Advantages and Disadvantages of Standardized Terminologies
Nothing is perfect and this includes all of the standardized terminologies. Despite their many advantages for nursing, there are issues that need to be addressed. However, allowing the issues to prevent the use of a standardized terminology that illustrates nursing is to support the status quo and keep nursing as only a partial profession with a limited voice in patient care.
There are two free to use interdisciplinary terminologies, SNOMED-CT and LOINC. To make SNOMED-CT more useful to nursing, developers of the International Classification of Nursing Practice (ICNP) have been working with the nursing subgroup from SNOMED-CT to merge the nursing subsets that both have developed. Additionally, they are working to truly map all the ANA recognized terminologies to SNOMED-CT. LOINC is used for nursing assessments.
Although there are licensing requirements for many of the nursing specific terminologies, the Continuing Care Classification (CCC) and the Omaha System are free to users.
Advantages
Standardized terminologies provide a means of assessing and providing nursing care based on actual patient needs versus a one size fits all paradigm 1. When the terminology is seamlessly integrated into an electronic health record the familiar nursing process model can be used without the need to worry about coding.
They provide a way to bill for nursing care based on the care needed and provided instead of including nursing as part of room and board. 2 Used intelligently standardized terminologies could make nursing a revenue-generating center instead of a cost.
They illustrate nursing in ways that allows differentiation between the care nurses provide and that provided by other healthcare professions.
Patients benefit from continuity of care that is made possible with unambiguous communication between clinicians and facilities. 3,4
They improve communication between professionals.4
They provide data for evidence-based practice that can be used to improve nursing practice. Data from actual clinical practice is far more abundant than individual research data that focuses on a limited set of subjects and is not limited to the population of the study.
They allow better planning for the use of nursing resources.
They can provide a structure for a representation of patient states, behaviors and concerns, clinical judgments and decisions, and treatments. 5
They allow searching the literature in electronic databases such as Pub Med and CINAHL. All of the terms from the ANA recognized standardized terminologies are indexed in the Unified Medical Language System (UMLS). NANDA terms are only current through 2003.
They facilitate alleviating the problem of the invisibility of nursing by making nursing’s cognitive functions visible. 4,6,1 They document a nurse’s critical thinking. 7
The data they create provides empirical evidence for clinical decision support systems. 8,9
They allow searching the literature in electronic databases such as Pub Med and CINAHL. All of the terms from the ANA recognized standardized terminologies are indexed in the Unified Medical Language System (UMLS). NANDA terms are only current through 2003.
They allow nursing data to be included in Health Information Exchanges (HIEs) allowing comparisons across different agencies and in different geographic areas. 10, 11
More accurate and efficient documentation of nursing activities including the effectiveness of care, description of patient response to interventions strengthens nursing documentation. 12
Can provide direction in care planning. 3
Disadvantages
Several authors have questioned the accuracy of the assignment of nursing diagnosis. 13,14,15
The standardized nursing languages that support planning care can posed semantic challenges and create inaccuracies in documentation.16
Educating nurses to use terminologies accurately can be costly. This education must go beyond an initial introduction to the terminology. 14,17,18,19
Terminology users may not be comfortable with their use of the terms and have even less confidence in their colleagues use. 20
Nurses not seeing the value of standardized terminology. 18
Concepts may not be sufficiently concrete to describe the patient situation appropriately. Free text may be needed to fully describe the patient’s situation.21,22
Some authors have found a need to improve critical thinking skills if nurses are to use a terminology effectively.13,14,21
If either the North American Nursing Diagnosis-International, Nursing Interventions, or Nursing Outcomes terminology are used, to gain the full pictures of the critical thinking involved in assessing, implementing and reporting outcomes for nursing, it is necessary to purchase separate licenses for each one.
Some users feel that a terminology can be inflexible and support cookbook nursing versus individualized care. 23
The user may become frustrated if the categories available do not match the patient situation. 23
It is possible that a standardized nursing language may interfere with nurse-to-nurse communication about a clinical event. In order to avoid potential safety issues with this inaccuracies and semantic understandings must be avoided.16
References
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2. Saba V. Costing nursing care using the CCC system. Paper presented at: Summer Institute in Nursing Informatics 2004: Connecting the Health Care Continuum; July 22, 2004; Baltimore, MD.
3. Lundberg C, Warren J, Brokel J, et al. Terminology for the Electronic Health Record that Reveals the Impact of Nursing on Patient Care. Online Journal of Nursing Informatics Available at http:ojni.org/12_2/lundberg.pdf. 2008;12(2).
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ThePracticeofProfessionalNursing/Health-IT/StandardizedNursingLanguage.html] . OJIN: The Online Journal of Issues in Nursing. January 31 2008;13(1).
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6. LaDuke S. NIC puts nursing into words. Nurs. Manag. (Harrow). 2000;31(2):43-44.
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10. Stanton C. A new era with the Syntegrity Standardized Perioperative Framework. 2009; http://www.nxtbook.com/nxtbooks/elsevier/aorn_2010orproduct
guide/index.php?startid=108 . Accessed October15, 2014.
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12. Nunes ST, Rego G, Nunes R. The Experience of an Information System for Nursing Practice: The Importance of Nursing Records in the Management of a Care Plan. Computers Informatics Nursing. 2014;32(7):322-332
13. Paans W, Sermeus W, Nieweg R, Krijnen W, van der Schans C. Do knowledge, knowledge sources and reasoning skills affect the accuracy of nursing diagnoses? a randomised study. BMC Nurs. 2012/08/01 2012;11(1):1-12.
14. Müller-Staub M, Lavin MA, Needham I, van Achterberg T. Nursing diagnoses, interventions and outcomes- application and impact on nursing practice: Systematic review. Journal of Advanced Nursing. December 2006;56(5):514-531.
15. Thede L, Schwirian P, M. Informatics: The Standardized Nursing Terminologies: A National Survey of Nurses’ Experience and Attitudes—SURVEY II: Participants’ Perception of Comfort in the Use of Standardized Nursing Terminology "Labels". Online Journal Issues in Nursing. 2013;18(2). http://www.nursingworld.org/MainMenuCategories/
ANAMarketplace/ANAPeriodicals/OJIN/Columns/Informatics
/Informatics-Participants-Perception-of-Comfort-in-the-Use.html
16. Carrington JM. The usefulness of nursing languages to communicate a clinical event. Comput Inform Nurs. Feb 2012;30(2):82-88; quiz 89-90.
17. Thede LQ, Schwirian PM. Informatics: The Standardized Nursing Terminologies: A National Survey of Nurses’ Experience and Attitudes—SURVEY II: Participants’ Education for the Use of Standardized Nursing Terminology “Labels”. Online Journal of Issues in Nursing. 2013;18(2). http://www.nursingworld.org/MainMenuCategories/ANA
Marketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Education-for-the-Use-of-Standardized-Nursing-Terminology-Col-1.html . Accessed March 25.
18. Klehr J, Hafner J, Leah MS, Steen S, Weaver K. Implementation of Standardized Nomenclature in the Electronic Medical Record. International Journal of Nursing Terminologies and Classifications. 2009;20(4):169-182.
19. Kripps BJ. Toward Standardized Nursing Terminology: The Next Steps. CARING Newsletter. 2008;23(3):4-8.
20. Thede LQ, Schwirian P. Informatics: The Standardized Nursing Terminologies: A National Survey of Nurses’ Experience and Attitudes—SURVEY II: Participants’ Perception of Comfort in the Use of Standardized Nursing Terminology "Labels". Online Journal of Issues in Nursing. 2013;18(2). http://www.nursingworld.org/MainMenuCategories/ANA
Marketplace/ANAPeriodicals/OJIN/Columns/Informatics/Informatics-Participants-Perception-of-Comfort-in-the-Use.html .
21. Bernhart-Just A, Lassen B, Schwendimann R. Representing the nursing process with nursing terminologies in electronic medical record systems: a Swiss approach. CIN: Computers Informatics Nursing. Nov-Dec 2010;28(6):345-352.
22. Ehrenberg A, Ehnfors M, Thorell-Ekstrand I. Nursing documentation in patient records: experience of the use of the VIPS model. Journal of Advanced Nursing. Oct 1996;24(4):853-867.
23. McCloskey JC, Bulechek GM. Standardizing the language for nursing treatments: An overview of the issues. Nursing Outlook. 1994;42(2):56-63.
Created July 30, 2014
