Nursing Terminologies and Unified Language Unified language systems and nursing terminologies are vital components of healthcare information management. They provide a standardized framework for healthcare professionals, particularly nurses, to document, retrieve, and communicate patient information consistently and accurately. This ensures seamless information exchange across different healthcare settings, enhancing patient care and improving outcomes. In this context, understanding the unified language systems and their application in nursing is essential.
What is a Unified Language System?
A unified language system is a structured network of linked terms that allows the integration of existing sets of machine-readable terms, such as thesauri, classification systems, and nomenclatures, for efficient information retrieval. Unlike a uniform language system, which would require a single common set of terms for multiple purposes, a unified language system leverages the strengths of various existing systems designed for different perspectives and a broad range of purposes. Essentially, it builds on the diversity and richness of multiple terminologies to create a more comprehensive and flexible language system.
In healthcare, two primary unified language systems are relevant to nursing: the Unified Medical Language System (UMLS) and the Unified Nursing Language System (UNLS). These systems are designed to enhance communication, facilitate data exchange, and support clinical decision-making in nursing practice.
Knowledge for UMLS
The Unified Medical Language System (UMLS) is a comprehensive resource developed by the U.S. National Library of Medicine (NLM). The NLM initiated this long-term research and development project in 1986 to build the UMLS using a strategy of successive approximations, gradually achieving the desired capabilities over time. The UMLS aims to facilitate the integration and retrieval of biomedical information from diverse sources, thereby supporting healthcare professionals in clinical practice, research, and education.
The UMLS consists of four key knowledge sources:
- Meta Thesaurus: A database of concepts and terms drawn from various controlled source vocabularies, organized by concept rather than term, enabling the identification of synonymous or related terms across different vocabularies.
- Semantic Network: Provides a consistent categorization of concepts in the Meta Thesaurus, establishing relationships between them.
- SPECIALIST Lexicon: A lexicon of commonly used English and biomedical terms, including their base forms and lexical variants.
- Information Sources Map: Describes the publicly available databases and expert systems, both within and outside the NLM.
These knowledge sources are accessible via the Internet through the UMLS Knowledge Source Server, allowing healthcare professionals to leverage them for various purposes, including patient care, research, and education.
Meta Thesaurus as a Database
The Meta Thesaurus is the core component of the UMLS, serving as a comprehensive database of information on concepts that appear in at least one of the controlled source vocabularies. As of the 1996 version, the Meta Thesaurus included 252,892 concepts and 542,723 concept names drawn from 30 source vocabularies. Some of these vocabularies include:
- Medical Subject Headings (MeSH)
- International Classification of Diseases: Clinical Modification (ICD-CM)
- SNOMED International
In addition to these general medical vocabularies, the Meta Thesaurus includes four systems specifically designed for use by nurses:
- North American Nursing Diagnosis Association (NANDA) Taxonomy 1
- Omaha System
- Georgetown Home Health Care Classification
- Nursing Intervention Classification (NIC)
The Meta Thesaurus is organized by concept, with entries linking alternative names for the same concept (such as synonyms, lexical variants, and translations) from different vocabularies. For example, the terms “shortness of breath,” “breathlessness,” and “dyspnea” share a common concept identifier in the Meta Thesaurus but have different lexical identifiers based on their source vocabulary. This organization enables healthcare professionals to navigate and retrieve information efficiently, regardless of the terminology used in different systems.
Role of UMLS
The UMLS Semantic Network is a crucial component of the UMLS, providing a consistent categorization of concepts represented in the Meta Thesaurus and establishing relationships between them. The 1996 version of the Semantic Network included 135 semantic types, broadly categorized into entities or events. Some semantic types relevant to nursing include:
- Finding
- Individual Behavior
- Therapeutic or Preventive Procedure
- Disease or Syndrome
The Semantic Network defines various types of relationships among concepts, the primary one being the “IS A” relationship. For example, “Pain Management IS A Therapeutic or Preventive Procedure.” Other relationships include temporal (e.g., “Diabetes Mellitus PRECEDES Diabetic Retinopathy”) and causal (e.g., “CMV Retinitis is CAUSED BY cytomegalovirus”).
By providing these categorizations and relationships, the UMLS Semantic Network supports the organization and retrieval of biomedical information, enhancing clinical decision-making and patient care.
Language of Used Terms
The SPECIALIST Lexicon is another key component of the UMLS, comprising a set of commonly used English and biomedical terms. The lexicon includes the base form of each term and its lexical variants, allowing for consistent and accurate documentation of patient information. For example, the lexicon provides variations for terms like “assess,” “assesses,” “assessed,” etc., ensuring that different forms of the same term are recognized and correctly interpreted.
The Information Sources Map within the UMLS describes the publicly available databases of the NLM and selected expert systems and databases from outside the NLM. This map serves as a guide to the vast array of resources available for healthcare professionals, supporting information retrieval and knowledge integration across various domains.
The Unified Nursing Language System (UNLS)
The Unified Nursing Language System (UNLS) is a specialized application of the unified language system concept within the nursing domain. The UNLS is designed to provide a standardized framework for documenting nursing care, ensuring consistent communication among nurses and other healthcare professionals. The American Nurses Association (ANA) Steering Committee on Databases to Support Nursing Practice has endorsed the concept of a unified nursing language system within the structure of the UMLS.
The nursing care elements of the Nursing Minimum Data Set (NMDS) define the data elements of the UNLS, including:
- Nursing Diagnosis: Identifying patient problems or needs.
- Nursing Intervention: Actions taken by nurses to address patient problems.
- Nursing Outcome: The results of nursing interventions.
- Nursing Care Intensity: The amount and complexity of nursing care required by patients.
Currently, the UNLS comprises four nursing systems integrated into the UMLS:
- NANDA Taxonomy 1: A classification system for nursing diagnoses.
- Omaha System: A comprehensive system for describing and documenting nursing care in various settings.
- Georgetown Home Health Care Classification: A system for documenting home healthcare services.
- Nursing Intervention Classification (NIC): A comprehensive classification of nursing interventions.
Research and Development in UNLS
Extensive research is underway to enhance and refine the existing UNLS. Some of the ongoing efforts include:
- Nursing Intervention Lexicon and Taxonomy: Developing a comprehensive lexicon and taxonomy for nursing interventions to standardize documentation and communication.
- Patient Care Data Set: Creating a standardized data set for documenting patient care across various settings.
- Nursing Outcomes Classification (NOC): Developing a comprehensive classification system for nursing outcomes to measure the effectiveness of nursing interventions.
- International Classification of Nursing Practice (ICNP): An international effort to develop a standardized language for nursing practice, enabling consistent documentation and communication across different countries and healthcare systems.
Conclusion
Unified language systems and nursing terminologies play a critical role in modern healthcare, providing a standardized framework for documenting, retrieving, and communicating patient information. The Unified Medical Language System (UMLS) and the Unified Nursing Language System (UNLS) are two key systems that support these efforts, enabling seamless information exchange and enhancing patient care.
By leveraging the strengths of existing terminologies and classification systems, these unified language systems ensure that healthcare professionals can communicate effectively, make informed decisions, and deliver high-quality care to patients. As research and development continue to refine and expand these systems, their role in supporting clinical practice, research, and education will only grow, contributing to better healthcare outcomes worldwide.