NursingIntervention-v3.1(2017EN): verschil tussen versies

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(2 tussenliggende versies door dezelfde gebruiker niet weergegeven)
Regel 1: Regel 1:
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==General information==
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<!-- Hieronder wordt een transclude page aangeroepen -->
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Name: '''nl.zorg.NursingIntervention''' [[Bestand:NL.png|link=VerpleegkundigeInterventie-v3.1(2017NL)]]<BR>
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{{Versions-2.16.840.1.113883.2.4.3.11.60.40.3.14.2(EN)|1|NursingIntervention-v3.1(2017EN)}}
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Version: '''3.1''' <br>
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<!-- Tot hier de transclude page -->
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HCIM Status:Final<br>
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==General information<!--hdGeneralInformation-->==
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Release: '''2017''' <br>
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Name<!--hdName-->: '''nl.zorg.NursingIntervention''' [[Bestand:NL.png|link=VerpleegkundigeInterventie-v3.1(2017NL)]]<BR>
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Release status: Published<br>
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Version<!--hdVersion-->: '''3.1''' <br>
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Release date: 31-12-2017
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HCIM Status<!--hdStatus-->:Final<br>
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Release<!--hdPublication-->: '''2017''' <br>
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Release status<!--hdPublicationStatus-->: Published<br>
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Release date<!--hdPublicationDate-->: 31-12-2017
 
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<div style="text-align: right; direction: ltr; margin-left: 1em;" >[[Bestand: Back 16.png| link= HCIM_Release_2017(EN)]] [[HCIM_Release_2017(EN) |Back to HCIM list ]]</div>
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<div style="text-align: right; direction: ltr; margin-left: 1em;" >[[Bestand: Back 16.png| link= HCIM_Release<!--wikiReleasePage-->_2017(EN)]] [[HCIM_Release<!--wikiReleasePage-->_2017(EN) |Back to HCIM list<!--hdBackToMainPage--> ]]</div>
  
 
==Metadata==
 
==Metadata==
Regel 61: Regel 64:
 
==Revision History==
 
==Revision History==
 
<div class="mw-collapsible mw-collapsed">
 
<div class="mw-collapsible mw-collapsed">
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''Only available in Dutch''
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''Only available in Dutch<!--noTranslation-->''
  
 
<u>Publicatieversie 1.0</u> (01-07-2015)
 
<u>Publicatieversie 1.0</u> (01-07-2015)
Regel 86: Regel 89:
 
==Information Model==
 
==Information Model==
 
<BR>
 
<BR>
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<imagemap> Bestand:NursingIntervention-v3.1Model(EN).png | center  
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<imagemap> Bestand:NursingIntervention-v3.1Model(2017EN).png | center  
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rect 358 35 522 85 [[#InterventionSnomedCodelist]]
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rect 368 43 532 93 [[#InterventionSnomedCodelist]]
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rect 540 716 647 786 [[Patient-v3.1(2017EN)]]
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rect 550 724 657 794 [[Patient-v3.1(2017EN)]]
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rect 392 716 498 786 [[ContactPerson-v3.1(2017EN)]]
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rect 402 724 508 794 [[ContactPerson-v3.1(2017EN)]]
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rect 375 586 517 656 [[#12363]]
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rect 385 594 527 664 [[#12363]]
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rect 192 476 334 546 [[#12366]]
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rect 202 484 344 554 [[#12366]]
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rect 192 251 334 321 [[TreatmentObjective-v3.1(2017EN)]]
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rect 202 259 344 329 [[TreatmentObjective-v3.1(2017EN)]]
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rect 192 361 334 431 [[MedicalDevice-v3.1(2017EN)]]
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rect 202 369 344 439 [[MedicalDevice-v3.1(2017EN)]]
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rect 473 422 625 492 [[#12358]]
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rect 483 430 635 500 [[#12358]]
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rect 191 587 333 657 [[#12365]]
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rect 201 595 343 665 [[#12365]]
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rect 759 138 901 208 [[#12361]]
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rect 769 146 911 216 [[#12361]]
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rect 563 587 705 657 [[#12354]]
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rect 573 595 715 665 [[#12354]]
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rect 760 587 902 657 [[#12370]]
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rect 770 595 912 665 [[#12370]]
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rect 759 251 901 321 [[HealthProfessional-v3.2(2017EN)]]
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rect 769 259 911 329 [[HealthProfessional-v3.2(2017EN)]]
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rect 192 138 334 208 [[Problem-v4.1(2017EN)]]
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rect 202 146 344 216 [[Problem-v4.1(2017EN)]]
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rect 760 365 902 435 [[#12357]]
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rect 770 373 912 443 [[#12357]]
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rect 760 468 902 538 [[#12359]]
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rect 770 476 912 546 [[#12359]]
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rect 481 140 615 211 [[#12356]]
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rect 491 148 625 219 [[#12356]]
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rect 242 716 349 786 [[HealthProfessional-v3.2(2017EN)]]
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rect 252 724 359 794 [[HealthProfessional-v3.2(2017EN)]]
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rect 472 247 624 327 [[#12371]]
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rect 482 255 634 335 [[#12371]]
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rect 578 36 720 86 [[#InterventionNICCodelist]]
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rect 588 44 730 94 [[#InterventionNICCodelist]]
 
desc none
 
desc none
 
</imagemap>
 
</imagemap>
Regel 112: Regel 115:
 
{| border= "1"  width="1500px" style = "font-size: 9.5pt;  border: solid 1px silver; border-collapse:collapse;" cellpadding = "3px" cellspacing ="0px"  
 
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|-style="background-color: #1F497D; color: white; font-weight: bold; font-variant: small-caps; "
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|style="width:30px;"|Type<!--imType-->||style="width:100px;"|Id<!--imId-->||colspan="6 " style="width:140px;"|Concept<!--imConcept-->||Card.<!--imCard-->||style="width: 600px;"|Definition<!--imDefinition-->||style="width:200px;"|DefinitionCode<!--imDefinitionCode-->||style="width:200px;"|Reference<!--imReference-->
 
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|-style="vertical-align:top; background-color: #E3E3E3; "
 
|style = "text-align:center" |[[Bestand: block.png| 20px | link=]]
 
|style = "text-align:center" |[[Bestand: block.png| 20px | link=]]
Regel 172: Regel 175:
 
{|
 
{|
 
|-
 
|-
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|<span Title="Codesystem: SNOMED CT"> 9632001 Nursing procedure</span>
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|<span title = "Codesystem: SNOMED CT>[https://terminologie.nictiz.nl/art-decor/snomed-ct?conceptId=9632001 9632001] Nursing procedure</span>
 
|}
 
|}
 
|
 
|
Regel 329: Regel 332:
 
{|
 
{|
 
|-
 
|-
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|<span Title="Codesystem: LOINC"> 48767-8 Annotation comment</span>
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|<span title = "Codesystem: LOINC>[https://terminologie.nictiz.nl/art-decor/loinc?conceptId=48767-8 48767-8] Annotation comment</span>
 
|}
 
|}
 
|
 
|
 
|}
 
|}
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Columns Concept and DefinitionCode: hover over the values for more information<BR>
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Columns Concept and DefinitionCode: hover over the values for more information<!--imHover--><BR>
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For explanation of the symbols, please see the legend page [[Bestand:list2.png|link=Legend]]
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For explanation of the symbols, please see the legend page<!--imLegend--> [[Bestand:list2.png|link=Legend<!--wikiLegend-->]]
  
 
==Example Instances==
 
==Example Instances==
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''Only available in Dutch''
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''Only available in Dutch<!--noTranslation-->''
  
 
{|class="wikitable" width="666px" style= "font-size: 9.5pt;"
 
{|class="wikitable" width="666px" style= "font-size: 9.5pt;"
Regel 410: Regel 413:
 
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|-style='vertical-align:top; background-color: #E8D7BE;'
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|-style="background-color: #1F497D; color: white; font-weight: bold; "
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|Conceptname
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|Conceptname<!--vsConceptName-->
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|Codesystem name||Codesystem OID
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|Codesystem name<!--vsConceptSystemName-->||Codesystem OID<!--vsConceptSystemOID-->
 
|-style="vertical-align:top; "
 
|-style="vertical-align:top; "
 
|Alle waarden
 
|Alle waarden
Regel 421: Regel 425:
 
|2.16.840.1.113883.6.15
 
|2.16.840.1.113883.6.15
 
|}
 
|}
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=== InterventionSnomedCodelist===
 
=== InterventionSnomedCodelist===
 
{| class="wikitable" width="60%"  
 
{| class="wikitable" width="60%"  
 
|-style='vertical-align:top; background-color: #E8D7BE;'
 
|-style='vertical-align:top; background-color: #E8D7BE;'
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{| class="wikitable"  width="60% "
 
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|-style="background-color: #1F497D; color: white; font-weight: bold; "
 
|-style="background-color: #1F497D; color: white; font-weight: bold; "
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|Conceptname
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|Conceptname<!--vsConceptName-->
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|Codesystem name||Codesystem OID
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|Codesystem name<!--vsConceptSystemName-->||Codesystem OID<!--vsConceptSystemOID-->
 
|-style="vertical-align:top; "
 
|-style="vertical-align:top; "
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|SNOMED CT: <<71388002 <noWiki>|</noWiki> procedure <noWiki>|</noWiki>
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|SNOMED CT: <<[https://terminologie.nictiz.nl/art-decor/snomed-ct?conceptId=71388002 71388002]<noWiki>|</noWiki>procedure<noWiki>|</noWiki>
 
|SNOMED CT
 
|SNOMED CT
 
|2.16.840.1.113883.6.96
 
|2.16.840.1.113883.6.96
 
|}
 
|}
  
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==This information model in other releases<!--ftOtherReleases-->==
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==This information model in other releases==
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<!-- Hieronder wordt een transclude page aangeroepen -->
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<ul>
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{{Versions-2.16.840.1.113883.2.4.3.11.60.40.3.14.2(EN)|2|2017}}
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<li>[[NursingIntervention-v1.0(2015EN) | Release 2015, (Version 1.0)]]</li>
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<!-- Tot hier de transclude page -->
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<li>[[NursingIntervention-v3.0(2016EN) | Release 2016, (Version 3.0)]]</li>
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==Information model references<!--ftReferences-->==
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</ul>
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====This information model refers to<!--ftRefersTo-->====
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==More on this information model==
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*[[ContactPerson-v3.1(2017EN)|ContactPerson-v3.1]]
 +
*[[HealthProfessional-v3.2(2017EN)|HealthProfessional-v3.2]]
 +
*[[MedicalDevice-v3.1(2017EN)|MedicalDevice-v3.1]]
 +
*[[Patient-v3.1(2017EN)|Patient-v3.1]]
 +
*[[Problem-v4.1(2017EN)|Problem-v4.1]]
 +
*[[TreatmentObjective-v3.1(2017EN)|TreatmentObjective-v3.1]]
 +
====This information model is used in<!--ftReferredBy-->====
 +
*[[AbilityToManageMedication-v1.0(2017EN)|AbilityToManageMedication-v1.0]]
 +
*[[AbilityToPerformNursingActivities-v1.0(2017EN)|AbilityToPerformNursingActivities-v1.0]]
 +
*[[OutcomeOfCare-v3.1(2017EN)|OutcomeOfCare-v3.1]]
 +
*[[PlannedCareActivityForTransfer-v3.1(2017EN)|PlannedCareActivityForTransfer-v3.1]]
 +
==Technical specifications in HL7v3 CDA and HL7 FHIR<!--ftHeader-->==
 
To exchange information based on health and care information models, additional, more technical specifications are required.<BR>
 
To exchange information based on health and care information models, additional, more technical specifications are required.<BR>
−
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:
+
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:<!--ftReferenceIntro-->
 
<ul>
 
<ul>
−
<li>HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment [http://decor.nictiz.nl/art-decor/decor-scenarios--zib2017bbr-?id=2.16.840.1.113883.2.4.3.11.60.7.4.2.14.2&effectiveDate=2017-12-31T00:00:00&language=en-US&scenariotree=false [[File:artdecor.jpg|16px|link=]]]</li>
+
<li>HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment<!--ftArtDecorReference--> [http://decor.nictiz.nl/art-decor/decor-scenarios--zib2017bbr-?id=2.16.840.1.113883.2.4.3.11.60.7.4.2.14.2&effectiveDate=2017-12-31T00:00:00&language=en-US&scenariotree=false [[File:artdecor.jpg|16px|link=]]]</li>
−
<li>HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR [https://simplifier.net/NictizSTU3/~resources?text=zib&category=StructureDefinition [[File:fhir.png|link=]]]</li>
+
<li>HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR<!--ftSimplifierReference--> {{SimplefierLinks|2017}}</li>
 
</ul>
 
</ul>
−
This information model is also available as [[Media:nl.zorg.NursingIntervention-v3.1(2017EN).pdf|pdf file]] [[File:PDF.png|link=]] or as [[Media:nl.zorg.NursingIntervention-v3.1(2017EN).xlsx|spreadsheet]] [[File:xlsx.png|link=]]
+
==Downloads<!--ftDownloadTitle-->==
−
==About this information==
+
This information model is also available as [[Media:nl.zorg.NursingIntervention-v3.1(2017EN).pdf|pdf file]] [[File:PDF.png|link=]] or as [[Media:nl.zorg.NursingIntervention-v3.1(2017EN).xlsx|spreadsheet]] [[File:xlsx.png|link=]]<!--ftDownloads-->
−
The information in this wikipage is based on Release 2017 <BR>
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==About this information<!--ftHeader2-->==
−
Conditions for use are located on the mainpage [[Bestand:list2.png|link=HCIM_Mainpage]]<BR>
+
The information in this wikipage is based on<!--ftInfoBase--> Release 2017 <BR>
−
This page is generated on 22/01/2018 11:06:17 <BR>
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Conditions for use are located on the mainpage<!--ftConditions--> [[Bestand:list2.png|link=HCIM_Mainpage<!--wikiMainpage-->]]<BR>
 +
This page is generated on 21/12/2018 14:49:22 with ZibExtraction v. 3.0.6929.24609<!--ftDate--> <BR>
 
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<div style="text-align: right; direction: ltr; margin-left: 1em;" >[[Bestand: Back 16.png| link= HCIM_Release_2017(EN)]] [[HCIM_Release_2017(EN) |Back to HCIM list ]]</div>
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<div style="text-align: right; direction: ltr; margin-left: 1em;" >[[Bestand: Back 16.png| link= HCIM_Release<!--wikiReleasePage-->_2017(EN)]] [[HCIM_Release<!--wikiReleasePage-->_2017(EN) |Back to HCIM list<!--hdBackToMainPage--> ]]</div>

Huidige versie van 24 dec 2018 om 11:04


Attention!! This is not the most recent version of this information model. You can find the most recent version ''here''.

General information

Name: nl.zorg.NursingIntervention NL.png
Version: 3.1
HCIM Status:Final
Release: 2017
Release status: Published
Release date: 31-12-2017

Back 16.png Back to HCIM list

Metadata

DCM::CoderList Werkgroep RadB Verpleegkundige Gegevens
DCM::ContactInformation.Address *
DCM::ContactInformation.Name *
DCM::ContactInformation.Telecom *
DCM::ContentAuthorList Werkgroep RadB Verpleegkundige Gegevens
DCM::CreationDate 7-7-2014
DCM::DeprecatedDate
DCM::DescriptionLanguage nl
DCM::EndorsingAuthority.Address
DCM::EndorsingAuthority.Name PM
DCM::EndorsingAuthority.Telecom
DCM::Id 2.16.840.1.113883.2.4.3.11.60.40.3.14.2
DCM::KeywordList Interventie, verpleegkundige actie
DCM::LifecycleStatus Final
DCM::ModelerList Werkgroep RadB Verpleegkundige Gegevens
DCM::Name nl.zorg.VerpleegkundigeInterventie
DCM::PublicationDate 31-12-2017
DCM::PublicationStatus Published
DCM::ReviewerList Projectgroep RadB Verpleegkundige Gegevens & Kerngroep Registratie aan de Bron
DCM::RevisionDate 31-12-2017
DCM::Superseeds nl.zorg.VerpleegkundigeInterventie-v3.0
DCM::Version 3.1
HCIM::PublicationLanguage EN

Revision History

Only available in Dutch

Publicatieversie 1.0 (01-07-2015)

Publicatieversie 3.0 (01-05-2016)

Publicatieversie 3.1 (04-09-2017)

ZIB-542 Verwijderen verwijzingen naar codesystemen ICF, Omaha System, NANDA,,NIC en NOC

Concept

A nursing intervention is the care and/or treatment carried out by a nurse based on an expert opinion and clinical knowledge. It is part of the nursing process; interventions are determined as a result of indexed healthcare problems (nursing diagnoses) and based on treatment goals. The interventions are outlined in the nursing procedures.
In a home care situation some actions can also be performed by the patient or a caregiver after a relevant instruction

Purpose

The nursing interventions are an essential part of the nursing process. A nursing intervention is recorded to document the nursing policy and to update other health professionals on the intervention. The documentation of nursing interventions offers the option to determine whether the interventions outlined in the treatment plan have been carried out. This way, we can facilitate optimal nursing and continuity of care.

Information Model


#InterventionSnomedCodelistPatient-v3.1(2017EN)ContactPerson-v3.1(2017EN)#12363#12366TreatmentObjective-v3.1(2017EN)MedicalDevice-v3.1(2017EN)#12358#12365#12361#12354#12370HealthProfessional-v3.2(2017EN)Problem-v4.1(2017EN)#12357#12359#12356HealthProfessional-v3.2(2017EN)#12371#InterventionNICCodelistNursingIntervention-v3.1Model(2017EN).png


Type Id Concept Card. Definition DefinitionCode Reference
Block.png NL-CM:14.2.1 Arrowdown.pngNursingIntervention Root concept of the NursingIntervention information model. This root concept contains all data elements of the NursingIntervention information model.
CD.png NL-CM:14.2.2 Arrowright.pngIntervention 1 A nursing intervention is a treatment carried out by a nurse based on an expert opinion and clinical knowledge for the benefit of the person requesting healthcare. The intervention is targeted towards a certain problem (diagnosis) and has a predetermined healthcare result.
List2.png InterventionNICCodelist
List2.png InterventionSnomedCodelist
Verwijzing.png NL-CM:14.2.6 Arrowright.pngIndication::Problem 0..1 The nursing-related problem (indication) providing cause for the intervention.
Block.png Problem
Verwijzing.png NL-CM:14.2.14 Arrowright.pngTreatmentObjective 0..1 The description of the treatment goal that the intervention decision is based on.
Block.png TreatmentObjective
Folder.png NL-CM:14.2.9 Arrowdown.pngNursingProcedure 1..* Container of the NursingProcedure concept. This container contains all data elements of the NursingProcedure concept.
9632001 Nursing procedure
PQ.png NL-CM:14.2.3 Arrowright.pngInterval 0..1 Interval indicates the time between planned procedures.

When entering an interval, the focus is on the time between the consecutive procedures, such as in the treatment of a wound, for example. The exact times are of lesser importance.

PQ.png NL-CM:14.2.4 Arrowright.pngFrequency 0..1 The frequency describes how often and in which period certain procedures are carried out, e.g. 3x a day.
ST.png NL-CM:14.2.10 Arrowright.pngActivity 1 The description of nursing procedures carried out in the care for a patient. A nursing intervention consists of a set of patient-related nursing procedures.
TS.png NL-CM:14.2.11 Arrowright.pngProcedureStartDateTime 0..1 The start date (and if possible start time) of the procedure. The concept offers the option to indicate the start of the period of a series of repeating procedures.
TS.png NL-CM:14.2.12 Arrowright.pngProcedureEndDateTime 0..1 The end date (and if possible end time) of the procedure. The concept offers the option to indicate the end of the period of a series of repeating procedures.
Verwijzing.png NL-CM:14.2.13 Arrowright.pngMedicalDevice 0..* Description of the materials used for the nursing procedure, such as bandages.
Block.png MedicalDevice
ST.png NL-CM:14.2.18 Arrowright.pngInstruction 0..1 Instructions for performing the nursing action. This is particularly at issue when the action is performed by the patient himself or by a caregiver.
Folder.png NL-CM:14.2.15 Arrowdown.pngPerformer 0..1 The person carrying out the nursing procedure.
Verwijzing.png NL-CM:14.2.7 Arrowright.pngHealthcareProvider (0..1) The health professional carrying out the nursing procedure.
Block.png HealthProfessional
Verwijzing.png NL-CM:14.2.16 Arrowright.pngCaregiver::ContactPerson (0..1) The caregiver carrying out the nursing procedure.
Block.png ContactPerson
Verwijzing.png NL-CM:14.2.17 Arrowright.pngPatient (0..1) The patient carrying out the nursing procedure.
Block.png Patient
Verwijzing.png NL-CM:14.2.8 Arrowright.pngRequester::HealthProfessional 0..* The health professional who requested the nursing intervention. If desired, only the requester’s specialty can be entered.
Block.png HealthProfessional
ST.png NL-CM:14.2.5 Arrowright.pngComment 0..1 Comment on the nursing intervention.
48767-8 Annotation comment

Columns Concept and DefinitionCode: hover over the values for more information
For explanation of the symbols, please see the legend page List2.png

Example Instances

Only available in Dutch

VerpleegkundigeInterventie
Interventie Pijnmanagement
Indicatie
ProbleemNaam Pijn
Behandeldoel
Streefwaarde
MetingNaam Pijnscore
UitslagWaarde <4
UitslagDatumTijd 10-09-2015
VerpleegkundigeActie
Activiteit Ondersteuning van de wond bij hoesten.
ActieStartDatumTijd 10-08-2015
ActieEindDatumTijd 15-08-2015
VerpleegkundigeActie
Activiteit Toedienen medicatie volgens voorschrift bij pijnscore > 4.
ActieStartDatumTijd 10-08-2015
Toelichting -

References

1. Richtlijn Verpleegkundige en verzorgende verslaglegging (V&VN, 2011) [Online] Beschikbaar op:http://www.diliguide.nl/document/4060/file/pdf/ [Geraadpleegd: 13 februari 2015]

2. Vreeke E, Klein Wolterink G. Classificatie- en terminologiestelsels voor verpleegkundige informatie. Nictiz & NFU (2014). [Geraadpleegd: 13 februari 2015]

3. The Omaha System [Online] Beschikbaar op:http://www.omahasystem.org/ [Geraadpleegd: 13 februari 2015]

4. Nursing Intervention Classification (NIC) [Online] Beschikbaar op:http://www.nursing.uiowa.edu/center-for-nursing-classification-and-clinical-effectiveness [Geraadpleegd: 13 februari 2015]

5. Nursing Outcome Classification (NOC) [Online] Beschikbaar op:http://www.nursing.uiowa.edu/center-for-nursing-classification-and-clinical-effectiveness [Geraadpleegd: 13 februari 2015]

6. North American Nursing Diagnosis Association (NANDA) [Online] Beschikbaar op:http://www.nanda.org/ [Geraadpleegd: 13 februari 2015]

7. International Classification for Nursing Practice (ICNP) [Online] Beschikbaar op:www.icn.ch[Geraadpleegd: 13 februari 2015]

8. International Classification of Functioning, Disability and Health (ICF) [Online] Beschikbaar op:http://www.rivm.nl/who-fic/icf.htm [Geraadpleegd: 13 februari 2015]

Valuesets

InterventionNICCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.14.2.2 Binding:
Conceptname Codesystem name Codesystem OID
Alle waarden NIC 2.16.840.1.113883.6.15

InterventionSnomedCodelist

Valueset OID: 2.16.840.1.113883.2.4.3.11.60.40.2.14.2.4 Binding:
Conceptname Codesystem name Codesystem OID
SNOMED CT: <<71388002|procedure| SNOMED CT 2.16.840.1.113883.6.96

This information model in other releases

Information model references

This information model refers to

This information model is used in

Technical specifications in HL7v3 CDA and HL7 FHIR

To exchange information based on health and care information models, additional, more technical specifications are required.
Not every environment can handle the same technical specifications. For this reason, there are several types of technical specifications:

  • HL7® version 3 CDA compatible specifications, available through the Nictiz ART-DECOR® environment Artdecor.jpg
  • HL7® FHIR® compatible specifications, available through the Nictiz environment on the Simplifier FHIR Fhir.png

Downloads

This information model is also available as pdf file PDF.png or as spreadsheet Xlsx.png

About this information

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