The Nursing Minimum Data Set: Abstraction Tool for Standardized, Comparable, Essential Data Hamet H. Werley, RN, PhD, Elizabeth C. Devine, RN, PhD, Cecilia R. Zom, RN, MSN, Polly Ryan, RN, MSN, and Bonnie L. Westra, RN, MSN Inrducdion is a system that can be used by public health nurses in theirpractice and for com- With the rapid explosion of nursing parison of nursing care and resource con- knowledge worldwide, the amount ofdata sumption across other settings, thus pro- nurses use and process in the delivery of viding linkage to all other nursing care care is extensive and often unmanageable. settings. Advances in information management In addition to providing a mechanism and computer technology have broad im- for the comparison of nursing care data plications for this knowledge explosion across settings, the Nursing Minimum and can facilitate the collection, manipu- Data Set can be combined with the more lation, and retrieval of essential nursing detailed data accumulated in nursing in- data for practice and research. A uniform formation systems and other health care standardized data base that will allow for information systems. In the future, it is the grouping and comparison of nursing anticipated that these nursing information across various data collected populations, will be both and in settings, geographic locations, and time systems computerized existence at the institutional level, would be a boon to both assessing and where, comparing nursing care provided and re- through data-base management systems, sources used, as well as to research. Eli the nursing data can be linked to other Ginzberg,1 in reviewing nursing's past and health data. In this way, the use of the present, noted that nurses still are writing NMDS in detecting trends in nursing care patient records for two to three hours out practices and resource allocation is ex- of every eight-hour shift; he predicted the panded further. necessity for reviewing essential record- The Nursing Minimum Data Set is keeping and of greater use of computer- nursing's first attempt to standardize the ization in nursing. collection of essential, comparable core Public health nurses identified the nursing data. In this paper we discuss need to explore minimum data set require- briefly: background, including definition, ments for their practice and planned to purposes, and elements of the NMDS; prepare a miniproject proposal to accom- availability and reliability ofthe data; ben- plish this.2 However, as this project was efits; implications with emphasis on nurs- descnrbed, the data acquired in a public ing research; and health policy decision health setting apparently could not be making. linkedwith those from other areas ofnurs- ingpractice. Thiswould continue the frag- mentation of documentation on nursing From the School ofNursing, UniversityofWis- care of patients. As nurses in public consin-Milwaukee. Address reprint requests to health, and in other practice areas, con- Harriet H. Werley, RN, PhD, Distinguished tinue to discuss the necessity and value of Professor, School of Nursing, University of a minimum data set, itis essential that they Wisconsin, Milwaukee, WI 53201. This paper, submitted to the Journal August 25, 1989, was recognize that the Nursing Minirnum Data revised and accepted for publication June 30, Set (NMDS), along with its elements and 1990. definitions, constitutes a minimum set of Editor's Note: See also related editorial p 413 nursing's essential core data.3 The NMDS this issue. American Journal of Public Health 421 Werky, et al. toward submission of proposals to de- velop nursing information systems. In ad- dition, one of the small work groups was given the challenge of identifying a basic nursing data set. Their effort9 is shown in Figure 1. However, the timing for move- ment in this direction apparently was not NIS right for nursing at that time. One of the authors (HHW) opened the subject again a fewyears later. In 1985, Community a NMDS Conference was developed at Data the University of Wisconsin-Milwaukee School of Nursing. The NMDS was de- Resources, veloped consensually through the efforts Health Problems, ofa national group of64 experts, who par- Socioeconomic ticipated in this three-day invitational con- -cultural status ference. The participants included: nurse Aggregate data on experts in a variety of areas; health policy population at risk spokespersons; information systems, health data, and health records specialists; Institutional Data governmental and proprietary agency per- Personnel Structural Finance sonnel; and persons knowledgeable about Variables the development ofthe previous niinimum Interpersonal Data health data sets.3,10,11 Nursing NMDS Definition Intervenitions & Goal Medical Orders (Outcome) Built on the concept ofUniform Min- imum Health Data Sets, the NMDS is de- Patient Data fined as a minimum set of items of infor- Demographic Physiological & Medical & Patient's mation with uniform definitions and Character Psychosocial Nursing Perception categories concerning the specific dimen- factors Diagonosis & Goal sion of nursing which meets the informa- tion needs of multiple data users in the NURSES' SCIENTIFIC KNOWLEDGE 1 health care system. It includes those spe- cific items of information that are used on FIGURE 1-Categories of a Basic Nursing Data Set a regular basis by the majority ofnurses in NOTE: Adapted from Nursing Information Systems by H. H. Werley and M. R. Grer (eds). any care delivery setting. It is an abstrac- NewYork: Springer Publishing, 1981; 282. Copyright 1981 by Springer Publishing Company, tion system, or tool, designed for the col- Inc, New York 10012. Used by permission. lection of uniform, standard, comparable, minimum nursing data for use across var- ious types of settings and patient groups. Background pital Discharge Data Set is the only min- These data also are useful to other health imum health data set in widespread use professionals and researchers. The NMDS was derived from the currently, since these data must be col- general concept of a Uniform Minimum lected on all hospitalized patients receiv- Purposes ofthe NMDS Health Data Set, defined as "a niinimum ing Medicare benefits; it does not include set of items [or elements] of information The purposes of the NMDS are to: nursingdata, however. The NMDS is con- * establish comparability of nursing with uniform definitions and categories, sistent with but expands the Hospital Dis- or dimension data across clinical populations, settings, concerning a specific aspect charge Data Set by including core nursing ofthe health care system, which meets the geographic areas, and time; essential needs of multiple data users."4 data. The Long-Term Health Care Mini- * describe the nursing care ofclients Note the emphasis on multiple users and mum Data Set and the Ambulatory Care and their families in a variety of settings; not only a specific group of users; a min- Minimum Data Set currently are being re- * demonstrate or project trends re- imum set of items of information in nurs- vised and tested. garding nursing care provided and alloca- ing must meet the needs of other data us- The NMDS effort is a follow-through tion of nursing resources to individuals or ers as well as nurses. on earlier work that was done at the Uni- populations according to their health Existing patient-focused health data versity of Illinois. In a Nursing Informa- problems, or nursing diagnoses; sets built on this concept include: the Uni- tion Systems Conference held in 1977 at * stimulate nursing research using form Hospital Discharge Data Set, the the University of Illinois College of Nurs- the NMDS elements alone, as well as Long-Term Health Care Minimum Data ing in Chicago,8 an effort was made to through links to the more detailed data Set, and the Uniform Ambulatory Medi- stimulate nurses to move toward comput- existing in nursing and other health care cal Care Minimum Data Set.5-7 The Hos- erization of nursing services data and information systems;" and 422 American Journal of Public Health Aprfl 1991, Vol. 81, No. 4 NMDS, Abstraction Tool for Standardized Data The nursing care elements consist of Interventions (which were included for pi- Nursing Diagnosis, Nursing Intervention, lot testing only), was a satisfactory 91 per- Nursing Outcome, and Intensity of Nurs- cent, with an item-specific range of57 per- ing Care (with its two subelements of cent to 100 percent. For categorical-tpe Hours of Care and Staff Mix).3 Unfortu- data with fewer than 10 possible coding nately no single classification system for categories, coefficient Kappa was calcu- t::t2: .'.'..!..'.'!''..'!"'~~ ~~~~~~ '"'.'.'';''"''.'.''.''......" '' '!'"!t''''t' nursing diagnoses is widely and univer- lated,19 with similar results. The implica- sally accepted. Currently, two well-recog- tion of these results is that the definitions :|"":S f:: :-,...X.-.. ..-...-.} - - ..........}::.-.- ...-.... :'.':-..>:.....:..}e. nized classification systems are available: and protocol for coding were generally ac- the North American Nursing Diagnosis ceptable, although a few elements needed g.":,: .":,:, : .f S f i ; ~~~~~~...::.. .......... .::..... :: :'''S S "S5 5: Association Taxonomy I Revised13 and refinement, which has been done.17 f' ""'g"S5'S':'..'.s""|"'' :':~f'S' SS fef e ...,....S':'.'.'' the Classification Scheme for Client Prob- -:s.-.s.-..rS.s.s..mS.-~~~~~~~~~~.....r.S..: ._s s.... lems in Community Health Nursing from Benefit ofthe NADS Th|! NMDSincludesS >..,,,,,.'!e:f ,16,.,items or el Omaha14