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Nursing Minimum

Data Set System

Introduction

The impetus for access to and use of nursing data and information has never been stronger. Recognition of this growing need

for nursing data has been powered by forces both internal and external to nursing. Moreover, this growing need has been fueled by

international as well as national factors. The identification of the NMDS visionary work begun in the United State in 1980s by

Werley and Lang has indeed spurred activity extending to national efforts to develop similar datasets around the world. Moreover

these national efforts have supported an initiative to develop an international NMDS.

NMDS Historical Summary

The NMDS identifies essential, common and core data elements to be collected for all patients/clients receiving nursing care. The

NMDS is a standardized approach that facilitate the abstraction of these minimum. Common, essential core data elements to describe

nursing practice from both paper and electronic records. It is intended for use in all settings where nurses provide care, spanning, for

example, acute care, ambulatory centers, home healthcare, community practices, occupational health and school health.

The NMDS was conceptualized through a small group work at the nursing information system conference held in 1977. it was during

this conference that the NMDS was developed consensually through the efforts of 64 conference participants and formalized.

The aim of the NMDS is not to be redundant of other data sets, but rather to identify what are the minimal data needed to be collectedfrom records of patients receiving nursing care.

The NMDS was developed by building on the foundation established by the U.S uniform hospital discharge data set. The number of

new items mainly the nursing care items is relatively less. The nursing care items elements of the NMDS ( nursing diagnosis, nursing

interventions, nursing outcome and intensity of nursing care ) were derived from nursing process.

Eight benefits of the NMDS, when adopted and implemented nationally or internationally with a system of ongoing data collection,

were identified. These benefits were:

1.

Access to comparable, minimum nursing care and resource data on 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 provider.

4.

Impetus to improved costing of nursing process.

5. Improved data for quality assurance evaluation.

6.

Impetus to further development and refinement of NIS’s.

7.

Comparative research on nursing care, including research on nursing diagnoses, nursing intervention, nursing outcome,

intense of nursing care and referral for further nursing service.

8.

Contribution toward advancing nursing as a research-based discipline.

The NMDS includes three broad categories of elements:

1.

Nursing care

2. Patient or Client demographics

3. Service elements

Many of the elements are consistently collected in the majority of the patient/client record across healthcare settings in the United

State, especially the patient and service elements.



Nursing care element

• Nursing diagnoses

•

Nursing intervention

•

Nursing outcome

• Intensity of nursing care

Patient or client demographic elements

• Personal identification

•

Date of birth

•

Gender

• Race and ethnicity

• Residence

Service elements

• Unique facilities or service agency number

•

Unique health record number or patient/client

•

Unique number of principle registered nurse provider

• Discharge or termination date

•

Disposition of patient or client

Standard and Research Ere-Twenty- first Century

Although the full benefits of the NMDS are still being realized, the NMDS work has influenced a number of advances. They influence

the work of nurses association . 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 bases to support clinical nursing practice.

The NMDS serves as a key component of the standards developed by Nursing Information & Data Set Evaluation Center. In 1996,

NIDSEC develops and disseminates standard related to nomenclature, clinical association, clinical data repositories and system

characteristics support variables pertaining to data sets in information system that support the documentation of nursing practice.

NIDSEC evaluates voluntarily submitted vendor data sets against this standard. The advancement of the NMDS has supported nurse’s

participation in developing computerized health information system, utilization 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

The early NMDS work in the United State spurred and development of NMDSs in numerous other countries. To date seven countries

have identify NMDS system, including Australia , Canada, Belgium, Iceland, The Netherland, Switzerland and Thailand. A perusal of

these data sets reveal a definite consensus on the importance of nursing care element across all countries with identified NMDSs.

There is variability as to the level of granularity in the specification of these data sets. Some are very granular in specifying specific

patient problem and specific nursing intervention of interest, while other data sets maintain high conceptual focus and emphasize

empowering nursing to establish NMDSs that can address all nursing problem/intervention/outcome per encounter. There is also



support for collection of key characteristics related to the patient/client and the service. There is variation as to applicability of the data

sets to settings other than acute care.

Emergent NMDSs

Several countries across most continent beyond north America are exploring development of NMDS system.

For example, in Europe the World Health Organization has been concerned with variables including nursing care, personal data,

medical diagnosis and service data. Many of these elements are similar to U.S NMDS. work is ongoing in the United Kingdom. The

Nordic countries likewise have much ongoing activity to identify NMDS. Moreover, Brazil is leading efforts in South America toidentify a NMDS. Korea and Japan are focusing on development efforts as well.

In Summary, it is clear that there is major work being accomplished across the globe to ensure that nursing essential data will be more

comprehensively in the future. There is varying capacity to capture variables related to the context of care.

Call for standardized conceptual data

Ample studies have demonstrated the significance of nurse staffing, patient/staff ratios, professional autonomy and control,

organization characteristics, unit internal environment, work delivery pattern, work group , external environment, education staff

collaboration and education level on the quality and outcomes of patient care. These studies have influenced the identification and the

use of NMDS elements. It indicates that several countries with established NMDSs have included some contextual data in the

NMDSs.

For example, Belgium calls for data related to number of beds and number of nurses available: Switzerland includes for specific

workload data related to each nursing intervention.

The NMMDS is the minimum set of items of information with uniform definition and categories concerning the specific dimension of

the context patient/client care delivery. It represent the essential data used to support the management and administration of nursing

care delivery across all types of settings. The most appropriate focuses on the nursing delivery unit/service/center of excellence level

across these settings.

This minimum data set provide the structure for the collection of uniform information that influences quality of patient care, directly

and indirectly. These data in combination with actual patient data identified in the NMDS support clinical decisions making.

The development within the United State of the NMMDS address this void. The 18 NMMDS elements are organized into threecategories: environment, nursing care resources and financial resources.

Environment

• Unit/cost center identifier

• Type

•

Patient/client population

•

Volume

•

Accreditation

•

Organizational decision making power

• Patient/client

• Method of care delivery

•

Clinical decision making complexity

Nursing Care

• Management demographic profile



•

Staffing

•

Staff demographic profile

• Staff satisfaction

Financial Resources

•

Payer type

•

Reimbursement

• Budget

•

Expenses

NMDS’s relationship to international nursing minimum data set

EVALUATION OF CONCEPT

The i-NMDS include the core, international relevant, essential, minimum data elements to be collected in the course for providing

nursing care. These data can provide information to describe, compare and examine nursing practice around the globe. Work toward

the i-NMDS is intended to build on the efforts already underway in individual countries. It is imperative that the national healthcare

infrastructure support the collection and reuse of nursing data.

Consequently, partner countries participating in the development of the i-NMDS are encouraged to established triads composed of (a)

representatives of the National Nurses Association. (b) international Medical Informatics Association Nursing Informatics Special

Interest Group representatives and (c) informatics experts. Projects team provide coordination and communication of project in each

country.

COSPONSORSHIP

The i-NMDS Research Center is lead by a steering committee of international representative of the countries with existing and

emerging NMDSs as well as professional cosponsorship and areas of informatics expertise.

PURPOSE

The contribution of nursing care and nurses is essential to healthcare globally. The i-NMDS as a key data set will support:

Describing the human phenomena, nursing intervention, care outcomes and resources consumption related to nursing

service.

Improving the performance of healthcare system and the nurses working within these system worldwide.

Enhancing the capacity of nursing and midwifery services.

Addressing the nursing shortage, inadequate nursing condition, poor distribution and inappropriate utilizing of nursing

personnel, and the challenges as well as opportunities of global technology innovation.

Testing evidence-based practice improvements.

Empowering the public internationally.

DATA ELEMENTS

The i-NMDS elements are organized into three categories: setting, subjects of care and nursing elements.



o

Setting variables include country characteristics as well as descriptors of the location of care, whether the setting is acute,

ambulatory, home and so on. Measures include are personnel characteristics, including numbers, full-time equivalent,

education, gender, and so on.

o

Subjects of care can include individuals, families, groups or communities. Demographic of the subject are included, eg.,

country of residence, disposition, age, gender, medical diagnosis are described.

o

Last nursing care elements include nursing diagnosis/subject of care problem, intervention and outcomes. A measure of

intensity resource consumption will be developed. Nursing care date may be collected using standardized language.

ISSUES

Continuing attention needs to focus on consistency with the i-NMDS as well as supporting development of NMDSs

across all countries. Consensus has been established to support the development and adoption of NMDSs that support all core

nursing data collection in information systems across all settings. However, congruent with the state of adoption, specific

studies addressing critical areas of international import will be designed to support the inclusion of countries with the

capacity to collect the data which the focus of specific studies. Normalization of data definitions must occur. Normalization

of data collection time periods is a difficult issues.

Future Directions

The power of NMDSs to describe nursing practice from an international perspective is daunting. Knowing the

human phenomena served by nursing , the interventions given and the outcomes realized are essential to improving

outcomes, assuring patient/client safety and providing wise stewardship of all resources, from human to financial.

Information and knowledge are key to supporting an essential knowledge-driven professional service and improving through

effective policy changes.

The End

GROUP 2

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