Introduction to the

Perioperative Nursing Data Set

(PNDS)
Department of Perioperative Services
University of Minnesota Medical Center, Fairview
University of Minnesota Amplatz Childrens Hospital

Revised: May 2011

Pamela Taulman, MA, RN, CPAN
Perianesthesia Clinical Learning Specialist
Original: Dec 2006
Paula Anne Latz, MSN, RN, CNOR, BC
Perioperative Clinical Learning Specialist
Adapted from the Association of Perioperative Registered Nurses
 The Perioperative Nursing Data Set (PNDS)

Purpose: This resource is intended to familiarize nurses with a standardized language that will
support their perioperative practice.

Objectives:
1. Describe the Perioperative Nursing Data Set.
2. Describe the development of the PNDS.
3. Describe the purpose of a standardized language in nursing.
4. Describe potential clinical implications for a standardized language in the perioperative
nursing setting.

Introduction
The Perioperative Nursing Data Set (PNDS) is a standardized language that addresses the
perioperative patient experience from pre-admission until discharge. It describes the nursing
diagnoses, interventions and patient outcomes that make up the nursing process.

As a nursing language, the PNDS is parsimonious, validated, reliable, and useful for clinical
practice. It is the first nursing language developed by a specialty organization that has been
recognized by the American Nurses Association as a data set useful for perioperative nursing
practice. The PNDS can serve many purposes, depending on the audience and user. A few
examples of these potential purposes include:

Providing a framework to standardize documentation;

Providing a universal language for perioperative nursing practice and education;
Assisting in the measurement and evaluation of patient care outcomes;
Providing a foundation for perioperative nursing research and evaluation of patient
outcomes;
Informing decisions about the relationship of staffing to patient outcomes;
Providing data about the contributions of nurses to patient outcomes in the perioperative
arena.

Members of AORN, the Association of periOperative Registered Nurses, developed the PNDS.
This is the premiere organization for perioperative registered nurses. Members of AORN
provide professional nursing care in perioperative settings all over the world. Their clinical
expertise is reflected in the PNDS in that it is an empirically based, inductively derived, and
clinically validated nursing language that is useful for clinical practice, education, and research.
 Development of the PNDS
Starting in the late 1980s, the AORN Board of Directors recognized the need to develop a
national computerized database related to perioperative nursing. Building on Norma Langs
pronouncement of, "If you cannot name it, you cannot control it, finance it, teach it, or put it into
public policy," the Board of Directors committed resources to develop a perioperative nursing
language.

The development of a standardized language was an important first step toward formally
defining the professional roles and contributions of perioperative registered nurses. The
committee members believed that a standardized nursing language would provide a structured
vocabulary and thus a common means of communication. Identifying terms that were clear,
precise, consistent, and described nursing care in the perioperative setting was an essential part
of that process. The guiding premise of the language development effort was that it would assist
perioperative nurses document the care they gave while providing a foundation for examining
and evaluating the quality and effectiveness of that care.

To develop nursing diagnostic, nursing intervention, and patient outcomes statements, committee
members:

Conducted a review of the published and non-published nursing and related literature, as
well as AORN documents related to each component;
Examined and considered the current status and predicted future of perioperative nursing
practice;
Established a process for determining inter-rater reliability for accepted terms and
definitions;
Conducted a series of validation studies with experienced perioperative nurses as
respondents; and
Ensured that each component contributed to an integrated product that reflected the entire
perioperative patient care experience.
 Purpose of the PNDS
These efforts resulted in the PNDS, a standardized nursing data set that describes perioperative
nursing practice. It consists of 74 nursing diagnoses, 133 nursing interventions, and 28 nurse-
sensitive patient outcomes. The language is clinically relevant and empirically validated. The
PNDS is appropriate for use in any surgical setting and any time during the perioperative
experience.

The data set is useful for:

Consistent clinical documentation;

Communication between clinicians in various practice settings;
Benchmarking activities;
Evaluating patient outcomes;
Orientation programs and competency evaluation;
Research;
Activity-based costing.

In 1999, AORN received written notification from the American Nurses Association that the
PNDS had been officially recognized as a data set useful for the practice of nursing. This highly
respected recognition and designation indicates that the PNDS has met the stringent criteria set
forth by the ANA. These criteria were established to ensure that vocabularies and classification
schemes for nursing practice are clinically useful, reliable, and valid; have a coherent taxonomic
structure; have a unique coding system; and are clear and precise.
 The PNDS Model
The Perioperative Nursing Data Set (PNDS) model consists of four domains that illustrate the
dynamic nature of the perioperative patient experience and nursing presence throughout that
process.

1. Behavioral Responses: Family & Individual

This domain is defined as: "Human responses primarily concerned with the
psychological, sociological and spiritual actions and reactions of patients and their
families."
The nurse is responsible for exploring with the patient their perceptions of the
surgery and altered body image. The nurse can empower the family by
encouraging and facilitating communication regarding the impact of the surgery
on various members of the family. Information regarding the patient's condition
is shared with the patient's family or significant others according to the preference
of the patient.
For example, a woman who is going to have a mastectomy is going to have a
psychological as well as physiological response to the procedure, and so is her
family. The patient has a right to demand psychological support regardless if it
were an operative or minimally invasive procedure.
2. Safety
This domain is defined as "Human responses primarily concerned with protection
and security of the patient that focus on nursing activities to keep the patient free
of injury, danger and loss."
The nurse is responsible for assessing, intervening, and documenting these
assessments and interventions using the PNDS in the electronic medical record.

3. Physiological Responses
This domain is defined as "Human responses primarily concerned with human
functioning and physical and biochemical processes."
The PNDS sets the level of acuity for the patient and demands that nurses are
competent to provide the optimal level of care for patients. This sets a standard
for clinical competency as well as appropriate staffing that can be measured and
validates management decisions.
For example, the patient who comes in for bypass and grafting has diminished
cardiac output due to stenosis of the valves from some external factor. The patient
is probably very symptomatic preoperatively, and the standard would demand that
the nurse be adept at using all monitoring devices to be totally aware of the
patient's cardiac status at all times. The PNDS patient outcome in this scenario is:
2.6 The patient's cardiac function is consistent with or improved from baseline
levels established preoperatively. This outcomes addresses that the patient comes
through the perioperative phase with expected vital signs and other measures of
stability.

4. Health System
This domain is made up of structural data elements and focuses on clinical
processes and outcomes. The patient is in constant contact with the health
environment itself.
For example, infection control processes must be followed in order to prevent
the spread of infection to additional patients.
 Clinical Implications of the PNDS
Clinicians, managers, educators and researchers are currently using the Perioperative Nursing
Data Set (PNDS) in a variety of real world, perioperative clinical applications and settings. In
order to fully appreciate the value of the PNDS, it is important to consider the strengths of the
PNDS itself and the opportunities related to its use. When fully implemented, the PNDS guides
research in the perioperative setting and provides a framework to:

Identify which interventions contribute to specific outcomes;

Allows for better data collection and the ability to compare data across clinical
situations and settings;
Support the ability to create a data repository and aggregate data sources;
Provide large populations of surgical patients from which to explore data;
Provide outcome statements that are explicit, clearly defined, observable, and
measureable.

The PNDS
A description of the PNDS and how to incorporate it into your nursing practice at UMMC,
Fairview and UMACH is located on the UMMC Perioperative Services intranet home page.
Click on the following link to view: UMMC-Perioperative Services Perioperative Care Plan.

Additional Resources
AORN website
Rothrock, J.C. & Smith, D.A. (2000). Selecting the perioperative patient focused model.
AORN Journal, 71 ,1030 1037.
 Frequently Asked Questions
What is the Perioperative Nursing Data Set?
The Perioperative Nursing Data Set (PNDS) is a standardized nursing vocabulary that addresses
the perioperative patient experience from pre-admission to discharge. It consists of 64 nursing
diagnoses, 127 nursing interventions, and 29 nurse-sensitive patient outcomes. As a nursing
vocabulary, it is parsimonious, validated, reliable, and useful for clinical practice. It is the first
standardized nursing vocabulary developed by a specialty nursing organization that has been
recognized by the American Nurses Association as a data set useful for perioperative nursing
practice.

What is a standardized nursing language?

A standardized nursing language is a structured vocabulary that provides nurses with a common
means of communication. Nurses should and do use a standardized language or vocabulary in the
same way physicians do, in other words, to describe diagnoses or problems, interventions, and
outcomes. Imagine the communication problems if all physicians did not mean or have the same
thing in mind when they used the term "appendicitis."

Inconsistency of language and meaning makes it almost impossible to manage information in an

electronic format or compare clinical outcomes across settings. A standardized vocabulary
provides clear, consistent, precise terms and definitions for clinical problems, interventions, and
outcomes. Such a vocabulary provides the framework for making comparisons between groups
of patients in a variety of clinical settings.

Who developed the PNDS?

Members of AORN, the Association of periOperative Registered Nurses, developed the PNDS.
This is the premier organization of over 40,000 perioperative registered nurses and its members
provide professional nursing care in perioperative settings all over the world.

Why was the PNDS developed?

The guiding premise of the language development effort was that it would assist perioperative
nurses document nursing care while providing a foundation for examining and evaluating the
quality and effectiveness of that care. A standardized perioperative vocabulary provides the
foundation for comparison of clinical data and benchmarking, as well as measuring outcome data
and evaluating the quality and effectiveness of care.

How can the PNDS be used?

A few examples of potential uses include:

Providing a framework to standardized documentation;

Providing a universal vocabulary for perioperative nursing practice and education;

Assisting in the measurement and evaluation of patient care outcomes;

Providing a foundation for perioperative nursing research and evaluation of patient
outcomes;

Informing decisions about the relationship of staffing to patient outcomes;

Providing data about the contributions of nurses to patient outcomes in the perioperative
arena.
How do I learn more?
Start with reading the various articles related to the PNDS and standardized language published
in the AORN Journal. There is also information available on the AORN website (www.aorn.org).
Review the book, Perioperative Nursing Data Set that includes diagnoses, interventions,
activities, and outcomes. This book is available from AORN or may be available at your site.
Check with your clinical learning specialist.

How can staff nurses, educators and managers implement the perioperative nursing data
set?
There are several ways in which nurses can use the PNDS. The language of the data set allows it
to be adapted into an electronic format that would measure risk factors. By qualifying the true
risk value of patients, the nursing manager can plan and justify staffing levels that correlate to
the needs of the patients. By examining trends, nurse managers facilitate the budgeting process.
By identifying risk factors, nurse educators obtain data on educational needs of the staff. By
documenting assessment and evaluation of risk factors and safety issues for patients, clinical
nurses meet many of the directives from The Joint Commission. Policies and procedures are
strengthened when based on data collection, and the PNDS can help identify areas that need to
be addressed to provide standardization and continuity of care and assist in the development of
patient teaching materials.
When perioperative nurses learn the elements of the domains of the PNDS, they often realize
their own significant contribution and identify their specialization in the surgical arena through
nurse-sensitive outcomes, regardless of the setting.

Within the Perioperative Nursing Data set, what is the definition of a nursing diagnosis?
"A nursing diagnosis is a concise clinical judgment label of a perioperative patient problem
formulated for the purpose of directing nursing actions intended to achieve the expected
outcomes."
A total of 24 diagnoses are identified in a primary tier ranking and are categorized as low
frequency, high priority diagnoses and as "primary" diagnoses. This includes such things as pain,
hypothermia and impaired tissue integrity.
A tier of infrequent, moderate priority, non-urgent diagnoses are considered "secondary
diagnoses". These are mostly human response diagnoses and often are not observed during the
intraoperative phase. They are, however, diagnoses that would concern nurses at other stages of
the surgical experience for the patient. Examples of these secondary diagnoses include acute
confusion, noncompliance, and post-trauma response.

Does this mean that I will have to type in all these diagnoses, interventions and outcomes
when I am documenting care of my patient?
No, your colleagues on the Clinical Documentation team are determining which PNDS elements
will be imbedded in the screens that you will be documenting on. You will have the ability to
select additional PNDS elements based on your assessment of the patient and your determination
of whether additional elements are needed.