Political dreams, practical boundaries: The case of the nursing minimum data set, 1983-1990

Nursing History Review

Volumn 19, Issue , 2011, Pages 127-155

  Hobbs, Jennifer ^a  

^a VA SAN DIEGO HEALTHCARE SYSTEM   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 78651458365     PISSN: 10628061     EISSN: None     Source Type: Journal    
DOI: 10.1891/1062-8061.19.127     Document Type: Article

References (88)

1. Harriet Werley and Norma Lang, eds., Identification of the Nursing Minimum Data Set (New York: Springer, 1988).
2. Harriet Werley Papers, unprocessed, University of Wisconsin-Milwaukee, Manuscript Collection (hereafter HWP); Norma Lang Papers, unprocessed, University of Wisconsin-Milwaukee, Manuscript Collection (hereafter NLP); Irma Lou Hirsch Papers, Private Collection, Author (hereafter ILH).
3. The nurses involved with the NMDS believed there were many instances where nursing practice needed to be "defended." Distinguishing the difference between nursing care and medical care was particularly important to nurses because of attempts by the American Medical Association to interfere with decisions regarding nursing education and nursing scope of practice.
4. See Julie Fairman, Making Room in the Clinic: Nurse Practitioners and the Evolution of Modern Health Care (New Brunswick, N.J.: Rutgers University Press, 2008).
5. For an in-depth treatment of the economic issues surrounding health care during the twentieth century, see Rosemary Stevens, In Sickness and in Wealth: American Hospitals in the Twentieth Century (Baltimore: Johns Hopkins University Press, 1999).
6. See Nancy Tomes, "Patients or Health-Care Consumers? Why the History of Contested Terms Matters," in History and Health Policy in the United States: Putting the Past Back In, ed. Rosemary Stevens, Charles E. Rosenberg, and Lawton Burns (New Brunswick, N.J.: Rutgers University Press, 2006).
7. See Lawrence Weed, Medical Records, Medical Education, and Patient Care: The Problem-Oriented Record as a Basic Tool (Cleveland: Case Western Reserve University Press, 1969).
8. For a brief overview on nursing care planning (ADPIE), see Virginia Henderson, "On Nursing Care Plans and Their History," Nursing Outlook 21, no. 6 (1973): 378-79.
9. Patricia D'Antonio and Julie Fairman, "Organizing Practice: Nursing, the Medical Model, and Two Case Studies in Historical Time," Canadian Bulletin of Medical History 21, no. 2 (2004): 411-29.
10. In the 1970-1990 nursing literature there was a general sense that if the actions nurses took on behalf of patients were captured, the ability to bill for those services would follow.
11. The APA was designing a data set, PSRO was developing quality screens, and AHA was developing a discharge data set in cooperation with DHHS.
12. Nancy Pearce, Statistician, Office of Program Planning, DHHS, to Harriet Werley, 11 June 1985, HWP.
13. Department of Health and Human Services, Criteria of Minimum Data Sets (Washington, D.C.: Department of Health and Human Services, 1978).
14. Sherrill L. Leifer and Laurie K. Glass, "Planning for Mass Disaster in the 1950s: Harriet Werley and Nursing Research," Nursing Research 57, no. 4 (2008): 237 - 44.
15. Harriet Werley and Norma Lang, Preface, in Werley and Lang, eds., Identification of the Nursing Minimum Data Se, xvii.
16. Norma Lang CV, 1986, NLP. For information about PSRO see Michael J. Goran, The Evolution of the PSRO Hospital Review System (Philadelphia: Lippincott, 1979).
17. Minutes, Local Data Base Group, 19 May, 27 June, 11 July, 25 July, 7 September, 12 October, 17 October, 21 November, 21 December 1983, HWP.
18. Jo Eleanor Elliot, Director, Division of Nursing, DHHS, to Harriet H. Werley, 17 August 1983, HWP; Minutes, Local Data Base Group, 27 June, 7 September 1983, HWP.
19. Minutes, Local Data Base Group, 11 July, 25 July, 17 October 1983, HWP.
20. Minutes, Local Data Base Group, 11 July 1983, HWP.
21. Minutes, Local Data Base Group, 17 October 1983, HWP.
22. Minutes, Local Data Base Group, 25 April 1985, HWP.
23. Portions of the nursing workforce were by this time (1985) recognized independently within health care organizations inasmuch as they were able to bill and generate revenue. These workers were NPs.
24. Minutes, Local Data Base Group, 19 January 1984, HWP. Paper authors were not identified consistently in the archive material reviewed.
25. Draft, Minimum Variables in Cost Effectiveness of the NMDS, 1984, HWP.
26. Draft, Minimum Variables in Costing Out Nursing Care, 1984, HWP.
27. Minutes, Local Data Base Group, 19 January 1984, HWP.
28. Minutes, Local Data Base Group, 19 May, 27 June, 11 July, 25 July 1983, HWP.
29. Minutes, Local Data Base Group, 7 September 1983, HWP.
30. According to the information Werley had, the APA database was abandoned because of lack of funding for provider-specific data sets. However, it was probably because the APA was in the midst of a revision of the Diagnostic Statistical Manual. This was one of the more controversial revisions and took a great deal of the organization's resources.
31. See Stuart Kirk and Herb Kutchins, The Selling of the DSM: The Rhetoric of Science in Psychiatry (New York: Aldine de Gruyter, 1992).
32. Werley's information was obtained from Minutes, Local Data Base Group, 21 November 1983, HWP.
33. Minutes, Local Data Base Group, 21 November 1983, HWP.
34. Minutes, Local Data Base Group, 19 January 1984, HWP.
35. Stevens, In Sickness and in Wealth.
36. Elements in the public data set include International Classification of Diseases, Ninth Revision, Clinical Manual (known as ICD-9-CM) diagnosis and procedures codes, gender, date of birth, admission date, discharge date, admission priority, length of stay, discharge status, total charges (based on specific items such as prescriptions), admission source, payer source, and country of origin.
37. Minutes, Local Data Base Group, 31 May, 24 August 1984, HWP; Edward N. Brandt, Jr., Assistant Secretary for Health, Chairperson, DHHS Health Information Policy Council, to the Secretary, 25 July 1984, HWP; 1984 Revision of the Uniform Hospital Discharge Data Set, U.S. DHHS Health Information Policy Council, July 1984, HWP.
38. Minutes, Local Data Base Group, 31 May, 24 August 1984, HWP.
39. HCA financing was $103,000. Minutes, Local Data Base Group, 6 December 1984, HWP; Transmittal Form for Extramural Support, NMDS Conference, 21 February 1984, HWP.
40. NMDS Conference Group, Nursing Minimum Data Set Conference Schedule, 15 - 17 May 1985 (Milwaukee: NMDS, 1985); List, Task Force Groups, NMDS Conference, n.d., HWP.
41. Harriet Werley, Opening Remarks, NMDS Conference, Milwaukee, 15 May 1985, HWP.
42. Norma Lang, Opening Remarks, 15 May 1985, NLP.
43. Jennifer Hobbs, "Defining Nursing Practice: The ANA Social Policy Statement, 1980-1983," Advances in Nursing Science 32, no. 1 (2009): 3-18.
44. Norma Lang, Opening Remarks, 15 May 1985, NLP.
45. Minutes, Local Planning Committee, 25 April, 29 May, 2 July, 11 July, 26 July, 6 September, 14 October 1984, HWP.
46. List, Task Force Groups, NMDS Conference, n.d., HWP.
47. Report, Demographic Task Force, 16 May 1985, HWP; Demographic Task Force Consensus Statement, Session 3, 17 May 1985, HWP; Minutes of Task Force on Demographics, Session 1, 17 May 1985, HWP.
48. Minutes of Task Force on Demographics, 10 June 1985, HWP.
49. Nursing Assessment Group Consensus Statement, 17 May 1985, HWP.
50. Nursing Assessment Task Force Report, 17 May 1985, HWP.
51. For example, the general categories for assessment were biophysical health and ten "problems." The ten problem categories were as follows: nutritional, elimination, sensory function, neurological, circulatory, respiratory, emotional, social, cognitive, and health management. Concern was raised over how these categories would apply to a typical medical-surgical patient, and the group suggested adding stress, anxiety, fear, and depression as categories. This addition of other areas continued through ambulatory care, home health, and so forth.
52. Nursing Assessment Task Force Report, 17 May 1985, HWP.
53. Nursing Diagnosis Task Force Report, 17 May 1985, HWP.
54. See also J. L. Hobbs, "Defining Nursing Practice: The ANA Social Policy Statement, 1980-1983," Advances in Nursing Science 32, no. 1 (2009): 3-18.
55. The statement was discussed at the conference; the draft was sent to Werley about two weeks later. Nursing Diagnosis Task Force, Nursing Assessment Group Consensus Statement, 5 June 1985, HWP.
56. List, Task Force Groups, NMDS Conference, n.d., HWP.
57. Minutes, Session 3, 17 May 1985, HWP.
58. Intervention Task Force, Diagram of NMDS Contents, 17 May 1985; Intervention Task Force, Report on Nursing Intervention Task Force, Final, 17 May 1985, HWP.
59. Draft, Outcomes Task Force Consensus Statement, 17 May 1985, HWP; Final Report, Outcomes Task Force, NMDS Conference, 17 May 1985, HWP.
60. Nursing Acuity/Intensity Group Consensus Statements, 17 May 1985, HWP.
61. Author Tracking Form (1 of 6), Nursing Data Set Conference Proceedings Publication, May 1985, HWP.
62. Many of the participants went on to develop different parts of the data set and explicate the subsections. For example, the contingent from the University of Iowa worked on and eventually developed the Nursing Intervention Classification. Werley was supportive of these developments and focused on how the data set as a whole was being promoted. The requests to discuss and explain the data set were coming to both Werley and Lang, and Werley wanted more control. Comments accompanied the formal school memorandum communication between Werley and Lang, June 1985 - October 1985, HWP.
63. Werley had multiple tracking forms and was continually writing the authors after just a few days beyond the set due date. Author Tracking Form (1 of 6). Comments accompanied the papers by Ozbolt, Gallant, Joel, Anderson-Stewart, Sovie, McCormick, Shultz, Saba, and Dowling, November 1985-April 1986, HWP.
64. An example of Werley's editorial style can be seen in Cecelia R. Zorn, M. C. Smith, and Harriet H. Werley, "Watch Your Language," Nursing Outlook (1991): 183-85.
65. Nursing Assessment Task Force Report Prepared by Suzanne Flaco, NMDS Conference, 2 August 1985, HWP; Nursing Diagnosis Task Force Report Prepared by Phyllis Kritek, NMDS Conference, 6 September 1985, HWP; Nursing Assessment and Nursing Diagnoses, Task Force Joint Report Prepared by Suzanne Falco, NMDS Conference 29 August 1985, HWP; NMDS Conference Report of Task Force on Intensity, 29 August 1985, HWP; Karen Rieder to Harriet Werley, Nursing Intervention Post Task Force Work, 19 August 1985, HWP.
66. A.M. Proceedings of Post-Conference Task Force Meeting, 16 September 1985, NLP.
67. The data set at this point was a series of categories with definitions, followed by subcategories. Some subcategories had checklists; others had references to larger data sources. For example, the ND category referred users to the NANDA taxonomy, the Omaha system, or some other framework for ND.
68. A.M. Proceedings of Post-Conference Task Force Meeting, 16 September 1985, NLP.
69. P.M. Proceedings of Post-Conference Task Force Meeting, 10 October 1985, NLP.
70. A.M. Proceedings of Post-Conference Task Force Meeting, 16 September 1985, NLP; P.M. Proceedings of Post-Conference Task Force Meeting, 10 October 1985, NLP.
71. The communication on the matter began prior to the post-conference. Handwritten notes by Werley to Lang were attached to formal school business communications, June 1985-October 1985, HWP. In the notes Werley began to question what activities Lang was engaged in surrounding the NMDS, particularly her presentation schedule. Werley requested that Lang clear presentation requests through her.
72. Note, September 1985, NLP.
73. Springer had committed to publishing the conference proceedings that were released in 1988; see note 1.
74. A.M. Proceedings of Post-Conference Task Force Meeting, 16 September 1985, NLP; P.M. Proceedings of Post-conference Task Force Meeting, 10 October 1985, NLP.
75. Proceedings of the Post-Conference Task Force Meeting on the NMDS, 16 September 1985; Lucille Joel to Harriet Werley, 30 October 1985, HWP; Carolyn Anderson-Stewart to Harriet Werley, 25 November 1985, HWP; Margaret Sovie, Professor of Nursing, University of Rochester, to Harriet Werley, 11 November 1985, HWP.
76. Harriet Werley to Norma Lang, 7 November 1988, NLP.
77. The correspondence surrounding the NMDS submission was routed through Kathleen McCormick. The first citation is a draft letter sent to Abdellah for review, and the second is the feedback. Harriet Werley and Norma Lang to James Mason, Acting Assistant Secretary for Health, and Chairman Health Information Policy Council, 1 October 1985, HWP; Kathleen McCormick, DHHS to Harriet Werley, 11 November 1985, HWP.
78. Harriet Werley and Norma Lang to James Mason, Acting Assistant Secretary for Health, and Chairman Health Information Policy Council, 6 August 1986, HWP; Ronald Blankenbaker, M. D., Chairman, National Committee of Vital and Health Statistics, to Robert E. Windom, M. D., Assistant Secretary for Health, 8 January 1987, HWP.
79. Letter routed to Irma Lou Hirsch from Jan Heinrich, Letter from Ronald Blankenbaker, Chairman, National Committee on Vital and Health Statistics, to Robert Windom, Assistant Secretary for Health, DHHS, 8 January 1987, ILH; Robert E. Windom, M. D., Assistant Secretary for Health, to Harriet Werley, 3 April 1987, HWP.
80. Ronald Norby, Associate Chief of Staff, Associated Health Professions, VA San Diego Medical Center, to Harriet Werley, 20 April 1987, HWP.
81. Ron Norby, personal communication, 24 June 2007.
82. Harriet Werley to Vernice Ferguson, Director, VA Nursing Service, 2 July 1987, HWP.
83. Harriet Werley to Ida Cooney, Vice President, Foundation Hospital Corporation of America, 1 July 1985, HWP.
84. The story surrounding Werley's funding for the NMDS is commonly understood as coming primarily from the NIH, but there was no evidence to support that claim. Werley had moneys from the Healthcare Corporation of America Foundation and the Blanke Foundation, a foundation that funds University of Wisconsin-Milwaukee faculty projects. She did receive approval of her NIH application, but there was no evidence the project was funded. Ada Sue Hinshaw, Director, National Center for Nursing Research, to Harriet Werley, 29 September 1988, HWP.
85. Note, September 1985, NLP.
86. Harriet Werley to Ursula Springer and Ruth Chasek, 6 August 1986, HWP.
87. Harriet Werley to Norma Lang, 23 June 1986, HWP.
88. Note, September 1985, NLP.