NANDA NIC NOC Linkages

NANDA-I (North American Nursing Diagnoses Association International)

The NANDA International Classification is used for the identification of nursing diagnoses. The classification is recognized as a well established diagnosis terminology which is included in UMLS and recognized by ANA. The NANDA Nursing Diagnoses: Definition & Classification 2009-2011 includes 21 new diagnoses, 9 revised diagnoses, 6 retired diagnoses, and has a total of 202 nursing diagnoses for use in practice. Each diagnosis has a definition and the actual diagnoses include defining characteristics and related factors. Risk diagnoses include risk factors (NANDA-I, 2009). In this study, NANDA-I diagnoses are based on 155 nursing diagnoses including related factors and signs/symptoms (NANDA-I, 1999) used in the study hospital.

NOC (Nursing Outcomes Classification)

The current 4th edition Nursing Outcomes Classification has 385 outcomes with definitions, indicators, and measurement scales (1 to 5) for use at the individual, family, and community levels. It includes 58 new outcome labels and 67 revised outcomes (Moorhead et al., 2008). NOC allows nurses to follow changes in or maintenance of outcome states over time and across settings. Before providing an intervention, nurses use NOC to understand the patient’s current problems and nursing diagnoses and rate the chosen outcome to obtain a baseline rating. After providing an intervention, NOC is used to measure the outcome and determine a change score. In this study, NOC outcomes are defined as the second edition of NOC with 260 outcomes labels (Johnson, Maas, & Moorhead, 2000) as the available terminology in the study hospital

NIC (Nursing Interventions Classification)

The NIC taxonomy has 7 domains and 30 classes and 542 interventions in the fifth edition. It currently contains 34 new interventions and 77 revised interventions (Bulechek et al., 2008). Each intervention has a list of more specific activities for implementing the intervention that are selected based on the patients needs. In the study, NIC interventions from the third edition with 468 interventions were used in the study hospital as part of the nursing care planning (Dochterman & Bulechek, 2000)

NANDA NIC NOC NNN Linkages

NNN linkages provide associations between three standardized languages recognized by the American Nurses Organization: NANDA-I, NIC, and NOC. The first step in the process to link NNN is for nurses to determine a nursing diagnosis using NANDA-I diagnoses. The diagnoses that occur most frequently reflect their importance in representing an entire group of patients. After determining the nursing diagnosis, nurses consider which NOC outcomes are appropriate for the patient situation, and then choose NIC interventions that are most likely to achieve the desired outcome (Johnson, 2006).

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Strengths of Nursing Interventions Classification (NIC)

Strengths of Nursing Interventions Classification (NIC)

1. Comprehensive Nursing Interventions Classification NIC includes the full range of nursing interventions from general practice and specialty areas. Interventions include physiological and psychosocial; illness treatment and prevention; health promotion; those for individuals, families and communities; and indirect care. Both independent and collaborative interventions are included; they can be used in any practice setting regardless of philosophical orientation.
2. Research based The research, begun in 1987, uses a multi-method approach; methods include content analysis, questionnaire survey to experts, focus group review, similarity analysis, hierarchical clustering, multidimensional scaling, and clinical field testing.
3. Developed inductively based on existing practice Original sources include current textbooks, care planning guides, and nursing information systems from clinical practice, augmented by clinical practice expertise of team members and experts in specialty areas of practice.
4. Reflects current clinical practice and research All interventions are accompanied by a list of background readings that support the development of the intervention. All interventions have been reviewed by experts in clinical practice and by relevant clinical practice specialty organizations. A feedback process is used to incorporate suggestions from users.
5. Has easy to use organizing structure (domains, classes, interventions, activities) all domains, classes and interventions have definitions; principles have been developed to maintain consistency and cohesion within the Classification; interventions are numerically coded.
6. Uses language that is clear and clinically meaningful Throughout the work, the language most useful in clinical practice has been selected; the language reflects clarity in conceptual issues (e.g. what's an intervention versus a diagnosis or an assessment to make a diagnosis, or an outcome).
7. Has established process and structure for continued refinement The Classification continues to be developed by researchers at the College of Nursing, the University of Iowa; commitment to the project is evident by years of work and continued involvement. The continued refinement of NIC is facilitated by the Center for Nursing Classification and Clinical Effectiveness, established in the College of Nursing at the University of Iowa in 1995 by the Iowa Board of Regents.
8. Has been field tested The process of implementation was studied in five field sites representing the various settings where nursing care takes place; hundreds of other clinical and educational agencies are also implementing the Classification. Steps for implementation have been developed to assist in the change process.
9. Accessible through numerous publications In addition to the classification itself, approximately five dozen articles and chapters have been published by members of the research team since 1990. Book and article reviews and publications by others about use and value of NIC attest to the significance of the work.
10. Linked to NANDA nursing diagnosis, Omaha system problems, NOC outcome, RAP in long term care, OASIS for home health A second edition book linking NOC outcomes and NIC interventions to NANDA diagnoses is available from Mosby. Other linkages are available in monograph form from the Center for Nursing Classification and Clinical Effectiveness.
11. Recipient of national recognition NIC is recognized by the American Nurses Association, is included in the National Library of Medicine’s Metathesaurus for a Unified Medical Language, is included in indexes of CINAHL, is listed by JCAHO as one classification that can be used to meet the standard on uniform data, is included in Alternative Link’s ABC codes for reimbursement by alternative providers, is registered in HL7, and included in SNOMED CT.
12. Developed at same site as outcomes classification The Nursing Outcomes Classification (NOC) of patient outcomes sensitive to nursing practice has also been developed at Iowa; both NIC and NOC are housed in the Center for Nursing Classification and Clinical Effectiveness and the work on the two classifications is coordinated.
13. Included in a growing number of vendor software clinical information systems  The Systematized Nomenclature of Medicine (SNOMED) has included NIC in its multidisciplinary record system. Several vendors have licensed NIC for inclusion in their software, targeted at both hospital and community settings, as well as practitioners in either general and specialty practice.
14. Translated into several languages Although NIC has been developed for applicability to nursing in the United States, nurses in several other countries are finding the Classification useful. Translations are complete or in process for the following languages: Chinese, Dutch, French, German, Icelandic, Japanese, Korean, Portuguese, and Spanish.

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Nursing Interventions Classification (NIC)

Nursing Interventions Classification (NIC). The Nursing Interventions Classification (NIC) is a comprehensive, research-based, standardized classification of interventions that nurses perform. It is useful for clinical documentation, communication of care across settings, integration of data across systems and settings, effectiveness research, productivity measurement, competency evaluation, reimbursement, and curricular design. The Classification includes the interventions that nurses do on behalf of patients, both independent and collaborative interventions, both direct and indirect care. An intervention is defined as "any treatment, based upon clinical judgment and knowledge that a nurse performs to enhance patient/client outcomes." While an individual nurse will have expertise in only a limited number of interventions reflecting on her or his specialty, the entire classification captures the expertise of all nurses. NIC can be used in all settings (from acute care intensive care units, to home care, to hospice, to primary care) and all specialties (from critical care to ambulatory care and long term care). While the entire classification describes the domain of nursing, some of the interventions in the classification are also done by other providers. NIC can be used by other non-physician providers to describe their treatments.

NIC interventions include both the physiological (e.g. Acid-Base Management) and the psychosocial (e.g. Anxiety Reduction). Interventions are included for illness treatment (e.g. Hyperglycemia Management), illness prevention (e.g. Fall Prevention), and health promotion (e.g. Exercise Promotion). Most of the interventions are for use with individuals but many are for use with families (e.g. Family Integrity Promotion), and some are for use with entire communities (e.g. Environmental Management: Community). Indirect care interventions (e.g. Supply Management) are also included. Each intervention as it appears in the classification is listed with a label name, a definition, a set of activities to carry out the intervention, and background readings.

The 542 interventions in NIC (5th ed.) are grouped into thirty classes and seven domains for ease of use. The 7 domains are: Physiological: Basic, Physiological: Complex, Behavioral, Safety, Family, Health System, and Community. Each intervention has a unique number (code). NIC interventions have been linked with NANDA nursing diagnoses, Omaha System problems, and NOC outcomes. The classification is continually updated with an ongoing process for feedback and review. In the back of the book, there are instructions for how users can submit suggestions for modifications to existing interventions or propose a new intervention. All contributors whose changes are included in the next edition are acknowledged in the book. New editions of the classification are planned for approximately every 4 years. The classification was first published in 1992, the second edition in 1996, the third edition in 2000, the fourth edition in 2004, and the fifth edition in 2008. Work that is done between editions and other relevant publications that enhance the use of the classification are available from the Center for Nursing Classification & Clinical Effectiveness at the College of Nursing, The University of Iowa.

NIC is recognized by the American Nurses' Association (ANA) and is included as one data set that will meet the uniform guidelines for information system vendors in the ANA's Nursing Information and Data Set Evaluation Center (NIDSEC). NIC is included in the National Library of Medicine's Metathesaurus for a Unified Medial Language and the cumulative index of nursing Literature (CINAHL). NIC is also included in The Joint Commission as one nursing classification system that can be used to meet the standard on uniform data. The National League for Nursing has made a 40-minute video about NIC to facilitate teaching of NIC to nursing students and practicing nurses. Alternative Link has included NIC in its ABC codes used for reimbursement for alternative providers. NIC is registered in HL7 and is mapped into SNOMED (Systemized Nomenclature of Medicine).

Hundreds of health care agencies have adopted NIC for use in standards, care plans, competency evaluation, and nursing information systems; nursing education programs are using NIC to structure curriculum and identify competencies of graduating nurses; authors of major texts are using NIC to discuss nursing treatments; and researchers are using NIC to study the effectiveness of nursing care. Interest in NIC has been demonstrated in several other countries, notably Brazil, Canada, Denmark, England, France, Germany, Iceland, Japan, Korea, Spain, Switzerland, and The Netherlands. NIC has been translated into Chinese, Dutch, French, German, Icelandic, Japanese, Korean, Portugese, and Spanish; other translations are in progress.

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North American Nursing Diagnosis Association International

In 1973, the first conference on nursing diagnosis was held to identify nursing knowledge and to establish a classification system suitable for computerization. From this conference developed the National Group for the Classification of Nursing Diagnosis, composed of nurses from different regions of the United States and Canada, representing all elements of the profession: practice, education, and research. From 1973 to the present, the National Group has met 15 times. Its most recent list of nursing diagnoses is presented at the end of Section One.

In 2003, the organization was renamed the North American Nursing Diagnosis Association International (NANDA). In addition to reviewing and accepting nursing diagnoses for addition to the list, NANDA also reviews previously accepted nursing diagnoses. For example, in 1994, NANDA revised ten previously accepted diagnoses.

In March 1990, the first issue of Nursing Diagnosis, NANDA’s official journal, was published. This journal aims to promote the development, refinement, and application of nursing diagnoses and to serve as a forum for issues pertaining to the development and classification of nursing knowledge. The journal is now named Nursing Diagnosis: The International Journal of Nursing Language and Classification.

At the International Council of Nursing (ICN) in Seoul in 1989, the Canadian and American Nurses Associations proposed a resolution to the Council of National Representatives. The resolution asked that “ICN encourage member nurses’ associations to become involved in developing classification systems for nursing care, nursing information management systems, and nursing data sets to provide tools that nurses in all countries could use to describe nursing and its contributions to health” (Clark & Lang,

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NANDA Nursing Diagnosis

NANDA Nursing Diagnosis. A nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable The general need or problem in Nursing diagnosis is stated without the distinct cause and signs and symptoms, which would be added to create a client diagnostic statement when specific client information is available. For example, when a client displays increased tension, apprehension, quivering voice, and focus on self, the nursing diagnosis of Anxiety might be stated: severe Anxiety related to unconscious conflict, threat to self-concept as evidenced by statements of increased tension, apprehension; observations of quivering voice focus on self. In addition, diagnoses identified within these guides for planning care as actual or risk can be changed or deleted and new diagnoses added, depending entirely on the specific client information. NANDA Nursing Diagnosis

Nursing diagnosis accepted for use and research for 2009–2011
NANDA Nursing Diagnosis:
Activity Intolerance [specify level]
Activity Intolerance, risk for
Activity Planning, ineffective
Airway Clearance, ineffective
Allergy Response, latex
Allergy Response, risk for latex
Anxiety [specify level]
Anxiety, death
Aspiration, risk for
Attachment, risk for impaired
Autonomic Dysreflexia
Autonomic Dysreflexia, risk for
Behavior, risk-prone health
Bleeding, risk for
Body Image, disturbed
Body Temperature, risk for imbalanced
Bowel Incontinence
Breastfeeding, effective
Breastfeeding, ineffective
Breastfeeding, interrupted
Breathing Pattern, ineffective
Cardiac Output, decreased
Caregiver Role Strain
Caregiver Role Strain, risk for
Childbearing Process, readiness for enhanced
Comfort, impaired
Comfort, readiness for enhanced
Communication, impaired verbal
Communication, readiness for enhanced
Conflict, decisional
Conflict, parental role
Confusion, acute
Confusion, risk for acute
Confusion, chronic
Constipation
Constipation, perceived
Constipation, risk for
Contamination
Contamination, risk for
Coping, defensive
Coping, ineffective
Coping, readiness for enhanced
Coping, ineffective community
Coping, readiness for enhanced community
Coping, compromised family
Coping, disabled family
Coping, readiness for enhanced family
Death Syndrome, risk for sudden infant
Decision-Making, readiness for enhanced
Denial, ineffective
Dentition, impaired
Development, risk for delayed
Diarrhea
Dignity, risk for compromised human
Distress, moral
Disuse Syndrome, risk for
Diversional Activity, deficient
Electrolyte Imbalance, risk for
Energy Field disturbed
Environmental Interpretation Syndrome, impaired
Failure to Thrive, adult
Falls, risk for
Family Processes, dysfunctional
Family Processes, interrupted
Family Processes, readiness for enhanced
Fatigue
Fear
Feeding Pattern, ineffective infant
Fluid Balance, readiness for enhanced
[Fluid Volume, deficient hyper/hypotonic]
Fluid Volume, deficient [isotonic]
Fluid Volume, excess
Fluid Volume, risk for deficient
Fluid Volume, risk for imbalanced
Gas Exchange, impaired
Glucose Level, risk for unstable blood
Grieving
Grieving, complicated
Grieving, risk for complicated
Growth, risk for disproportionate
Growth and Development, delayed
Health Maintenance, ineffective
Health Management, ineffective self [formerly Therapeutic Regimen Management, ineffective]
Health Management, readiness for enhanced self [formerly Therapeutic Regimen Management, readiness for enhanced]
Home Maintenance, impaired
Hope, readiness for enhanced
Hopelessness
Hyperthermia
Hypothermia
Identity, disturbed personal
Immunization Status, readiness for enhanced
Infant Behavior, disorganized
Infant Behavior, readiness for enhanced organized
Infant Behavior, risk for disorganized
Infection, risk for
Injury, risk for
Injury, risk for perioperative positioning
Insomnia
Intracranial Adaptive Capacity, decreased
Jaundice, neonatal
Knowledge, deficient [Learning Need] [specify]
Knowledge [specify], readiness for enhanced
Lifestyle, sedentary
Liver Function, risk for impaired
Loneliness, risk for
Maternal/Fetal Dyad, risk for disturbed
Memory, impaired
Mobility, impaired bed
Mobility, impaired physical
Mobility, impaired wheelchair
Motility, dysfunctional gastointestinal
Motility, risk for dysfunctional gastointestinal
Nausea
Neglect, self
Neglect, unilateral
Noncompliance [Adherence, ineffective] [specify]
Nutrition: less than body requirements, imbalanced
Nutrition: more than body requirements, imbalanced
Nutrition: more than body requirements, risk for imbalanced
Oral Mucous Membrane, impaired
Pain, acute
Pain, chronic
Parenting, impaired
Parenting, readiness for enhanced
Parenting, risk for impaired
Perfusion, ineffective peripheral tissue
Perfusion, risk for decreased cardiac tissue
Perfusion, risk for ineffective cerebral tissue
Perfusion, risk for ineffective gastrointestinal
Perfusion, risk for ineffective renal
Peripheral Neurovascular Dysfunction, risk for
Poisoning, risk for
Post-Trauma Syndrome [specify stage]
Post-Trauma Syndrome, risk for
Power, readiness for enhanced
Powerlessness [specify level]
Powerlessness, risk for
Protection, ineffective
Rape-Trauma Syndrome
(Rape-Trauma Syndrome: compound reaction retired 2009)
(Rape-Trauma Syndrome: silent reaction retired 2009)
Relationship, readiness for enhanced
Religiosity, impaired
Religiosity, risk for impaired
Religiosity, readiness for enhanced
Relocation Stress Syndrome
Relocation Stress Syndrome, risk for
Resilience, impaired individual
Resilience, readiness for enhanced
Resilience, risk for compromised
Role Performance, ineffective
Self-Care, readiness for enhanced
Self-Care Deficit: bathing
Self-Care Deficit: dressing
Self-Care Deficit: feeding
Self-Care Deficit: toileting
Self-Concept, readiness for enhanced
Self-Esteem, chronic low
Self-Esteem, situational low
Self-Esteem, risk for situational low
Self-Mutilation
Self-Mutilation, risk for
Sensory Perception, disturbed (specify: visual, auditory, kinesthetic, gustatory, tactile, olfactory)
Sexual Dysfunction
Sexuality Pattern, ineffective
Shock, risk for
Skin Integrity, impaired
Skin Integrity, risk for impaired
Sleep, readiness for enhanced
Sleep Deprivation
Sleep Pattern, disturbed
Social Interaction, impaired
Social Isolation
Sorrow, chronic
Spiritual Distress
Spiritual Distress, risk for
Spiritual Well-Being, readiness for enhanced
Stress Overload
Suffocation, risk for
Suicide, risk for
Surgical Recovery, delayed
Swallowing, impaired
(Therapeutic Regimen Management, effective retired 2009)
(Therapeutic Regimen Management, ineffective community retired 2009)
Therapeutic Regimen Management, ineffective family
Thermoregulation, ineffective
(Thought Processes, disturbed retired 2009)
Tissue Integrity, impaired
Transfer Ability, impaired
Trauma, risk for
Trauma, risk for vascular
Urinary Elimination, impaired
Urinary Elimination, readiness for enhanced
Urinary Incontinence, functional
Urinary Incontinence, overflow
Urinary Incontinence, reflex
Urinary Incontinence, stress
(Urinary Incontinence, total retired 2009)
Urinary Incontinence, urge
Urinary Incontinence, risk for urge
Urinary Retention [acute/chronic]
Ventilation, impaired spontaneous
Ventilatory Weaning Response, dysfunctional
Violence, [actual/]risk for other-directed
Violence, [actual/]risk for self-directed
Walking, impaired
Wandering [specify sporadic or continual]

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Nursing diagnosis ineffective breathingpattern

Nursing diagnosis: ineffective breathing pattern
Related to:
Decreased lung expansion due to air or fluid accumulation; musculoskeletal impairment; pain and anxiety; inflammatory process

Possibly evidenced by:

• Dyspnea, tachypnea
• Changes in depth or equality of respirations; altered chest excursion
• Use of accessory muscles, nasal flaring
• Cyanosis, abnormal ABGs

Desired Outcomes/Evaluation Criteria Client Will

• Respiratory Status: Ventilation
• Establish a normal and effective respiratory pattern with ABGs within client’s normal range.
• Be free of cyanosis and other signs or symptoms of hypoxia.

Nursing intervention with rationale:

• Identify etiology or precipitating factors, such as spontaneous collapse, trauma, malignancy, infection, and complication of mechanical ventilation. Rationale: Understanding the cause of lung collapse is necessary for proper chest tube placement and choice of other therapeutic measures.
• Evaluate respiratory function, noting rapid or shallow respirations, dyspnea, reports of “air hunger,” development of cyanosis, and changes in vital signs. Rationale: Respiratory distress and changes in vital signs occur because of physiological stress and pain or may indicate development of shock due to hypoxia or hemorrhage.
• Monitor for synchronous respiratory pattern when using mechanical ventilator. Note changes in airway pressures. Rationale: Difficulty breathing with ventilator or increasing airway pressures suggests worsening of condition and development of complications, such as spontaneous rupture of a bleb creating a new pneumothorax.
• Auscultate breath sounds. Rationale: Breath sounds may be diminished or absent in a lobe, lung segment, or entire lung field (unilateral). Atelectatic area will have no breath sounds, and partially collapsed areas have decreased sounds. Regularly scheduled evaluation also helps determine areas of good air exchange and provides a baseline to evaluate resolution of pneumothorax.
• Note chest excursion and position of trachea. Rationale: Chest excursion is unequal until lung reexpands. Trachea deviates from affected side with tension pneumothorax.
• Assess fremitus. Rationale: Voice and tactile fremitus (vibration) is reduced in fluid-filled or consolidated tissue.
• Assist client with splinting painful area when coughing, or during deep breathing. Rationale: Supporting chest and abdominal muscles makes coughing more effective and less traumatic.
• Maintain position of comfort, usually with head of bed elevated. Turn to affected side. Encourage client to sit up as much as possible. Rationale: Promotes maximal inspiration; enhances lung expansion and ventilation in unaffected side.
• Maintain a calm attitude, assisting client to “take control” by using slower, deeper respirations. Rationale: Assists client to deal with the physiological effects of hypoxia, which may be manifested as anxiety or fear.

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