The C-HOBIC builds on and expands the original Ontario initiative. While the project sponsor, CNA, has a particular interest in a national clinical terminology standard to meet the needs of nursing practice, its overriding interest is in integration of clinical information from all healthcare providers to obtain the best information suitable for influencing patient outcomes. The CNA envisions standardized nursing assessment information collected in all provinces that is included in provincial EHRs, along with associated outcome information. illustrates the relationship between the nursing process and C-HOBIC collection of assessment and outcomes data.
Relationship between C-HOBIC and the nursing process.
indicates how the 38 elements comprising the C-HOBIC dataset are used to address the eight outcomes. As shown in , twenty-six of the C-HOBIC data elements for seven of the outcomes are collected in all four sectors of the health system (Acute Care, Complex Continuing Care, Long Term Care, and Home Care), while other elements pertain only in a more precise form to particular sectors. Therefore, in some sectors, only the more precise form of the element is captured.
Table 1 C-HOBIC Assessment Data Elements for Seven Outcomes (All Sectors)
In addition, as shown in , another twelve data elements related to the eighth Outcome, Readiness for Discharge (Therapeutic Self-Care), are only gathered when patients are being assessed for discharge from Acute Care or Home Care.
Table 2 C-HOBIC Data Elements Related to the Readiness For Discharge (Therapeutic Self-Care) Outcome (two sectors only)
C-HOBIC: Mapping to ICNP®
The International Classification for Nursing Practice® is endorsed by CNA for documentation of nursing practice in Canada. 9
As part of the C-HOBIC project, the concepts originally identified in Ontario were mapped to ICNP®. Specific details of the mapping process have been previously published in a complete report; 10
only the steps and final product are summarized herein. The ICNP®, Version 1.0, provided a standardized clinical terminology suitable for capturing, analyzing and reporting nursing-sensitive patient outcomes across diverse sectors of the health care system. The mapping also addressed the issue of proprietary vendor software by creating a coding set that allowed cross mapping. The C-HOBIC mapping involved creating conceptual and semantic matches between original concepts and specific terms in ICNP® Version 1.0. 11
The mapping process shown in resulted in terms that are uniquely reflective of nursing-sensitive patient outcomes.
The initial stage of the mapping involved analysis of the outcomes concepts identified in the original Ontario work. Each concept underwent review of its definition, conceptual meaning, and measurement scales specific to practice areas, i.e., acute care, complex continuing care, long term care, and home care. Meaning and intent for each concept were carefully preserved throughout to ensure accurate mapping. Similarly, ICNP® Version 1.0 was reviewed, both in content and structure. When a potential match was identified, term comparability was evaluated on the basis of conceptual equivalency, where definitions of both the originating concept and the ICNP® term were matched. Additionally, semantic equivalency was considered, where exact terms were identified as equivalent (i.e., “nausea” was mapped to “nausea”, or “toileting” was mapped to “Ability to Toilet Self”, etc). Where both conceptual and semantic equivalencies were confirmed, a C-HOBIC mapping to the ICNP term was created. Whenever multiple semantic or conceptual equivalencies were identified (i.e., mappings were not unique to a single target term), the C-HOBIC mapping options were recorded and set aside for future discussion and validation. Not all original concepts could be mapped to ICNP® V1.0. The ICN 12
readily affirms that the terminology continues to develop. Mapping challenges presented the opportunity for C-HOBIC to contribute to ongoing development of ICNP® V1.0 by identifying new terms and by generating a discussion of how to combine terms to fully express a concept.
In September 2007, initial mapping results were presented at a Canadian national forum comprised of nurses from academic settings, government ministries, policy institutions and practice environments. The forum also included international ICNP® experts. Forum participants reviewed, discussed, and validated both mapping results and mapping challenges. provides an example of the final mapping results; complete results are available in the previously published report. 10
Table 3 Mapping Results (Example Only): Functional Status (ADL) Terms for Acute Care Domain
At the conclusion of the mapping process, fifty-eight (58) original concepts were identified and validated as matched C-HOBIC terms, 13 of the original concepts were partially mapped and required a new ICNP® term for completion as C-HOBIC matched terms, and twenty-four (24) C-HOBIC terms were identified as suggestions for inclusion as new terms in ICNP®. Proposed new terms were submitted for approval to the ICNP® Project, and a C-HOBIC catalogue of precombined ICNP® terms was requested.