Standardized Languages NANDA-I, NIC, and Nurse
Effective communication in the health care setting is vital in providing consistent quality care for patients. Nurses work in a variety of settings, and patients may be cared for in a variety of settings, sometimes with transfer from one facility to another. The use of a standardized language (terms that have the same definition and meaning regardless of who uses them) fosters communication regarding aspects of patient care.
NANDA-I, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC) provide standardized nursing diagnoses, nursing intervention, and nursing-sensitive patient outcomes. These classification systems further provide research-based information regarding nursing treatments and judgments. NANDA-I, NIC, and terminology are used internationally in all patient settings, including acute care hospitals, long-term care facilities, outpatient and ambulatory settings, and home care. The benefits of these systems are support for the framework for clinical decisions, evidence-based plans of care, and support of effective staffing, student learning, and staff education. The groups behind NANDA-I, NOC, and NIC (NNN) are working together to demonstrate links between these three standardized languages and thus to improve communication both in the United States and internationally. An example of an NNN linkage is listed as follows (Johnson et al., 2012):
Nursing Interventions Classification (NIC)
This standardized language, developed at the University of Iowa, encourages enhanced communication between nurses about nursing interventions. The current NIC edition lists more than 500 interventions and 13,000 activities. Each NIC intervention has a label, a definition for that label, a list of activities that can be used for that intervention, and background information. The label and definition should not be altered when they are used, but the activities can be individualized to the patient’s needs. The title given to nursing interventions is concise. Examples of nursing interventions are airway management; analgesic administration; teaching: prescribed diet; and therapeutic play. Some NIC interventions are called indirect interventions because they occur away from the bedside but on behalf of the patient. Examples of indirect care interventions are emergency cart checking, shift report, staff development, and supply management (Bulechek et al., 2013).
The list of activities is very helpful to guide beginning nurses. The following example shows a NIC intervention and lists 3 of the 36 possible activities for the intervention (Bulechek et al., 2013). Note the definition given and the indicated number that can be retrieved with computer systems. These numbers “run in the background” and are not for memorization.
NIC intervention: 6540
Infection control: Minimizing the acquisition and transmission of infectious agents
Activities:
•Isolate persons exposed to communicable disease.
•Wash hands before and after each patient-care activity.
•Ensure appropriate wound care technique.
Nursing Outcomes Classification (NOC)
NOC, which measures the effects of nursing care, is the effort of a group of researchers working at the University of Iowa. These researchers have developed a standardized system with an organized structure to name and measure nursing-sensitive patient outcomes. Identification of outcomes that are responsive to nursing care is important work for nursing, especially in connection with efforts to contain costs and establish best practices (Moorhead et al., 2013). There are currently 385 outcomes with accompanying definitions, measurement standards, indicators, and references (Moorhead et al., 2013).
The NOC outcomes use brief phrases to describe the result of nursing care. Indicators are given as subheadings for each outcome. These indicators use a measurement scale to evaluate the degree of outcome attainment. An example of an NOC outcome with 1 of the possible 19 indicators follows. The outcome statement and indicator can be described with selected key words from a patient outcome statement (“The patient will demonstrate beginning grief resolution as evidenced by the ability to verbalize reality of loss after nursing interventions”). Also note the coded nature of the outcome and indicators that are used to enhance entry and retrieval of information from a computer database.
•Grief resolution (outcome 1304). Verbalizes reality of loss (indicator 130403). The scale used for this indicator measures from “never demonstrated” to “consistently demonstrated” (1 to 5 scale) (Moorhead et al., 2013).
The nurse should realize that these measurement scales can be used to establish a baseline assessment and then the scale can be applied again during the evaluation phase. Some facilities use these indicators to plan for patient discharge. For example, if the patient does not achieve a 4 or 5 on a scale, then a referral is sometimes necessary.