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CNC - Overview: Nursing Outcomes Classification (NOC)

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The Nursing Outcomes Classification (NOC) is a comprehensive, standardized classification of patient/client outcomes developed to evaluate the effects of interventions provided by nurses or other health care professionals. Standardized outcomes are essential 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 490 outcomes in Nursing Outcomes Classification (NOC) (5th 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, scale(s) to measure patient status, and a short list of references used in the development and refinement of the outcome. A five-point Likert scale is used with all outcomes and indicators. A rating of a '5' is always the best possible score and '1' is always the worst possible score. Examples of measurement scales used with the outcomes are: 1=Extremely compromised to 5= Not compromised and 1=Never demonstrated to 5=Consistently demonstrated. The NOC outcomes are grouped in a coded taxonomy that organizes the outcomes within a conceptual framework to facilitate identifying an outcome. The 490 outcomes are grouped into thirty-two 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 outcomes based on new research or user feedback.

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 diagnoses, 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. In addition linkages have been developed between the International Classification of Functioning, Disability and Health (ICF) and NOC in an attempt to explore the components of ICF and its international and interdisciplinary use.  A more in depth look at the linkage between NOC, NIC, and NANDA-I is available in a separate book NOC and NIC Linkages to NANDA-I and Clinical Conditions: Supporting Critical Reasoning and Quality Care.

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 Chinese (simplified and traditional), Dutch, French, German, Japanese, Korean, Norwegian, Portuguese, and Spanish and several other translations are in progress.

Source: Moorhead, S., Johnson, M., Maas, M., & Swanson, E. (Eds.). (2013). Nursing outcomes classification (NOC) (5th ed.). St. Louis, MO: Elsevier.

For further information contact :

Center for Nursing Classification & Clinical Effectiveness
The University of Iowa, College of Nursing 407 NB
Iowa City IA 52242-1121
319-335-7051
e-mail: classification-center@uiowa.edu