Nursing data at present is too often confined to a paper record and used only for individual patient care. It is never included in data that is submitted by health care agencies to governments and other regulating entities for use in health care planning. This creates a situation in which nursing's contribution to health care is invisible. If nursing data is to be included in submitted data it is imperative that it be computerized. Computerizing the data requires the solution to two problems:

Problem
Solution
What data should be included? Minimum Data Sets
What terms will be used to designate this data? Standardized Terminologies

Technically, the term, data set, means "... a collection of data elements organized for a specific purpose." (Hunter, 2001). Under this definition, the term can include both minimum data sets and standardized terminologies. In these pages, the term data set will be used to mean the designation of data categories (elements) with unambiguous definitions, for example "nursing diagnosis," and standardized terminology will mean a collection of agreed upon terminology for concepts such as "decreased cardiac output." Confusion arises, however, because some collections called data sets also contain a standardized terminology. In nursing, the nursing specific standardized terminologies are designed to capture the nursing care elements in the Nursing Minimum Data Set (NMDS)(See page 295 for the elements in the NMDS.)

Standardized terminologies permit several operations. One, the use of data in an aggregated (the same data for many patients) format to determine outcomes and to plan regional, state, national, and international levels for health care, and two, the ability to find information (literature or clinical records) about a given term.

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Minimum Data Sets

The United States Health Information Policy Council defines a minimum data set as the "minimum set of items of information with uniform definitions and categories, concerning a specific aspect or dimension of the health care system which meets the essential needs of multiple data users." (Health Information Policy Council, 1983, p. 3 as cited in Werley, Ryan & Zorn, 1995.) Thus, the minimum data required depends on the circumstances. Meeting the needs of care givers requires data that is different than the data required by those who make policy. The first requires detailed information, the second data that has been summarized.

There are several minimum data sets in health care. Table 17-4 on page 296 lists some of these. None, however, contain nursing sensitive data. Yet data from these data sets are used in making decisions about health care.

To overcome this deficiency, a Nursing Minimum Data Set (NMDS) was conceived in the 1970s and birthed in the 1980's. Unfortunately, it is too often confused with other minimum data sets.

In a minimum data set, the definitions of each element need to be clear and unambiguous. The current U.S. Nursing Minimum Data Set contains only the names and definitions for the elements, not the terminology used as data for each element. For example, in the NMDS nursing diagnosis is defined as "A clinical judgment made by a nurse about a human response to an actual or potential health problem, the intervention for which nurses are accountable." (Werley, Devine & Zorn, 1988, p. 31.). The terminology used to represent a nursing diagnosis is NOT defined by the US Nursing Minimum Data Set (NMDS). The standardized terminology from the North American Nursing Diagnoses Association International (NANDA) is one of the American Nurses Association (ANA) recognized standard nursing terminologies that can be used to collect the nursing diagnosis element in the NMDS.

There are two minimum data sets recognized by the ANA. The Nursing Minimum Data set (page 295) and the Nursing Management Minimum Data Set (NMMDS) (page 296).

Other countries have developed nursing minimum data sets also as described on page 295-296.

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Standardized Terminologies

Very simply a standardized terminology is a list of terms with agreed upon definitions so that when a term is used it means the same thing to everyone. Often the terms are organized into a taxonomy (See page 291) so that data from various categories can be aggregated. For example, in NANDA all terms that belong to the overall category of "Infection" could be looked at as a whole. Going further up the taxonomy, all the terms from any category in the "Safety/Protection" category, of which infection is one, can be further aggregated. This type of arrangement makes it easy to look at parts, but also the whole. Usually when the terms are aggregated, data other than just the nursing diagnosis will be included. For example, one might combine a specific medical diagnosis with nursing diagnoses from either a specific nursing diagnosis, or any of the categories above it in the taxonomy.

Some terminologies are what are called multi-axial. (See page 291 in the text for more information.)

Whether a set of standardized terminologies is officially termed a vocabulary, a taxonomy, combinatorial vocabulary, or formal language (the Ingenerf typologies) is not important for our purposes here. In presenting this summary of the standardized terminologies the term standardized nursing terminology will be used to represent all of the standardized terminologies recognized by the ANA.

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ANA Contributions to Standardized Nursing Terminologies

In the United States the American Nurses Association (ANA)has spearheaded efforts to coordinate the various minimum data sets and standardized nursing terminologies. The ANA Committee for Nursing Practice Information Infrastructure (CNPII) evaluates minimum data sets and standardized terminologies submitted to them to see if they meet specific criteria. This criteria includes a rationale for the development of the terminology, that it be clinically useful, and that the terms be clear and unambiguous (Beyea, 2000). Following is a list of the two minimum data sets and 11 standardized nursing terminologies that have been recognized by the American Nurses Association as of this date (August 21, 2009). Note that the ANA "recognizes" terminologies, it does not "approve" them.

The comittee that evaluates how a terminology is implemented in a vendor product is the Nursing Information & Data Set Evaluation Center (NIDSEC)

ANA Recognized Minimum Data Sets

Nursing Minimum Data Set (NMDS) (1999)

Nursing Management Minimum Data Set (NMMDS) (2003)

 

ANA Recognized Standardized Terminologies That Support Nursing Practice

The date in parentheses is the year the terminology was first recognized. A terminologies in green text is retired. The small number in parentheses after the terminology is the page in the text where more information can be located.

Standardized Terminology Nursing Elements of the NMDS Classification Schemes
Nursing Diagnosis Nursing Intervention Nursing Outcome Nursing Intensity
NANDA-I (North American Nursing Diagnosis Association International) (1992) (page 297) x


Nursing Diagnosis
NIC (Nursing Interventions Classification) (1992)(page 298)
x

Interventions
NOC (Nursing Outcomes Classification (1997) (page 298)

x
Outcomes
The above three are intended to be used together. Currently in process is a classification scheme to unite all three of these. However, they are still 3 different terminologies. (298)

1-Omaha System (1992) (page 296)

 x x x
1) Problems
2) Outcomes
3) Interventions

1-CCC (Clinical Care Classification - Formerly the HHCC Home Health Care Classification) (1992) (page 297) x x x
1) Nursing Diagnoses & Outcomes
2) Interventions

Patient Care Data Set (1998)
http://www.ncvhs.hhs.gov/990518t3.pdf

This terminology was retired in 2006.

 x x x

PNDS (Perioperative Nursing Data Set) (1999)(page 299) x x x

1) Nursing Diagnoses
2) Interventions & Goals

2-SNOMED-CT (1999) Systematized Nomenclature of Medicine. SNOMED-CT has replaced SNOMED-RT which has been retired. SNOMED-CT received recognition from the ANA in 2003.(page 299) x x x

3-ICNP International Classification for Nursing Practice (2000) (page 299)

 x x x

1) Nursing Diagnosis & Outcomes 2) Nursing Interventions
4-Alternative Link (2000) (page 275)
x


1-LOINC - Logical Observation Identifiers Names & Codes (2002) (page 300) x        

1- These two languages can be used "as is" without payment of royalties. Users, however, are not authorized to alter or modify them.

2- SNOMED-CT (Clinical Terms) allows mapping to the nursing problems (diagnoses) for NANDA II, the Omaha system, HHCC, and the PNDS. Interventions for NIC, Omaha, HHCC, and PNDS and outcomes for NOC, and the PNDS.

3. This language is copyrighted. Written permission from the International Council of Nurses is required, but no fee is required for non-commercial use. A small fee is charged for-profit use. It is currently being mapped to SNOMED-CT.

4-Alternative Link's products support electronic and paper claims processing and fee structures for providers, health care payers, managed care organizations and affiliate organizations. Although ANA recognized, it has a purpose different than the others.

For information about the ANA committee, Nursing Information & Data Set Evaluation Center (NIDSEC) that evaluates how a standardized terminology is used by vendor see http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/
NursingStandards/DocumentationInformatics/NIDSEC.aspx This committee does NOT recognize terminologies, it only evaluates how those recognized by the Committee for Nursing Practice Information Infrastructure are implemented by a vendor into an information system.

See the Online Journal of Issues in Nursing topic on standardized languages for several articles about standardized nursing terminologies

For a description of each of the ANA Recognized Languages see Chapter 17 in the text.

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References

Beyea, S. (2000). Standardized nursing vocabularies and the perioperative nursing data set. CIN Plus 3(2), 1;5-6.

Health Information Policy Council (1983). Background paper: Uniform minimum health data sets (unpublished). Washington, DC: U.S. Department of Health and Human Services.

Hunter-Milholland, K. (2001). Electronic Health Records. In S. Englebardt & R. Nelson, (Eds.) Health care informatics: An interdisciplinary approach. St. Louis: Mosby, pp 209-230.

Werley, H. H., Devine, E. C. & Zorn, C. R. (1988). Nursing Minimum Data Set data collection manual. Milwaukee, WI: University of Wisconsin-Milwaukee School of Nursing.

Werley, H.,H., Ryan, P., & Zorn, C. R. (1995). The nursing minimum data set (NMDS): A framework for the organization of nursing language. In Lang, N. M. (Ed.) Nursing Data System: The Emerging Framework. American Nurses Association: Washington, DC., pp 19 - 30.

Created June 11, 2009 - updated August 21, 2009

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