Using Nursing Interventions Classification as a Framework ...

1 Using Nursing Interventions Classification as aFramework to revise the belgian NursingMinimum Data Setijnt_1124 Van den Heede, PhD, RN, Dominik Michiels, Msc, RN, Olivier Thonon, Msc, RN, andWalter Sermeus, PhD, FEANS, develop the revised Belgiannursing minimum data set (B-NMDS). Nursing InterventionsClassification (NIC, 2nd edition) was used as aframework. Six expert nurse panels (cardiology,oncology, intensive care, pediatrics, geriatrics,chronic care) were consulted. Seventy-ninepanelists completed standardized e-mailquestionnaires and discussed results inface-to-face initially selected 256 of 433 NICinterventions. After panel discussions, plenarymeetings, and pretesting, the revised B-NMDS(alpha version) contained 79 items covering 22 NIC classes and 196 NIC building promotedacceptance of the B-NMDS, while the NICprovided a good theoretical basis and guaranteedinternational FOR Nursing B-NMDS instrument can be used tovisualize Nursing activities in differentapplications ( , financing, staffing allocation).

2 Search terms:Consensus building,NursingInterventions Classification (NIC),nursingminimum data set (NMDS) van een nieuweversie van de Minimale VerpleegkundigeGegevens (MVG). Nursing InterventionsClassification (NIC, 2nd editie) werd gebruiktals raamwerk. Zes experten panels (cardiologie,oncologie, intensieve zorgen, pediatrie, geriatrie,chronische zorg) werden panelleden vuldengestandaardiseerde e-mail vragenlijsten in enbediscussieerden de resultaten selecteerden initieel 256 vande 433 NIC-interventies. Na panel-discussies,plenaire vergaderingen, en pre-tests, bevatte deherziene MVG (alpha versie) 79 items uit 22 NIC klassen en 196 draagvlak voor de herzieneversie van MVG werd gecre erd door hetnastreven van consensus. Het gebruik van NICvormde hierbij een geode theoretische basis enverhoogt het internationaal karakter van denieuwe VOOR DE nieuwe MVG kan gebruiktworden om de dagelijkse verpleegkundigepraktijk zichtbaar te maken in verschillendebeleidsdomeinen ( , financiering, toewijzingpersoneel).

3 Zoektermen: Nursing Interventions Classification (NIC),Minimale Verpleegkundige Gegevens,ontwikkelingvan consensusInternational Journal ofNursing Terminologies and Classificationsdoi: Journal of Nursing Terminologies and Classifications Volume 20, No. 3, July-September, 2009 Koen Van den Heede, PhD, RN, is Research Fellow at theCentre for Health Services and Nursing Research,Katholieke Universiteit and Staff Member of the NursingCompetence Center, University Hospitals Leuven, Leuven,Belgium; Dominik Michiels, Msc, RN, is Care ProgramManager, General Management, University HospitalsLeuven, Leuven, Belgium; Olivier Thonon, Msc, RN, isNurse Manager and Research Fellow of the Medical andEconomical Information Department, University Hospitalof Li ge, Li ge, Belgium; and Walter Sermeus, PhD,FEANS, RN, is Professor and Program Director, TheCentre for Health Services and Nursing Research,Katholieke Universiteit Leuven, Leuven, , healthcare agencies use cost-cuttingstrategies such as shortening length of stay andincreasing the numbers of 1-day hospitalizations tostem exploding healthcare costs (Schubert et al.)

4 , 2008).Because Nursing is the largest professional groupwhich provides direct care, there is a compelling needfor the Nursing profession to demonstrate to thegeneral public as well as to other healthcare profes-sionals and policy makers what exactly nurses do. Oneway to visualize Nursing care is to use nursingminimum data sets (NMDS). Although the interna-tional Nursing community recognizes the necessity ofNMDS (Goossen, Delaney, & Coenen, 2005), the onlycountry that has implemented NMDS data on a wide-spread scale is Belgium (Mac Neela, Scott, Treacy, &Hyde, 2006).Since 1988, the belgian Ministry of Public Healthhas randomly sampled Nursing activity during 5 dayswithin the first 15 days of March, June, September, andDecember. On these days, hospitals collect nurse staff-ing patterns and Nursing care activity data. These dataare commonly known as the national belgian NMDS(B-NMDS).

5 First, for every patient admitted to inpa-tient hospitalization units or 1-day clinics, a list of 23nursing Interventions is scored. Second, for eachnursing unit where these patients are treated, thenumber and qualifications of Nursing staff directlyinvolved in patient care is recorded (Sermeus, Delesie,Van den Heede, Diya, & Lesaffre, 2008). Twenty yearsof registration has resulted in a unique database thatcontains information about Nursing care, coveringmore than 18 million inpatient days. This informationis used by hospital managers to support decisionsregarding nurse staffing allocation and by the Ministryof Public Health to allocate about of the overallhospital budget to care has changed drastically since , starting January 2008, all belgian acute hospitalshave implemented a revised B-NMDS. This paperdescribes the process used to revise the 23-itemB-NMDS to form the revised B-NMDS (alpha version).

6 In the first phase (2002 2004), the Ministry of PublicHealth commissioned a research team to revise theB-NMDS for only six care programs geriatric care,chronic care, pediatric care, intensive care, oncology,and cardiology. In the second phase (2005 2006), therevision of the B-NMDS was broadened to includegeneral surgical care, internal medicine, 1-day clinics,and maternity care. This paper only describes the revi-sion process involving the first six care revision process had two foci: (a) buildingrecent international Nursing language developments,and (b) building national professional the first foci required that the revisedB-NMDS be based on a standardized international lan-guage. When the original B-NMDS was developed in1983, a standardized international Nursing languagedid not exist. Thus, the content of the original B-NMDSwas based only on professional consensus and statisti-cal criteria derived from empirical tests (Delesie, DeBecker, & Sermeus 1986).

7 The content of the B-NMDSis therefore specific to the belgian context, which limitsits potential for international comparisons. Based on anarrative literature review (Sermeus et al., 2006), themost frequently cited Nursing languages were theNursing Interventions Classification (NIC) (McCloskyet al., 1996), the International Classification for NursingPractice (International Council of Nurses, 1999), theHome Health Care Classification or Clinical Care Clas-International Journal of Nursing Terminologies and Classifications Volume 20, No. 3, July-September, 2009123sification System (Saba, 2007), and the Omaha System(Martin & Scheet, 1992). For the B-NMDS revision, wechose the NIC (2nd edition) as a Framework for fivemain reasons: (a) the NIC is an internationally acceptednursing language ( , incorporated into the NationalLibrary of Medicine Metathesaurus of Unified MedicalLanguage); (b) the NIC is research based; (c) the NICcovers all fields of Nursing ; (d) the NIC undergoessystematic revisions; and (e) the NIC is logical from aclinical point of view ( , developed inductively fromnursing clinical practice, and NIC domains, classes,and Interventions are used in daily Nursing practice).

8 In addition, the NIC is available in two official Belgianlanguages (Dutch and French) and has been previouslyinvestigated in belgian home health care (De Vliegheret al., 2005).The second principle, building national professionalconsensus, involves the belgian healthcare national professional consensus is an impor-tant component of this project, as successful nationalimplementation of the revised B-NMDS requiresnational consensus. Ignoring this second principle canbe one of the explanations why the NMDS initiativesoutside of Belgium have failed. The detailed descrip-tion of both principles makes this data applicable to theinternational community and can provide informationfor similar initiatives in other Comparison of NIC and B-NMDSThe NIC is a Nursing language that provides a stan-dardized and unambiguous method to document anddescribe Nursing activities that are performed orshould be performed (McClosky et al.)

9 , 1996). The NICfacilitates communication through labels and defini-tions which ensure that users fully understand perti-nent are three main differences between the NICand the B-NMDS. First, unlike the NIC, the B-NMDS isnot a pure language. Rather, it is more of a data collec-tion instrument that measures phenomena in an unam-biguous way. Therefore, including items into theB-NMDS requires adherence to stringent inclusion andexclusion criteria. In addition, the registration ofnursing activities in the B-NMDS is linked to specificcriteria that allow the Ministry of Public Health toperform external audits , Is the coded nursingactivity documented in the patient record? Second, theB-NMDS includes only direct Nursing care activities,while the NIC includes both direct and indirectnursing care activities. Third, the NIC is limited tointerventions that follow a Nursing or medical diagno-sis.

10 Nursing activities such as assessment are notwell covered by the NIC. Assessment is part of thenursing diagnostic process which is covered by theNorth American Nursing Diagnosis Association Inter-national (NANDA-I, 2009). In the present study, wedescribe the process of transforming NIC language foruse in a B-NMDS registration PanelsWe recruited a panel of 12 experts for each of the sixcare programs, cardiology, oncology, intensive care,pediatrics, geriatrics, and chronic care ( , 72 expertsin total). During a national conference for nurse direc-tors organized by the Ministry of Public Health at thestart of the project (September 2002), all hospitals wereinvited to recommend candidates from their institu-tion with clinical expertise in the six care resulted in 129 applications. Based on specific cri-teria ( , type of hospital, size of hospital, geographi-cal region, illustrated expertise), representatives of theMinistry of Public Health, in collaboration with theresearch team, selected at least six Dutch-speaking andsix French-speaking experts for each of the six aim was to compose each panel such that eachcontained a majority of ward managers and clinicalnurse specialists (because of their clinical expertise),some nurses with middle management positions(for their management expertise), and some B-NMDS coordinators (for their experiences with the originalUsing Nursing Interventions Classification as a Framework to revise the belgian NursingMinimum Data Set124 International Journal of Nursing Terminologies and Classifications Volume 20, No.)