Nursing Minimum Data Set System
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FLORDELISA ROMANO DIVINA AUDITOR Connie White Delaney NMDS HISTORICAL SUMMARY The NMDS identifies, common, and core data elements to be collected for all patients/clients receiving nursing care. The NMDS is a standardized approach that facilitates the abstraction of these minimum,common,essential core data elements to describe nursing practice (Werley anLang,1988) from both paper and electronic records. It is intended for example, community practices, occupational health, and school health. The NMDS was conceptualized through a small group work at the nursing information system (NISs)conference held at the university of Illinois college of nursing. Werley and colleagues took the NMDS forward at the NMDS conference in 1985,held at the university of Wisconsin-Milwaukee school of nursing. The NMDS includes three broad categories of elements: A.NURSING CARE B.PATIENT OR CLIENT DEMOGRAPHICS C.SERVICE ELEMENTS The aim of the NMDS is not to be redundant of other data sets, but rather to identity what are the minimal data needed to be collected from records of patients receiving nursing care. The U.S. NMDS Data Elements Nursing care elements Patient or client Nursing diagnosis demographic elements Nursing intervention Personal identification Nursing outcome Date of birth Intensity of nursing care Sex Race and ethnicity Residence Service Elements Episode admission or Unique facility or service encounter date. agency number. Discharge or termination Unique health record date. number of patient or Disposition of patient client. and client. Unique number of Expected payer for most principle registered of this bill (anticipated nurse provider. financial guarantor for services). The nursing care elements of the NMDS(nursing diagnosis , nursing interventions , nursing outcome , and intensity of nursing care) were derived from the nursing process. 8 benefits of NMDS 1. Access to comparable, minimum nursing care, and resources data in local, regional, national, and international levels. 2. Enhanced documentation of nursing care provided. 3. Identification of trends related to patient or client problems and nursing care provided. 4. Impetus to improved coming of nursing services. 5. Improved data for quality assurance evaluation. 6. Impetus to further development and refinement of NISs. 7. Comparative research on nursing care, including on research nursing diagnoses, nursing interventions, nursing outcomes, intensity of nursing care and referral for further nursing services. 8. Contributions toward advancing nursing as a research-based discipline. Standard and Research Era-Twenty- First Century In 1991, the American Nurses Association (ANA) recognized the NMDS as the minimum data elements to be included in any data set or patient record. The ANA consequently established the American Nurses Association Steering Committee on Data Basis to Support Clinical Nursing practice. This committee launched a recognition process for standardized nursing vocabularies needed to capture the NMDS data elements for nursing diagnoses, interventions and outcomes in a patient record. The NMDS serves as a key components of the standard developed by the Nursing Information and Data Set Evaluation Center (NIDSEC) Established in 1996, NIDSEC develops and disseminates standards related to nomenclature, clinical associations, clinical data repositories, and system characteristics/decision support/contextual variables pertaining to data sets in information systems that support the documentation of nursing practice. The advancement of the NMDS has supported nurses’ participation in developing computerized health information systems, utilizations of data and information to support evidence-based practice and inclusion of information management as an essential component of the discipline. National Nursing Minimum Data Sets Established NMDSs The early NMDS work in the United States spurred the development of NMDSs in numerous other countries. To date seven countries have identified NMDS systems, including Australia, Canada, Belgium, Iceland, The Netherlands, Switzerland, and Thailand. A perusal of these data sets reveals a definite consensus on the importance of the nursing care elements across all countries with identified NMDSs. Some are very granular in specifying specific patient problems and specific interventions of interests, while other data sets maintain a high conceptual focus and emphasize empowering nursing problems/interventions/outcomes per encounter. There is variations as to applicability of the data sets to settings other than acute care. Emergent NMDSs Several countries across most continents beyond North America are exploring development of NMDS systems. Many of these elements are similar to the U.S. NMDS Work is ongoing in the united kingdom, e.g., Scotland to identify NMDSs to be congruent with the initiatives of the National Health Service. Call for Standardized Contextual Data The development within the United States of the NMDS addresses this void. The 18 NMDS elements are organized into three categories: environment, nursing care resources and financial resources. The NMDS is the minimum set of information with uniform definitions and categories concerning the specific dimension of the context of patient/client care delivery across all types of settings. Nursing Management Minimum Data Set (NMDS) Data Elements Environment Nursing Care Unit/cost center identifier Management demographic Type profile Patient/client population Staffing Volume Staff Demographic profile Accreditation Staff satisfaction Organized decision making Financial Resources power Payer type Environmental complexity Reimbursement Patient/client accessibility Budget Method of care delivery Expense Clinical decision making complexity Cosponsorship The NMDS Research Center is lead by a steering committee of international representatives of countries with existing and emerging NMDSs as well as professional cosponsorship and areas of informatics expertise. The project is cosponsored by the ICN and the IMIA NI-SIG. Project work is also coordinated with international standards organizations and other stakeholders to assure harmonization of these efforts. Purposes .Describing the human phenomena, nursing interventions, care outcomes, and resource consumption related to nursing services .Improving the performance of healthcare systems and the nurses working within these systems worldwide .Enhancing the capacity of nursing and midwifery service .Addressing the nursing shortage, inadequate working conditions, poor distribution and inappropriate utilization of nursing personnel, and the challenges as well as opportunities of global technological innovations .Testing evidence-based practice improvements .Empowering the public internationally DATA ELEMENTS The three categories: 1. Setting 2. Subjects of care 3. Nursing elements Setting variables include country characteristic as well as descriptors of the location of care, whether the setting is acute, ambulatory, home, and so on. Subjects of care can include individuals, families, groups ,or communities . Demographics of the subjects are include, example : country of residence, disposition, age, gender, medical diagnosis are described. Nursing care elements include nursing diagnosis/ subjects of the care problems, interventions, and outcomes. .