Nursing Interventions and Outcomes Nursing Interventions Classification (NIC)
1. Overview and Development:
The Nursing Interventions Classification (NIC) was developed by researchers at the University of Iowa with funding from the National Center for Nursing Research. Initiated through a national Delphi survey involving masters-prepared nurses, the NIC was created to standardize and classify nursing interventions. This extensive survey helped in generating an initial list of 336 specific interventions, reflecting a comprehensive range of nursing activities (Moorehead, McCloskey, & Bulechek, 1993).
2. Structure and Categories:
The NIC currently includes over 514 research-based, standardized clinical interventions. These interventions are categorized into seven broad groups to facilitate organization and application in various clinical settings:
- Basic Physiological: Includes interventions focused on fundamental physiological needs, such as monitoring vital signs, managing fluid balance, and supporting basic nutrition.
- Complex Physiological: Encompasses more intricate interventions, often involving critical care or chronic disease management, such as ventilator management and complex wound care.
- Behavioral: Addresses interventions aimed at influencing patient behavior, including stress management techniques, behavior modification strategies, and therapeutic communication.
- Safety: Focuses on ensuring patient safety through measures such as fall prevention, infection control, and risk management.
- Family: Involves interventions that support and educate family members, such as providing caregiver support and facilitating family counseling.
- Health System: Pertains to interventions that impact or utilize health care systems, including patient advocacy, care coordination, and policy development.
- Community: Covers interventions that address community health needs, such as health promotion activities, disease prevention programs, and community health assessments (Dochterman & Bulechek, 2004; McCloskey & Bulechek, 2000).
3. Validation and Updates:
The NIC taxonomy has undergone extensive validation to ensure its accuracy and relevance. A sample of 121 nurses from the Midwest Nursing Research Society provided feedback that led to revisions and enhancements of the original taxonomy. The NIC is regularly updated based on ongoing feedback and review processes, ensuring it reflects current evidence and practice standards (McCloskey & Bulechek, 2000).
4. Application and Integration:
NIC is designed for use across various nursing specialties and care settings, making it a versatile tool for documenting and standardizing nursing interventions. It is included as a key dataset in the American Nurses Association’s Nursing Information and Data Set Evaluation Center (NIDSEC), which evaluates and recognizes information systems that support comprehensive documentation of nursing care within automated systems and computer-based patient records (Dochterman & Bulechek, 2004).
Nursing Outcomes Classification (NOC)
1. Development and Purpose:
The Nursing Outcomes Classification (NOC) was developed by researchers from the NIC team to address the need for a systematic approach to classify patient outcomes. Published in 1997 by Johnson and Maas, the NOC includes 330 outcomes that can be applied across various episodes of care and settings. This classification system helps in documenting and evaluating the impact of nursing interventions on patient outcomes.
2. Linkage to Other Classification Systems:
NOC outcomes are linked to several other classification systems and frameworks, enhancing their applicability and relevance. These include:
- NANDA International Diagnoses: Provides a link between nursing diagnoses and corresponding outcomes.
- Gordon’s Functional Patterns: Aligns outcomes with functional health patterns.
- Taxonomy of Nursing Practice: Integrates outcomes with a broader taxonomy of nursing practices.
- Omaha Classification System (OCS): Connects outcomes with a comprehensive classification system used in community health settings.
- Resident Admission Protocols: Used in nursing homes to document resident outcomes.
- OASIS System: Employed in home care settings to measure patient outcomes.
- NIC Interventions: Ensures that outcomes are connected with the interventions listed in the NIC taxonomy (Iowa Outcomes Project, Johnson, Maas, & Moorhead, 2000).
3. Individual, Family, and Community Outcomes:
Although the majority of NOC outcomes focus on individual patients (311 out of 330), the system also includes measures for family and community outcomes. This allows for a broader assessment of nursing interventions and their impact beyond individual patients.
4. Historical Context and Development:
Before the introduction of classification systems like NIC and NOC, documenting nursing actions was often inconsistent and lacked a standardized language. The development of these systems provided a structured approach to link nursing diagnoses, interventions, and outcomes, making it easier for novice nurses to navigate complex care scenarios and document patient progress systematically.
Outcome Measures and NANDA
1. Integration with NANDA:
The integration of outcome measures with NANDA International diagnoses is crucial for comprehensive care planning. NANDA provides a standardized framework for nursing diagnoses, while outcome measures help evaluate the effectiveness of nursing interventions. This linkage ensures that nursing actions are aligned with patient needs and expected outcomes.
2. Benefits of Integration:
Combining NANDA diagnoses with outcome measures facilitates a more holistic approach to patient care. It helps in identifying clear goals for patient outcomes and provides a basis for evaluating the success of nursing interventions. This integration supports evidence-based practice and improves the overall quality of nursing care.
Outcome Measures and Benefits in Nursing Education
1. Teaching and Learning:
The NIC/NOC system is a valuable tool for nursing educators in teaching students how to assess patients, select appropriate interventions, and measure outcomes. By using these classifications, instructors can guide students in linking assessments to evidence-based interventions and expected outcomes. This systematic approach enhances students’ clinical judgment and decision-making skills.
2. Clinical Judgment and Decision-Making:
While the NIC/NOC system provides a structured approach to documenting and communicating nursing actions, it does not replace clinical judgment. Nursing students and professionals must exercise their judgment when selecting interventions and evaluating outcomes. The NIC/NOC framework serves as a guide, but effective nursing practice requires the application of critical thinking and individualized care.
3. Comparative Advantages:
Different classification systems offer distinct advantages for various users. For instance, the NANDA diagnosis classification is widely recognized for categorizing nursing diagnoses but does not include taxonomies for interventions and outcomes. The OCS provides a more comprehensive classification system but has remained largely unchanged. In contrast, NIC/NOC offers a universally applicable framework that has undergone extensive development and validation, making it a valuable tool for diverse care environments.
4. Ongoing Research and Integration:
The NIC, NOC, and NANDA systems are continually updated through ongoing research and validation efforts. The integration of these systems into the NIC/NOC/NANDA (NNN) Taxonomy of Nursing Practice ensures that they remain relevant and effective in documenting and communicating nursing care. This integration supports the advancement of nursing practice and education by providing a cohesive and up-to-date framework for managing patient care (Dochterman & Bulechek, 2004).