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Philip Shields RN BaNurse (Hons) PhD candidature nursing Informatics

Node-Arc-Node graphs: Acquiring nursing domain expert knowledge

The problem

Is the lack of data describing nursing processes in Donabedian’s quality framework My study addresses the problem by using semantic technology to acquire process data because it paints a picture of human reality in terms of words, that describe concepts and their relationships. What nurses do Patient

• utcomes

Nurse skill mix, Culture, work load

Donabedian’s quality framework

Software robot Semantic & Logic evaluation Usability Study Human Pattern evaluation Design Science methodology Nurse Expert

Node-Arc-Node Graph OWL-DL Ontology

Broad overview of methodology (completed four times)

The Semantic Web. Made of connected

• ntologies

An Ontology Made of connected triples A Triple Made of three addresses

Parts of Semantic Technology

But, nurses can’t be expected to write a thousand lines of triples to describe their process domain, nurses are not knowledge engineers and knowledge engineers are not

• nurses. So what’s the answer?

Node-arc-node graphs are the human-readable equivalent of the

• triple. Graphs are easy to build and connect together with knowledge

acquisition software like Visual Understanding Environment (VUE).

Methodology Question 1) How can Donabedian’s process domain be evaluated using nurse-constructed node-arc-node graphs?

Aim The methodology aims to construct four ontologies from four nurse expert- constructed graphs.

Back to the study

A usability pilot study had a purposive sample of four nursing domain experts with different specialities (Transitional Care, Triage, Surgical, Administration) from the same health cluster. To focus the domain experts on their process domain they were given a ‘starter’ graph containing the three Doran, Dianne., Sidani, Keatings et al. (2002) Nursing Role Effectiveness Model (NREM) process nursing roles: 1) Independent: Autonomous nursing roles 2) Interdependent: Nurses in conjunction with allied health 3) Dependent: Doctor’s order roles The domain experts were instructed to visualise their place in their process environment and ‘fill in the blanks’ from the roles.

The transitional care nurse identified with five links from the independent role,

• ne link from the dependent role and one link from the interdependent role.

http://cablesat.com.au/KA/transitional/transitional_nurse.html

The surgical nurse identified with eight links from the independent role,

• ne link from the dependent role and one link from the interdependent
• role. http://cablesat.com.au/KA/surgical/surgical_nurse.html

The administrative nurse identified with two links from the independent role, no links from the dependent role and one link from the interdependent role. http://cablesat.com.au/KA/administration/administrative_nurse.html

The triage nurse identified with seven links from the independent role, four links from the dependent role and no links from the interdependent role and had no clusters. The patient is shown off to the side because in reality, the patient concept would encompass the entire graph and would lose readability. http://cablesat.com.au/KA/triage/triage_nurse.html

Graphs, So what?

Semantic technology makes the nurse’s contribution to patient care visible. Nurses may use graphs to: 1) Locate ‘edges’ in the graph where embedded technology, indicators or documentation may be placed. 2) Visualise patient care priorities 3) Move resources around to provide better outcomes 4) Graphs provide a ‘bridge’ in which both knowledge engineers and nurses can work together for better patient outcomes. 5) Graphs can be turned into ontologies which are robot readable Answers to the methodology Question: How can Donabedian’s process domain be evaluated using nurse-constructed node-arc-node graphs?

Robots, So what?

1) Robots audit the domain structure looking for logic errors. For example, Is a nurse in the right place/has the correct qualifications? Is there a nurse ‘out in the cold’? The start of automated auditing. 2) Robots locate similar semantics across nursing domains for vocabularies and

• ntology ‘connection points’.

Table 2: Term ranking between transitional care and Administrator Transitional Care Administrator I-Sub Number Family Family_Meeting 0.778 Bed_Occupancy_Indicator Bed_Occupancy 0.836 Nurse Nurses .945 ACAS ACAS 1.0 ACAT ACAT 1.0 Care_Plan Care_Plan 1.0 Case_Conference Case_Conference 1.0 External_Agencies External_Agencies 1.0 Hospital Hospital 1.0 IIMS_Reporting IIMS_Reporting 1.0 Policies_and_Procedures Policies_and_Procedures 1.0 WH&S WH&S 1.0 Family Family 1.0

The significance This study provides a window into the process domain as the nurse sees it. Knowledge acquisition techniques such as graphing, semantic classification and logic consistency checking put value on nursing’s contribution to patient

• care. These techniques bring the nurse's working reality to a stage where it can

be visualised and analysed

Limitations 1) Small sample size Nielsen (1994) recommends a sample of not more than five people in a usability study, because he observes, there is no point continuing with a large sample if there is a possibility of an inherent problem in the system being studied. Also, ontologies are completed one at a time and connected together if possible 2) No direct way of converting the output of VUE to OWL-DL

• ntology

The graph information had to be transferred by hand from VUE to Protégé which meant printing the graphs and highlighting the node- arc-nodes when they were entered, introducing the possibility of error 3) Am I looking at the process domain? Although the graphs use Doran’s Process roles as a base, the graph may venture into structural and outcome domains

Thank you to my supervisors: Associate Professor Liza Heslop,

• Dr. Lucy (Sai) Lu and Industry Mentor,

Adjunct Professor Evelyn Hovenga.

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