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DOI: 10.1055/s-0041-1728706
Representation of Diagnosis and Nursing Interventions in OpenEHR Archetypes
Funding M.R.C. reports grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico, Brazil during the conduct of the study. D.C.G. reports grants from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Capes) (financing code 001) during the conduct of the study.Abstract
Objective The study aimed to represent the content of nursing diagnosis and interventions in the openEHR standard.
Methods This is a developmental study with the models developed according to ISO 18104: 2014. The Ocean Archetype Editor tool from the openEHR Foundation was used.
Results Two archetypes were created; one to represent the nursing diagnosis concept and the other the nursing intervention concept. Existing archetypes available in the Clinical Knowledge Manager were reused in modeling.
Conclusion The representation of nursing diagnosis and interventions based on the openEHR standard contributes to representing nursing care phenomena and needs in health information systems.
Keywords
nursing informatics - health information interoperability - standardized nursing terminology - nursing notes - patient recordsProtection of Human and Animal Subjects
None.
Publikationsverlauf
Eingereicht: 02. Dezember 2020
Angenommen: 09. März 2021
Artikel online veröffentlicht:
14. April 2021
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