Standardized Nursing Language in the Systematized Nomenclature of Medicine Clinical Terms

Lu, Daning; Eichmann, David; Konicek, Debra J.; Park, Hyun Tae; Ucharattana, Prangtip; Delaney, Connie

doi:10.1097/00024665-200609000-00011

Cited by 11 publications

(10 citation statements)

References 1 publication

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“…Evaluation of the nursing concepts in SNOMED continued for another decade [47,48]. Later research has evaluated the differences between nursing concepts within SNOMED-CT [49,50]. After years of work, nursing terminology was well integrated into the common nomenclature (UMLS).…”

Section: Discussionmentioning

confidence: 99%

Physician nurse care: A new use of UMLS to measure professional contribution

Boyd

Lopez

Lugaresi

et al. 2018

International Journal of Medical Informatics

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Background Physician and nurses have worked together for generations; however, their language and training are vastly different; comparing and contrasting their work and their joint impact on patient outcomes is difficult in light of this difference. At the same time, the EHR only includes the physician perspective via the physician-authored discharge summary, but not nurse documentation. Prior research in this area has focused on collaboration and the usage of similar terminology. Objective The objective of the study is to gain insight into interprofessional care by developing a computational metric to identify similarities, related concepts and differences in physician and nurse work. Methods 58 physician discharge summaries and the corresponding nurse plans of care were transformed into Unified Medical Language System (UMLS) Concept Unique Identifiers (CUIs). MedLEE, a Natural Language Processing (NLP) program, extracted “physician terms” from free-text physician summaries. The nursing plans of care were constructed using the HANDS© nursing documentation software. HANDS© utilizes structured terminologies: nursing diagnosis (NANDA-I), outcomes (NOC), and interventions (NIC) to create “nursing terms”. The physician’s and nurse’s terms were compared using the UMLS network for relatedness, overlaying the physician and nurse terms for comparison. Our overarching goal is to provide insight into the care, by innovatively applying graph algorithms to the UMLS network. We reveal the relationships between the care provided by each professional that is specific to the patient level. Results We found that only 26% of patients had synonyms (identical UMLS CUIs) between the two professions’ documentation. On average, physicians’ discharge summaries contain 27 terms and nurses’ documentation, 18. Traversing the UMLS network, we found an average of 4 terms related (distance less than 2) between the professions, leaving most concepts as unrelated between nurse and physician care. Conclusion Our hypothesis that physician’s and nurse’s practice domains are markedly different is supported by the preliminary, quantitative evidence we found. Leveraging the UMLS network and graph traversal algorithms, allows us to compare and contrast nursing and physician care on a single patient, enabling a more complete picture of patient care. We can differentiate professional contributions to patient outcomes and related and divergent concepts by each profession.

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Section: Discussionmentioning

confidence: 99%

Physician nurse care: A new use of UMLS to measure professional contribution

Boyd

Lopez

Lugaresi

et al. 2018

International Journal of Medical Informatics

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“…We defined “medication” to refer to all prescription and over-the-counter drugs, supplements, and herbal products. Unlike other terminology validation studies in which the terminology to be validated existed prior to validation, 30–32 our study attempted to validate the use of concepts from one domain of healthcare (pharmacy) in another domain (medicine).…”

Section: Methodsmentioning

confidence: 99%

Systemized Nomenclature of Medicine Clinical Terms for the structured expression of perioperative medication management recommendations

Rafiei

Pieczkiewicz

Khairat

et al. 2014

American Journal of Health-System Pharmacy

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“…Lack of consistent terminology has been cited as a factor in the marginalization of certain concepts in contemporary nursing practice (Webber 2009). Other authors have identified the importance of standardized nursing language in improving patient safety, increasing quality, enhancing visibility of nursing care, and improved evaluation of the impact of nursing care on outcomes (Lu et al 2006, Jiang et al 2007, Rutherford 2008. Our findings are consistent with the suggestion that variations in terminology can contribute to variations in practice.…”

Section: Implications For Nursingmentioning

confidence: 99%

Terms used for isolation practices by nurses at an academic medical center

Landers

McWalters

Behta

et al. 2010

Journal of Advanced Nursing

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Aim This paper is a report of a study to determine if the terms used by nurses to describe isolation precautions are associated with correct identification of required personal protective equipment. Background Isolation measures are important in the prevention of health care-associated infections. The terms used to describe categories of isolation have changed in response to new pathogens and with advances in infection prevention. Methods For three months in2009, nurses from an academic medical center on the East Coast of the United States of America completed a survey consisting of ten clinical scenarios which asked about recommended personal protective equipment and for the name of the recommended isolation type. Correct identification of required personal protective equipment was compared to use of an approved isolation category term, controlling for infection knowledge and demographic variables. Results Three hundred and seventeen nurses gave responses to2, 215 clinical scenarios. Use of non-approved category terms was associated with statistically significantly lower rates of correct personal protective equipment identification compared to use of an approved term (62.2% vs. 77.8%; p<.001). Specific PPE was also selected for use when not indicated--including gowns (42%), N-95 respirators (13%), fluid shield masks(13%) and sterile gloves (6%). Conclusion Inconsistent terminology for isolation precautions may contribute to variations in practice. Adoption of internationally-accepted and standardized category terms may improve adherence to these precautions.

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Standardized Nursing Language in the Systematized Nomenclature of Medicine Clinical Terms

Cited by 11 publications

References 1 publication

Physician nurse care: A new use of UMLS to measure professional contribution

Physician nurse care: A new use of UMLS to measure professional contribution

Systemized Nomenclature of Medicine Clinical Terms for the structured expression of perioperative medication management recommendations

Terms used for isolation practices by nurses at an academic medical center

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