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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Benefits Nursing Outcomes Classification (NOC)

Values of Standardized Nursing Language-NOC in Managed Care

• Labels and provides measures for comprehensive outcomes that respond to nursing intervention.
• Defines outcomes that focus on the patient and can be used by both nurses and other disciplines.
• Provides more specific outcome information than global health status measures. This allows providers to identify problems when global health status measures are not in an acceptable range.
• Provides outcomes that are intermediate to the achievement of longer range desired outcomes.
• Uses a scale to measure outcomes which provides quantifiable information about patient outcomes achieved in an organization or managed care system.
• Facilitates the identification of risk adjustment factors for population groups. This is a necessary step in the assessment of outcome variance.

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Nursing Outcomes Classification (NOC)

The Nursing Outcomes Classification (NOC) is a comprehensive, standardized classification of patient/client outcomes developed to evaluate the effects of nursing interventions. Standardized outcomes are necessary for documentation in electronic records, for use in clinical information systems, for the development of nursing knowledge and the education of professional nurses. An outcome is a measurable individual, family, or community state, behavior or perception that is measured along a continuum and is responsive to nursing interventions. The outcomes are developed for use in all settings and with all patient populations. Clinical sites used to test the NOC included tertiary care hospitals, community hospitals, community agencies, nursing centers, and a nursing home. The outcomes are developed for use in all settings and can be used across the care continuum to follow patient outcomes throughout an illness episode or over an extended period of care. Since the outcomes describe patient/client status, other disciplines may find them useful for the evaluation of their interventions.

The 330 NOC outcomes in Nursing Outcomes Classification (NOC) (third ed.) are listed in alphabetical order. Each outcome has a definition, a list of indicators that can be used to evaluate patient status in relation to the outcome, a target outcome rating, place to identify the source of data, a five-point Likert scale to measure patient status, and a short list of references used in the development of the outcome. For 76 of the outcomes an additional measurement scale was added to the outcome based on feedback from our research in 10 clinical sites. Examples of scales used with the outcomes are 1=Extremely compromised to 5= Not compromised and 1=Never demonstrated to 5=Consistently demonstrated. The NOC (third ed.) includes 311 individual level outcomes, 10 family and 9 community level outcomes. The NOC outcomes are grouped in a coded taxonomy that organizes the outcomes within a conceptual framework to facilitate locating an outcome. The 330 outcomes are grouped into thirty-one classes and seven domains for ease of use. The seven domains are Functional Health, Physiologic Health, Psychosocial Health, Health Knowledge & Behavior, Perceived Health, Family Health, and Community Health. Each outcome has a unique code number that facilitates its use in computerized clinical information systems and allows manipulation of data to answer questions about nursing care quality and effectiveness. The classification is continually updated to include new outcomes and to revise older outcomes based on new research or user feedback and is published on a 4 year cycle.

The research to develop NOC began with the formation of the outcomes research team in 1991 and has progressed through the following phases.

• Phase I - Pilot Work to Test Methodology (1992-1993)
• Phase II - Construction of the Outcomes (1993-1996)
• Phase III - Construction of the Taxonomy and Clinical Testing (1996-1997)
• Phase IV - Evaluation of Measurement Scales (1998-2002)
• Phase V - Refinement and Clinical Use (1997 - Present)

Funding for Phase I was received from Sigma Theta Tau International and funding for Phases II through V from the National Institutes of Health, National Institute of Nursing. Multiple research methods have been used in the development of NOC. An inductive approach was used to develop the outcomes based on current practice and research. Concept analysis and research team review were used in the construction of the outcomes. Questionnaire surveys of expert nurses were used to assess the content validity and nursing sensitivity of the outcomes. The taxonomy was constructed using similarity/dis-similarity analysis and hierarchical clustering techniques. Feedback from clinical test sites and other sites implementing NOC have been used to identify new outcomes for development and refine current outcomes. Currently, inter-rater reliability, criterion measures and other methods are being used to evaluate the reliability, validity, and sensitivity of the outcome measures in clinical sites. This data is included in the third edition.

The outcomes have been linked to NANDA International diagnosis, to Gordon's functional patterns, to the Taxonomy of Nursing Practice, to Omaha System problems, to resident admission protocols (RAPs) used in nursing homes, to the OASIS System used in home care and to NIC interventions. A more in depth look at the linkage between NANDA, NIC and NOC is available in a separate book Nursing diagnoses, outcomes, & interventions: NANDA, NOC, and NIC Linkages. This publication is also available in a CD-ROM.

NOC is one of the standardized languages recognized by the American Nurses' Association (ANA). As a recognized language it meets the language guideline standards set by ANA's Nursing Information and Data Set Evaluation Center (NIDSEC) for information system vendors. NOC is included in the National Library of Medicine's Metathesaurus for a Unified Medical Language and in The Cumulative Index to Nursing Literature (CINAHL) and has been approved for use by Health Level 7 Terminology (HL7). NOC is currently being mapped into SNOMED (Systemized Nomenclature of Medicine). The use of NOC in practice, nursing education, and research is the most accurate indicator of NOC's usefulness. NOC is being adopted in a number of clinical sites for the evaluation of nursing practice and is being used in educational settings to structure curricula and teach students clinical evaluation. Interest in NOC has been demonstrated in other countries. NOC has been translated into Dutch, Japanese, Korean, French, and Spanish and several other translations are in progress including German and Portuguese.

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