Nursing in the Netherlands could benefit from the use of information and communication technology to support its communication, patient care documentation and data collection tasks. Further, the nursing data, once entered in an electronic patient record, could be used for other purposes like research, management and policy making. However, the use of information and communication by the nursing profession in the Netherlands is still very limited. This situation calls for a further analysis of the problems. Such an analysis is justified by the growing need for information about nursing care, since nurses constitute of the largest workforces in Dutch health care and the potential benefits applying Electronic Patient Records for patients, nurses, and health care at large are tremendous.
The general goal of the reviews and research described in this thesis is to analyse problems associated with information management and the use of Information and Communication Technology (ICT) in nursing and proposing solutions. Based on this analysis, two tools are developed, the application of which eventually will contribute to information management and processing by nurses, and to a competent development of nursing information systems that are part of the electronic patient record. If we find such solutions, it is important that these will be implemented, therefore the implementation possibilities will be explored.
Derived from these considerations, the following research objectives are specified, which are addressed in the subsequent chapters.

1. Analyse problems that are related to professional information management and the use of information and communication technology in nursing.
2. Suggest a well-defined, systematic and scientific approach to the further advancement and development of the field of nursing informatics.
3. Gain consensus about the Nursing Information Reference Model and determine criteria for the systematic development, implementation and use of nursing information systems that are part of the electronic patient record.
4. Identify the implications of formalised nursing knowledge systems for the development of electronic patient record system.
5. Identify relevant patient data and data about nursing phenomena and nursing activities that are useful to get insight in nursing care.
6. Develop a Nursing Minimum Data Set for the Netherlands based on identified categories and items.
7. Evaluate the Nursing Minimum Data Set for the Netherlands for its usability to describe differences in patient populations and nursing activities.
8. Investigate the interrater reliability and discriminative validity of the data collection of the Nursing Minimum Data Set for the Netherlands.

Specific topics and composition of this dissertation

To achieve these goals, various studies were undertaken, together constituting the dissertation. The chapters 2-9 are written as scientific papers, which have either already been published, are accepted, or are submitted for publication. This means that each chapter can be read separately, but it also implies that a certain overlap was inevitable.
• Chapter two addresses the first research objective, the analysis of problems that exist in nursing information management, and in the development and use of nursing information systems.
• Chapter three proposes a definition, framework, and overview of scientific methods for nursing informatics to meet research objective 2.
• Chapter four addresses research objective 3: getting consensus about the Nursing Information Reference Model and criteria for nursing information systems.
• Chapter five reviews the consequences for the electronic patient record when formalised nursing knowledge, such as unified terminology, and classification systems are used. This to meet research objective 4.
• Chapter six addresses research objective 5 by reviewing existing nursing minimum data sets.
• Chapter seven focuses on the identification and development of the Nursing Minimum Data Set for the Netherlands to achieve research objective 6.
• Chapter eight addresses research objective 7 and describes the evaluation of the NMDSN in 9 Dutch hospitals.
• Chapter nine meets research objective 8, and describes an investigation of the interrater reliability and discriminative validity of the NMDSN.
• Chapter ten presents general conclusions and gives suggestions for using the results of the current studies. It ends with recommendations for future research and development in the area of nursing information systems, electronic patient records, the Nursing Minimum Data Set for the Netherlands and the Nursing Information Reference Model.