European Nursing Care Pathways
European nursing care pathways (ENP) is a nursing classification for concrete formulation support in the context of nursing process documentation. ENP includes nursing diagnoses (with indicators, causes, resources), nursing goals and nursing measures, both horizontally in the structure of an ENP practice guideline and vertically with their own taxonomic structure of the "groups" nursing diagnoses, indicators, causes, resources, nursing goals and Maintenance measures are established. The ENP developers understand an ENP practice guideline to be the technically sound and, as far as possible, evidence-based assignment of possible nursing objectives and concepts of measures to remedy / alleviate a nursing problem / a nursing diagnosis. The developers also speak of modified “practical theories” or a “care diagnosis-related treatment path”.
Development history of ENP
The ENP development began in 1989 at a nursing school in Germany. In the course of development, several nursing schools have participated in the development. Around 1996, with the first publications on ENP, a nursing science department "ENP Research & Development Group" was set up for the further development of technical language at RECOM (institution in the health sector, see OID directory at DIMDI). The ENP developers are a team of nursing and health scientists who have undertaken the continuous improvement of the system in close cooperation with the ENP users. The team of ENP developers also includes specialist translators who manage the translation projects. The various phases of development presented below could not always be precisely dated from the literature, because on the one hand there are overlaps of the phases and on the other hand corresponding descriptions could not be found. Some information comes from conference lectures.
Phase 1 (1989–1998) - inductive development
The starting point was initially an inductive approach. As part of practical instructions for training to become a health and nurse, specific care situations (> 2000) with patients were used to create a care plan and to agree in a team with trainees, carers and the teaching staff of the training center. The formulations found to map the care situation in the form of care problems / diagnoses, care goals and care measures were technically supported and cataloged by literature. The aim of the teachers at the time was to standardize the training linguistically and to offer the trainees a formulation aid for nursing process documentation.
Phase 2 (1998 to today) - User feedback on further development
In 1998, ENP was made software- enabled for the first time in the form of a database, which could be integrated into software products for maintenance process documentation. Since the first applications of the technical language ENP in software, the developers have used the feedback from users for further development. Feedback regarding missing nursing diagnoses / measures is / was analyzed and, after a comparison with the specialist literature / guidelines or a term analysis, is included in ENP. The first use in a care documentation system can be dated to 1996 through a publication. The use of ENP in an electronic resident file in an elderly care facility was first described in a diploma thesis from 2001. These statements are subject to a certain degree of fuzziness, as it is conceivable that ENP was already used in an electronic patient / resident record before the first publications. In the current book publication by ENP, the authors write that users still influence the further development of ENP and that suggestions are taken up after a corresponding examination of the specialist literature.
Phase 3 (2005–2009) - Development of the classification structure
Based on the book publication by Pia Wieteck (Hrsg.) 2004 it can be understood that the entire components of ENP have a notation (unique numbering). The author writes in this publication that ENP is not yet a classification system with its own taxonomy . This was only built up step by step in the years 2005–2009. In the scientific background to ENP published on the ENP homepage since 2006, the further development of ENP into a care classification can be traced. The classificatory structure of the ENP nursing diagnoses was mentioned for the first time in a specialist article (2006), here it is also mentioned for the first time that ENP is a nursing classification system.
In 2006, ENP named seven classes today as groups (nursing diagnoses, causes, characteristics, resources, nursing goals, nursing interventions and action-guiding information). The group of nursing diagnoses already had a mono-hierarchical structure with 3 domains , 22 classes and 128 categories . The remaining sibling classes / groups such as causes, characteristics etc. did not have a hierarchical structure. However, the respective concepts / terms (such as indicators of causes, goals, measures, etc.) of the classes had relationships with the relevant nursing diagnoses. The individual groups were systematically structured monohierarchically by means of clustering and transferred to today's classification structure. In 2007–2008, the groups ENP care goals and ENP care measures were converted into a taxonomic structure. Subsequently, the groups Identifiers, Causes and Resources were hierarchized. The concepts / terms of these groups follow a different organizational logic than that of the ENP nursing diagnoses, goals and measures.
Phase 4 (since around 2008) - translation of ENP a continuous process
According to the ENP developers, ENP is translated into German, English, Italian and French. Book publications in English, French and Italian are still pending. In a doctoral thesis, Serge Haag describes the validation of ENP in French. The Italian translation by ENP has started the final thesis for the master’s degree as a specialist translator at the University of Bologna. Since then, Elisabetta De Vecchis has been in charge of the ENP translation into Italian as well as the validation work of the translation as a member of the ENP development team.
ENP is registered as a standardized care classification by means of an Object Identifier (OID) for object recognition in the "German health service". This enables data to be exchanged between the various electronic patient / resident files. The information on ENP can be found on the homepage of the German Institute for Medical Documentation and Information (DIMDI).
Objectives of European Nursing Care Pathways
The objectives of ENP are very similar to those of other nursing classifications such as NANDA , NIC or NOC . ENP is intended to offer a uniform, standardized language for mapping the nursing process . The communication is to be improved through the technical language between the actors in the care, through the electronic use the semantic interoperability is enabled and the data and information exchange between the sectors and the various electronic patient / resident files are supported. The ENP developers also pursue the goal of using the structure and granularity of ENP to support nurses in making decisions in the context of the nursing process by presenting the latest nursing expertise. The idea of using the data resulting from daily nursing process documentation to form / test hypotheses in the context of nursing research is also underpinned by existing research. By storing the ENP nursing measures with normative time values, both the nursing staff management and the case cost calculations of nursing services as part of the DRG remuneration are to be supported.
Structure of the care classification ENP
ENP is a care classification that has both a horizontal and a vertical structure. The ENP developers speak of three sub-areas A (classification), B (ENP pre-combinations) and C (ENP practical guidelines).
Section A - Classification
The vertical structure comprises six groups (ENP nursing problems / diagnoses; resources; indicators; causes; ENP nursing goals and ENP nursing interventions). Each group has its own hierarchical structure, which is partially harmonized. The domains, classes and categories of the groups ENP nursing diagnoses, ENP nursing goals and ENP nursing measures are harmonized. There are four domains, 21 classes and 136 categories. For a better understanding of harmonization, an example from the taxonomy of the ENP.
| Taxonomy: ENP nursing diagnosis | Taxonomy: ENP maintenance goal | Taxonomy: ENP maintenance measure |
|---|---|---|
Domain: functional / physiological area
|
Domain: functional / physiological area
|
Domain: functional / physiological area
|
According to the ENP developer, the characteristics, causes and resources in ENP also have their own taxonomic structure. A precise description of this is currently lacking in the specialist literature and can only be traced in the database, according to statements made at specialist congresses.
Section B - pre-combination
The ENP nursing diagnoses are already pre-combined. This means that the nursing diagnostic statement already contains information about the individual / the person affected, the nursing problem and a specification such as a cause or description of the mark. An example to explain.
| Group nursing problem / diagnosis | Group causes | Affected individual |
|---|---|---|
Domain: functional / physiological area
|
Emotional / behavioral factors
|
patient |
The terms / concepts from the different groups of ENP (Part A Classification) are combined to form a nursing diagnostic statement.
"The patient cannot dress independently due to an apraxia"
A detailed description of the taxonomy and structure of the ENP nursing diagnosis can be found in the Pflegewiki. The ENP maintenance measures are also already pre-combined. For example, for a care measure such as “carry out a full body wash”, a specification is offered through location information (such as “in bed”, “at the sink”) or the level of support (such as “full takeover”; “instructions, activation”).
Section C - ENP practice guidelines
The horizontal structure of ENP arises from the cross-class connections of technically related elements from the overall structure. This part of the ENP is used in nursing practice. The nursing staff select a suitable nursing diagnosis to describe the patient's condition / problem as part of the nursing diagnostic process. The nursing staff can then consider the nursing goals and nursing measures offered for the nursing diagnosis and select the appropriate ones to map the nursing process for the specific patient / resident. Against the background of the knowledge representation of current nursing expertise, the ENP developers also speak of an ontology in connection with ENP. Each ENP practice guideline is supported by national and / or international specialist literature.
Summary consideration
ENP is a maintenance classification system that was developed for front-end use. This means that the care diagnoses, care goals and care measures should be suitable for the care process documentation. According to the definition of Bakken et al. (2000) ENP can thus be counted among the interface terminologies. The ENP classification structures are monohierarchical and pre-combinatorial and the individual elements of ENP nursing diagnoses, goals and measures represent, according to the developers, the current nursing expertise for nursing process documentation. Each element of the care classification system ENP has a unique ID (identification number) or notation. In the book publication by Wieteck Hrsg. (2004), the numbers for each text module are shown. In the current book publications, in order to improve readability, the ID numbers have not been printed.
Validity of the nursing classification
A wide variety of validation work was carried out. The following outline does not claim to be complete. In the context of the content validity tests, it should be mentioned that Woodtli (1988) already considers it to be content valid if nursing diagnoses are appropriately supported by specialist literature. This is generally the case at ENP, but it should be critically questioned whether this circumstance meets a scientific requirement for content validity. In the context of content validation methods, numerous methods for content validation are known in the context of maintenance classification systems and lead far beyond what Woodtli said, for example:
- Grant and Kinney (1992) describe the Delphi technique as a useful method for examining the content validity of nursing diagnoses
- Fehring published the various methods of validating the content of nursing diagnoses. These are: Diagnostic content validity (DCV), Differential diagnostic validation (DDV), Etiologic correlational validation model (ECR), Clinical diagnostic validity (CDV)
- The cross-mapping method is also described in the literature for examining the content validity
The content validity of the ENP nursing diagnoses was examined in two cross-mapping studies. A mapping with ICNP and a mapping with NANDA were carried out. The studies carried out with the method (cross-mapping) of comparing the ENP nursing diagnoses with the nursing diagnoses of the NANDA and the ICNP show a high level of agreement in terms of content. It is assumed that if different teams of experts develop similar or identical concepts / terms to describe the maintenance process, this can be interpreted as a quality statement for the content validity. In addition, within the framework of the ENP-NANDA mapping, experts rated the expressiveness and clarity of ENP nursing diagnoses to about 84% as good or higher than the NANDA nursing diagnoses.
In detail:
- In terms of expressiveness, 53% of the carded ENP diagnoses got higher,
- and 15% of ENP nursing diagnoses rated lower than NANDA by experts;
- In terms of clarity, 43% of ENP nursing diagnoses were higher,
- and 14% of ENP nursing diagnoses rated lower than NANDA nursing diagnoses.
The study shows that with the ENP nursing diagnoses at that time (2007) a total of 13% of the NANDA nursing diagnoses could not be mapped via ENP. In addition, further studies, e.g. according to the Fehring method, as well as international literature analyzes for the validation of the content of ENP were carried out.
A unique selling point in the field of validation studies are the criterion validity studies that were carried out; not just a sub-element but the entire ENP practice guideline was examined here. For example, as part of the investigation by Berger. 1931 Narrative nursing process planning formulations mapped with ENP in the hospital setting. The formulations are taken from exam papers that were graded 1–2. Overall, 73% of the formulations could be mapped completely, 14% of the formulations partially and 13% of the formulations not. The 2010 study by Schmitt in the field of neonatal intensive care comes to similar results.
In summary, the studies listed here indicate good validity, but also show that there is a need for further action. For example, no reliability tests were found, and some nursing diagnoses do not seem to be sufficient to meet the requirements of international literature security.
Web links
Individual evidence
- ↑ Wieteck, Pia (Ed.) (2013: 21): Practice guidelines for care, planning and documentation based on care diagnoses of the ENP classification. Kassel, RECOM Verlag
- ↑ Wieteck, Pia (2003): European Nursing care Pathways (ENP®). Develop nursing treatment pathways based on practical theories. PR-Internet 5 (11): 84-94
- ↑ Wieteck, Pia (2007: 259) Documentation using the standardized nursing language ENP®: depicting the nursing process in detail and up-to-date. Nursing Journal 60 (5): 257-259
- ↑ Presentations for the specialist congress “One Language for Care” 2013 Villach
- ↑ Abstract volume ENI 2004 International Scientific Congress for Nursing Information ( Memento of the original from April 11, 2007 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 306 kB)
- ↑ Wieteck, P. and H.-J. Velleuer (1994): Handbook on Care Planning. Baunatal, RECOM
- ↑ a b OID directory of DIMDI
- ↑ Congress 2011 organizers UMIT and tilak Topic: A language for care
- ↑ Wieteck, Pia, ed. (2004: 27 ff): ENP - European Nursing care Pathways. Standardized nursing terminology for mapping nursing treatment pathways. Bad Emstal, RECOM Verlag
- ↑ Wieteck, Pia, (Ed.) (2004: 25): ENP - European Nursing care Pathways. Standardized nursing terminology for mapping nursing treatment pathways. Bad Emstal, RECOM Verlag
- ↑ Wieteck, Pia, eds. (2004: 26 and 35): ENP - European Nursing care Pathways. Standardized nursing terminology for mapping nursing treatment pathways. Bad Emstal, RECOM Verlag
- ↑ Wieteck, Pia, ed. (2013): Practice guidelines care, planning and documentation based on care diagnoses of the ENP classification. Kassel, RECOM Verlag
- ↑ Deppmeyer, Christine (1999): From Claim to Reality - Dealing with Care Planning and Care Documentation. The Nurse / The Carer 38 (9): 743-745
- ↑ Wieteck, Pia (2001): Intervention study on the quality development of care documentation with the help of an IT-supported care planning program in an inpatient facility. Nursing and health science. Darmstadt, Protestant University of Applied Sciences Darmstadt
- ↑ Wieteck, Pia, Hrsg. (2013: 16): Practice guidelines care, planning and documentation based on care diagnoses of the ENP classification. Kassel, RECOM Verlag
- ^ Wieteck, Pia (ed.): (2004: 72) ENP - European Nursing Care Pathways. Standardized nursing terminology for mapping nursing treatment pathways. 1st edition, Bad Emstal: RECOM Verlag
- ↑ Scientific background to ENP ( Memento of the original from August 8, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ a b Nursing classification system
- ↑ Wieteck, P. (2006): Working with ENP. Nursing process documentation of the future. Health Professions 58 (11): 62-63
- ↑ Wieteck, Pia et al. (2007) Scientific background European Nursing care Pathways. (download 2013) (PDF; 635 kB)
- ↑ Wieteck, Pia, ed. (2013: 26 f): Practical guidelines for care, planning and documentation based on care diagnoses of the ENP classification. Kassel, RECOM Verlag
- ↑ Wieteck, Pia, ed. (2013: 18): Practice guidelines care, planning and documentation based on care diagnoses of the ENP classification. Kassel, RECOM Verlag
- ↑ Haag, Serge (2009): Optimizing the efficiency of inpatient care: Analysis of intervention-related need and time-of-effort values, Edition Pflegewwissenschaft Volume 3. Kassel, RECOM Verlag
- ↑ ENP development team
- ↑ De Veccis specialist translator ( Memento of the original from March 3, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Wieteck, Pia, ed. (2013: 12): Practice guidelines care, planning and documentation based on care diagnoses of the ENP classification. Kassel, RECOM Verlag
- ↑ a b Wieteck, P., Ed. (2004): ENP - European Nursing Care Pathways. Standardized nursing terminology for mapping nursing treatment pathways. Bad Emstal, RECOM Verlag
- ↑ Konrad, H. (2009): Pneumonia prophylaxis in hospital patients. Analysis of data of the nursing classification ENP® in electronic patient files. Bad Emstal, RECOM GmbH & Co. KG
- ↑ Wieteck, P. (2005): On the importance of interdisciplinary cooperation in the context of the DRG. A contribution to the discussion on optimized process control. Care & Society 10 (3): 115-124
- ↑ Wieteck, Pia, ed. (2013: 37): Practice guidelines care, planning and documentation based on care diagnoses of the ENP classification. Kassel, RECOM Verlag
- ^ Opel, B. (2005): Successful balancing act. Elderly Care 30 (8): 36-38
- ↑ Wieteck, Pia, ed. (2013: 29 ff): Practical guidelines for care, planning and documentation based on care diagnoses of the ENP classification. Kassel, RECOM Verlag
- ↑ Wieteck, Pia, Hrsg. (2013: 30): Practice guidelines care, planning and documentation based on care diagnoses of the ENP classification. Kassel, RECOM Verlag
- ↑ ENP nursing diagnosis
- ↑ Wieteck, Pia, Hrsg. (2013: 35): Practice guidelines care, planning and documentation based on care diagnoses of the ENP classification. Kassel, RECOM Verlag
- ↑ Bakken, S., MS Cashen, et al. (2000): Representing Nursing Activities within a Concept-oriented Terminological System: Evaluation of a Type Definition. JAMIA, Journal of the American Medical Informatics Association 7 (1): 81-90
- ↑ a b Wieteck, Pia (2008) Validation of nursing diagnoses of the nursing classification ENP (European Nursing care Pathways). Cross-mapping of ENP® with ICNP® and NANDA. Bad Emstal, RECOM Verlag RECOM GmbH & Co. KG
- ↑ Woodtli, A. (1988): Identification of Nursing Diagnoses and Defining Characteristics: Two Research Models. Research in Nursing & Health 11 (6): 399-406
- ^ Grant, JS and MR Kinney (1992): Using the Delphi Technique to Examine the Content Validity of Nursing Diagnoses. Nursing Diagnosis 3 (1): 12-22
- ^ Fehring, RJ (1986): Validating Diagnostic Labels: Standard Methodology. Classification of Nursing Diagnoses: Proceedings of the Sixth Conference. ME Hurley. St. Louis, CV Mosby Company: 183-190
- ^ Fehring, RJ (1987): Methods to validate nursing diagnoses. Heart & Lung: Journal of Critical Care 16 (6 part 1): 625-629
- ^ Fehring, RJ (1994): Symposium on Validation Models. 3: The Fehring Model. Classification of Nursing Diagnoses: Proceedings of the Tenth Conference. RM Carroll-Johnson and M. Paquette. Philadelphia, JB Lippincott Company: 55-62
- ↑ Zielstorff, RD, C. Tronni, et al. (1998): Mapping Nursing Diagnosis Nomenclature for Coordinated Care. Image: Journal for nursing scholarship 30 (4): 369-373
- ↑ Burkhart, L., D. Konicek, et al. (2005): Mapping Parish Nurse Documentation Into the Nursing Interventions Classifications. CIN: Computers, Informatics, Nursing 23 (4): 220-229
- ↑ Wieteck, P. (2008): Furthering the development of standardized nursing terminology through an ENP®-ICNP® cross-mapping. International Nursing Review 55 (3): 296-304
- ↑ Hyun, S. and H.-A. Park (2002): Cross-mapping the ICNP with NANDA, HHCC, Omaha System and NIC for unified nursing language system development. International Nursing Review 49 (2): 99-110
- ↑ Wieteck, P. (2007): Validation of selected components of the ENP® (European Nursing care Pathways). ENP® - an instrument for process-oriented, case-related and action-based nursing process documentation. Institute for Nursing Science, Faculty of Medicine. Witten, University of Witten / Herdecke. Doctor rerum medicinalium
- ↑ Hardenacke, D. (2007): The validity of three ENP nursing diagnoses using the example of malnutrition. PrInterNet 10 (10): 530-538
- ↑ Helmbold, A. (2010): Literature analysis on body washing - A step in the validation process of ENP nursing diagnoses. Nursing Science 02: 100-107
- ↑ Berger, S. (2008): Criterion validity of ENP. Mapping of individually formulated nursing process plans with ENP. Nursing Science 10
- ↑ Schmitt, A. (2010): Criterion validity test of ENP in a neonatal intensive care unit. submitted in PR-Internet 12 (4): 224-232
