Transforming Practice through Nursing Innovative Patient Centered Care: Standardized Nursing Languages

Abstract

As health care system is becoming more and more demanding globally, nurses are required to demonstrate that they are equal to the task. For this to be achieved, nurses need to be innovative in developing evidenced based ideas that bring transformative changes in practice. One of such is developing a, high level standard of communication skills needed by nurses to interpret their services within a multidisciplinary health care team. The use of standardized nursing terminologies and classification systems is one innovative way through which nurses can use in achieving this. The voice of the patient is the voice of nurses.Nurses need to generate new ideas to be able to give back to their patient in terms of good care that expresses quality, safety and better outcomes. North America Nursing Diagnosis, Nursing Intervention Classification and Nursing Outcome Classification are typical standardized nursing languages that express the value of nurses work to patients in the clinical practice environment. Nurses therefore need to absorb the use of the content of this terminology, relating it and utilizing it to further express what is known about nursing practice through their use in improving patient outcomes.

Headnote

Abstract

As health care system is becoming more and more demanding globally, nurses are required to demonstrate that they are equal to the task. For this to be achieved, nurses need to be innovative in developing evidenced based ideas that bring transformative changes in practice. One of such is developing a, high level standard of communication skills needed by nurses to interpret their services within a multidisciplinary health care team. The use of standardized nursing terminologies and classification systems is one innovative way through which nurses can use in achieving this. The voice of the patient is the voice of nurses.Nurses need to generate new ideas to be able to give back to their patient in terms of good care that expresses quality, safety and better outcomes. North America Nursing Diagnosis, Nursing Intervention Classification and Nursing Outcome Classification are typical standardized nursing languages that express the value of nurses work to patients in the clinical practice environment. Nurses therefore need to absorb the use of the content of this terminology, relating it and utilizing it to further express what is known about nursing practice through their use in improving patient outcomes.

Keywords: transforming practice, nursing, innovative, patient centered care, standardized nursing languages.

Introduction

Nurses are being positioned to be a key contributor to transformative changes that are occurring in the health care system today. Being a member of an interprofessional health care team, they have conformed over time with changes that brought a significant paradigm shift in the health care system, ranging from episodic, provider-based, fee-for-service care to team-based, patient-centered care across the continuum that provides seamless, affordable, and quality care (Salmond & Echevarria, 2017). These shifts, however, require a nurse to have an enhanced set of knowledge, skills, and attitudes around wellness and population care through a standardized language of communication which is more focus on patient-centered care, care coordination, data analytics, and quality improvement (Salmond & Echevarria, 2017).

Nursing innovations: a paradigm shift

In health care system today, language terminologies use in documentation of care rendered is needed for improvement in patient care, patient safety and patient outcomes. However, for continuity of care to be maintained within the system, appropriate measures need to be put in place as often times nursing task documentation level has been fragmented, which is obviously noticed with recurring communication barriers and unacceptable levels of errors. Also, because of the multidisciplinary adopted system of approach use in the health care system, there is a need to relate care across the continuum; Nurses to nurses, physician and other members of the health care team. As they all requires the articulation of nurses in focusing on the concerns and responses of patients to improve patient outcomes (Jones et al, 2010) as a lack of effective communication terminologies and coordination of care services across the continuum of care poses disadvantages for patients, and majorly on those patients that requires long-term management of their chronic conditions (Akinci &Patel, 2014). John (2010), also posits that nursing as an international profession needs to have a standard terminology that is compliant with international standards, which can be used by a nurse in the remote community and at the same time understood clearly by a nurse in the most sophisticated setting.

However, North American Nursing Diagnosis International conference held in 2014 in Portugal serves as an eye opener to issues confronting nurses on problems relating to client care and interpretations. It became obvious that nurses had difficulties in trying to resolve 21st-century nursing education, and practice issues with 20thcentury answers barely forgetting that these old answers might not work if not clearly figured out. It is of great importance to note that Nursing as a profession needs to find new answers to strategic clients based needs, and not dwell more on using past ideas for resolution of problems but they should rather explore to find answers to today clients' needs.

The question then is, what does nursing need? We need a paradigm shift in all of our language of communication, nursing care, and patient care. We need to think of different/new alternatives as professionals to just not dogmatically following orders by physicians thus making nursing and nurses' invisible in health care settings. Again, it has become necessary for nursing to find a common language to describe what nursing is, what nursing does, and how to codify it. Attempts to finding solution to this challenges led to the birth of standardized nursing languages (SNLs) which was pioneered by the North American Nursing Diagnosis Association (NANDA). The SNLs is the pathway for making the Nursing process useable and visible. After over 4 decades, this organization had changed the frontier of nursing by making the Nursing process the global tool for nursing practice meaningful (Olaogun, 2014).Though there are different types of SNLs, however, the North American Nursing Diagnosis Association International (NANDA-I), Nursing Intervention Classification (NIC) and Nursing Outcome Classification (NOC) are embraced more globally because they are comprehensive, researchbased, have standardized classifications of nursing diagnoses, nursing interventions and are nursingsensitive to patient outcomes. It furthers assist nursing administrators in knowing the actual costs and benefits of nursing care so as to make informed decisions regarding staffing ratios and budgets (Lundberg et al 2008)

Innovation in Nursing: Standardized Nursing Languages

According to Brysiewicz, Hughes & Mccreary (2015), innovative behaviour can be referred to as the process of facilitating new problem and solving ideas in an organizational practice. It is a way of taking things that already exist and putting them together in a new form. From the perspective of the International Council of Nurses (ICN) (ICN, 2009), innovation is the process of developing new approaches, technologies and ways of working. While the National Health Service (NHS) (NHS, 2011), institute for innovation and improvement state that innovation is about doing things differently or doing different things to achieve large gains in performance. Through innovation, nurses are able to provide a rapid response to changing physiological parameters using evidencebased protocols to improve patient outcomes, participate in decisions about facility technology purchases and improve patient's care quality (Hussung, 2018). Joseph (2015) agrees that nurses are perfectly placed to develop creative and innovative strategies that can make a huge difference in the lives of their patients.

Innovations in nursing started from the age of Florence Nightingale, the beginner of modern nursing. She was the first person to make statistics in the world, a creator of the intensive care unit, as evident by her unique contribution to environmental improvement, and also contributes in proving the relationship between infection and care (Mcsherry & Douglass, 2011). Recently, innovative ideas and services useful to the nursing profession is becoming increasingly today all around the world, but a unified and supported innovative idea that supports clients oriented service and bring about evidenced in practice rendered to the patient and speaks the language of nursing in the voice of nursing is the standardized nursing language that is generally acceptable worldwide.

Standardized Nursing Languages (SNLs) is a structured vocabulary that provides nurses with a common means of communication to describe care (Beyea, 1999). Several standardized nursing languages exist, but the one that is mostly referred to globally is the NANDA-I, NIC and NOC because of its peculiarity to patient centered care .The development of SNLs has its foundation of many years of research at the University of IOWA. In Nigeria, the use of NANDA-I have been incorporated into nursing education since 1980s, but the concepts of Nursing Outcome Classification (NOC) and Nursing Intervention Classification (NIC) was introduced into the country through an international workshop hosted by NANDA-I Africa chapter and the center for Nursing Classification and Clinical Effectiveness of the College of Nursing, University of Iowa, in 2010. Since then effort has been made by nurses to see its applicability to the Nigerian hospital and community settings, which is a paradigm shift to support the continuum of care. Out of the few studies done in Nigeria, includes Odutayo et al, 2013; Adubi, Olaogun & Adejumo, 2017. The former conducted a study among public health nurses and clinical nurses on impact of an educational program on the use of standardized nursing languages for nursing documentation and the later conducted a study to measure the effect of standardized nursing language continuing education programme on quality of documentation of nursing care, the findings of the studies revealed significant qualitative improvement at posttest, as nurses were able to identify actual nursing diagnosis with signs and symptoms and aetiologies, while on risk related factors they were able to identify the nursing diagnoses with risk related factors. They also identified NIC activities specific to solving client problems and linked indicators of NOC, which were related to the identified diagnoses and interventions. One can therefore say there are several benefits of SNLs since its introduction to a developing country such as Nigeria. The benefits include the following,

* It provided a means to document the nursing process by clearly naming nursing diagnoses, interventions and outcomes (This is evident in a study done by Odutayo et al 2013; Adubi et al 2017).

* It enables the ongoing retrieval and analysis of documentation over time to support evidence-based practice and quality nursing care.

* The analyses of documentation in standardized format, interventions are known and patient responses are understood, this benefit was also stated by (Müller-Staub Lavin, Needham, & van Achterberg, 2006).

* It provides the structure for quantifying clinical nursing practice, same stated by (Lee et a, 2010).

* It communicates the elements of clinical nursing practice within the Electronic health record, though this is a new concept in Nigeria, which has been pilot tested in a study by Adereti, 2018 (Unpublished PhD thesis).

* It promotes clinical nurses quality nursing care, validate the effectiveness of clinical nursing services, and enable data collection for research, this can be justified in a study by (Abiodun & Olaogun 2014).

In Nigeria today, there is high awareness of the importance of utilization of standardized nursing languages, the process and its implementation is still ongoing, including the implementation of NANDA-I, NIC & NOC linkages in the nursing care plan.

Conclusion

Without consistent terminologies in nursing for effective communication, nurses run the risk of becoming invisible as it will remain difficult to quantify nursing and the unique contribution and the impact of nursing will go unrecognized (Hardiker & NR, 2011). Therefore, in order to relieve some of the inconsistencies in the action part of nurses towards patient care and to focus more on making a nursing care patient centered and goal oriented, there is a need for nurses to embrace Standardized Nursing Languages.

Sidebar

Corresponding author: Ayorinde Mary Oyenike, Clinical Nursing Department University College Hospital Ibadan, Oyo State, Nigeria, [email protected]

References

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