HANDS: Refining Methods to Generate Comparable Nursing Data

PURPOSE

To create a feasible method for collecting, storing, and retrieving a standardized clinical nursing data set across the continuum of care: the Hands-on Automated Nursing Data System (HANDS).

METHODS

In phase 1 of a three-phase approach, a multidisciplinary team of clinicians, researchers, and technical experts at the University of Michigan developed a data model for capturing a standardized nursing data set and from this a prototype automated system. The single-user application provided a consistent format for recording, updating, and retrieving care plans entered across settings and time with terms and measures from NANDA, NOC, and NIC. The application is in compliance with the American Nurses Association Nursing Information and Data Set Evaluation Center standards and HL7 standards.

It is intended that the prototype application evolve to generate comparable information that is useful and easy for clinicians to capture in daily practice and can be aggregated for use in examining nursing effectiveness. Target users were asked to operate the system under a range of laboratory conditions and to note strengths, weaknesses, and suggestions for enhancing use under actual clinical conditions. Three research assistants tested the application while gathering data for the Michigan component of a regional study designed to examine the reliability and validity of NOC measures across the continuum of care. The assistants collected a baseline of HANDS data from approximately 250 patient subjects. Another 100 students and faculty from schools of nursing have also tested the application in the HANDS laboratory and provided input to the team.

FINDINGS

In general, the feedback from testers indicated that the application is an efficient means for helping potential users understand at a glance why nursing standardized languages are important, and the intended use. Nurse, student, and faculty evaluators were positively impressed with the ease and simplicity of the application. Users noted that the time needed to create and enter care plans with standardized terminologies was significantly less when compared to noncomputerized approaches. In addition, the software was found to promote efficient learning of the standardized languages. The search functions, linkage of terms, and measures for diagnoses, outcomes, and interventions were described as major facilitators for identifying appropriate standardized terms. The online help feature was also rated very positively because it provided immediate access to complete information on any NANDA, NOC, or NIC term.

A number of suggestions were also noted to improve functionality. For example, many found it cumbersome to select terms one at a time for a diagnosis, outcome, or intervention and recommended that a multiple-term selection feature be made available. Another suggestion was to allow the user the option to enter NANDA, NOC, and NIC terms in any sequence versus the current linear path that requires selection of diagnoses first and then outcomes followed by interventions.

DISCUSSION AND CONCLUSIONS

The favorable responses of the test audience indicate the value of HANDS in speeding the integration of nursing languages into practice. Well-designed automated systems can be used to enhance understanding and motivation for learning and incorporating standardized terminologies into documentation. In addition, the application can be used to dramatically decrease the training time and costs associated with educating nurses to use standardized terminologies competently. Phase 2 involves the translation and upgrade of the software into a Webbased format. In phase 3 the application will be thoroughly tested and refined across settings under actual conditions of use. With adequate resources a standard for collecting and retrieving a standardized nursing data set will be available for use in practice within the next few years.