Recei ed: 27 June 2024 Accep ed: 29 Sep embe 2024
DOI: 10.1111/2047-3095.12493
ORIGINAL REPORT
Enhancing nu sing ca e h ough echnology and s anda dized
nu sing language: The TEC-MED mul ilingual pla o m
Ana-Ma ía Po cel Gál ez PhD, Associa ed P o esso 1
Ma a Lima-Se ano PhD, Associa ed P o esso 1Regina Allande-Cussó PhD, Senio
Lec u e 1Ma ia-Giulia Cos anzo-Tala ico Doc o al S uden 2
Ma ía-Dolo es Ma eos Ga cía PhD, Associa ed P o esso 1
Me cedes Bueno-Fe án PhD, Lec u e 1Elena Fe nández-Ga cía PhD, Assis an
P o esso 1Fabio D’Agos ino PhD, Associa ed P o esso 3
José-Manuel Rome o-Sánchez PhD, Assis an P o esso 4
1Nu sing Depa men , Facul y o Nu sing,
Physio he apy and Podia y, Uni e sidad de
Se illa, Se illa, Spain
2Resea ch g oup Ecological Economy, Feminis
Economy and De elopmen (EcoECoFem – SEJ
507), Uni e sidad Pablo de Ola ide, Se illa,
Spain
3Medicine and Su ge y Depa men , Sain
Camillus In e na ional Uni e si y o Heal h
Sciences, Rome, I aly
4Nu sing Depa men , Facul y o Nu sing,
Physio he apy and Podia y, Uni e sidad de
Cádiz, Cádiz, Spain
Co espondence
Regina Allande-Cussó, 41009, A enzoa s .,
Se illa, Spain.
Email: [email p o ec ed]
Funding in o ma ion
TEC-MED P ojec , G an /Awa d Numbe : ENI
CBC 2014-2020
Abs ac
Pu pose: This s udy desc ibes he design, in eg a ion, and seman ic in e ope abili y p o-
cess o a minimum da a se using s anda dized nu sing language in he ca ing module o
he TEC-MED ca e pla o m.
Me hods: The ca ing module was de eloped in h ee phases (2020–2022): pla o m con-
cep , unc ional design and cons uc ion, and es ing and e alua ion. Phases in ol ed col-
labo a ion among academics, in o ma ion echnology de elope s, and social/heal hca e
p o essionals. Nu sing axonomies (NANDA-I, NOC, NIC) we e in eg a ed o suppo he
nu sing p ocess. The pla o m was pilo ed in six Medi e anean coun ies.
Findings: The inal pla o m ea u es an assessmen module wi h eigh dimensions o
da a collec ion on olde adul s and hei ca egi e s. A clinical decision suppo sys em
links assessmen da a wi h nu sing diagnoses, ou comes, and in e en ions. The pla o m
is a ailable in six languages (English, Spanish, F ench, I alian, G eek, and A abic). Usabili y
es ing iden i ied he need o imp o ed A abic language suppo .
Conclusions: The TEC-MED pla o m is a pionee ing ool using s anda dized nu sing lan-
guage o imp o e ca e o olde adul s in he Medi e anean. The pla o m’s mul ilingual-
ism p omo es accessibili y. Limi a ions include o line use and mobile app unc ionali y.
Pilo es ing is unde way o e alua e e ec i eness and acili a e c oss-cul u al alida ion
o nu sing axonomies.
Implica ions o nu sing p ac ice: The TEC-MED pla o m o e s s anda dized nu sing
ca e o olde adul s ac oss he Medi e anean, p omo ing consis en communica ion and
e idence-based p ac ice. This app oach has he po en ial o imp o e ca e quali y and
accessibili y o a ulne able popula ion.
This is an open access a icle unde he e ms o he C ea i e Commons A ibu ion-NonComme cial License, which pe mi s use, dis ibu ion and ep oduc ion in any
medium, p o ided he o iginal wo k is p ope ly ci ed and is no used o comme cial pu poses.
© 2024 The Au ho (s). In e na ional Jou nal o Nu sing Knowledge published by Wiley Pe iodicals LLC on behal o NANDA In e na ional.
In J Nu s Knowl. 2024;1–9. wileyonlinelib a y.com/jou nal/ijn 1
2PORCEL GÁLVEZ ET AL.
KEYWORDS
digi al heal h, elde ly, heal h equi y, nu sing diagnosis, s anda dized nu sing language, axonomy
RESUMEN
Obje i o: Es e es udio desc ibe el diseño, la in eg ación y el p oceso de in e ope abili-
dad semán ica de un conjun o mínimo de da os u ilizando un lenguaje es anda izado de
en e me ía en el módulo de a ención de la pla a o ma de cuidados TEC-MED.
Mé odos: El módulo de a ención se desa olló en es ases (2020–2022): concep o de
la pla a o ma, diseño y cons ucción uncional, y p uebas y e aluación. Las ases in olu-
c a on la colabo ación en e académicos, desa ollado es de ecnología de la in o mación
y p o esionales sociales/sani a ios. Se in eg a on axonomías de en e me ía (NANDA-I,
NOC, NIC) pa a apoya el p oceso de en e me ía. La pla a o ma se pilo ó en seis países
medi e áneos.
Resul ados: La pla a o ma inal p esen a un módulo de e aluación con ocho dimensiones
pa a la ecopilación de da os sob e adul os mayo es y sus cuidado es. Un Sis ema de
Apoyo a la Decisión Clínica (CDSS) incula los da os de e aluación con diagnós icos,
esul ados e in e enciones de en e me ía. La pla a o ma es á disponible en seis idiomas
(inglés, español, ancés, i aliano, g iego, á abe). Las p uebas de usabilidad iden i ica on la
necesidad de mejo a el sopo e en idioma á abe.
Conclusiones: La pla a o ma TEC-MED es una he amien a pione a que u iliza un
lenguaje es anda izado de en e me ía pa a mejo a la a ención a los adul os mayo es en
el Medi e áneo. La disponibilidad en a ios idiomas de la pla a o ma p omue e la acce-
sibilidad a la misma. Las limi aciones incluyen el uso sin conexión y la uncionalidad de la
aplicación mó il. Se es án ealizando p uebas pilo o pa a e alua la e ec i idad y acili a
la alidación in e cul u al de las axonomías de en e me ía.
Implicaciones pa a la p ác ica de en e me ía: La pla a o ma TEC-MED o ece a ención
de en e me ía es anda izada pa a los adul os mayo es en odo el Medi e áneo, p o-
mo iendo la comunicación consis en e y la p ác ica basada en e idencia. Es e en oque
iene el po encial de mejo a la calidad y accesibilidad de la a ención pa a una población
ulne able.
INTRODUCTION
Mul iple eHeal h in e en ions ha e been de eloped in ecen decades
o suppo nu sing ca e, including digi al pla o ms (Bohme &
Law ence, 2008; Escobedo e al., 2019). A digi al ca e pla o m is an
eHeal h-based ool ha aims o inc ease coo dina ed and pa ien -
cen e ed ca e. Digi al heal hca e pla o ms can p o ide pa ien s wi h
si ua ion-speci ic in o ma ion, an o e iew o hei medical eco ds,
and a means o di ec and secu e communica ion wi h heal hca e p o-
essionals (Hops aken e al., 2021; Meie e al., 2013). E idence o he
use o ca e pla o ms o pa ien s wi h ch onic diseases demons a es
hei posi i e e ec on inc easing and imp o ing physical ac i i y, qual-
i y o li e, sel -con idence, adhe ence o ea men , and sa is ac ion
wi h he ca e ecei ed (Sle e al., 2016; Tighe e al., 2020; Xu e al.,
2019). In he speci ic con ex o olde people, a s udy by Jongs a e al.
(2017) showed ha he design o a speci ic ca e pla o m o olde
people wi h ca dio ascula p oblems posi i ely impac ed adhe ence o
medical ea men and basic heal h ca e. Howe e , i highligh ed he
need o imp o e digi al compe ence in his g oup.
On he o he hand, cu en heal h sys ems ace he challenge o
longe i y and an in e ed demog aphic py amid due o he inc ease
in he wo ld’s popula ion o e 60. In his sense, all coun ies should
implemen s a egies o ensu e hei heal h and social sys ems a e
eady o ake ull ad an age o his demog aphic change (Bonne
e al., 2021). Fu he mo e, people wi h social ca e needs ha e expe i-
enced an inc eased isk o de e io a ion o hei physical and men al
heal h wi h he COVID-19 pandemic (Ho e al., 2020). This ex ao -
dina y challenge o social assis ance equi es immedia e and well-
coo dina ed esponses among di e en le els o go e nmen and
non-go e nmen al sec o s and he gene al public wo ldwide (Comas-
20473095, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/2047-3095.12493 by Readcube (Lab i a Inc.), Wiley Online Lib a y on [10/02/2025]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
DIGITAL PLATFORM & NURSING LANGUAGE 3
He e a e al., 2020). Nu sing ca e mus also be adap ed o his
demog aphic si ua ion, always unde he p emise o e idence-based
ca e. Thus, he wo king me hod o nu ses is ma e ialized h ough he
nu sing p ocess, based on an o ganized da a collec ion, using exis ing
ools; ha would include e idence-based knowledge esou ces such as
Go don’s (1994) Func ional Heal h Pa e ns and he esea ch-based
s anda dized classi ica ions (Tö n all & Jansson, 2017). Nu ses who
use a common s anda dized language o iden i y and eco d pa ien
diagnoses, ou come c i e ia, and in e en ions would allow hem o
communica e pa ien ca e o he ou side wo ld (Mousa inasab e al.,
2020). The NANDA-In e na ional axonomy is an example o s anda d-
izednu singlanguage ha p o idesanin e na ionaluni o mde ini ion,
de ining cha ac e is ics, and ac o s o nu sing diagnoses (H. He d-
mane al., 2024), as doNu singOu comesClassi ica ionwi hde ini ion
and indica o s o measu e (Moo head e al., 2023) and Nu sing In e -
en ions Classi ica ion wi h de ini ion and nu sing ac i i ies (Wagne
e al., 2023). Each p o ides a common s anda dized language wi h
e idence-based de ini ions and con ex o desc ibe nu sing p ac ices
o be conside ed in he planning, implemen a ion and e alua ion o
nu sing p ocess (Mülle -S aub e al., 2007).
The “De elopmen o a T anscul u al social-e hical-ca e model o
dependen popula ion in Medi e anean basin-TEC-MED” esea ch
p ojec (ENI CBC 2014–2020) add esses hese in e na ional chal-
lenges by de eloping an inno a i e and e hical c oss-cul u al social
ca e model. This model aimed o imp o e he unc ioning o companies
ha p o ide socio-heal h ca e and collabo a ion wi h public admin-
is a ions in ca ing o olde people wi h dependency and a isk o
social exclusion in he Medi e anean basin. Wi h an app oach based
on jus ice, p i acy, con iden iali y, gende , uni e sal accessibili y, ac i e
communi y pa icipa ion, digi al li e acy, and he alues o he wel a e
s a e and go e nance, he p ojec in ol es he coun ies o Spain (coo -
dina ing coun y), I aly, G eece, Lebanon, Egyp , and Tunisia (Po cel
e al., 2019).
Acco dingly, one o he ou pu s o he TEC-MED p ojec is de el-
oping a mul ilanguage (English, Spanish, F ench, I alian, G eek, and
A abic) online mul ipu pose pla o m. The TEC-MED pla o m is mul i-
pu pose and composed o h ee modules: (1) a managemen module
aimed o p omo e he communica ion and collabo a ion be ween he
pa ne s and s akeholde s, (2) an e-lea ning module, and (3) social-
heal h ca ing module.
The implemen a ion o he pla o m also cons i u es a alida ion
ool o he TEC-MED model. The in o ma ion collec ed h ough he
online pla o m is use ul o inc ease awa eness o he pe cep ion o he
socialca emodelandga he s eedbackon heg ound osuppo u u e
implemen a ion o a la ge in eg a ed model o social ca e (Po cel-
Gál ez e al., 2021). Addi ionally, he online pla o m is use -o ien ed
and a ends o guide ubiqui ous communica ion and collabo a ion
among social wo ke s, pa ien s, and amilies. The in o ma ion collec ed
h ough he online pla o m is use ul o inc ease he knowledge o
model pe cep ion and collec eedback om he g ound in iew o he
nex u u e implemen a ion o a wide in eg a ed social-ca e model. I
will allow social and heal h wo ke s (SHW), olde people, and hei am-
ilies o ecei e ins uc ions, sha e expe iences and bes p ac ices, and
ecei e aining and coaching suppo in a well-es ablished communi y
o p ac ices. In his con ex , his s udy aims o desc ibe he design, in e-
g a ion, and seman ic in e ope abili y p ocess o a minimum da a se in
he ca ing module o TEC-MED ca e pla o m.
MATERIALS AND METHODS
The design and de elopmen o he elec onic ca ing module o he
TEC-MED pla o m was accomplished du ing he pe iod 2020–2022,
in h ee phases: (1) pla o m concep ; (2) unc ional design and con-
s uc ion o he ca e pla o m; and (3) es ing and e alua ion. I was
de eloped in close collabo a ion be ween he conso ium pa ne s,
wi h academic p o iles and IT de elope s, oge he wi h key playe s
a he mic o–meso–mac o le el om public and p i a e ins i u ions,
uni e si ies, nongo e nmen al o ganiza ions, NGOs, and he gene al
popula ion.
The esea ch p ojec ob ained he app o al o he Andalusian
Resea ch E hics Commi ee (Cod.2412-N-19) and adhe ed o he ec-
ommenda ions on he p o ec ion o pe sonal da a desc ibed in he
Eu opean Di ec i e 2016/679 o he Eu opean Pa liamen and o he
Eu opean Council o Ap il 27, 2016.
Be o e he de elopmen o he ca ing module o he TEC-MED pla -
o m, he eam de eloped he TEC-MED ca e model, on which he
de elopmen o he TEC-MED ca e module was based (Figu e 1).
Phase 1: pla o m concep
This phase was de eloped du ing he second hal o he yea 2020 and
he i s qua e o 2021.
The ca e pla o m module consis s o ou modules: (1) assess-
men ,(2) diagnosis, (3)planning,and (4) implemen a ionande alua ion
(Figu e 2), based on he s ages o he nu sing p ocess as well as on
implemen a ion wi h axonomies (Bulechek e al., 2018; H. He dman
e al., 2021; Moo head e al., 2018; Wilkinson, 2012)(Figu e2).
Fo de eloping he assessmen module, a e iew o he digi al
heal h and social eco ds exis ing in he pa icipa ing coun ies was
ca ied ou du ing he i s qua e o 2021. Fo example, in Spain,
we based on he Di aya’s heal h ca e sys em (Se icio Andaluz de
Salud, 2010) o he RESISOR’s elec onic single social eco d (Gál ez
e al., 2016). Fu he mo e, unc ional pa e nso Ma jo y Go don (Go -
don, 1994) we e conside ed o he assessmen amewo k o olde
people ( inal bene icia y [FB]) as well as hei amily ca egi e s (FC),
conside ing also he amily and social dimensions. Weekly mee ings
o wo king g oups and expe panels wi h he p ojec pa ne s we e
de eloped un il a consensus was achie ed abou he dimensions o he
assessmen . A p ocess o iden i ying alida ed scales ela ed o each
o he dimensions was ca ied ou o be inse ed in o he designed
ca e pla o m h ough a li e a u e e iew. I was conside ed o selec
he assessmen scales i alida ed in he languages o he coun-
ies pa icipa ing in he p ojec . Pe mission om hei au ho s was
ob ained.
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4PORCEL GÁLVEZ ET AL.
FIGURE 1 TEC-MED model and ca ing module in TEC-MED
pla o m de elopmen p ocess.
FIGURE 2 O e iew o he modules o he TEC-MED digi al ca e
pla o m ha is based on he nu sing p ocess and he nu sing
axonomies.
The conso ium ag eed on he need o include nu sing axonomies,
gi en i s scien i ic e idence and in e na ional sys ema iza ion, con-
ce ning he diagnos ic phase and ca e planning. Simila ly, o he assess-
men design, he consensus abou labels, ou comes, and in e en ion
was done h ough wo king g oups and panel o expe s. NANDA
In e na ional diagnos ic labels ela ed o he assessmen dimensions
and he labels ela ed o Nu sing Ou comes Classi ica ion and Nu s-
ing In e en ions Classi ica ion ela ed o he iden i ied diagnos ic
labels we e iden i ied. Once he inal lis was ob ained, pe mission
was ob ained, and he NANDA In e na ional o ganiza ion, he pub-
lishe Thieme, he eam o edi o s o he Uni e si y o Iowa (USA),
and he publishe Else ie Limi ed we e con ac ed o eques he due
pe missions o including he labels in he ca e pla o m. Du ing he
e alua ion, he ealiza ion o he nu sing in e en ion and he change
o ou come indica o s a e assessed. All da a a e downloadable unde
da a p o ec ion es ic ions.
Phase 2: unc ional design cons uc ion o he ca e
pla o m
This phase was de eloped du ing he i s and second qua e s o 2021.
A clinical decision suppo sys em (CDSS) was included in he pla -
o m o assis SHW in assessing, diagnosing, planning, and e alua ing
ca e. The aim was o acili a e a uni o m app oach o applying he
model among mul iple p o essionals om di e en coun ies who pa -
icipa ed in he p ojec . CDSSs p o ide clinicians wi h pa ien -speci ic
ecommenda ions o clinical decision-making (Kawamo o e al., 2005).
They a e conside ed a way o educing a ia ion in heal hca e p ac ice
(Coie a e al., 2006).
The CDSS was based on logically de eloped algo i hms based on he
assessmen da a o lead he aining agen o an endpoin disposi ion o
he pa ien ’s condi ion, in his case, o a nu sing diagnosis. An algo i hm
was c ea ed in he pla o m o each p eselec ed nu sing diagnosis. The
ollowing p ocedu e was ollowed: (1) The componen s o each nu sing
diagnosis ha we e mos ep esen a i e o hem we e selec ed, ha is,
hei signs/symp oms (de ining cha ac e is ic) and he mos equen
causes ha could cause hem ( ela ed ac o ); (2) o all da a included
in he assessmen , hose ha we e equi alen o he mos ep esen-
a i e componen s o each diagnosis we e iden i ied and assigned o
each o he ; hese da a came om di ec ques ions abou hem, om
he esponses o speci ic i ems o psychome ic and clinome ic ins u-
men s included o he o e all sco e o hese ins umen s; (3) based on
he abo e, he algo i hms we e cons uc ed conside ing whe he he
da a we e collec ed: dicho omously, ha is, as he p esence o absence
o a sign/symp om o cause o diagnosis, o con inuously, ha is, when
he sign/symp om o cause o diagnosis was quan i ied in some way,
and a ce ain cu -o poin mus be conside ed ele an . A condi ional
s uc u e was used o de elop he algo i hms. Condi ional s uc u es
compa e he alues o one da a i em wi h hose o ano he (s). Based
on his compa ison, a cou se o ac ion is ollowed wi hin he pla o m.
In his case, he condi ional s uc u e allowed one o decide ha al e -
na i e he pla o m low will ollow, sugges ing o no a diagnos ic
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DIGITAL PLATFORM & NURSING LANGUAGE 5
label o he SHW. When he condi ion was me , he da a o in e es
o he diagnosis eached speci ic alues simul aneously; he calcula-
ion e u ned a ue alue and, consequen ly, assumed ha he pa ien
p esen ed he diagnosis o he SHW, which was eco ded. I he condi-
ion was no me , i e u ned a alse alue, implying ha he diagnosis
was absen . Rela ional ope a o s (>,<,≤,=>) we e used o es ablish
complex condi ions. Once he CDSS assigned a diagnosis, he sys em
au oma icallyassigned he ou come(s)and in e en ion(s) co espond-
ing o ha diagnosis, p e iously nes ed hem oge he o achie e he
linkage. I an SHW disag eed wi h he sugges ed endpoin , he e was
a acili y o o e ide he decision. Simila ly, i , based on he assess-
men , he SHW, applying his/he clinical easoning, conside ed ha he
pa ien had a nu sing diagnosis no sugges ed by he CDSS, he/she
could assign i o he pa icipan and eco d i .
Phase 3: es ing and e alua ion
Du ing he hi dqua e o 2021, woTEC-MEDca epla o musabili y
es ing sessions we e conduc ed in each coun y o e alua e i s com-
p ehensibili y and co ec unc ioning. In each es , a ic i ious use was
assessed by illing in all ields allowed by he pla o m. In he end, each
pilo was discussed in a join mee ing wi h all pa icipa ing pa ne s, in
which he echnology pa ne s ook no e o he necessa y changes.
RESULTS
Phase 1: pla o m concep
The inal con igu a ion o he pla o m in ol es he assessmen mod-
ule, which is ocused on da a collec ion and in e p e a ion o in o ma-
ion ha will de e mine he heal h si ua ion o FB and FC. I consis s o
eigh dimensions, concep ualized om he concep ual amewo k ha
suppo s he TEC-MED Model, which allow o collec clinical, biologi-
cal, and psychosocial aspec s om a comp ehensi e pe spec i e. These
a e as ollows: (1) heal h condi ion; (2) physical– unc ional capaci y; (3)
cogni i e abili y; (4) basic needs; (5) emo ional managemen and social
ela ions;(6)abili y op omo ea heal hyli e/dea h; (7) amily,pa ne s,
and ca egi e s; and (8) socio-economic ac o s and digi al li e acy.
Each o hese dimensions is suppo ed by subdimensions wi h i ems
and a ing scales. The ollowing scales we e iden i ied and selec ed
o he assessmen : INICIARE (Mo ales-Asencio e al., 2015); AROPE
(Explained Eu os a s a is ics- Eu opean Commi ee, 2021); AUDIT
es (Saunde s e al., 1993); Mo isky G een es (Simpli ied Medica-
ion Adhe ence Ques ionnai e) (Beyhaghi e al., 2016); AD8 Demen ia
es (Gal in e al., 2006); Eu oQol (quali y o li e) (M. He dman e al.,
2001); P ei e ques ionnai e (P ei e , 1975); Mon eal Cogni i e
Assessmen —MoCA (Nas eddine e al., 2005); Mini Nu i ional Assess-
men ; Duke ques ionnai e (Koenig e al., 1993); Ge ia ic Dep ession
Scale 15 Ques ions e sion (Yesa age e al., 1983); Pe cei ed S ess
Scale (PSS-10) (Cohen e al., 1983); Gene alized Anxie y Diso de
Ques ionnai e (GAD-7) (Spi ze e al., 2006); Rosenbe g Sel -Es eem
scale (Rosenbe g, 1979); COPE Ques ionnai e (sho e sion 28 i ems)
(Ca e e al., 1989); Heal h Li e acy (HLS-EU-Q16) (Haun e al., 2014);
Elde s Heal h Empowe men Scale (Se ani Azcu a, 2014); Subscale
2 “P ope dying p ocess” o he Colle -Les e Fea o Dea h Scale
(Les e , 2004); Ca egi e S ain Index—CSI (Tho n on & T a is, 2003);
Sel -pe cep ion o amily heal h s a us (Lima-Rod íguez e al., 2022);
and Ca egi e Time (RUD-Li e) and Ca egi e Wo k S a us (RUD-Li e)
(Wimo e al., 2013).
Phase 2: unc ional design cons uc ion o he ca e
pla o m
TheCDSSspeciallydesigned o hepla o mwascomposedo 34algo-
i hms connec ing he assessmen da a wi h he p eselec ed NANDA-I
diagnoses (H. He dman e al., 2021), Nu sing Ou comes-NOC (Moo -
head e al., 2018), and Nu sing In e en ions-NIC (Bulechek e al.,
2018). Table 1 epo s examples o he a ionale behind de eloping he
algo i hms o a ious diagnoses. Fo his pu pose, e alua ion c i e ia
ha mus be complied wi h o he CDSS o sugges o he SHW he
assignmen o an FB o FC’s diagnosis we e p esen ed. The sugges ed
diagnosis and he in e en ion o ha diagnosis a e also p esen ed.
Ma hema ical o mulas included in he p og amming code o he pla -
o m ha e been a oided o ease o epo ing. As men ioned abo e,
once he diagnosis was sugges ed, he SHW had o alida e i . I he o
she alida ed he CDSS sugges ion, he diagnosis emained assigned o
he FB/FC. I he o she el ha addi ional assessmen da a did no sup-
po he sugges ion, he o she could unassign he diagnosis. In addi ion,
he o she could add diagnoses no sugges ed i hey we e conside ed
jus i ied.
Phase 3: es ing and e alua ion
Du ing he wo usabili y es ing sessions o he ca e pla o m in each
coun y, he assessmen implemen ed on he pla o m was pilo ed o
de ec e o s o unde s anding o echnological issues. A e ha , i
was only necessa y o imp o e usabili y in he case o he A abic lan-
guage; hus, he pla o m was adap ed elec onically so ha codes and
diagnos icscouldbe ead co ec ly om igh ole . Figu e3desc ibes
he inal con igu a ion o he ca e module o he TEC-MED pla o m.
DISCUSSION
The p esen s udy in es iga ed he c ea ion o a digi al comp ehen-
si e ca e pla o m ha allows he execu ion o he nu sing p ocess
h ough all i s s ages, assessmen , diagnosis, planning, execu ion, and
e alua ion using he e minology NANDA-I nu sing diagnoses, Nu s-
ing Ou come Classi ica ion, and Nu sing In e en ion Classi ica ion
(Bulechek e al., 2018; H. He dman e al., 2021; Moo head e al., 2018).
Nume ous au ho s highligh he alidi y and imp o emen o pa ien
ca e using his e minology compa ed o o he s (Klanˇ
cnik e al., 2021;
20473095, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/2047-3095.12493 by Readcube (Lab i a Inc.), Wiley Online Lib a y on [10/02/2025]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License

6PORCEL GÁLVEZ ET AL.
TABLE 1 Examples o he a ionale unde he in e ela ionships among assessmen c i e ia, diagnosis, ou come, and in e en ion.
Assessmen c i e ia Diagnosis sugges edaOu come sugges edbIn e en ion sugges edc
Selec ions o op ions “Ne e ,” “Ra ely,” o “Some imes”
in INICIARE i em “050312 U ina y Con inence.”
00016 Impai ed u ina y
elimina ion
0310 Sel -Ca e: oile ing 1804 Sel -ca e
Assis ance: oile ing
Selec ions o op ion “No” in i ems: 5.6.1 (Do you ha e
objec i es o goals?), 5.6.2. (Do you ha e plans o ca y
ou ?) o 5.6.3. (Do you eel as i you can con ol you li e
igh now?), OR assigna ion o diagnosis “ isk o
dep ession,” “low sel -es eem,” o “ine ec i e coping”
00210 Impai ed
esilience
1309 Pe sonal esiliency 8340 Resiliency
p omo ion
Selec ion o op ion “No” in i em 5.7.3 (gene ally, would
you say ha you sexual ela ionship is sa is ac o y?)
00065 Ine ec i e
sexuali y pa e n
0119 Sexual unc ioning 5248 Sexual counseling
No e: Codes and labels e ie ed om:
aNANDA In e na ional Nu sing Diagnoses: De ini ions & Classi ica ion, 2021–2023 (12 h ed.). Thieme Medical Publishe s.
bMoo head, Swanson, E, S., Johnson, M., & Maas, M. (2018). Nu sing Ou comes Classi ica ion (NOC).
cBulechek, G., Bu che , H., Doch e man, J., & Wagne , C. (2018). Nu sing In e en ions Classi ica ion (NIC).
FIGURE 3 S uc u e o he ca ing module o he TEC-MED pla o m.
Pa k & Lee, 2015; Rabelo-Sil a e al., 2017). Al hough his language is
s anda dized in e na ionally o nu sing p o essionals, he e is a digi al
di ide in i s use in he digi al ools and pla o ms implemen ed (Wes-
a e al., 2008). Howe e , scien i ic e idence highligh s he ad an ages
o i s use, highligh ing ha he in o ma ion included in his digi al pla -
o m subsequen ly allows i s coding and da a p ocessing, making i
possible o ad ance esea ch in nu sing classi ica ion sys ems (Je é,
2007). Likewise, he implemen a ion o nu sing axonomies in digi al
pla o ms could imp o e he quali y o ca e and he ca e p o ided, in
e mso quali y,gene aliza ion,andsys ema iza ionwo ldwide. On he
one hand, i alues nu sing science as a discipline based on a scien i ic
decision-makingp ocess ha unde pins he nu singp ocess(Nibbelink
&B ewe ,2018); his ansla es in o in e en ions and ou comes ha
could be iden i ied objec i ely and ha e scien i ic e idence (Tö n all
& Jansson, 2017). On he o he hand, he use o hese axonomies in
ca e pla o ms also o e s he possibili y o all nu ses o wo k unde
he same linguis ic amewo k, which can be applied and alida ed in
all he languages o he wo ld. I is no hing mo e han a ehicle o
homogenize nu sing language in any con ex and, a he same ime,
o a oid language ba ie s in nu sing p ac ice unde he same in e na-
ional nume ical codes, which main ain he same meanings a ound he
wo ld.
Focusing on he popula ion ha conce ns us in his s udy, he olde
people, a digi al di ide is obse ed due o he lack o digi al li e acy
and/o lack o access o echnological means o economic easons ha
hinde communica ion among use s–ca egi e s–p o essionals digi-
ally. In his sense, he TEC-MED p ojec has also ca ied ou speci ic
wo kshops o ain olde people in echnology o imp o e accessibili y
20473095, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/2047-3095.12493 by Readcube (Lab i a Inc.), Wiley Online Lib a y on [10/02/2025]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
DIGITAL PLATFORM & NURSING LANGUAGE 7
o people in si ua ions o social exclusion o using he compu e ools
included in he pla o m.
Following he s eng hening and use o he TEC-MED digi al pla -
o m, he digi al skills o SHW, FB, and FC ha e inc eased. In addi ion,
ollowing he COVID-19 pandemic, he e has been a digi al e o-
lu ion in he use o echnology in ca e (Abdolkhani e al., 2022;
Po cel-Gál ez e al., 2021). Mansou and Nogues (2022) e ealed ha
nu ses had p oac i e a i udes owa d new echnologies, hus imp o -
ing e iciency, sus ainabili y, communica ion, and knowledge sha ing.
Mo eo e , he TEC-MED pla o m in ol es FC h ough ac i i ies and
in e en ions ha can se e o imp o e o main ain hei heal h. This
is a no el aspec because, a e he p e ious esea ch, he impo -
ance o ca egi e s in hese coun ies o he Medi e anean basin was
iden i ied. The e o e, his need iden i ied du ing he execu ion o he
p ojec has been answe ed. Addi ionally, Mo eno-Cáma a e al. (2019)
iden i ied his need in amily ca e o people wi h demen ia in he
Medi e anean.
Fu he mo e, he TEC-MED p ojec will con ibu e o educing he
ma ginaliza ion o olde people and imp o ing he quali y o social and
heal h se ices p o ided o hem. Fu he mo e, by de eloping a com-
mon model suppo ed by so wa e applica ions, he p ojec can help
es ablish a e e ence model o social assis ance in he Medi e anean
egion (Po cel e al., 2019). Mo eo e , gi en ha he “o icial language”
in mos coun ies a ound he wo ld is English (59 coun ies), ollowed
by F ench (29 coun ies), A abic (27 coun ies), and Spanish (20 coun-
ies), 2 billion people could bene i om he use o his ca e pla o m
(Ramí ez, 2018).
CONCLUSIONS, LIMITATIONS, AND FUTURE
DIRECTIONS
C ea ing a digi al pla o m ha uses nu sing languages as he p i-
ma y communica ion and implemen a ion ool o imp o e he ca e
p o ided o olde people, dependen s, and hose a isk o social
exclusion in coun ies o he Medi e anean basin is a pionee ing
miles one.
In addi ion, he ca e module o he TEC-MED pla o m has been
de eloped in English, F ench, Spanish, I alian, G eek, and A abic,
including NANDA, NOC, and NIC labels. This achie emen gi es he
TEC-MED pla o m a e y high alue as a ool o he global dissemina-
ion o nu sing axonomies, acili a ing hei use, and aking ad an age
o he ise o eHeal h sys ems and pla o ms applied o he heal hca e
con ex wi h sha ed nu sing knowledge and decision suppo .
Despi e his, i is no exemp om limi a ions such as he impossibil-
i y o using he ool o line wi hou he need o an in e ne connec ion.
I could also be made mo e iendly, wi h a mo e in ui i e o ma and
easy access, and wi h a mobile module o acili a e he SHW–FB–FC
in e ac ion.
The TEC-MED digi al ca e pla o m is being es ed wi h he a ge
popula ion in a pilo phase in he six Medi e anean coun ies in ol ed
in he p ojec . I is expec ed ha 36 SHW and 28.200 use s, FB and
FC, will pa icipa e in he pilo s udy phase, and quan i a i e and qual-
i a i e indica o s will be assessed o alida e he pla o m. Finally,
hese da a will also allow he implemen a ion o c oss-cul u al alida-
ion p ocedu es, oge he wi h he au ho s o he di e en axonomies
o diagnos ic labels, in e en ions, and ou comes in A abic and G eek
languages.
AUTHOR CONTRIBUTIONS
Ana-Ma ía Po cel Gál ez, José-Manuel Rome o-Sánchez, Regina
Allande-Cussó, Ma ia-Giulia Cos anzo-Tala ico, Elena Fe nández-
Ga cía, Fabio D’Agos ino and Ma a Lima-Se ano concep ualized
and d a ed he manusc ip . Ana-Ma ía Po cel Gál ez, José-Manuel
Rome o-Sánchez, Regina Allande-Cussó, Ma ia-Giulia Cos anzo-
Tala ico,Ma a Lima-Se ano,Fabio D’Agos ino,Ma ía-Dolo esMa eos
Ga cía, and Me cedes Bueno-Fe án conduc ed he da a analysis o
he s udy. Ana-Ma ía Po cel Gál ez, José-Manuel Rome o-Sánchez,
Ma a Lima-Se ano, Regina Allande-Cussó, Elena Fe nández-Ga cía,
and Fabio D’Agos ino designed and c i ically e iewed he documen .
All au ho s ead and app o ed he inal e sion submi ed.
ACKNOWLEDGMENTS
The au ho s hank he pa icipan s and expe s om all coun ies o
hei suppo . Special hanks o he publishe Thieme o g an ing pe -
mission o he use o he nu sing diagnoses p oposed by NANDA
In e na ional and o he eam o edi o s o he NOC and NIC ax-
onomies, as well as o he publishe Else ie o g an ing pe mission o
he use o bo h axonomies. Funding p o ided by he TEC-MED P ojec
(A_A.3.2_0376) esea ch p ojec o he ENI CBC 2014-2020.
CONFLICT OF INTEREST STATEMENT
The au ho s decla e no con lic s o in e es .
DATA AVAILABILITY STATEMENT
The da a unde lying his a icle a e a ailable on eques om he
au ho s.
ETHICS STATEMENT
This s udy did no in ol e human pa icipan s and he e o e did no
equi e E hics Commi ee app o al.
ORCID
Ana-Ma ía Po cel Gál ez PhD h ps://o cid.o g/0000-0001-8461-
6379
Ma a Lima-Se ano PhD h ps://o cid.o g/0000-0003-3909-2718
Regina Allande-Cussó PhD h ps://o cid.o g/0000-0001-8325-0838
Ma ia-Giulia Cos anzo-Tala ico Doc o al S uden h ps://o cid.o g/
0000-0001-8783-8460
Ma ía-Dolo es Ma eos Ga cía PhD h ps://o cid.o g/0000-0001-
7646-9532
Me cedes Bueno-Fe án PhD h ps://o cid.o g/0000-0002-0119-
165X
Elena Fe nández-Ga cía PhD h ps://o cid.o g/0000-0002-7922-
2663
FabioD’Agos inoPhD h ps://o cid.o g/0000-0002-4641-604X
20473095, 0, Downloaded om h ps://onlinelib a y.wiley.com/doi/10.1111/2047-3095.12493 by Readcube (Lab i a Inc.), Wiley Online Lib a y on [10/02/2025]. See he Te ms and Condi ions (h ps://onlinelib a y.wiley.com/ e ms-and-condi ions) on Wiley Online Lib a y o ules o use; OA a icles a e go e ned by he applicable C ea i e Commons License
8PORCEL GÁLVEZ ET AL.
José-Manuel Rome o-Sánchez PhD h ps://o cid.o g/0000-0001-
8227-9161
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DIGITAL PLATFORM & NURSING LANGUAGE 9
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