Background In healthcare there is a call to provide cost-efficient and safe care. This can be achieved through evidence-based practice (EBP), defined as the use of evidence from research, context, patient preferences, and clinical expertise. However, the contemporary and process-integrated supply of evidence-based knowledge at the point of care is a major challenge. An integrative knowledge management system supporting practicing clinical nurses in their daily work providing evidence-based knowledge at the point of care is required. The aim of this study was (1) to map standardized and structured nursing interventions classification and evidence on a knowledge platform to support evidence-based knowledge at the point of care, and (2) to explore the challenge of achieving interoperability between the source terminology of the nursing interventions classification (LEP Nursing 3) and the target format of the evidence provided on the knowledge platform (FIT-Nursing Care). Methods In an iterative three-round mapping process, three raters, nurses with clinical and nursing informatics or EBP experience, matched nursing interventions from the LEP Nursing 3 classification and evidence provided from Cochrane Reviews summarized on FIT-Nursing Care as so-called study synopses. We used a logical mapping method. We analysed the feasibility using thematic analysis. Results In the third and final mapping round, a total of 47.01% (252 of 536) of nursing interventions from LEP Nursing 3 were mapped to 92.31% (300 of 325) of synopses from FIT-Nursing Care. The interrater reliability of 77.52% suggests good agreement. The experience from the whole mapping process provides important findings: (1) different content orientations—because both systems pursue different purposes (content validity), (2) content granularity—differences regarding the structure and the level of detail in both systems, and (3) operationalization of knowledge. Conclusion Mapping of research evidence to nursing classification seems feasible; however, three specific challenges were identified: different content orientation; content granularity; and operationalization of knowledge. The next step for this integrative knowledge management system will now be testing at the point of care.
To be able to compare job titles in healthcare, a proposal for a classification of healthcare professionals was developed. The proposed LEP classification for healthcare professionals is suitable for Switzerland, Germany and Austria and includes nurses, midwives, social workers and other professionals.
Zusammenfassung. Hintergrund: Es ist bekannt, dass das SwissDRG-Tarifsystem den Pflegeaufwand nicht ausreichend berücksichtigt, weil seine Grouperkriterien die Variabilität des Pflegeaufwands innerhalb der DRG-Fallgruppen zu wenig erklären. Um eine angemessene Vergütung und Ressourcen-Allokation zu erreichen, muss der Pflegeaufwand eindeutig quantifiziert und abgebildet werden können. Ziel des vorliegenden Projekts war, ein Set aufwandrelevanter Pflegeindikatoren zu erarbeiten, von denen angenommen werden kann, dass sie in Ergänzung zu den bisherigen SwissDRG-Kriterien die Varianz des Pflegeaufwands innerhalb einzelner Fallgruppen reduzieren. Methode: Das Vorgehen umfasste verschiedene Methoden. Eine systematische Literaturrecherche, Beiträge eines Fachbeirates und Expertengremiums sowie drei Fokusgruppeninterviews mit Pflegefachpersonen und Abteilungsleitenden bildeten die Grundlage für die anschließende Synthese der aus diesen Quellen gewonnen Daten und Informationen. Ergebnisse: Ein Set von 14 aufwandrelevanten Pflegeindikatoren wurde entwickelt. Von diesen wird angenommen, dass sie die Homogenität des Pflegeaufwands in den SwissDRG-Fallgruppen verbessern können. Bevor diese Pflegeindikatoren als Grouperkriterium eingesetzt werden können, müssen sie in einer SwissDRG-konformen Weise formalisiert und empirisch geprüft werden. Schlussfolgerung: Das vorliegende Indikatorenset ist ein erster Schritt in die Richtung einer angemessenen Abbildung des Pflegeaufwands in SwissDRG-Fallgruppen. Als nächstes muss die Herausforderung bewältigt werden, dieses in eine kodierbare Form zu operationalisieren.
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