Page 91 - Encyclopedia of Nursing Research

58 n CLInICAL DECISIon MAKInG

the lowest level of the framework and pro- action. This coding structure facilitates the
vides the codes for expected outcomes (goal design of clinical care pathways as well as
C of care) and actual outcomes (goal resolu- other plans of care applications.
tion); for example, Expected outcome (Goal) The CCC System has been implemented
to Improve Activity Alteration (A01.0.1), by numerous HIT vendor systems: Siemens
whereas Actual outcome Activity Alteration Medical Solutions integrated the CCC into
Stabilized (A01.0.2). Sorian©, which is distributed around the
The CCC of nursing Interventions and world. It has also been implemented in hospi-
Actions is the terminology used to docu- tals, for example, Rush Presbyterian Hospital
ment the “essence of nursing care” deter- (Chicago, IL), Southeast Hospitals Group
mined to treat the diagnosis, problem, or (Fall River, MA), orton Hospital (Helsinki,
condition. The definition of a nursing inter- Finland), Kupio Hospital (Kupoi, Finland),
vention is “A single nursing action designed Hospital Corporation of America (HCA), and
to achieve an outcome for a nursing or medi- numerous others. Further, it is translated into
cal diagnosis for which the nurse is account- Dutch, Portuguese, Spanish, Finnish, Korean,
able” (Saba, 2007, p. 328). An example of CCC Turkish, and so forth.
nursing Intervention is Cast Care (A02.1). In summary, the CCC System version
Each nursing interventions is always mod- 2.1 documents nursing practice follow-
ified by one of four Action qualifiers: (1) ing the nursing process. It is being used
assess/monitor, (2) perform/care, (3) teach/ in nursing research for the design of deci-
instruct, or (4) manager/refer. The quali- sion support systems, in nursing education
fier digit also represents the lowest level of by incorporating it in PDAs for electronic
the framework, which expands the nursing documentation, and as a simulated system
intervention, service, activity, and so forth, using a PC to enhance the learning of the
and provides the codes for the four action nursing process. The CCC System validates
types. Examples of intervention actions are the documentation of nursing practice
as follows: assess cast care (A02.1.1), perform makes nursing visible, provides the data for
cast care (A02.1.2), teach cast care (A02.1.3), the “essence of nursing” care, and contrib-
and manage cast care (A02.1.4). The four utes to patient care while advancing nurs-
codes make the intervention action data eas- ing science.
ier to process, retrieve, and analyze; that is,
the four intervention actions require differ- Virginia K. Saba
ent services, skills, and time, making it pos-
sible to measure outcomes, determine cost,
workload, and resources.
The CCC System coding structure is CliniCal deCision Making
based on the structure of the International
Classification of Diseases and Health Related
Problems, Tenth Revision (Who, 1992). Each Clinical decision making is a process that
diagnostic and intervention concept is involves the interaction among the knowl-
assigned a unique five alphanumeric charac- edge of preexisting pathological conditions,
ter code: first position, an alphabetic charac- patient data, clinical experience, and judg-
ter for the care component; second and third ment (Banning, 2008). Clinical decision-
positions, a two-digit code for a core data ele- making ability is defined as the ability by
ment (major category) followed by a decimal which a clinician identifies, prioritizes, estab-
point; fourth position, a one-digit code for a lishes plans, and evaluates data. Decision
subcategory (if needed); and fifth position, making is central to professional nursing
a one-digit code for a qualifier outcome or and has vital links to patient care outcomes