Standardized Nursing Language NANDA NOC NIC

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Standardized Nursing LanguageNANDA NOC
NIC

• Lemuel Dizon, RN

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Definition

• NANDA taxonomy of nursing diagnosis
• North American Nursing Diagnosis Association

NOC nomenclature of nursing outcomes Nursing
Outcomes Classification
NIC nomenclature of nursing interventions Nursin
g Interventions Classification
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Scope

• NANDA 172 diagnosis 47 classes 13 domains
• NOC 385 outcomes 31 classes 7 domains
• NIC 542 interventions 31 classes 7 domains

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Organizational Structure

• Nursing Information and Data Set Evaluation
  Center (NIDSEC)
• Evaluates information systems along Four
  dimensions
• 1. Nomenclature (terms used)
• 2. Clinical content (the linkages among
  terms)
• 3. Clinical data repository (how the data are
  stored and made accessible for retrieval)
• 4. General system characteristics (i.e.,
  performance, security, confidentiality, etc.)
• NANDA International
• Center for Nursing Classification and Clinical
  Effectiveness (NIC/NOC)

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Formulation of a Nursing Diagnosis

• Format Problem related to cause of problem
  evidenced by symptoms of problem.
• Examples
• Impaired gas exchange related to excessive
  secretions as evidenced by O2 saturation of 86.
• Fluid volume deficit related to frequent vomiting
  for three days as manifested by increased pulse
  rate.

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Format Features of NIC

• ELECTROLYTE MANAGEMENT 2000Definition
  Promotion of electrolyte balance and prevention
  of complications resulting from abnormal or
  undesired serum electrolyte levelsActivities-
  Monitor for manifestations of electrolyte
  imbalance- Maintain patent IV access Administer
  fluids, as prescribed, if appropriate -
  Maintain intravenous solution containing
  electrolyte(s) at constant flow rate, as
  appropriate- Administer supplemental
  electrolytes (e.g., oral, NG, and IV) as
  prescribed, if appropriate- Consult physician
  on administration of electrolyte-sparing
  medications (e.g., spiranolactone), as
  appropriate- Administer electrolyte-binding or
  -excreting resins (e.g., Kayexalate) as
  prescribed, if appropriate- Obtain ordered
  specimens for laboratory analysis of electrolyte
  levels (e.g., ABG, urine, and serum levels), as
  appropriate- Monitor for loss of
  electrolyte-rich fluids (e.g., nasogastric
  suction, ileostomy drainage, diarrhea, wound
  drainage, and diaphoresis)- Irrigate
  nasogastric tubes with normal saline- Provide
  diet appropriate for patient's electrolyte
  imbalance (e.g., potassium-rich, low-sodium, and
  low-carbohydrate foods)- Teach patient and
  family about the type, cause, and treatments for
  electrolyte imbalance, as appropriate - Consult
  physician if signs and symptoms of fluid and/or
  electrolyte imbalance persist or worsen-
  Monitor patient's response to prescribed
  electrolyte therapy- Place on cardiac monitor,
  as appropriate

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Components of NOC

• Fluid Balance 0601
• Balance of water in the intracellular and
  extracellular compartments of the body
• Extremely Compromised Substantially Compromised
  Moderately Compromised Mildly Compromised Not
  Comprised
• 1
  2
  3 4
  5
• Indicators
• BP IER
• 1
  2
  3 4
  5
• Mean arterial pressure IER
• 1
  2
  3 4
  5
• Pulmonary wedge pressure IER
• 1
  2
  3 4
  5
• Peripheral pulses palpable
• 1
  2
  3 4
  5
• Ascites not present
• 1
  2
  3 4
  5
• Neck vein distention not present
• 1
  2
  3 4
  5
• Peripheral edema not present
• 1
  2
  3 4
  5

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NIC/NOC Inclusion

• SNOMED multidisciplinary record system
• National Library of Medicines Metathesaurus for
  a Unified Medical Language
• Joint Commission
• Alternative Billing Concepts (ABC) codes
• Registered in HL7

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Vendors who have licenses for NIC NOC

• AtStaff, Inc., Durham, NC, www.atstaff.com   
  NOC integrated within their ClairVia
  outcomes-driven acuity and patient management
  solutions for use by hospitals.
• Healthland (Formerly Dairyland Healthcare
  Solutions), Louisville, KY, www.healthland.com  
   NIC and NOC integrated with their Clinical
  Documentation software system for care planning.
  System is used by small to midsize hospitals
• DIPS ASA, www.dips.com    NIC integrated within
  their Electronic Patient Record System for care
  planning. Company located in Norway.
• DxR Development Group, Carbondale, IL,
  www.dxrgroup.com    Web based system for
  teaching students nursing process. Product called
  DxR Nursing.
• eClinical Notes, LLC, Centreville, VA,    NIC
  and NOC are being integrated within a nursing
  documentation section of an electronic
  documentation system for hospice providers.
• Ergo Partners, Lake Quivira, KS,
  www.ergopartners.com    Product is EMRitus
  software
• McKesson Corporation, Alpharetta, GA,
  www.mckesson.com    NIC and NOC integrated
  within Horizon Expert Plan for use in Care
  planning
• MedSoftCCS, LLC., Vancouver, WA,
  www.medsoftccs.com    NIC integrated within
  Medtrack CCS job specific Orientation
  e-checklists.
• Nurse's Aide LLC, Keller, TX, www.nursesaide.net
     Product for School Nurses to assist with
  their care plans for students.
• Purkinje, Inc., www.purkinje.com    Electronic
  clinical documentation tool. Company located in
  Canada.
• Sanum AS, www.sanum.no    Sanum system used
  within hospitals and the educational market.
  Company located in Norway.
• IHTSDO (SNOMED-ownership has transferred),
  Northfield, IL. www.snomed.com    NIC and NOC
  used within mapping tool.
• Tech-Time, Inc., Billings, MT, www.techtimeinc.com
     Clinical documentation system
• Typhon Group, LLC, Metairie, LA,
  www.typhongroup.com    NIC and NOC integrated
  within their Registered Nurse Student Tracking
  (RNST) program used by Nursing Schools. Product
  helps student users develop patient care plans.

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Impact A call for nursing standards

• Developing standards would improve
  vendor-supplied nursing information systems.
• Standards from the nursing community would
  significantly reduce the cost and time of
  developing the nursing component of clinical
  systems.
• Nursing-developed standards would enhance nurses
  efficiency.
• Automated information systems would help the
  current nursing shortage crisis by supporting the
  work of nurses.

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Reference

• www.nanda.org
• www.nursing.uiowa.edu/excellence/nursing_knowledge
  /clinical_effectiveness
• Simpson, R. Whats in a name? The taxonomy and
  nomenclature puzzle, part 2. Nursing Management.
  August 2003, p. 12, 14, 16.
• Simpson, R. Setting the Informatics Standards An
  Overview of NIDSECs Information Systems
  Evaluation Criteria. Nursing Economic.
  September-October 1998, Vol. 16, No. 5,
  pp.279-281.
• Simpson, R. Finally, a Central Place to Evaluate
  Nursing Systems. Nursing Management. July 1997,
  pp.17-18.