PURPOSE To orient nurses caring for critically ill emergency patients to a standardized nursing language–based protocol system in the field.
METHODS An experimental learning program was developed and conducted by a nurse consultant. Nursing process–oriented, theoretical-practical classes focused on the analysis of real clinical situations with the purpose of generating a reflective process in the nurses' conceptual schemes and incorporating standardized nursing language in their clinical practice.
FINDINGS The expansion of nursing process–oriented clinical sessions and the retrospective clinical analysis of individualized patients has occurred in 7 of the 8 leading cities of the region (in one of them the teaching program has not been performed yet). Nine courses have been taught to a total of 185 RNs. The mean satisfaction rate reported was 90%, and one externally funded research project was initiated in regard to implementing nursing process in emergency prehospital care and taught to 75 nurses. A qualitative-quantitative research project funded by the health department of the Andalusian government was initiated by one of these nurses with respect to nursing process implementation in emergency services.
The Quality and Accreditation Center developed an evaluation system that included nurse perfomance. Two of 11 nurses participating as educators were designated as members of the evaluation board. The evaluation described impediments in determining the specific contribution of nurses to the overall process. The 2 nurses proposed that incorporating standardized nursing language was the best way to evaluate nursing performance. As a consequence, a nursing record based on the initial one designed in the research project was implemented. This record is divided into assessment, diagnosis, outcomes, and interventions based on Henderson's 14 needs, NANDA, NIC, and NOC. The electronic record will set the standards for evaluating the dimensions of the nursing data set established by the Nursing Information and Data Set Evaluation Center: nomenclature, clinical context, clinical data repository, and general system characteristics. The electronic record has been implemented in all the main cities of Andalusia and will be a main component of the Critical Patient Clinical Dossier that integrates both medical and nursing records.
DISCUSSION Implementation of standardized nursing language requires an adequate orientation program with defined objectives. The simple addition of nursing terminology to clinical areas or guidelines development not only offers some difficulties in their usage, but also creates a conceptual conflict among nurses with a biomedical paradigm orientation. Using standardized nursing language presupposes a paradigm shift among nurses and managers. Nursing process and standardized nursing language are not always the primary focus of healthcare systems; it is necessary to demonstrate the lack of sensitivity present in information systems regarding nursing practice, nursing resources evaluation, and competency design. This situation cannot be modified piecemeal, and collaboration between nurses and administration is critical.
CONCLUSIONS A nursing information system is not only a recordkeeping system and a software application; it needs also a qualitative transformation of the nurses' conceptual point of view and adequate linkage between theory and clinical practice. A patient-centered, longterm evaluation of the nursing process implementation is needed to assess the effectiveness of this reorientation of nurses' clinical practice.
