Analyzing the Structure of Nursing Action Labels in Practice

Abstract

 The purpose of this study is to clarify the following three points on labels of nursing action required for electronic patient records for hospitals.

 ① clarify the structure of nursing actions through collection and analysis of labels of nursing action.

 ② clarify the complexity of nursing actions according to the information about the structure.

 ③ specify the required condition of labels of nursing action prepared for master file of nursing action.

 ‘MEDIS-DC’ collected 7,503 action labels that the nurses carry out (July, 2002) from 10 hospitals that had introduced the hospital information system and home nursing region. Of the nursing action labels, 3,776 were left as higher discretional ones from the viewpoint of assessment, plan, order and do. The analysis was carried out for them.

 We separated and assigned each action label into either “essential nursing action” and/or “the requested condition in the execution,” and reconstructed the whole structure. As a result, 153 action labels and 23 classes (classification according to the nursing target) were settled.

 “The requested condition in the execution” was classified into “person,” “time,” “equipment,” “place” and “notice.” There were “the basic set items” conditions, for “person” and “time,” which were applicable to all 153 actions. At the same time there were “specific items” conditions, applicable only for peculiar actions. Each proportion of the “specific items” applied was “person” 22%, “time” 24%, “equipment” 32%, “place” 23%, “notice (1)” 9%, “notice (2)” 12%, when 153 labels were the population parameter. As a result of cross tabulation of “23 classes” and “existence of the conditional factor,” Reduction of pain, Spirit psychological care, Rehabilitation, Cleanness of body and Excretion mainly had the action with the conditional factors. This may indicate that these forms of care had high complexity. Also we understood that the frame of 23 classes, meaning the nursing target, was deconstructed as a result of making cluster analysis from the viewpoint of the conditional factor of “person, time, equipment, place and notice.” The following are indicated: That the property of the complexity of 153 actions classified into 23 differs and that the new classification can be built from the viewpoint of the complexity.

 On the basis of the facts above, it is suggested that nursing actions are composed of 1st, 2nd and 3rd layers (nursing target), the 4th layer (which indicates the degree of complexity, etc), and the condition in the execution.