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Discussion question: Week 3: Virtual Learning
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Online learning is considered a virtual learning environment (VLE); however, there are other types of VLE that you may have used or heard about. Please discuss one of the following VLE’s and your experience with using it:
– Virtual simulation
– Edutainment
– Three-dimensional virtual environment or world
– Augmented-reality games (ARGs)
– Virtual Reality devices
Then discuss how you, as the advanced practice nurse, would use this in your practice.
Lecture
Standardized terminologies (STs) contribute to the development of knowledge because they ensure that all nurses share the same understanding or meaning of a given concept, ensuring that everyone is on “the same page.” This clarifies communication, facilitates research, provides structure for decision support tools and EHRs. As you look at the Foundation of Knowledge model, STs support knowledge acquisition, dissemination, generation, and processing. Now let’s discuss what “makes” a ST, some current STs, benefits of adoption and use, the process for acceptance and of revision of STs, associated issues, and your role in adopting and using STs.
Background
STs are structured, controlled languages developed to represent concepts in a given domain in a clear, unambiguous fashion that conveys the exact same meaning for data, information, and knowledge across settings, regions, and even different countries. This consistency affords access to information and knowledge when it is needed without regard to the current model or period of care. STs are key to the development of an EHR in order to represent, communicate, exchange, reuse, and report data, information, and knowledge, including Meaningful Use criteria (Matney & Lundberg, 2013). In addition to vocabularies, terminology standards also include nomenclatures, classification systems, data sets, and code sets. Each will be discussed briefly.
While your initial response may be that you never knew that there were standardized languages,think again. Remember those nursing care-planning books that listed nursing diagnoses and defining cues? Those books were based on NANDA, which originally stood for both the organization entitled North American Nursing Diagnosis Association and the terminology of the same name— the first ST recognized by the American Nurses Association.
Defining Characteristics
Guidelines for the development of standard terminologies were established during the late 1990s and remain in use today (Cimino as cited in Matney & Lundberg, 2013). Cimino’s guidelines included 12 items. Guidelines addressed aspects that include content, concepts, identification of concepts, hierarchy, relationships, and formal definitions. Terminologies are based upon concepts rather than terms and allow for growth over time. Also, once concepts enter a terminology, they should not be deleted or reused. While a concept has a single unambiguous meaning, it can have one or more representations or synonyms. Each concept has a unique identifier known as a code, which is made of alphanumeric characters. The code supports tracking data for various purposes, including evidence-based practice, decision support, and reports.
Current Terminologies and Language
Despite the intent of STs to represent concepts in a clear, unambiguous fashion, the numbers and different types of terms used to discuss STs can be confusing initially. Some of these terms include the following.
- Nomenclature refers to a system of rules and procedures for adding names used in an art or science, such as nursing.
- Classification systems that capture categories, which are then used to determine costs or outcomes but are insufficient in detail for clinical documentation purposes.
- Taxonomy, which uses classification according to a predetermined system, with the resulting catalog used to provide a conceptual framework for discussion, analysis, or information retrieval.
- Data set, which refers to a named collection of data consisting of individual information organized in a prescribed fashion.
As you might guess, the terms nomenclature, classification, and taxonomy are sometimes used interchangeably.
The American Nurses Association currently recognizes 12 nursing languages.
Some of these languages are considered multidisciplinary in nature.
The Benefits of ST Adoption and Use
ST improves communication, supports data reuse, contributes to the further development of nursing knowledge, and provides a framework for EHRs. Standard terminologies support the collection of data that can provide more information, not only on what nurses do but the amount of time spent in various activities and their contributions to patient outcomes. This is the type of information that can be used to cost out nursing services or to provide justification for staffing ratios. In this respect, many nurse leaders anticipate that STs within EHRs will provide information that is meaningful not just to qualify for financial incentives but for nurses and nursing.
According to Matney and Lundberg (2013), the beneficiaries of ST adoption and use include the nurse, patient, providers, healthcare delivery systems, and because they support Meaningful Use, one might say that data collected as a result can provide information that can be analyzed to achieve better population health and decision support. Patients benefit via decreased costs, improved quality of care, improved outcomes, and improved safety. Providers benefit through improved access to data along the continuum of care. Healthcare delivery systems benefit through the structured vocabularies within and between information systems that provide access to complete and accurate data. Nurses gain efficiency, accuracy, and effectiveness, resulting in improved patient care and outcomes. STs support the integration of evidence-based practice. Organizations benefit from resulting cost savings, the ability to support clinical decision support, improved outcomes measurement, the ability to collect core measures for Meaningful Use, and the ability to use analytics to examine the data collected for multiple purposes that will allow them to serve their communities better. Because STs can help to yield cost savings and better management of population health, they should help to lower overall healthcare costs that we pay as a nation.
The Process for Acceptance and Revision of ST
Earlier, we spoke about the guidelines for the development of standard terminologies, but acceptance needs to be addressed at two levels. The first level occurs at the organizational level that provides oversight for the development (and revision) process. For nursing languages in North America, this responsibility lies with a committee within the American Nurses Association (Schwirian, 2013). ICNP falls under the International Council of Nurses (ICN).
The second level entails acceptance at the international, national, and local levels—essentially, one organization at a time. This requires an appreciation on the part of administrators and staff of the potential that STs hold. It is essential that all nurses understand the need to use STs to demonstrate nursing’s contributions to patient care. The benefits associated with STs cannot be realized if they are not used.
Issues With the Adoption and Use of ST
ST use can be challenging because many existing systems still in use have locally defined concepts, which must be linked to STs. This situation is changing due to federal incentives to spur the adoption of technology capable of collecting Meaningful Use criteria—EHRs that qualify for Meaningful Use incentive monies integrate SNOMED, which, while not specific to nursing, supports nursing STs. Harkiker (2012) noted that models of terminology use have been developed to ease the integration of STs into information systems and EHRs. Education and good screen design can also play an important part in the integration and acceptance issue.
On another front, Schwirian (2013) notes the mixed blessing of having multiple nursing STs, which may actually impede the rate of adoption and optimal use. While it is unlikely that nursing will agree on a single ST in the near future, there are issues of permissions and fees with the use of most STs. In a cost-conscious, penny-pinching, healthcare delivery environment, these costs may influence adoption decisions. Both the Clinical Care Classification (CCC) and the Omaha systems fall in the public domain, however, so that their use is free.
Discussion question: Week 3: Virtual Learning
Summary
Standardized terminologies (STs) are structured, controlled languages developed to represent concepts in a given domain in a clear, unambiguous fashion.
The STs enable the representation, communication, exchange, reuse, and reporting of data, information, and knowledge that are key to the development of an EHR and health information exchange. There are established guidelines for the development of STs. The American Nurses Association currently recognizes 12 STs.
There are multiple benefits associated with ST adoption and use that include improved communication, data-reuse, and improved processes and patient outcomes. Standard terminologies also support the visibility of nursing as a profession and support research and a growing body of nursing knowledge. The adoption and use of ST requires commitment and an appreciation of benefits.
Nurse leaders have an obligation to understand the potential benefits and issues surrounding the adoption and use of STs and to advocate for their use.
References
Hardiker, N. & Nagle, L. (2015). Information and knowledge needs of nurses in the 21st century. In D. McGonigle & K. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (3rd ed.). Sudbury, MA: Jones and Bartlett.
Matney, S. & Lundberg, C. (2013). The role of standardized terminology and language in informatics. In T. Hebda & P. Czar (Eds.), Handbook of informatics for nurses and healthcare professionals (5th ed.) (pp. 295-323). Upper Saddle River, NJ: Prentice-Hall, Inc.
Schwirian, P. W. (2013). Informatics and the future of nursing: Harnessing the power of standardized nursing terminology. Bulletin of the Association for Information Science and Technology, 39(5), 20-24. Retrieved from http://www.asis.org/Bulletin/Jun-13/JunJul13_Schwirian.pdf
