NURSING SPECIAL INTEREST SUBGROUP OBSERVABLES MODELLING Judith Warren

NURSING SPECIAL INTEREST SUBGROUP – OBSERVABLES MODELLING Judith Warren, Susan Matney, Kathryn Hannah

Testing the Observables Model with Nursing Content 2 2013 -10 -06

Nursing Outcomes Indicators Concepts from the Catalog are in Four Categories: § functional status § therapeutic self-care (readiness for discharge) § symptom management (pain, nausea, fatigue, dyspnea) § safety (falls, pressure ulcers)

Process (evaluation done by S. Matney, K. Hannah and J. Warren) § Created a spreadsheet with “Observable” attributes as § § § headers (with definitions) Loaded nursing outcomes, chose six for initial model testing, completed all Mapped using Observables guidance document Met with D. Karlsson in Copenhagen Joined monthly Observable calls Identified patterns or heuristics for outcome observations

Observables Model Example TECHNIQUE WHAT Observation device SCALE UNITS DIRECT SITE PROPERTY TYPE INHERES IN. . . HOW

Fully specifying an Observable § There are 3 elements that define the observable: § Property inheres in realization/location § For each function there is a process § Should we define functions in terms of processes § Is Ability a property type or should we use Function?

Inheres in § Homo sapiens (organism) 362077003

Function observables Functions have processes as realizations E. g. ability to walk has realization walking Do we need both functions and processes? ‘Towards’ is a realization What axis do the values come from Observable Qualifiers

Technique § Use Observation in the broadest possible meaning as Technique § Classes that specify some aspect of the observation procedure, such as scale, units, technique, site, or informer

Informer § Leave blank if we want users to post-coordinate § Specify if we want to limit who can inform § Patient § Caregiver § Patient and/or caregiver § Responsible Person

Bathing Observable entity and specified. By some (Patient status observation and observes some (Quality/Realizable and property. Type Function/Ability inheres. In Homo sapiens/Person and has. Realization some Bathing ) )

Recognition of changes in your body (symptoms) related to your illness § Observable: Ability to recognize symptoms (700485008) § Property type: observable (observable entity) § § § (363884002) Inhere in Location: Homo sapiens (organism) 362077003 Process duration: current (qualifier value) Towards: Knowledge 371733000 Technique: evaluation procedure (procedure) 386053000 Informer: Patient Scale type: ORD

Able to adjust your regular activities when you experience body changes (symptoms) related to your illness § Observable: Ability to self manage symptoms (700484007) § Property type: Health related behavior (228272008) § Inheres in location: Homo sapiens (organism) 362077003 § Process duration: current (qualifier value) § Towards: Knowledge 371733000 § Techniques: evaluation procedure (procedure) 386053000 § Informer: Patient § Scale type: ORD

Walk in Room § § § § § Observable: ability to walk in room Property type: Ability to perform a function/activity Inheres in location: Homo sapiens (organism) 362077003 Process duration: current (qualifier value) Towards: Technique: Mobility 363803005 Techniques: patient status observation (procedure) 103705002 Informer: Subject of record or other provider of history (ID 419358007) Scale type: ORD Result values: Dependent, Independent, Requires Assist….

Understand purpose of the medication § § § § Observable: Ability to verbalize understanding| 418907009| Property type: Knowledge (new concept) Inheres in location: Homo sapiens (organism) 362077003 Process duration: current (qualifier value) Towards: knowledge level (observable entity) 371733000 Technique: evaluation procedure (procedure) 386053000 Informer: Subject of record or other provider of history (ID 419358007) Scale type: ORD

Pain Intensity § Observable: Pain Intensity 406127006 § Property type: Perception § Inheres in location: Homo sapiens (organism) 337915000 § Process duration: current (qualifier value) § Towards: Pain ? ? Or comfort § Technique: evaluation procedure (procedure) 386053000 § Informer: Patient § Scale type: ORD

Discussion New Properties § Function, Perception, Knowledge § Towards: “. . . used to specify the third element of a relational quality. . . ” Are functions relational qualities? A has realization object property? § Technique § Patient Stated - missing § Patterns § The properties above always inhere in the person (homo sapiens) § Perception and knowledge are always stated by the patient §

Observable for qualities property type inheres in is-about observable entity quality (inherent) location Material entities (inherent) ingredient substances towards Independent continuants relative to substances (rel-to) part of specifiedby observation procedure independent continuants precondition Independent continuants Precondition values observes scale types units techniques direct site informer specified-by ○ observes ⊑ is-about Material entities subjects