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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