECTIVES: To describe the change in documentation of the nursing process in all inpatient wards in a 900-bed university hospital. Major research question was what are the differences between before and after implementation of documentation policy related to the steps of the nursing process? BACKGROUND: Implementation of standardized languages has been shown to be difficult to accomplish in clinical practice. Patients are the source of data and their conditions, responses and well-being should be reflected in the nursing record. As such, nursing documentation can create the premises for the development of new knowledge in nursing and the improvement of nursing performance and can provide data and information necessary for nursing researchers to evaluate the quality of interventions and participate in the formulation of healthcare policy. This study is part of longitudinal project to prepare nurses for electronic documentation within the interdisciplinary health record and to improve documentation of nursing using standardized languages. DESIGN AND METHOD: A cross-sectional study design was used: a pretest (n = 355 nursing records) for baseline status of nursing documentation, an intervention and a post-test (n = 349 nursing records) to obtain data on nursing documentation. The year-long intervention comprised planned work in groups, and educational and supporting efforts. RESULTS: A statistically significant improvement was found in the use of Functional Health Patterns for documentation of nursing assessment, NANDA for nursing diagnoses and Nursing Interventions Classification for nursing interventions in documentation of daily nursing care for inpatients. CONCLUSION: At all organizational levels intervention aimed at putting policy regarding documentation into clinical practice considerably improved daily use of standardized nursing languages. Relevance to clinical practice. Nurses need to use standardized language to document patient care data in the electronic health record and to demonstrate contributions to nursing care.

Applicability of the Nursing Interventions Classification to describe nursing.

The aim of this survey was to test the applicability of the Nursing Interventions Classification (NIC) system for use in a future nursing information system for documenting nursing in an electronic patient record in Iceland. Also, the aim was to test the translation of NIC into Icelandic. In order to be applicable to nursing NIC needs to be sensitive enough to describe the work nurses do, differentiate between specialities in nursing, and be understandable to nurses. A sample of 198 nurses was asked to identify how often they used each of 433 NIC nursing interventions. Of the 36 most frequently used interventions half are within the physiological domain. Core nursing interventions were different between specialities, e.g. Analgesic Administration had a high mean score in surgical nursing, and Health Education in primary health care. anova for the 27 classes in NIC showed significant differences (p < 0.01) by all nursing specialities except one, Crisis Management. A Tukey post hoc test showed how nursing specialities were reflected differently in the NIC domains, e.g. medical/surgical nursing in the Physiological: Basic Domain, but psychiatric nursing in the Behavioural Domain. Factor analysis of classes in NIC show good resemblance with the domains in NIC and the structure of the classification is strongly supported, except the Safety Domain. The results from this study indicate that nurses in the sample consider NIC to be applicable to describe nursing. The language is a powerful tool and is central in reflecting nursing practice as well as supporting the construct of knowledge. The translation of NIC to Icelandic is one step in many in preparing nurses to use a standardized language which can also be used in an electronic patient record.

Nursing diagnosis taxonomy across the Atlantic Ocean: congruence between nurses' charting and the NANDA taxonomy.

PURPOSE AND AIMS: The purpose of this study was to analyse expressions or terms used by nurses in Iceland to describe patient problems. The classification of NANDA was used as reference. The research questions were: (a) Does NANDA terminology represent patient problems documented by Icelandic nurses? (b) If so, what kind of nursing diagnoses does it represent? (c) What kind of patient problems are not represented by NANDA terminology? (d) What are the most frequent nursing diagnoses used? METHODS: A retrospective chart review was conducted in a 400 bed acute care hospital in Iceland. The sample was defined as nursing diagnosis statements in charts of patients hospitalized in two 6-month periods in two separate years. The data were analysed according to a predefined grading system based on the PES format or Problem -- (A)aetiology -- Signs and symptoms. RESULTS: A total of 1217 charts were used for the study, which yielded 2171 nursing diagnoses statements for analysis. Charts with at least one nursing diagnosis documented were 60.1% and the number of diagnoses per patient ranged from 0 to 10, with 65% of charts with three diagnoses or less. The number of diagnoses correlated with patients' length of stay, but not with increased age of the patients. The average number of statements per patient was 3.28. Almost 60% of the diagnoses were according to NANDA terminology, another 20% were stated as procedures, medical diagnoses or risks for complications. The 20 most frequently used nursing diagnoses accounted for 80% of all diagnoses documented. Discrepancy between nurses' documentation on emotional problems and availability of diagnosis in the NANDA taxonomy was evident. CONCLUSION: It can be concluded that the NANDA taxonomy seems to be culturally relevant for nurses in different cultures.

Translation and validation of the Nursing Outcomes Classification labels and definitions for acute care nursing in Iceland.

BACKGROUND: The Nursing Outcomes Classification (NOC), second edition, consists of 260 patient outcomes with definitions. This has been translated into five languages, but has not been clinically validated outside the United States of America (USA). AIM: The aim of this paper is to describe the translation of the labels and definitions from the NOC, second edition from English to Icelandic and validation for acute-care nursing in Iceland. METHOD: A survey that has been designed to identify nurses' perception of the percentage of patients' for whom each NOC outcome is relevant in clinical nursing practice was used for clinical validation in this study. The translation procedure involved source to target language translation, parallel comparison, pilot test and field test. Validation included test-retest to measure the reliability for each of the 260 outcome variables. Data collected from 140 clinical nurses from 54 departments within 13 nursing specialties at Landspitali University-Hospital in Iceland, in November 2001, were analysed to establish construct validity by confirmatory factor analysis. Internal consistency was calculated. RESULTS: Translation was successful. Test-retest showed that 181 of the 260 NOC outcomes were significant (P < 0.05) and moderately or highly correlated (r > 0.50) (Pearson's correlation). The confirmatory factor analysis showed that 22 of the 29 NOC classes had only one factor at the loading criteria > or =0.30. Of the 260 outcomes, 244 had loading on one factor (> or =0.30) within its class. Internal consistency was >0.80 (Cronbach's alpha). LIMITATIONS: Low response rate was a limitation. The indicators of each NOC outcome were not addressed. CONCLUSION: The Icelandic version of the NOC survey is a comprehensive tool that can be applied to nursing in acute-care for research purposes as well as to prepare for the implementation of NOC in clinical information systems.