by Kathleen A. McCormick, PhD, RN, FAAN, FRCNA, FACMI
and Cheryl B. Jones, PhD, RN

Article originally published Sept. 30, 1998

Introduction

Misinterpretations that arise in every day personal and professional discussions highlight the critical role of vocabulary in communication generally, and in practice specifically. Without the common understanding that comes from vocabulary, these misinterpretations extend to affect care delivery, practice patterns, role differentiation, and, ultimately, patient and organizational outcomes, including quality and costs of care. Communicating information is necessary to objectively make health care decisions, yet information is useless without vocabulary.

The health care industry has a dearth of data upon which to base decisions. In fact, O'Connor (1998) cites "bad data" as the primary reason those decreased health expenditures cannot be attributed to managed care: existing data do not allow that linkage to be fully explored. Further, "bad data" may be one of the reasons that health care expenditures are expected to rise in the future: the costs of data collection and health information system development or redesign can be prohibitive if both direct and indirect costs are considered, and the burden of those costs likely will be passed on to individuals, communities, and society.

Data for making health care decisions are deficient, not simply because of an insufficient amount of data, but because of an insufficient amount of the right type of data. Existing data consists of large amounts of claims data, some administrative and clinical data, and minimal outcomes, quality, and comprehensive cost data. Healthcare environments are creating large databases and repositories, but various healthcare groups are struggling to collect data and build a case for support to collect data that document the contributions of different skill levels and types of healthcare professionals and nonprofessionals. Jacox (1992) addressed the relevance of this issue for nursing, and noted that databases are needed to clearly distinguish care delivered by individual and/or groups of nurses.

In the quest to gather data related to nursing, vocabulary is essential to communicate information and guide data collection. However, there is general disagreement about what the vocabulary should be or how the vocabulary or vocabularies should be developed. This paper will propose those multiple levels of nursing vocabulary, classifications, and taxonomies that will be needed in the future. A model will be presented to demonstrate that multiple vocabularies, classifications and taxonomies are needed, convergence is necessary at a certain level, and that a unicode or unified taxonomy is required if global, international, worldwide, or universal comparisons of nursing care are to be made. Given that knowledge development begets debate, this paper aims to provoke such discourse. Key terms relevant to this discussion are shown in Table 1 (next page).