“To better understand a work is recommende n possible information about e l author and his / her context .”

Note : The text reproduced below was published as an annex to the author’s doctoral thesis in 2012.

” The reasons that led the author to the construction of the terminology of interface ATIC has been spelled out along the different sections of this thesis; reasons that have evolved over time, scientific and disciplinary advances but also with the researcher’s own personal and professional history. In this sense, there are different events that significantly influenced the development of this work.

Shortly after that Don Joan Antoni Samaranch uttered the words that open this Annex, started to pursue university studies of then Diploma in Nursing at the University School of Nursing ” Princeps d’Espanya ” attached to the University of Barcelona (1987) . Among other magnificent teachers, nurses, and doctors , who taught theory classes and guided practical learning at this school, I was fortunate to learn from a young but experienced nurse, María Teresa Luis Rodrigo. I think I remember that it was towards the end of the second year that Maite suggested that I collaborate with her in a project, an initiative of the Manresa University School of Nursing , to translate a classification of nursing diagnoses : NANDA Taxonomy I. The document, whose main author is María Teresa Luis, entitled ” NANDA Diagnostics d’ infermeria : according to the revised taxonomy I-1989″, was the first translation in the Spanish state of the North American Nursing Diagnosis Association works .

I remember doing the translation work in my room , in our family home, with a “huge” computer that one of my uncles (Jordi Udina ) had given me , using a program called Word Star and with a floppy disk filing system that no longer exists. It was my first work done entirely on a computer (until then the works used to be presented by hand or typewritten).

At that time, already he knew the work of this association because Maite and some other teachers explained to us in class the meaning and use of the methodology nurse by application of the process of care in nursing and because fortunately, during my childhood and adolescence my parents They insisted on the need to be fluent in English , which I learned with one of my aunts ( Maria Cinta Comas) and by listening carefully and interpreting the songs of Frank Sinatra, Ella Fitzerald , Billie Holiday or Tina Turner. All of this allowed me to locate and consult some British and American nursing books during university studies , such as Nancy Holloway’s works on standardized care plans , which already contained NANDA diagnoses and differentiated them from interdependent problems.

For several years working and as a staff nurse, I was a member (partner) of NANDA, study in depth the content of diagnostic , aspects related to its application within the framework of the process of care in nursing and attended to multiple courses organized by the Spanish Association of Teaching Nursing (AEED) and taught in Barcelona and Madrid by important scholars such as Rosalinda Alfaro or Linda Juall Carpenito .

At that time I was working as a nurse in clinical hematology at the Duran i Reynals Hospital that depended on the Ciutat Sanitaria i Univeristaria de Bellvitge and in 1992, I had the opportunity to train for a few months at the Royal Marsden Hospital in Sutton (Surrey, UK) to expand my knowledge about the provision of care to patients who needed a transplant of marrow marrow . Direct contact with reality and the weight of the history of English Nursing impressed me pleasantly. I was impressed not only by the professionalism of the nurses and their discipline, but above all by their outstanding role in the community, the real social recognition they had and the responsibility with which they wielded their power. It was there that she fully understood the influence of Florence Nightingale on the scientific and professional development of Nursing in Anglo – Saxon countries and the difference that this marked in the social conception of our discipline, as well as the divergence, in the form and the content, of the nursing competence areas for the provision of latent care in our country , in whose history forty years of dictatorial regime weighed , a strong Catholic and military tradition that permeated the way of learning and practicing health disciplines and the weight of too many years of nursing training programs as Sanitary Technical Assistants . More than twenty years later I believe that the distance has not been reduced as I expected.

In the “ Marsden ” I subscribed to several North American oncology nursing magazines , I loaded my bags back home with countless books on cancer patient care but also other works on chronic patient care and other topics in vogue. today in our country , which I devoured in the following months and which I have kept as reference books for many years for my professional activity. In the ” Marsden ” I observed attentively, not only procedures and attitudes towards patients but above all, the way in which they took care of words in their oral and written expression . In this hospital, nurses records were very complete and it caught my attention not to use the taxonomy diagnoses of NANDA. It was there that he discovered the strong position of English nurses in relation to a vocabulary that in his critical opinion did not suit their registration needs at all, which was subsequently the reason for various publications in journals such as the Journal of Advanced Nursing . This fact made me reflect on something that I had already observed in the healthcare practice in the hospitals where I had worked in Barcelona: the “veteran” nurses (many of whom deserve the name of pro-efficient and expert nurses ), who were my Teachers and they accompanied me in the first years of my incorporation to clinical practice , they objected that the diagnoses of the NANDA taxonomy did not allow to really identify many of the situations that hospitalized patients lived . The history of the dichotomization of the debate on diagnoses and the opposing positions in the application and usefulness of the nursing methodology in our country is known; the results to this day are evident.

For a few years more Segui working as a clinical nurse and clinic . I tried to incorporate aspects of methodology and language, I published a couple of articles in the journal Nursing Clinic oriented to the field of care for onco – hematological patients in which I used concepts from the NANDA taxonomy and Marjory Gordon’s functional health patterns , and in 1996 I published a book on the care of oncohematological patients in which I included elements of the terminology , but continued to show a lack of connection between the academic world and healthcare practice . I felt that perhaps the problem was not only method and language, but above all in the socialization processes that surrounded him, and I understood that he should begin to do several things: establish strategies to promote a progressive rapprochement between the nurses’ natural language and language. discipline, learning methodology of research , further progress in developing the study of theoretical and optimize my skills in the use of systems information .

As initial strategies for approach, I observed for months how the nurses with whom I worked or maintained contact on various issues presented and expressed their reasoning and I identified that the natural language with which they expressed themselves in practice included an infinity of verbs, especially in first and third person singular in all verb tenses, with a surprisingly intensive use of the imperative mood to identify what they did , what they should indicate and what they observed in the patients (“ How are you feeling today?”, “I’m going to talk with … “,” I must prepare … “,” he was not moving “,” he is crying “,” for the pump “,” suspend the administration “,” call the doctor “,” look at the dressing “) and also on occasions, with forms that in a certain way “ alienated ” the patient or abducted him into the nurse-patient dyad (“let’s calm down”, “for now we shouldn’t worry”, “we’ll start with a drug that ….” , “We have s the intervention has been suspended ”). I think that some professionals understand this type of speech as a form of empathy , proximity or complicity with the patient. Personally, I have always tried to make very limited use of this resource. In any case, this observation coincided with a very generalized traditional idea “nurses DO things”, which was reflected in the old saying of popular ideology “nurses are the doctor’s hands “, as if thought and reasoning were a medical domain and the solicitous execution , the reason for being a nurse. I understand that this phrase is part of the historical influence that Medicine has exerted on nursing practice but I always rebelled against it, because one cannot do without observing, thinking and making decisions, cogito ergo sum, but to her I owe my interest and my subsequent studies on the relationship between nursing professional autonomy , decision-making and nursing competence and also , the opportunity to discover the work of Patricia Benner on nursing competence and of the brothers Hubert and Stuard Dreyfus , on decision- making. decisions, skill acquisition and artificial intelligence.

Nursing natural language also contains an infinity of conditions, conditional verbs and doubtful adverbs (“probably”, “it is possible”, “if everything goes well”, “if it does not improve”, ” should “), almost always related to management of the uncertainty characteristic of situations of illness, change or transition in vital situations, also as a way of showing respect to the person with conventions such as “ could you raise your arm a little more ” or “would you mind holding this sheet for a moment ” and at least as a reflection of the professional’s indecision in the face of a new situation that generates insecurity.

Nursing natural language is rich in adjectives (” pale “, “sad”, “moderate”, “extensive”, “serous”, “localized”, “passive”, “stable”, “inactive”, “clear”, ” solitary ”), which contribute to enrich the descriptions of the observations and findings, being in most cases a subjective interpretation but of great clinical value , and also abound in adverbs (“ extremely intense ”,“ progressively decreasing ”,“ near of the area ”,“ during the night ”), which allow adding circumstantial information in its natural or superlative way and facilitate the evaluation of the evolution of the patients’ situation and the determination of the achievement of expected results.

The lexical elements , verbs, adjectives, pronouns, adverbs are used in an extremely common way, but what about nouns? … Over the years , I realized that the naming of nursing phenomena had been one of the main reasons for the disciplinary theoretical development of recent decades , initially linked to the attempt to build the identity and professional autonomy of the nurse and differentiate it from medicine . Language is one of the cornerstones on which the social construction of a discipline is based and not only has the practical effect of facilitating the identification of phenomena and interprofessional communication , but it also has important connotations at an ethical , political and economic level. ; It is a double-edged sword since it is the formal representation of knowledge and, at the other extreme, its ignorance places the individual (or the group) in ignorance. But in addition , disciplinary language has the socio – political function of presenting what is important, what is ethically correct in practice and consequently, of making visible what one is and does.

For years , different sectors of nursing have fiercely advocated avoiding the use of medical concepts in nursing language. Professionally and personally I have never shared this opinion . The history of modern medicine contemporanea has been nurtured and greatly enriched concepts from other branches of knowledge such as chemistry , the mathematics , the economy , law, biology , the physical or psychology and this has not subtracted any value On the contrary, it has allowed it to grow and advance enormously. If nurses can, and as Nightingale asserted, “we must” incorporate statistical knowledge and language , why should n’t we be able to incorporate (or recover) aspects of medical language , as part that contributes to developing our knowledge? The phenomena themselves are not the exclusive property of any discipline; They are human or environmental elements and each discipline focuses on them, studies them and develops them from its perspective and with its methods , in some cases sharing the name , in others attributing a specific term . Or is it that we nurses do not use terms and concepts from mathematics or physics , when regulating an intravenous infusion , from chemistry , when considering the prescription of the most appropriate diet for the patient’s situation , or from philosophy , sociology and theology when we help a sick person to express his spiritual suffering?

One of the first things I learned about nursing diagnoses , which was also clearly stated in the works on the subject, is that the nursing diagnosis should not be used to describe or attempt to substitute a medical diagnosis . The nursing literature of recent years is full of examples of an incorrect use of the nursing diagnosis in this sense. One will never replace the other. There are two complementary judgments, one aimed at the precise identification of the disease from the field of medical knowledge , the other aimed at determining the different health states and their consequences from the wealth of nursing knowledge. And it is from this symmetry of both knowledge, despite the historical disadvantages of nursing , that the people we intend to help, one and the other, can really benefit in terms of health outcomes and autonomy . I do not share the warlike positions of some doctors and nurses. There are many lexical elements that Medicine offers to human knowledge and also many concepts that Nursing has developed and contribute to the growth of other disciplines, see if not, for example, the current language used by social workers; The jargon of social and health well-being is full of constructs that the nursing discipline generated almost a century ago: autonomy , self-care, responsibility for the health and well-being of people and the community are constructs that already appear in the works of Bertha Harmer from 1922 Likewise, the origin of some of these concepts is previously linked to other humanistic disciplines such as philosophy , ethics or law.

The observation of nursing natural language and the study of controlled vocabularies were, for years , the sources of inspiration for many works that I carried out and that contributed to progressively introduce small changes in the nursing records and in interprofessional communication and that finally, would allow the creation of this approximation language . Not become aware of its potential as terminology of interface until some time later , when the then director of nursing of Ciutat Sanitaria i Universitaria de Bellvitge (Montserrat Artigas) proposed me to work in the ” Computerization of care plans”. I must admit that the various failures to help develop and implement a system of information nurse based care plans between the years 1997 and 2001 and incomprehension that perceived in the value of developing and assign the use of this vocabulary, front to the hegemony of the doctrine of the American nursing vocabularies, they slowed down their progress. Sometimes I thought that only Montse Artigas and few people more understand what he was trying to do and where the boundary between my work was placed in the hospital for the elaboration of plans of care and my personal work, developing and bringing this vocabulary. A part of the ATIC terminology was used as the basis for the data model of that project to computerize care plans, first linked to an application prototype developed by the company Andersen Consulting ; after the development of an application computer science by the company Centrisa and finally, between 1998 and 2001, the expansion of software history clinical OMI-AH of the company STACKS-CIS, for the incorporation of nursing care. The structure of this data model, based on complexity theory , was published in the Spanish edition of Nursing in 2005. A short time later, I would have the opportunity to assign the use of ATIC terminology for the development of the ARES program for harmonization of standards. of care and the project to computerize the clinical history of the Institut Catala ̀ de la Salut hospitals , as mentioned in other sections of this thesis.

Mainly There were two doctors that I taught during the years 90, the methods of investigation quantitative and there were two nurses who introduced me in 2003 in the research qualitative. Subsequently, I was expanding my methodological training with the exercise of different research projects , publications and the completion of an official master’s degree to doctoral studies. Largely, it was this training in methodology of research which I allowed to advance the development of terminology by using formal procedures of search bibliografica , techniques of analysis of concepts or methods of systematization .

My work as a primary care nurse and manager in recent years , as well as my own personal life story, has allowed me to dedicate a limited but constant time to this terminology development project , for this reason this process of evaluating its validity sees the light before the publication of the essay itself on the construction and content of ATIC terminology . “

Since the publication of this text, a decade has passed in which I have continued with terminological developments , I have introduced novelties in all axes, I have strengthened the system of indicators and the data exploitation model for the management of care provision and I have carried out multiple research works, introducing a new classification of diagnostic typologies , the development of new ontologies to further facilitate the use of language in practice and the circular and iterative representation of the care provision process , the development of algorithms of screening and early detection of complications and validation of a patient classification system according to the intensity of nursing care required based on the main nursing diagnosis .