Number 2 - March 1997

ACENDIO NEWSLETTER
No 2 March 1997
Official Newsletter for the Association for Common European Nursing
Diagnoses, Interventions and Outcomes
Mailing Address: ACENDIO c/o The Royal College of Nursing, 20 Cavendish Square, London W1M
0AB, Fax + 44 171 355 1379
Editor: Rosemary Crow PhD RGN, Fax No (44) 1483 259395 E-mail [email protected]
The Editorial team apologise for the lack of translation in this edition of the newsletter.
This newsletter may be translated and copied for distribution
EDITORIAL
Over 100 abstracts have been submitted for the Amsterdam conference in May 1997.
This indicates a growing interest in the Association which is very encouraging. The
conference will have a similar structure to last year’s conference in Brussels.
Workshops and round table discussions will give more opportunity for active
participation and the sharing of knowledge. Please come and participate because it is
only through active discussion that we will successfully contribute to the knowledge
base for our profession.
It is promising to see so much research and development in our field across Europe.
There are now three large scale projects funded by the European Union with which
members of the Association have links. These projects are known as NIGHTINGALE,
TELENURSE and WISECARE. There are also numerous smaller projects. The results
of some of these projects will be presented in Amsterdam. Others are reported in this
newsletter.
Individual membership of the Association is stable but Institutional membership is
growing. Please renew your membership for 1997-1999 and encourage your
colleagues and your organisation to join. Your contribution is vital for a true European
platform for the development of a nursing language and its classification.
ACENDIO NEWS
The Board has met four times since May 1995. Their main business has been the
Amsterdam conference, the launch of this newsletter and a first proposal for the
working of the standardisation committee. A proposed budget was discussed and
accepted. The Royal College of Nursing of the United Kingdom offered to provide
secretarial assistance to the Board of the Association for the first two years and this
offer has recently been extended for a further two years until 1999. The Board decided
to use the Conference Organiser of the Royal College of Nursing for the first
ACENDIO conference.
1
The change of conference organiser has meant we have lost the database gathered by
our previous conference. This has caused considerable difficulty for the Association
and has delayed the Board’s intended programme.
Reminder about subscriptions
Subscription 1997-1999:
ordinary and associate member
student member
institutional member
£40 GB
£25 GB
£400 GB
These subscriptions cover a two year period from one general assembly to the next.
Application forms are enclosed with this newsletter and can be copied for others. Fees
should be paid in British pounds, by sterling cheque, Eurocheque or credit card.
Further information and forms can be obtained from ACENDIO (Anne Casey), Royal
College of Nursing, 20 Cavendish Square, London, W1M 0AB, UK.
COMPETITION FOR LOGO
ACENDIO still needs a logo. Our present documentation is temporary as the Board
will not make a final judgement without a competition. So we extend the invitation up
to 30th April 1997. Announcement of the winner will be made during the ACENDIO
conference in Amsterdam. The winner will receive full reimbursement of the
conference fee.
ORIGINAL ARTICLES
Developments on language and classification in Europe
Clark J.
University of Swansea, Wales
When ICN surveyed its member national nurses associations in 1991 to find out what
was happening around the world in the development of nursing classifications and
computerised information systems, there appeared to be very little happening in Europe
(1). By 1996 the situation had changed dramatically. Belgium had established a nursing
minimum data set to be used as part of its system for financing hospitals (2). The UK
had undertaken a Nursing Terms Project (3) to identify terms used by nurses in their
clinical practice to be included alongside those used by physicians and other health
professionals in a multi-disciplinary thesaurus coded in Read codes. Classifications of
nursing diagnoses were being developed in Denmark and the Netherlands. Local
initiatives were taking place in several other countries.
The award of a Winston Churchill Travelling Fellowship provided an opportunity to
find out more about these developments, to talk with the nurses who were developing
the systems, and to see some of the systems in use. I visited Denmark, Netherlands,
Belgium and Switzerland. I began at the MIE conference held in Copenhagen in August
1996. There were presentations of work being undertaken in all my study countries and
other countries, including an interesting community nursing project in Slovenia.
2
The Danish Institute of Health and Nursing Research launched its TELENURSE project
which is field testing the Alpha version of the ICN's International Classification for
Nursing Practice in twelve European countries. The conference also provided
opportunity to learn more about the standardisation work being undertaken by CEN
TC251, which covers health informatics (still called medical informatics) in the
European Union.
In the Netherlands I visited Breda (Kruiswerk Gezinszorg Community Health Centre),
Groningen (Northern Centre for Health CareResearch and Groningen University
Hospital, Hanzehogschool), Leeuwarden (Nursing Home), Leiden (HISCOM bv. and
Leiden University Hospital), Maastricht (University of Limberg, Department of Nursing
Science), Utrecht (National Centre for Nursing and Care (LCVV), Vught (Reinier van
Arkel Hospital), and Zoetemeer (WCC/CSIZ).
Of the three countries studied, Netherlands appears to be the most active in the
development of standardised vocabularies and classification systems; but the work is
fragmented and unco-ordinated. I was told that as a result of the current political
philosophy of privatisation, decentralisation, and market competition, Netherlands has
no national or central strategy or policy on information or IT: as in the USA, there are
many independent and competing systems currently being developed, funded from
several sources.
For example, the WCC, which was formerly part of the National Board of Health, was
split into two and privatised. It is now an independent commercial agency (CSIZ)
funded through contracts. Central government collects and registers very little data,
relying on access to data stored elsewhere. It does, however, take responsibility for the
following:
Information infrastructure
•
Standardisation and classification
•
Data protection legislation
•
Uniform patient identification
•
Research and development
•
One strength of the Netherlands’ work is its conceptual and theoretical analysis. The
ICIDH (International Classification of Impairments, Disability and Handicap) is the
dominant classification and is rapidly becoming institutionalised. Several conceptual
frameworks are used, but Gordon's Functional Health Patterns is by far the most popular
framework.
From the Netherlands to Belgium, where I visited the Katholieke Universiteit at Leuven
(Prof Georges Evers and Prof. Walter Sermeus), the Ministere de la Sante Publique et de
L'Environnement (Mme. Anita Simoens-Desmet, Directeur d'administration and M.
Lieven Van Langenaeker), and the Universitaire Ziekenhuizen Leuven(UZL) (Denis
Van Der Vaal).
Belgium is probably the only country in the world to have a Nursing Minimum data set
which is mandated by law and is an integral part of the country's sytem of health care
financing. The system is also generating a large dataset for nurse researchers which is
able to demonstrate, for the first time in Europe, linkages between nursing interventions
3
and patient outcomes, and changes in nursing practice over time. The challenge for
Belgium, however, is how to extend the system from hospitals into primary and
community care.
In Switzerland a new federal law on the collection of health data is providing a great
opportunity for the development of nursing informatics, which the Swiss Nurses
Association and the nursing group of MIE are working actively together to exploit.
In Geneva I met this group of nurses and also visited the Hopital Universitaire Belle Idee
(Dr Andre Assimacopoulos), and the Hopital Universitaire de Geneve (Jean Daniel
Henchoz), and, of course, the International Council of Nurses. In Lausanne I visited the
Hopital Universitaire de Lausanne (Marcel Despont), and another hospital at Morges
(Dominique Oudy).
My visits were brief and covered only four countries, but it is clear that Europe is now
very active in the development of nursing classifications and information systems. I look
forward to learning more and extending the "Network" at the ACENDIO conference in
Amsterdam in May.
References:
1. Wake M, Murphy M, Affara F, Clark J, & Mortenson R. Toward an International
Classification for Nursing Practice: A literature review and survey. International
Nursing Review. 1996. 40, 3, 77-80.
2. Sermeus W, Delesie L, Van Landuyt, Wuyts Y, Vanden Boer G, Manna M. The
Nursing Minimum Data Set in Belgium: A basic tool for tomorrow’s health care
management. Leuven, Belgium, Centre for Health services Research, Katholieke
Universiteit Leuven. 1994.
3. Casey A. Standard terminology for nurses: results of the nursing, midwifery and
health visiting terms project. Health Informatics. 1995. 1, 41-43.
Correspondence address: Department of Nursing, Midwifery and Health Care,
University of Wales Swansea, Swansea SA3 8PP, Wales, UK
ORIGINAL-ARTIKEL
Die Pflegediagnose aus didaktischer Sicht: Teil
Riegal,S.
Lübeck, Deutschland
Dieser Artikel, der die Pflegediagnostik aus einer didaktischen Perspektive betrachtet,
ist als eine dreiteilige Reihe angelegt. In diesem ersten Teil geht es um eine
allgemeine Dastellung ohne zu sehr in die Tiefe zu gehen. Im zweiten Teil soll aus
schulischer und prakitischer Sicht das Contra der Pflegediagnostik betrachtet werden.
Abschließend dann eine fachdidaktische Konstruktion als Versuch einer Legitimation,
vor allem als Ergänzung zu diesem ersten Teil. Insgesamt ist es das Ergebnis von
4
Beobachtungen und Analysen an der Krankenpflegeschule der Ilansestadt Lübeck zum
Thema - Umsetzung der Pflegediagnostik im Unterricht - und somit eine
Praxisbericht.
Retrachtet man die Situation der Pflegediagnostik in Deutschland, dann muß man
feststellen, daß diese Thematik scheinbar schon ad acta gelegt ist. Die Anzahl der
bisherigen Veröffentlichungen sind sehr verhalten und auch sonst entsteht nicht der
Eindruck, daß Pflegediagnosen in Deutschland irgendeine Bedeutung haben.
Noch dramatischer ist dieser Eindruck im Bereich der Ausbildung. Ilier ist bislang
jegliche Diskussion zu vermissen, ein Austausch findet nicht statt. Gerade diese
Situation ist sehr enttäuschend, da die Pflegediagnostik eine hervorragendes
didaktisches Instrument ist. Somit soll der Beitrag eine fachdidaktische Position
einnehmen.
An der Krandenpflegeschule im Städtischen Krankenhaus Lübeck (Deutschland) ist
die Pflegediagnostik ein fester curricularer Bestandteil. Auch unter der
Berüchsichtigung einer kritischen Betrachtung US-amerikanischer Entwicklungen und
deren Umsetzung in Deutschland, werden die NANDA-Diagnosen im Unterricht
besprochen und in der Praxisbegleitung - Pflegeplanung auf der Station mit den
Schülern vor Ort trainiert, Durch den Umgang mit den Pflegediagnosen wird den
Schülern ein tieferer Zugang zu dem Patienten vermittelt. Im Aufbau der einzelnen
Pflegediagnosen eröffnet sich dem Schüler eine andere Lernstituation und ermöglicht
dem Lehrer eine systematische strukturierte Tiefe, um dem Schüler
Patientensituationen transparenter zu machen.
Vor allem die Diagnosen, die sich mit nichtsomatischen Problemen befassen
ermöglichen einen anderen Zugang zum Patienten. Im Vordergrund des Unterrichts
stehen hier die Pflegediagnosen “Machtlosigkeit”, “Iloffnungslosigkeit” und
“Wissensdefizit”, die als exemplarisches und fundamentales Prinzip genutzt werden.
Durch eine problemorientierte Vorgehensweise erkennen die Schüler in der Regel,
durch eine eigenständige Ermbeitung der Tnematik, die weitreichende Bedeutung der
Pflegediagnostik. Das eigene intuitive subjektive Erkennen des Schülers, dieser mehr
psychosozialen Probleme, wird auf eine objektive Bahn gelenkt und erreicht dann eine
andere, eine professionelle Bewußtscinsebene.
Um die unterrichtsrelevante Bedeutung ansatzweise zu erfassen wurde hier an der
Schule ein narratives Interview durchgeführt, welches mit der hermeneutischen
Paraphrase ausgewertet wurde. Aus Personal-und Zeitgründen wurde das Interview
nur mit einem Schüler durchgerführt und hat somit nur eine stark eingegrenzte
Aussagekraft. Dennoch wurde deutlich, daß der Krankenpflegeschüler den Nutzen der
Pflegediagnostik ala sehr sinnvoll betrachtet. Beobachtet man ergänzend die
Diskussionen und Ergebnisse im Unterrichtsgeschehen lassen sich deutlich positive
Tendenzen in der Pflegediagnostik aus pädagogischer Sicht Feststellen.
Die Bedeutung der Pflegediagnostik als didaktirsches Instrument ist insgesamt hoch
zu bewerten (Auch wenn bislang wissenschaftliche Studien nicht vorliegen) und daher
ist eine didaktische Diskussion hier anzustreben. Es wäre weiterhin zu überlegen,
inwieweit sich die ACENDIO mit dieser pädagogisch-didaktischen Situation in
Zukunft befassen kann. Die Notwendigkeit jedenfalls ist deutlich zu erkennen.
5
Anschrift: Robert Koch Strass 10, D23562 Lübeck
ICNP ALPHA VERSION PUBLISHED
Extracts from: ‘ Introducing ICN’s International Classification for Nursing
Practice (ICNP): A Unifying Framework’ published in International Nursing
Review, 43, 6, 1996.
Seven years ago, ICN had a vision: To establish a common language about nursing
practice to describe nursing care that could be compared across borders, populations,
settings and time. Today part of this vision has become a reality: the Alpha Version
and a database for an International Classification for Nursing Practice (ICNP), for
which ICN is soliciting feedback, critique and recommendations from nurses in all
settings everywhere.
The idea for a common nursing language came at the ICN Congress in Seoul in 1989
in the form of a resolution that voiced concern about nursing’s significant
contributions to health going unrecognised due to no language to describe them. In
response to the request ICN appointed a team of consultants to develop a feasibility
study for an ICNP. This initial enthusiasm was seen by some nurses as too ambitious
(‘farfetched’) but by most as ‘farsighted’.
The dream and determination of ICNP’s supporters were to:
• Establish a common language for describing nursing practice in order to improve
communication between nurses and between nurses and others
• Describe the nursing care of people (individuals, families and communities) in a
variety of settings both institutional and non-institutional
• Enable comparison of nursing data across clinical populations, settings, geographic
areas and time
• Demonstrate or project trend in the provision of nursing treatments and care and
the allocation of resources to patients according to their needs based on nursing
diagnosis
• Stimulate nursing research through links to data available in nursing and health
information systems
• Provide data about nursing practice in order to influence health policymaking.
With the publication of the Alpha version the stage is set for consensus-building with
providers, researchers, users and policymakers and experts in informatics,
standardisation and classification. The ICN publication describes the ICNP’s
strategies, criteria and principles of classification. It is but a first draft, not the end
product, as the development of an ICNP is a long term project and will be continuous.
To make the system applicable and useful, feedback and collaboration are needed
from nurses in all settings and countries. Groups or individual nurses who are already
developing and/or using a nursing classification system are asked to share their
experiences and thoughts with the project team. The International Nursing Review
includes a description of how nurses can contribute.
6
Copies of ICNP: The Alpha Version - A Unifying Framework and feedback
forms can be obtained from ICN, 3 Place Jean-Marteau, CH-1202, Geneva,
Switzerland. Tel: +41 22 908 0100. Fax: +41 22 908 0101. Email:
[email protected]
RECENT PUBLICATIONS
Carpenito LJ. Nursing Diagnosis - Application to Clinical Practice (7th edition).
Philadelphia, JB. Lippincott. 1997.
Danish Institute of Health and Nursing Research (DIHNR). ICNP alpha version with
TELENURSE introduction. Copenhagen, DIHNR. 1996.
Gordon M. Manual of Nursing Diagnosis 1997 - 1998. St Louis, Mosby. 1997.
ICN. The ICNP: A unifying framework: the alpha version. Geneva, ICN. 1996.
Johnson M, Maas ML. Nursing Outcome Classification (NOC). St Louis, Mosby.
1997.
Lang NM (Ed). Data systems: an emerging framework. Washington, American
Nurses Association. 1996.
McCloskey JC, Bulechek GM. Nursing Interventions Classification (2nd edition).
St Louis, Mosby. 1996.
McFarland GK, McLane AM. Nursing Diagnoses and Interventions.
St Louis, Mosby. 1997.
NANDA. Nursing Diagnoses: Definitions and Classifications 1995-1996.
North American Nursing Diagnosis Association (price $10). Available form NANDA,
1211 Locust St, Philadelphia, PA 19107, USA. Fax +1 215 545 8107.
JÜNGSTE VERÖFFENTLICHUNGEN (DEUTSCH)
Collier IC, McCash KE, Bartram JM. Arbeitsbuch Pflegediagnosen.
Ullstein Mosby, Berlin/Wiesbaden 1997.
Gordon M. Handbuch Pflegediagnosen 2. Auflage.Ullstein Mosby,
Berlin/Weisbaden 1997.
Gordon M. Pflegediagnosen und Pflegeprozeß. Ullstein Mosby, Berlin/Wiesbaden
1997.
Kim MJ, McFarland GK, McLane AM. Pflegediagnosen und Pflegeinterventionen
Ullstein Mosby, Berlin/Wiesbaden 1997.
7
Meudt JM, Georg J. Pflegegutachten. Ullstein Mosby, Berlin/Wiesbaden 1997
CONFERENCES
First ACENDIO Conference: From Diagnosis to Outcome - Nurses Network
across Europe
May 2nd - May 3rd 1997
RAI Conference Centre, Amsterdam, Holland. Further information: Danielle
Rawstrom, RCN Conference Unit, Royal College of Nursing, 20 Cavendish Square,
London W1M 0AB, UK. Tel:+44 171 4093333. Fax: +44 171 629 7426
Pflegetheorien International Deutsch English Conference
April 10-12 1997
Nürenberg, Deutschland. Further Information: MCM Medizinische Congressorganisation, Nürenberg GmbH, Kongreßabteilung, Wielandstrasse 6, D-90419
Nürnberg, Deutschland. Tel:0911/393160. Fax:0911/331204
Fifth International Self-Care Deficit Nursing Theory Conference
August 7-9 1997
Leuven, Belgium. Further Infromation: Centre for Health Services and Nursing
Research, Katholieke Universiteit, Leuven, Kapuccijnenvoer 35 fourth floor,
3000Leuven, Belgium. Fax: +32 16 336970.
The Impact of Nursing Knowledge on health Care Informatics: NI’97
September 26 - October 1 1997
Stockholm, Sweden. Further Information: NI’97, c/o Stockholm Convention Bureau,
PO Box 6911, S-10239 Stockholm, Sweden. Tel: +46 8 7361500. Fax: +46 8 348441
Professor Rosemary Crow
Nursing & Midwifery
University of Surrey
Guildford, Surrey.
8