223452003 | Reminding (procedure) | and subtypes
The concept 223452003 |Reminding (procedure)| and its four subtypes are currently subtypes of 225217007 |Psychodynamic and/or supportive psychotherapeutic intervention (procedure)|. The placement of these concepts has been questioned via a customer request.
The Nursing CRG is being asked to provide input on whether they would see a reminding procedure as a type of 225217007 |Psychodynamic and/or supportive psychotherapeutic intervention (procedure). If not, information on the type of procedure nurses would see these as would be appreciated.
Thank you,
Cathy
Comments
Hi Cathy ,
apologies I could not attend the meeting on Tuesday. I have had some feedback from the Mental Health team that I work with on the 3 terms you wanted to discuss. please see attached.
Clinical Query – Terms
Our view on the terms and feedback as follows:
Client Participation, Complex Relationship Building, and Establishment of Trust, are inappropriately categorised as “procedures” under current SNOMED CT guidance.
Client Participation is a behavioural state and is dependent on client input
Complex Relationship Building is conceptually vague and is only identifiable as an emergent process
Establishment of Trust is a co-created emotional state and is not externally performed
Client Participation
This is not something done to a patient but rather is an interactive or co-produced state. Participation is assessed or reported and not performed. In mental health nursing and mental health care planning “participation” is typically observed or recorded via narrative, PROM/PREMs or assessments on engagement.
We believe this fits more appropriately under Observable Entity or Social Context, or as a Finding e.g. “Client engaged in care planning”.
Suggested alternative categorisation; Observable behaviour or engagement level, e.g. “Degree of client engagement in care”.
Complex Relationship Building
There is no clear boundary of start, completion or measurable outcome. The term is contingent on an emergent, iterative and mutual interaction which we consider is similar to therapeutic alliance development. This may involve techniques (i.e. Motivational Interviewing, Communication etc.) but the overarching term is too abstract and ambiguous to code as a procedure in our opinion.
Establishment of Trust
Trust is a bidirectional state. Establishment of trust is not reliably performative, measurable or even documentable as a clinical activity. In general, we in mental health use approaches that foster trust, but we cannot perform “trust”. As currently defined as a procedure it risks suggesting that clinicians can guarantee or complete “trust” like a task. Implying a binary outcome.
Suggested alternative is perhaps “intervention to promote therapeutic alliance” or “use of trust building techniques”.
Suggestions
Reclassify or retire these three terms
Explore or map new terms;
Observable Entity (e.g. Client engagement)
Relational or Contextual Factor (e.g. Therapeutic alliance)
Clinical Approach (e.g. Trust promoting techniques)
While the three terms hold conceptual weight in mental health practice, their current classification as “procedures” reflects potential category error in our opinion. They are process, relational and subjective, requiring contextual understanding and multi-party involvement making them unsuitable as standalone “procedures” within the definition.
Appendix – Query
Clinical reference group - Nursing - attended by Yvonne last week- discussion outcomes:
Client participation (procedure) - definition requested
Concept added in 2002
ICNP definition of participation: 'Interactive Behaviour: Taking part in something, sharing in an activity'.
Complex relationship building (procedure)| - definition requested
Concept added in 2003
CYPMH Comment: Part of care planning, broaden not just related to trust
Establishment of trust (procedure) - definition and use case as a requested procedure
Concept added in 2015
In ICNP refset
ICNP definition of trust: 'Emotion: Feeling of confidence, believing in goodness, strength and reliability of others'.
Parents
SNOMED CT Concept (SNOMED RT+CTV3)
Procedure (procedure)
Provider-specific procedure (procedure)
Psychologic AND/OR psychiatric procedure AND/OR service (procedure)
Psychotherapeutic, behavioral and/or communication procedure (procedure)
Psychodynamic and/or supportive psychotherapeutic intervention (procedure)
Psychosocial procedure (procedure)
Psychosocial intervention strategy (procedure)
Participative approach (procedure)
225330006 | Client participation
SCTID: 225330006
225330006 | Client participation (procedure) |
en Client participation (procedure)
en Client participation
Children (5)
Client involvement in management of their money (procedure)
Establishing client relationship (procedure)
Complex relationship building (procedure)
Establishment of rapport (procedure)
Establishment of trust (procedure)
Involving client in decision making process (procedure)
Involving client in planning care (procedure)
Identification of expectations of home care (procedure)
Identification of individual values and wishes concerning care (procedure)
Maintaining client participation (procedure)
Parents
SNOMED CT Concept (SNOMED RT+CTV3)
Procedure (procedure)
Provider-specific procedure (procedure)
Psychologic AND/OR psychiatric procedure AND/OR service (procedure)
Psychotherapeutic, behavioral and/or communication procedure (procedure)
Psychodynamic and/or supportive psychotherapeutic intervention (procedure)
Psychosocial procedure (procedure)
Psychosocial intervention strategy (procedure)
Participative approach (procedure)
Client participation (procedure)
Establishing client relationship (procedure)
384605003 |Complex relationship building
SCTID: 384605003
384605003 | Complex relationship building (procedure) |
en Complex relationship building (procedure)
en Complex relationship building
Children (0)
No children
Parents
SNOMED CT Concept (SNOMED RT+CTV3)
Procedure (procedure)
Provider-specific procedure (procedure)
Psychologic AND/OR psychiatric procedure AND/OR service (procedure)
Psychotherapeutic, behavioral and/or communication procedure (procedure)
Psychodynamic and/or supportive psychotherapeutic intervention (procedure)
SNOMED CT Concept (SNOMED RT+CTV3)
Procedure (procedure)
Psychosocial procedure (procedure)
Psychosocial intervention strategy (procedure)
Participative approach (procedure)
Client participation (procedure)
Establishing client relationship (procedure)
711122003 | Establishment of trust
SCTID: 711122003
711122003 | Establishment of trust (procedure) |
en Establishment of trust (procedure)
en Establishment of trust
Children (0)
No children
I hope the above is helpful
Thanks
Yvonne
Discussed on call - a type of behavioural procedure e.g. reminding a patient to do a blood glucose level, exercise. Located in the right place in the hierarchy.