Standardized Nursing Language
Standardized nursing terminologies form the framework for a consistent communication method. Every nurse in a healthcare environment should understand the unique contributions standardized terminologies have on direct patient care, and research (Rutherford, 2008). A nurse says, “We document our care using standardized nursing languages, but we don’t fully understand why we do.” It’s essential for the nurse to know that the documentation process is very vital in a healthcare environment. Patient care documents, assessments of processes, outcome measures, and patient care documents must be documented using standardized nursing language. I would explain to the nurse the importance of keeping patients documents. Such documents are kept to aid in coordinated care. The nurse who will take over in taking care of the patient needs to understand the background information of the patient’s disease. Moreover, I would make the nurse understand that doctors and physicians require complete information about a patient before the commencement of care delivery (Thede & Schwiran, 2011). Such information must thus be documented in a language the physician, the doctor, and the nurse understands, and that is the standardized nursing language. Standardized nursing language has several advantages in healthcare set up, and research but there are underlying challenges in its implementation.
Benefits of standardized nursing terminologies
The standardized nursing terminologies help in effective communication, and thus quality treatment outcomes. The patient’s level of satisfaction will be achieved if the desired care is given. The physicians can only prescribe the right medicine, and dosages depending on the level of the satisfaction they get from the information presented by the caregivers, and the doctors. The use of standardized language in nursing is beneficial for keeping the level of professionalism among the nurses, which help in direct care (Tastan et al, 2014). The standardized nursing languages help in better communication among the nurses and other health care providers. The standard language also increases the visibility of nursing interventions, which will be used in supporting, demonstrating, and judging nursing care practices (Tastan et al, 2014). The standardized language will also help in improving the data collection to evaluate the nursing care outcomes.
Challenges of implementing standardized nursing terminologies
Standardization of the nursing language is critical for verifiable, sharable, and comparable data needed for effective care delivery and in research. However, the lack of alignment on terminology standards for nursing content definition is proving to be one of the greatest challenges (Thede & Schwiran, 2011). There is the need for a common language that integrates all the nursing processes, such as actions and outcomes to determine their contributions to quality health outcomes across the care settings (Tastan et al, 2014). Many installed electronic health records (EHR) lack the data standardization in nursing contents. EHR systems are currently used in many care facilities, which focus on effective care delivery. The EHR should thus have customized development and implementation systems, which factor in the standardized nursing languages.
The process of mapping some of the local contents to the reference terminologies is resource-intensive. An individual can do mapping in the care setting, software developer or a third-party vendor (Tastan et al, 2014). Whichever the case, the process is complex and costly. The fewer skills inform the complexity in the process of terminology and mapping techniques. Therefore, the process of implementing standardized nursing terminologies is compromised (Thede & Schwiran, 2011). Even though many caregivers use the EHR system, there is still an absence of nursing data in the EHR system due to incomplete electronic documentation of nursing care. Some of the preferred terminologies for use may also be lacking from the system, thus compromising the use of the standardized nursing languages.