Development and validation of detailed clinical models for nursing actions in perinatal care

The aim of this study was to develop and evaluate detailed clinical models (DCMs) for nursing actions in perinatal care. We propose the use of action-target dyads as entities in DCMs for nursing actions.

We identified action and target concepts, attributes, and value sets by analyzing nursing documentation and reviewing the wider literature, in addition to published standards and models. We developed the DCMs by linking entities, attributes, and value sets. DCMs were classified by action type based on the Clinical Care Classification, and by target type based on the axes of the International Classification for Nursing Practice (ICNP). Attributes in the DCMs were also classified by ICNP axes. The quality of the DCMs was evaluated by domain experts, and their coverage was evaluated by mapping narrative nursing statements.

Nursing DCMs consisting of 233 entities (dyads comprising 34 action and 212 target concepts), 214 attributes and 541 values were developed. The most frequent action type was hands-on care (43.3%). The focus axis was used most frequently for the targets (51.9%) and attributes (38.8%). The quality scores of the DCMs ranged from 0.80 to 0.96. Most (174/192; 90.6%) of the statements were fully mapped, while 7 (3.7%) were partially mapped and 11 (5.7%) were not mapped. We modified the DCMs in accordance with these results.

In total, 240 DCMs were developed with action-target dyads as entities. The DCMs developed in this study could be implemented in an electronic nursing record system to enhance nursing practices and ensure semantic interoperability of nursing data.