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Nursing Interventions Classification (NIC)
NIC/NOC Newsletter
Nursing Interventions Classification/Nursing Outcomes Classification Vol. 5 No. 1 March 1997
With this issue, The NIC Letter changes to The NIC/NOC Letter. The Nursing Interventions Classification (NIC) is a comprehensive standardized language to describe the treatments that nurses perform. The Nursing Outcomes Classification is a comprehensive standardized language to describe patient outcomes sensitive to nursing treatments. The Classifications are useful in planning and documenting care, in communicating the essence of nursing to others, and in the development of large databases for research on the effectiveness of nursing care. The research to develop the Classifications by two large research teams at The University of Iowa is ongoing with support from the National Institute of Nursing Research. The purpose of this newsletter is to provide current information about the Classifications.
SOON TO BE PUBLISHED--NURSING OUTCOMES CLASSIFICATION (NOC)
Iowa Outcomes Project -- Johnson, M., & Maas, M. (Eds.). (1997 forthcoming). Nursing Outcomes Classification (NOC). St. Louis: Mosby-Year Book.
This is the first description of outcomes that standardizes terminology and criteria for measurable and desirable outcomes as the result of interventions performed by nurses. It includes 190 outcome labels with corresponding definitions, measures, indicators, and references. Introductory chapters cover research methodology, the use of NOC in practice, and implementing NOC in practice and education. It also contains discussion about the relationship between NOC outcomes and NANDA nursing diagnoses. The table of contents includes:
The Need for Standardized Nursing-Sensitive Patient Outcomes
Overview of the Project Development of the Outcomes and Indicators
The Classification and Its Use
Current List of Outcome Labels, Definitions, and Associated Indicators with Crude Measurement Scales
Continuing and Future Work
For further information about the book, contact Liz Fathman, Nursing Editorial Division, Mosby-Year Book, 11830 Westline Industrial Drive, St. Louis, MO 63146 (1-800-325-4177, ext 4866).
UNTIMELY DEATHS OF ESTEEMED COLLEAGUES
Margaret (Peg) Mehmert died January 9 after a short illness. She was Director of Nursing Practice and Systems Integration at Genesis Hospital in Davenport, Iowa, and a member of both the NIC and NOC research teams. She was a pioneer in nursing diagnosis research and was an inspiration to those who knew her. Her vision and energy will be missed. Before Peg died, she designated the Center for Nursing Classification for memorial contributions for those who wish to remember her.
Kathleen (Kathy) Kelly died of a heart attack in October, 1996. She was Associate Professor and Director of Continuing Nursing Education at The University of Iowa College of Nursing, and a member of the NOC research team. She was a respected and valuable member of the nursing administration faculty at Iowa. Kathy's expertise in community health care and her caring attitude for others will be missed by all those who knew her.
CENTER FOR NURSING CLASSIFICATION REACHES $100,000 MARK
We are 1/10 of the way there!! The goal is to raise $1,000,000 to provide an endowment for the Center which will provide the staff to assist with the upkeep of both the Nursing Interventions Classification and the Nursing Outcomes Classification. A contribution form for those who wish to contribute to the Center is included at the end of this newsletter. We wish to thank the following individuals who have contributed to the Center since the October newsletter:
Anderson, Mary Ann and Anderson, Richard, Sr., East Moline, IL, in memory of Debra Parmeter Varnadoe
Antle, Jack D. and Antle, Denise E., Davenport, IA, in memory of Peg Mehmert
Apple Computer, Inc., Cupertino, CA, in memory of Debra Parmeter Varnadoe
Bellinger, Sandra L., Moline, IL, in memory of Peg Mehmert
Brown, Billye, Manchaca, TX, in honor of Geraldene Felton
Bulechek, Gloria M. and Bulechek, James, R., Jr., Solon, IA, in memory of Kathy Kelly and in memory of Peg Mehmert
Bunting, Dean A. and Iossi-Bunting, Cynthia, Davenport, IA, in memory of Peg Mehmert
Carter, Joan, Creve Coeur, MO
Clarke, Mary F., Davenport, IA, in memory of Kathy Kelly and in memory of Peg Mehmert
Cox, Helen, Lubbock, TX, in memory of Peg Mehmert
Davis, Rita Kay, Iowa City, IA
Delaney, Connie W., North Liberty, IA, in memory of Ronda L. Squier
Denehy, Janice A., Iowa City, IA
Dustan, Laura C., Craftsbury Common, VT
Foehring, Anthony and Foehring, Mary, Fort Madison, IA, in memory of Peg Mehmert
Foehring, Eugene and Foehring, Carol, Fort Madison, IA, in memory of Peg Mehmert
Heick, Merle A. and Heick, Harold W., Iowa City, IA
Higgerson, Nancy J., Greensboro, NC, in honor of Eva H. Erickson
Hill, Pamela D., Camanche, IA, in memory of Peg Mehmert
Hittman, Sandra M. and Hittman, Jon, St. Louis, MO
Hood, James C. and Hood, Helene, M., Davenport, IA, in memory of Peg Mehmert
Hoskins, Paul H. and Hoskins, Lois M., Ashton, MD
Huber, Randy J. and Huber, Karen A., Davenport, IA, in memory of Peg Mehmert
Johnson, Marion, Coralville, IA
Johnson, Virginia L., West Des Moines, IA
Keenan, William E. and Keenan, Gail M., Ann Arbor, MI, in memory of Kathy Kelly and Norma Conn
Koellner, F. S. and Koellner, Sheila, Davenport, IA, in memory of Peg Mehmert
Kraus, Vicki, L., Iowa City, IA, in memory of Peg Mehmert
Lewis, Anne R., Davenport, IA, in memory Kathy Kelly and in memory of Peg Mehmert
Maas, Meridean and Maas, Richard R., Iowa City, IA, in memory of Debra Parmeter Varnadoe and Oral D. Bartholow and in memory of Kenneth J. and Miriam Speas
Macek, Marguerite A., Davenport, IA
Maske, Joy Y., Iowa City, IA
Mathis, Sally A., Iowa City, IA
McCloskey, Joanne C., Iowa City, IA, in memory of Peg Mehmert
Messina , Thomas J. and Messina, Teresa A., Pflugerville, TX , in memory of Debra Parmeter Varnadoe
Miller, Sheryl L., Iowa City, IA
Molyneaux, Anne M., Davenport, IA, in memory of Peg Mehmert
Nelson, Debra M., Toms River, NJ
Nolan, Patricia A., Davenport, IA, in memory of Peg Mehmert
Palm, Marvin W. and Palm, Anna R., Pekin, IL, in memory of Peg Mehmert
Parmeter, Charles and Parmeter, Willa, Bloomington, IL, in memory of Debra Parmeter Varnadoe
Rigby, Doris M., Shawnee Mission, KS
Scherb, Cindy and Scherb, Glenn R., Kiester, MN, in memory of Kathy Kelly and in memory of Peg Mehmert
Seebohm, Paul M. and Seebohm, Dorothy E., Iowa City, IA
Smania, Mary Ann, Oakland Park, FL
Snell, Anne F., Ida Grove, IA
Stavros, Jean, Denver, CO, in memory of Gust Stavros
Stolley, Jacqueline M., Davenport, IA, in memory of Peg Mehmert
Swanson, Elizabeth A., Iowa City, IA
Tenney, Judith K., Sheridan, WY
Wehunt 's, the Robert E., Blue Ridge, GA, in memory of Peg Mehmert
Yom, Young-Hee, Seoul, South Korea
NIC GRANT REVISED AND RESUBMITTED
The score on the July grant proposal was not high enough to receive funding. We revised the proposal according to reviewers' comments and resubmitted the grant March 1. We are hopeful for a more positive outcome this time and we thank all of those individuals who sent support letters. Our funding will be up June 1 requiring a reduction in staff in the NIC Project Office. William Donahue, Program Associate who has been with the NIC project for 7 years, will still be available to answer questions and provide assistance but he will have less time to devote to this. The phone number for the NIC Office, Center for Nursing Classification is 319-335-7051.
The aims of the revised grant are to: refine and expand the Nursing Interventions Classification (NIC) and validate use of NIC in clinical practice. Five objectives will be undertaken if the grant is funded:
1. Develop the interventions on the Under Consideration List including those related to the community; refine existing interventions as feedback from users indicates.
2. Determine linkages with the outcomes in the Nursing Outcomes Classification (NOC).
3. Determine which activities are critical to particular interventions.
4. Determine the use rate of particular interventions and identify intervention clusters that are typically used together for certain patient populations.
5. Determine the approximate time for delivery of each intervention.
We hope that NIC and NOC will each receive an additional grant in order to support continued development and validation of the Classifications and in order to maintain momentum on the work until we can raise the required endowment for the Center. The gap in funding for NIC highlights the urgency to financially establish the Center. Please consider a contribution.
NOC TAXONOMIC STRUCTURE
The NOC research team is working on the organizing taxonomic structure for the outcomes. The research team is using hierarchical cluster analysis to construct a multilevel taxonomy. This technique groups the developed patient outcomes on the basis of their abstraction and similarity into successively larger clusters. The grouping process creates a taxonomy that will provide meaningful structure for the patient outcomes in the Classification. Three different groups of nurses have provided similarity ratings of this phase of the research. An in-house publication will be available from the NOC Office when the work is completed. The research will also be present at the Midwest Nursing Research Society meeting in April.
APPLICATION OF NIC TO AN INTERNATIONAL DATA SET
Submitted by Violet H. Barkauskas, University of Michigan. For more information contact her at 313-647-0143 or vhbarkas@umich.edu.
In collaboration with the Lithuanian Ministry of Health, a study of nursing practice in Lithuania was conducted. The head nurses in all Lithuanian in-patient and long-term care units were asked to describe interventions for typical patients in narrative form. Responses were received from an estimated 75% of such units. NIC was selected to categorize the interventions. A Lithuanian scholar, not a health professional, was trained to code the data and was able to establish and maintain reliability in coding with a nurse researcher. This research associate understood and learned the NIC system easily and was able to match nurses' narrative descriptions of care with the NIC system. Only a small number of interventions in the Lithuanian data were not codable by NIC: aspiration of chest fluid, bendravimas (Lithuanian term for socializing), taures (cupping), mud application, water therapy, occupational and work therapy, pumping of stomachs, EKG, mustard plaster application, nose care, and kvarcavimas (ultra-violet disinfection of patient care units).
Of the 444 total possible interventions (433 NIC and 11 additional ones), 15 were noted in 50% or more of units; 47 were noted in 10% to 49% of units; 36 were noted in 3 to 9.9% of units; 108 were noted more than once, but in less than 3% of units; 26 were noted only once, with the remainder not noted at all. The following interventions were noted in 50% or more of the units (listed in alphabetical order): admission care, bendravimas, documentation, environmental management, examination assistance, family involvement, feeding, IV therapy, medication administration: oral, medication administration: parenteral, order transcription, self-care assistance: bathing/hygiene, specimen management, supply management, and vital signs monitoring. Profiles for the most commonly noted interventions for specialty units demonstrated variability among unit types and in directions logical to the specialty. Interventions not noted included a large portion of the management, prevention, enhancement, promotion, and counseling interventions.
Overall, the NIC taxonomy demonstrated high applicability and usability with an international database.
FIVE STUDIES VALIDATE NIC USE IN PRACTICE
The NIC Project Office has received the reports of five documentation studies which demonstrate that NIC does indeed capture the interventions that are performed by nurses. Four of the five studies have been conducted by individuals outside of Iowa with no connection to the research team.
Coenen, A., Ryan, P., & Sutton, J. (Unpublished manuscript). Translating nursing interventions from a hospital system to the Nursing Interventions Classification (NIC). Milwaukee University College of Nursing, Milwaukee, WI.
The documented interventions for the nursing diagnoses of pain, impaired physical mobility, ineffective individual coping, and impaired skin integrity from a non-computerized Wisconsin hospital information system were translated into NIC language. All of the interventions for these diagnoses could be translated into NIC.
Henry, S.B., Holzemer, W.L., Randell, C., Hsieh, S., Miller, T.J., & Reilly, C.A. (forthcoming). Comparison of Nursing Interventions Classification and Current Procedural Terminology codes for categorizing nursing activities. Image: Journal of Nursing Scholarship.
The authors compared the frequency with which 21,366 nursing activity terms could be categorized using NIC and CPT. The dataset of nursing activities was collected for the years 1989--1992 from patient interviews, nurse interviews, intershift reports, care plans, flowsheets, and kardexes for 201 patients with AIDS. The terms were categorized into 80 NIC interventions and 15 CPT codes. NIC was able to capture 100% of the activities for all six of the data sources whereas the CPT captured only 1.3% (care plan) to 16.4% (intershift report) of the activities.
Kirby, A. (1996). Classification of advanced practice nursing functions using the Nursing Interventions Classification Taxonomy. Doctoral Dissertation. University of Pennsylvania, Philadelphia, PA.
Nursing functions performed by Advanced Practice Nurses (APNs) who provided transitional follow-up care for 61 patients in the Brooten et al. low birth-weight studies were classified using NIC. Latent content analysis was employed to classify statements of nursing function from nursing process logs. The Taxonomy provided a thorough description of APN care and discriminated between care provided in the hospital and the home as well as care for morbid (febrile morbidity) versus non-morbid patients.
Moorhead, S., & Delaney, C. (Unpublished manuscript). Mapping nursing intervention data into the Nursing Interventions Classification (NIC): Process and rules. Iowa City, IA: College of Nursing, The University of Iowa.
All 191,256 nursing orders from six months of data from computerized care plans at one community hospital in the Midwest were successfully mapped to NIC. Both the Coenen et. al. and the Moorhead and Delaney manuscripts focus on the process that researchers must establish to map activity-level or order-level data with the more conceptual NIC interventions and the issues involved when this type of research is conducted.
Tillman, H.J. (1997). Classification schemes for nursing language. Doctoral Dissertation. Virginia Commonwealth University/Medical College of Virginia. Richmond, VA.
The author analyzed 32,000 intervention text phrases found in all documents on which nurses chart (flowsheets, consults, nursing notes) from 92 acute medical records from a university medical center that is not computerized. He found that 96% of these (30,717) could be coded to NIC. The phrases that he could not code have implications for new or revised interventions, particularly in the area of medication administration.
NURSING MANAGEMENT MINIMUM DATA SET (NMMDS) AVAILABLE
Delaney, C., & Huber, D. (1996). A nursing management minimum data set (NMMDS): A report of an invitational conference. Chicago: American Organization of Nurse Executives.
The standardization of management data is essential to evaluate the effectiveness of clinical data and to plan for nursing resource use. To this end, an invitational workshop led by Professors Delaney and Huber from The University of Iowa and sponsored by the American Organization of Nurse Executives was held in January, 1996. The recently released monograph contains a list of 27 basic elements with standardized definitions and measures. The 17 elements are clustered into three categories: environment, nurse resources, and financial resources. While the NMMDS remains a work in progress, the data set is ready for further testing in practice.
RECENT NIC AND NOC PUBLICATIONS
Blegen, M.A., & Tripp-Reimer, T. (1997). Implications of nursing taxonomies for middle-range theory development. Advances in Nursing Science, 19(3), 37-49.
Blegen, M.A., & Tripp-Reimer, T. (1997). Nursing theory, nursing research, and nursing practice: Connected or separate? In J.C. McCloskey, & H.K. Grace (Eds.), Current Issues in Nursing (5th ed.) (pp 68-74). St. Louis, MO: Mosby-Year Book, Inc.
Daly, J.M., Button, P., Prophet, C.M., Clarke, M., & A Androwich, I. (1997). Nursing Interventions Classification implementation issues in five test sites. Computers in Nursing, 15(1), 23-29.
Head, B., Maas, M., & Johnson, M. (1997). Outcomes for home and community nursing in integrated delivery systems. Caring Magazine, 16(1), 50-56.
Maas, M., Johnson, M., & Moorhead, S. (1996). Classifying nursing-sensitive patient outcomes, Image: Journal of Nursing Scholarship. 28(4), 295-301
NIC IMPLEMENTATION MANUAL AND NIC PUBLICATIONS ANTHOLOGY AVAILABLE
Implementation Manual
In response to requests for materials to help others implement NIC in their clinical agencies and educational programs, we have collected materials related to implementation and examples of forms used in selected agencies into a 500-page manual. The Implementation Manual is available for a cost-to-produce fee of $40. An abbreviated table of contents of the Manual follows:
Section 1: Implementation Process
Steps for Implementing NIC in a Clinical Practice
Agency
Annotated List of Helpful Readings
Reasons to Document
Rules of Thumb for Using NIC on a Nursing
Information System
NIC Use Survey
Examples of Core Interventions
Scale to Measure the Degree of Use of NIC in
Practice or Education
Model: Nursing Practice Data: Three Levels
Variables to Collect to Conduct Effectiveness
Research
NIC Patient Acuity Scale
Section 2: Implementation Tools
Examples of care plans, nursing care standards, staff competencies, case studies, user evaluation forms, and other implementation tools from Dartmouth Hitchcock Medical Center, Lebanon, NH; Genesis Medical Center, Davenport, IA; Loyola University Medical Center Mulcahy Outpatient Center, Maywood, IL; Lutheran General Hospital, Park Ridge, IL; Mayo Medical Center, Rochester MN; Oaknoll Retirement Residence, Iowa City, IA; Shands Hospital of the University of Florida, Gainesville, FL; University of Iowa Hospitals and Clinics, Iowa City, IA; and the University of Maryland Medical System, Baltimore, MD.
Section 3: Education
Steps for Implementing NIC in an Education Setting
Examples of forms used to assist in implementing NIC in educational programs from Loyola University Nursing Center, Chicago, IL; Loyola University Marsella Niehoff School of Nursing, Chicago, IL, University of Iowa College of Nursing, Iowa City, IA; and Bemidji State University, Bemidji, MN.
Section 4: Resource Materials
Annotated Bibliography of NIC Publications, NIC Products List, and information about: Classification Center List Serve, NIC video, and NIC Anthology.
Publications Anthology
We have reproduced (with permission from the publishers), in one bound volume, copies of more than 30 of the NIC publications--from the first article in 1990 through a recent article in June, 1996. This Anthology should assist others who wish to learn about NIC by making it easier to access the readings. Each of the publications has been coded to indicate whether it is an overview article; or specifically applies to research, practice, or theory development; or relates to linkages with other languages, AHCPR guidelines, indirect care, or informatics. Columns and other short pieces about the Classification are also included. (Note: The Anthology does not include the Classification itself.) The Anthology is available for the cost-to-produce fee of $25.
NEW NIC PRODUCTS
Monograph: *Iowa Intervention Project
$8 (pickup)
$10 (mail-order)
(1996). Iowa Intervention Project. Core
Interventions by Specialty
This monograph includes NIC interventions that are core to areas of specialty practice. The interventions were identified by representatives of 39 specialty practice organizations in response to a mailed survey. The lists of core interventions can be used to develop or revise nursing curricula for specialty practice and will facilitate the staff development of nurses practicing in specialty areas.
Manual: *Iowa Intervention Project
$40 (pickup and mail order)
(1996). Iowa Intervention Project.
NIC Implementation Manual.
The purpose of this 500-page manual is to provide examples of forms and materials that have been developed by leaders in health care agencies to facilitate the use of NIC in their settings. We believe that the sharing of these materials will assist others in the use of NIC. The Manual is an adjunct to the Classification itself. Categories of materials include implementation process, implementation tools,education, and resource materials.
Anthology: *Iowa Intervention Project
$25 (pickup and mail order)
(1996). Iowa Intervention Project. NIC
Publications Anthology.
This anthology contains over 30 NIC publications from 1990 through 1996 to assist those who wish to learn about NIC. For ease of use, each article has been coded as related to one or more of the following areas: overview, research, practice, theory development, linkages with other languages, AHCPR guidelines, indirect care, or informatics. Columns and other short pieces are also included. (Note: The Classification itself is not included.)
*Payment must be received with the order. All prices include shipping and handling. No phone orders accepted. Checks should be made out to: Iowa Intervention Project.
Mail to:
Iowa Intervention Project
Barbara Head
College of Nursing, The University of Iowa,
Iowa City, IA 52242-1121
