Drupal musings 12: Semantic Web, ICNP, Case studies and Care domains

Drupalcon 2010 Copenhagen is over for me. It's been a really useful week: awesome indeed. My head is dizzy with all the options, sources and resources to consider. I will contact the London Drupalcon group for 2011 with some suggestions regards beginners, networking and outreach.

Ever since setting off on the Drupal road, the semantic web has been a constant item of street furniture. In Szeged '08, Paris last year and this past week in Copenhagen the semantic web, RDF and terminologies have had a pivotal presence. I did not attend all the rdf / SW sessions but Wednesday's Semantic Terminologies was sit on the floor popular (even though at that point the program hit a bottleneck from 6 to 3 streams). Whatever the cause - I was there, late and my pivot ached (no padding!).

As a Drupal 7 prelude I'm creating a Drupal 6 site, a basic homepage for someone. The content for the latter is fixed - sorted. Apart from the pages for the archive, the new h2cm content involves me figuring out how to combine:

1. the health career model;
2. nursing - in theory and practice;
3. external sources and resources;
4. and Drupal.

Johannes Wehner's terminology session above did not emphasize RDF, but highlighted Open Linked Data by means of Open Calais as a tool to extend existing content. I've downloaded the Drupal OC module and obtained a key.

As for the list: #1 The health career model is straight forward really. Four care domains - get on with it! From there though it is quite a reach to encompass #2 & #3. My options appear to be:

• free tagging, auto tagging - let the users of the site decide;
• pre-define a data set, a terminology (classification) for the health career model;
• use an existing nursing classification / terminology scheme - perhaps a subset.

Before I decide I need to be aware of what is available. I e-mailed Derek Hoy in Scotland - contact for the International Classification for Nursing Practice® [ICNP]. This is another thing I pick up, put down. ... Now thanks to Derek I'm sorted now with ICNP downloaded (and I will need a module to import .csv files). There are videos on the ICNP website.

I have followed the development of nursing terminologies for quite some time. The most striking thing to me is how removed they are from the day-to-night life on wards and other care encounter situations. With mental health as a Cinderella in terms of the politics and recognition of nursing service provision I am in effect professionally twice removed. For the vast majority of nurses on the ground and from where I work in community mental health the ICNP, SNOMED CT, Omaha and other schemes are rather esoteric things. They are there in the background, part of management and reporting 'function'. This is not to say that the above initiatives have few followers, or lacks experts in this field. Make no mistake nursing has its own geeks, nursing classification its experts!

The scope of ICNP makes it a great candidate (from the website) -

Diagnosis/outcome

Interventions

Individual 7 axes

1. focus
2. action
3. client
4. judgement
5. location
6. means
7. time

Plus:

• it's International;
• it's by nurses, for nurses;
• it has momentum (political and financial support);
• So it is credible, and research based.

Despite this, I must take a critical look at what is available for my needs and time available. All the above provide way too much for a first bash - prototype, proof of concept. I have the luxury of not worrying about safety. My project does not constitute an electronic health record or other variant. Yes, I want to prove the health career model and to this end I must also find or create several nursing case studies to interrogate within Drupal and h2cm.

Perhaps as things improve economically, nursing classification will be revived and will allowed the time to fully mature? I recall in 2006 plans to explore mental health within SNOMED which unfortunately did not materialise. So, when I say mature, I mean like cheese in the holistic senses of the ingredients: nursing care concepts across contexts that also incorporate self-care, recovery, demographic trends ...; and the process across communities of practice (integrated care) through to academic and management applications - research / reporting.

In March 2010 plans were announced of plans to harmonize the efforts of the ICNP and SNOMED CT nursing.

So, with a possible jumpstart - a sprint for my site this autumn in Manchester, UK and work afoot to make nursing classification matter on the 'ground' there is more to follow on several fronts. ... I remember a presentation Derek did in the 1990s about classification and making nursing visible - let's do it!

contact: h2cmng @ yahoo.co.uk

Evidence Hodges' model #1: Research in Nursing

When as a nurse (OT, physio, medic....) you are on a course, especially one about research you may be required to complete a study or more significant piece of research. Courses at graduate and post graduate level invariably include such demands and stress the hope that this course will spur you to continue the research effort in the work place. The ideal is of course to routinise research in clinical settings. Whatever the debate regarding the merits of evidence-based nursing, medicine and so on, this still needs to happen in part to help bridge the theory - practice gap.


In the same way all nurses have a professional responsibility to educate their student peers, (patients and carers...) there is an expectation that nurses are like embedded media commentators in a war zone. Part of your time in practice will be devoted to research, audit and governance.

While there are audit and governance teams there willing to help, many people multi-task in their work and nurses are seasoned practitioners. Many just want to do what they were trained for and nurse. They recognize this as they hear the expectations of the course leaders, lecturers and yet they are aware of the constraints. The scope for research is weighed against other commitments, notably:

• direct(ing) patient care and safety
• management and supervision
• audit duties for management information

There are of course a host of psychosocial influences that come into play. What is my personal interest in research? Where do I prefer to be at work: office, ward, or home or retired? Cynical? No! Just being realistic. The information systems frequently in place can assist as a research tool, but their chief role is to provide management information through the collation of aggregated data. This is done by-and-large transparently in the background ('back-end'), and that is the problem. Nurses need to get their feet wet. The option must be there, and not just when on courses. Nurses need to immerse themselves in the data and information streams they help to create and source.

As the list above suggests nurses and not just senior nurses need direct access to the icon labelled 'reports'. There should be ways for nursing work to be captured in-situ, but how? Many clinical information system vendors have their solutions to this, but as regular readers know for a long time I've been wondering about -

1. How can the balance between management data and intelligence needs and clinical needs be supported and bridged?*
2. What is the evidence base to support Hodges' model in theory, practice, management and policy?
3. What is the state, characteristics, access and usability of nursing terminology, taxonomy, classification systems in informatics - information and communication systems?
4. If I am individually compelled (nuts!) to create a new website could I ally this aim with a course?

More to follow - including some of the sessions at Drupalcon Paris.....

*To this list we also need to add other stakeholders - members of the public.

Additional link:
https://www.icn.ch/what-we-do/projects/ehealth-icnp

Image sources:
Mind the gap: http://ci.coe.uni.edu/facstaff/zeitz/web/itag/mindthegap/
Report icon: http://artistsvalley.deviantart.com/art/Free-Task-Icons-Reports-Icons-89509953