Chapter 7

Developing Standardized
Terminologies in Nursing Informatics
 Objectives
• Explore the need and motivation behind the
development of standardized terminologies
for nursing.
• Describe the different approaches to
terminology development.
• Assess initiatives seeking to exploit
commonalities among terminologies and to
ensure appropriate implementation and
consistent use.
 Key Terms Defined
• Accessibility - Easy to access the information and
knowledge needed to deliver care or manage a health
service; the extent to which a system is usable by as
many users as possible.
• Archetype - Computable expression of a domain
content model in the form of structured constraint
statements, based on a reference (information) model
(Beale & Heard, 2007); broad or general, idealized
model of an object or concept from which similar
instances are derived, copied, patterned, or emulated;
original model after which other similar things are
patterned; first form from which varieties arise or
imitations are made.
 Key Terms Defined
• Conformance - Methodology used to ensure
that a product, process, computer program or
system meets a defined set of standards;
discourages anomalies within a particular
terminology and would facilitate
harmonization and possible convergence
among diverse terminologies.
 Key Terms Defined
• Enumerative Approach - Words or phrases
are represented in a list or a simple hierarchy;
gives an explicit and exhaustive listing of all
the objects that fall under the concept or term
in question.
• Longevity - Information should be usable
beyond the immediate clinical encounter;
having long term value.
 Key Terms Defined
• Model of Terminology Use - A domain
content model that is optimized for the
management of particular entities within an
informational and/or operational context.
• Monolithic - Single object; self contained;
single unit; an organized whole acting as a
single unified powerful or influential force.
 Key Terms Defined
• Nonconformance - Lack of conformity; occurs
when a product, process, computer program
or system does not meet a defined set of
standards; permits anomalies within a
particular terminology.
• Nursing Terminology - Body of the terms used
in nursing; terminology for nursing.
 Key Terms Defined
• Ontological Approach - Considers ontology
development (domain analysis) and its
mapping to object models (specification of
infrastructure); based on enumerating all
concepts used in a domain and in providing
their formal definitions according to suitable
formalisms (usually logic-based).
 Key Terms Defined
• Ontology - Compositional in nature and a partial
representation of the entities within a domain
and the relationships that hold between them; an
explicit specification of a conceptualization.
• Reusability - Information should be useful for a
range of purposes; the extent to which software
or other work related artifacts can be used in
more than one computing program or software
system.
 Key Terms Defined
• Standardized Nursing Terminology - A body
of terms used in nursing that is in some was
approved by an appropriate authority or by
general consent.
• Term - At its simplest level, is a word or
phrase used to describe something concrete
e.g., leg, or abstract e.g., plan.
 Key Terms Defined
• Terminology - Vocabulary of technical terms
used in a particular field, subject, science, or
art; concerned with the collection,
description, processing and presentation of
terms belonging to specialized areas of usage
of one or more languages; nomenclature.
 Key Terms Defined
• Ubiquity - State of being everywhere at once
(or seeming to be everywhere at once);
presence in many places especially
simultaneously; with changing models of
healthcare delivery, information and
knowledge should be available anywhere.
 Introduction to Standardized
Terminologies
• Since the early 1970s there has been a
concerted effort to develop standardized
terminologies for nursing.
• Accessibility: It should be easy to access the
information and knowledge needed to deliver
care or manage a health service.
• Ubiquity: With changing models of healthcare
delivery, information and knowledge should
be available anywhere.
 Need for Standards
• Longevity: Information should be usable beyond
the immediate clinical encounter.
• Reusability: Information should be useful for a
range of purposes.
• Without a standardized nursing terminology it
would remain difficult to quantify nursing, the
unique contribution and impact of nursing
would go unrecognized and the nursing
component of electronic health record systems
would remain at best rudimentary.
 Needs for Standards
• The current and future landscape of
information and communication technologies
and their inevitable infiltration into healthcare
will only serve to reinforce the need for a
standardized nursing terminology, while
providing an additional sense of urgency.
 Standardized Nursing Terminologies
• A nursing terminology is a body of the terms
used in nursing.
• There may be many nursing terminologies,
formal or informal.
• Nursing terminologies allow us to capture,
represent, access and communicate nursing
data, information and knowledge.
 Standardized Nursing Terminologies
• A standardized nursing terminology is a nursing
terminology that is in some way approved by an
appropriate authority or by general consent.
• The data element sets provide a framework for
the uniform collection and management of
nursing data.
• The use of a standardized nursing terminology to
represent that data serves to further enhance
consistency.
 Approaches to Nursing Terminology
• Nursing terminologies have evolved
significantly over the past several decades in
line with best practices in terminology work,
from simple lists of words or phrases to large
complex so-called ‘ontologies’.
 Approaches to Nursing Terminology
• This evolution has been facilitated by
advances in knowledge representation e.g.
the refinement of the description logic that
underpins many contemporary ontologies,
and in their accompanying technologies e.g.
automated reasoners that can check
consistency and identify equivalence and
subsumption (i.e. subclass-superclass)
relationships within those ontologies.
 Enumerative Approach
• With the enumerative approach, words or
phrases are represented in a list or a simple
hierarchy.
• In NANDA, a nursing diagnosis has an
associated name or label and a textual
definition (NANDA International, 2005).
• Each nursing diagnosis may have a set of
defining characteristics and related or risk
factors.
 Ontological Approach
• The ontological approach is compositional in nature
and a partial representation of the entities within a
domain and the relationships that hold between them.
• ICNP® is described as a ‘unified nursing language
system’.
• The compositional nature of the ICNP® ontology makes
it well-suited to support the development of local
terminologies; the rich hierarchy (and the opportunity
for automated reasoning) make it well-suited to
support cross-mapping between terminologies.
 Exploiting Commonality Among
Nursing Terminologies
• There are many differences between the
broader set of standardized nursing
terminologies in terms of scale, scope,
structure and intended use.
• At the heart of the standard are in fact two
models – a model for nursing diagnosis and a
model for nursing action.
 Utilizing Nursing Terminologies
• As standardized nursing terminologies
increase in complexity they become more
difficult to implement; they may be computer-
based but they are far from ‘plug and play’.
• Terminologies help us to convey our
understanding of the world.
• Models of terminology use help us to
structure information for particular purposes.
 Utilizing Nursing Terminologies
• A terminology or ontology describes how general
entities are represented and how those
representations relate to each other.
• A model of terminology use seeks to organize
data items in a way that fits with that context at
that time.
• The nursing terminologies were standardized but
not the models of terminology use – these were
often embedded within applications and it would
not be possible to share the valuable clinical and
pragmatic knowledge they contained.
 Utilizing Nursing Terminologies
• An archetype is ‘a computable expression of a
domain content model in the form of
structured constraint statements, based on a
reference model’.
• Archetypes provide a means of defining
explicitly clinical and pragmatic knowledge
apart from the applications that might use it.
 Thought Provoking Questions
• What to you believe are the advantages and
disadvantages of having a single shared
consensus-driven model of terminology use?

• How can a single agreed model of terminology