Improving the quality of nursing care through standardized nursing languages: Call to action across European countries

Int J Med Inform. 2024 Dec:192:105627. doi: 10.1016/j.ijmedinf.2024.105627. Epub 2024 Sep 19.

Abstract

Background: Standardized Nursing Languages (SNLs) have enabled nursing assessments and care to be better documented and visible in electronic health records (EHRs). However, its implementation is challenging and heterogeneous across clinical settings. This study aimed to demonstrate the challenges experienced by members of a European nursing organization, ACENDIO, in implementing SNLs in documentation systems across countries and offer recommendations about its use.

Material and methods: The study was executed in two phases. First, an online survey was distributed among ACENDIO members. Second, members participated in two expert panels. Discussions were recorded, and thematic analysis was performed to formulate challenges and recommendations on the use of SNLs.

Results: The findings highlight that nurses across Europe are faced with several issues with current documentation systems in clinical settings, limited education on SNLs, and challenges in research on SNLs. Nurses, managers, vendors, educators and researchers should work closely together to face the challenges in the implementation of SNLs in electronic documentation systems.

Conclusion: To fully utilize the beneficial effects of the use of SNLs, the call to action is to develop comprehensive collaborations of nursing practice, education, and research.

Keywords: Electronic health record; Nursing documentation; Standardized nursing languages.

MeSH terms

  • Documentation / standards
  • Electronic Health Records* / standards
  • Europe
  • Humans
  • Nursing Care / standards
  • Quality Improvement
  • Quality of Health Care
  • Standardized Nursing Terminology
  • Surveys and Questionnaires