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Nurses: Invisible forever?
Moya Conrick
Lecturer, School of Nursing, Griffith University, Brisbane QLD
Joanne Foster
Article Text
It can be argued that nurses are the major collectors of data in the health care system. We fill in the patient record and spend hours charting observations but what happens to the data? In most cases, it is archived and destroyed after five to ten years. Nursing data in the paper record, is difficult to retrieve and because of this, seldom used. In data collection and useability terms, nursing becomes invisible.
Many countries have moved towards the collection and standardisation of nursing data while the International Council of Nurses also advocate this, but on a global scale. In the United States, the trend has been towards the Nursing Minimum Data Set (NMDS) and nursing diagnosis. However, many clinicians see the nursing process as a tool of the academic and researcher. In general, it is regarded as unrepresentative of the thought processes of the clinician and clumsy in its articulation. Therefore, to a great extent, clinicians have resisted its introduction. It is the clinician who collects the data, and for timely, quality and representative data to be collected, the clinician must 'own the data'.
We can no longer argue about the 'whether' and 'if' of computerisation of data-it is too late. The issues are of 'how' and 'when'. Standardisation is crucial to nursing. If we do not standardise, if we do not have a common language we cannot be truly represent on electronic systems. Perhaps a full NMDS is something that will never be agreed to in this country, but standardisation in some form must be undertaken.
An alternative would seem to rest in the area of a nursing metathesaurus. This would allow for the standardisation of data with out encumbrances of a 'language' as such. Terms which are meaningful to the majority of practitioners could be collected. Simplistically, we could use common terms and code them. This process would probably sit more comfortably with nurse clinicians.
Nursing is already involved in the collection (micro-standardisation) of large amounts of data. This is evident in the move towards multidisciplinary clinical paths, where nursing is most visible. Therefore, it would seem sensible of this data collection to be managed in a more productive manner. Clinical paths are a compilation of expert clinicians' expectations of the most common progression of a patient through an episode of illness. We would argue that the path for an appendicectomy in Brisbane is not terribly different from that in Broome. Therefore, one would assume that the clinical path developed in one institution could be used in other settings with a minimum of change. Another area in which nursing data is being collected and standardised, at least to some extent, is nursing diagnostic related groups (DRGs) in casemix. Central to this data collection are the terms that nurses use. Are these data usable to standardise terms nationally? Perhaps it is these elements which could form the basis for the nursing metathesaurus.
Nursing has options-for now. However, if this opportunity is lost, it may never present again. Nursing has argued for many years that it is inadequately funded, then again, we have never named what it is that we do. If we do not name what we do, how can we expect adequate funding or for others to understand our profession? We will be consigned to a future of 'invisibility' and will remain underfunded as the dollar contracts.
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