Providing evidence-based knowledge on nursing interventions at the point of care: findings from a mapping project

In healthcare there is a call to provide cost-efficient and safe care. This can be achieved through evidence-based practice (EBP), defined as the use of evidence from research, context, patient preferences, and clinical expertise. However, the contemporary and process-integrated supply of evidence-based knowledge at the point of care is a major challenge. An integrative knowledge management system supporting practicing clinical nurses in their daily work providing evidence-based knowledge at the point of care is required. The aim of this study was (1) to map standardized and structured nursing interventions classification and evidence on a knowledge platform to support evidence-based knowledge at the point of care, and (2) to explore the challenge of achieving interoperability between the source terminology of the nursing interventions classification (LEP Nursing 3) and the target format of the evidence provided on the knowledge platform (FIT-Nursing Care).

In an iterative three-round mapping process, three raters, nurses with clinical and nursing informatics or EBP experience, matched nursing interventions from the LEP Nursing 3 classification and evidence provided from Cochrane Reviews summarized on FIT-Nursing Care as so-called study synopses. We used a logical mapping method. We analysed the feasibility using thematic analysis.

In the third and final mapping round, a total of 47.01% (252 of 536) of nursing interventions from LEP Nursing 3 were mapped to 92.31% (300 of 325) of synopses from FIT-Nursing Care. The interrater reliability of 77.52% suggests good agreement. The experience from the whole mapping process provides important findings: (1) different content orientations-because both systems pursue different purposes (content validity), (2) content granularity-differences regarding the structure and the level of detail in both systems, and (3) operationalization of knowledge.

Mapping of research evidence to nursing classification seems feasible; however, three specific challenges were identified: different content orientation; content granularity; and operationalization of knowledge. The next step for this integrative knowledge management system will now be testing at the point of care.