Nursing Interventions Classification (NIC)

NIC/NOC Newsletter
Nursing Interventions Classification/Nursing Outcomes Classification Vol. 5 No. 2 June 1997
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.

PREMIER CONFERENCE ON DIAGNOSES, INTERVENTIONS, AND OUTCOMES

Mark your calendars for the first-ever conference about NANDA, NIC, and NOC. The conference is entitled "Talking your language in this era of managed care: A conference to facilitate the use of NANDA, NIC, and NOC. The conference will feature guest speakers, symposia, peer review papers, posters, and information systems demonstrations--all related to the use of NANDA, NIC and NOC. There will be updates on the recent work related to all three classifications and informal opportunities to interact with the developers of each classification. Abstracts for presentation are being accepted until June 30. The conference is being sponsored by Nursecom, Inc., NANDA, and the Center for Nursing Classification at The University of Iowa. For information about the conference call Tracy Trauger at: 215-545-1985 or 800-408-8951, fax: 215-545-8107, and e-mail: tracy.trauger@nursecominc.com. (see ad page 5)

OUTCOMES CLASSIFICATION PUBLISHED

Iowa Outcomes Project -- Johnson, M., & Maas, M. (Eds.). (1997). Nursing Outcomes Classification (NOC). St. Louis: Mosby-Year Book.

NOC includes 190 patient outcomes sensitive to nursing interventions. Each outcome includes a label and definition, indicators, a simple measurement scale, and references. Examples of outcomes include: Bone Healing, Bowel Continence, Caregiver Emotional Health, Growth, Health Promoting Behavior, Mobility Level, and Will to Live. Introductory chapters cover research methodology, the use of NOC in practice, and implementing NOC in practice and education. The publication also contains linkages with NANDA nursing diagnoses. To order, Phone: 800-426-4545, Book Code: 30588, Cost: $37.95.

NOC TAXONOMIC STRUCTURE AVAILABLE

Just completed is a three level taxonomic structure for the outcomes. The outcomes are grouped into 24 classes and six domains. The groupings were done based upon similarity analysis and hierarchical cluster analysis of the outcomes. The domains are: Functional Health, Physiologic Health, Psychosocial Health, Health Knowledge and Behavior, Perceived Health and Family Health. Examples of classes are: Energy Maintenance, Growth and Development, Immune Response, Nutrition, Psychological Well-Being, Social Interaction, Health Beliefs, Health Knowledge, Symptom Status and Family Caregiver Status. The in-house publication is available from the Center for Nursing Classification - NOC office, for $5.00. To order please call Lori Penaluna at: 319-353-5414 or e-mail: lori-penaluna@uiowa.edu.

AYDELOTTE BIRTHDAY GIFTS RAISE NEARLY $15,000 FOR CENTER

Myrtle "Kitch" Aydelotte, former dean and professor emeritus at the College, recently celebrated her 80th birthday with a party given by the College of Nursing on May 31. She requested that those who wished to give gifts make donations to the Center for Nursing Classification. Kitch has been chairperson of the Center's Fundraising Advisory Board since its formation 18 months ago. Nearly $15,000 in donations were made in honor of Kitch. Thank you to those who made contributions:

Aadalen, Sharon Price, Edina, MN
Alteneder, Alfred and Ruth, Perrysburg, OH
Aquilino, Steven and Mary, Iowa City, IA
Anderson Blegen, Mary, Iowa City, IA
Anderson Richard and Mary Ann, East Moline, IL
Armstrong, Doris, Avon, CT
Behrens, Joan, Iowa City, IA
Benoliel, Jeanne, Fall City, WA
Bernhard, Linda, Dublin, OH
Biordi, Diana, Silver Lake, OH
Bloch, Doris, Olney, MD
Boyd, Willard and Susan, Iowa City, IA
Bulechek, Gloria and James , Solon, IA
Crowell, Carolyn, Iowa City, IA
Cuttler, Charles and Betty, Iowa City, IA
Diers, Donna, New Haven, CT
Donahue Patricia, North Liberty, IA
Donehower, Patricia, Burlington, VT
Doolittle, Dorothy, Iowa City, IA
Dreher, Melanie Creagan , Iowa City, IA
Dustan, Laura, Craftsbury Common, VT
Eckstein, John and Jean, Iowa City, IA
Erickson, Eva, Iowa City, IA
Fleming, Juanita, Frankfort, KY
Fochtman, Maureen, University of Guam
Freeman, Janet, Iowa City, IA
Frusti, Doreen, Rochester, MN
Fuszard, Barbara, Augusta, GA
Gelfand, Lawrence and Miriam, Iowa City, IA
Graff, Henry and Taunton, Roma Lee, Kansas City, MO
Grevey, Estelle, Albuquerque, NM
Hartwig, Sally Mathis, Iowa City, IA
Havel, Marie, Iowa City, IA
Heick, Harold and Merl, Iowa City, IA
Heinz, George and Hope, Kathryn, Springfield, MO
Herr, Keela, Solon, IA
Highriter, Marion, Chapel Hill, NC
Hockett, Franklin and Anita, St. Charles MO
Jacox, Ada, Ann Arbor MI
Johnson, Jone, Coralville, IA
Johnson, Marion, Coralville, IA
Johnson, Virginia, West Des Moines, IA
Johnsrud, Thomas, Conrad, IA
Jones, Susan, Richmond Heights, OH
Kansas University Endowment Association, Lawrence, KS
Kleiber, Paul and Charmaine, Iowa City, IA
Koerner, Jo Ellen, Sioux Falls, SD
Kraus, Vicki, Iowa City, IA
Lagorio, Valerie, Iowa City, IA
Lee, Henry and Jan, Ann Arbor, MI
Lewis, Charles and Mary Ann, Los Angeles, CA
Lindeman, Carol, Rohnert Park, CA
Martin, Betty, Conway, AR
Maupin, Judy, Columbus, IN
Mayo Medical Center, Rochester, MN
McBride, Angela Barron, Lafayette, IN
McClelland, Eleanor, Iowa City, IA
McCloskey, Joanne, Swisher, IA
Moorhead, Donald and Sue, Davenport IA
Moughton, Mona, Bowling Green, KY
Persons, Stow and Dorothy, Iowa City, IA
Powell, Sandra Rae, North Liberty IA
Rakel, Barbara, Iowa City, IA
Roberts, Joan, Lake Winnebago, MO
Rosenberg, Guy and Martha Craft-, Iowa City IA
Sachs, Barbara, Lexington, KY
Scherb, Glenn and Cindy, Kiester, MN
Settlemyer, Constance, New Kensington, PA
Sheafor, Marian, Spokane, WA
Sigma Theta Tau, Indianapolis, IN
Singleton, Enrika, New Orleans, LA
Swanger, Carolyn, Springfield, OH
Valiga, Donna, Iowa City, IA
Welch, Colleen, Nashville, TN
Youtzy, Cynthia, Wichita Falls, TX
Zander, Karen, South Natick, MA
OTHER CONTRIBUTORS TO CENTER SINCE MARCH

We have been told that people believe that because we have a Center at Iowa that we have state funding. This is unfortunately not how it works. Since the Center was approved by the Iowa Board of Regents approximately 18 months ago we have been working with The University of Iowa Foundation to raise $1,000,000 to provide an endowment for the Center which will provide staff to assist with the upkeep of the Nursing Interventions Classification and the Nursing Outcomes Classification. Those who wish to make a contribution to the Center should contact Alsatia Mellecker, Director of Development, 319-335-3305 or send your contribution directly to The University of Iowa Foundation, P.O. Box 4550, Iowa City, Iowa 52244, and indicate on the check that it is a gift for the Nursing Classifications Fund. You can specify "in honor of" or "in memory of" someone. We wish to thank the following individuals who have contributed to the Center since the March newsletter:

American Association of Critical Care Nurses, Aliso Viejo, CA
Bellinger, Sandra, Moline, IL
Brokel, David and Jane, Rockwell, IA
Buckwalter Joseph and Kathleen, Iowa City, IA, in honor of Joanne McCloskey
Christy, Dorothy, Lansing MI
Denger, Sue, Wichita, KS
Edwards, Doris, Columbus, OH, in memory of Lillian Hartwell
Gongaware, Carole, Bettendorf, IA, in memory of Peg Mehmert
Hartwig, Sally Mathis, Iowa City, IA
Higgerson, Nancy, Greensboro, NC
Hope, Kathryn and Heinz, George, Springfield, MO
Izenstark, Barbara, Chicago, IL, in memory of Burton Izenstark
Kaelber, Jean, Coralville, IA, in honor of Eva Erickson
Kingsbury, Margaret, Lansing, MI
Logsden, Ronald and Kara, Iowa City, IA.
Maibusch, Regina, Milwaukee, WI
Markovetz, Nicollet, Iowa City, IA, in memory of Allen Markovetz
Maxwell, Rosemary, Alburg, VT
McDaniel, Charlotte, Upper St. Clair, PA
McElmurry, Beverly, Zion, IL
Monsanto Fund, St. Louis, MO
Mullane, Mary, Naples, FL
NOC Health, Attitudes and Behavior Focus Group, Iowa City, IA, in memory of Kathy Kelly
Prophet, Colleen, Iowa City, IA
Rankin, Margaret, Iowa City, IA, in memory of Marjorie Gould
Rosenberg, Guy and Martha Craft-, Iowa City, IA
Scheffel, Annette, Iowa City, IA
Scherb, Glenn and Cindy, Kiester, MN, in honor of Marion Johnson and Meridean Maas, and in memory of Lorene Head
Swanger, Carolyn, Springfield, OH, in memory of Alma Lucille Krebs
Tarbox, Mary, Cedar Rapids, IA
Tomey, Ann, Terre Haute, IN
Wedig, JoAnn, Davenport, IA
HONOR ROLL OF MAJOR GIFTS TO CENTER
Domain Level ($10,000 and above)
Adelotte, Myrtle, Iowa City, IA
Outcome Level ($2,500-4,999)
Zenner, Janet, Lincoln, NE
Intervention Level ($1,000-2,499)
American Assoc. of Critical-Care Nurses, Aliso Viejo, CA
Buckwalter, Kathleen and Joseph, Iowa City, IA
Carter, Joan, Creve Coeur, MO
Christy, Dorothy, Lansing, MI
Dartmouth-Hitchcock Medical Center, Lebanon, NH
Denger, E. Sue, Wichita, KS
Eckstein, Jean and John, Iowa City, IA
English, Ann and John, Summit, NJ
Fochtman, Maureen, Mangilao, Guam
Gantz, Mary and Bruce, Iowa City, IA
Gingerich, Ruth, Carmel, CA
Hartwig, Sally, Iowa City, IA
Heinz, George and Hope, Kathryn, Springfield, MO
Hittman, Sandra and Jon, St. Louis, MO
Hockett, Anita and Franklin, St. Charles, MO
Johnson, Virginia, West Des Moines, IA
Johnsrud, Thomas, Conrad, IA
Kaelber, Jean, Coralville, IA
Maas, Meridean and Richard, Iowa City, IA
Markovetz, Nicollet, Iowa City, IA
Maske, Joy, Iowa City, IA
McCloskey, Joanne, Swisher, IA
Mosby-Year Book, Inc., St. Louis, MO
O'Grady, Barbara, Laguna Hills, CA
Seebohm, Paul and Dorothy, Iowa City, IA
Snell, Anne, Ida Grove, IA
Stavros, Jean, Denver, CO
RASMUSSEN MAKES ESTATE GIFT TO CENTER

The Center for Nursing Classification was recently the grateful recipient of a gift of appreciated securities from one of its former faculty members, Ms. Etta Rasmussen. We are extremely grateful that Etta knew the advantages of making such a gift, but we know that many people are not aware of those advantages. We thought we would share a few interesting insights with you about this kind of philanthropic contribution.

Long-term appreciated securities are stocks, mutual funds or bonds that have been owned for at least a year and have increased in value. Making a gift of appreciated securities benefits you in two ways: you receive a charitable income tax deduction for the full fair market value of the securities, and at the same time avoid capital gains taxes on the appreciated securities. For example, suppose you hold 1,000 shares of stock that were purchased at least a year ago. When you bought the stocks they were worth $10 per share, and today they are worth $30 per share, for a total of $30,000. If you make a gift of these securities outright, you immediately receive a $30,000 charitable income tax deduction and bypass capital gains taxes (at a rate of 28%) of $5,600.

When you make a contribution using a life income gift vehicle such as a charitable remainder trust or pooled income fund, you receive annual income during your lifetime. In many instances a life income gift provides more income than average stock dividends or CD rates. In addition to the income, you also receive a charitable income tax deduction and may also bypass capital gains taxes. Finally, upon your death, your gift can be used to benefit the Center for Nursing Classification.

Every situation is unique and careful planning and consultation is highly recommended. If you would like to learn more about gifts of appreciated securities that can benefit the Center, please contact Alsatia Mellecker at the UI Foundation, P.O. Box 4550, Iowa City, IA 52244 or call toll free 800-648-6973.

FUTURE NOC WORK

Until the Center endowment is raised we need to continue to work with grant funds. The current NOC grant funding will end November 30, 1997. A competitive renewal application will be submitted to NIH, National Institute of Nursing Research on July 1, 1997. The overall purpose of the grant is to refine and validate measures for the outcomes. The specific aims of the research are to:

1. Describe the outcomes used most frequently in specialty nursing practice and in selected field sites.

2. Assess the adequacy of measures (reliability, validity, sensitivity, specificity, practicality) for selected outcomes in the Nursing-sensitive Outcomes Classification (NOC).

3. Describe the relationship of selected patient characteristics and the level of achievement for selected outcome measures.

4. Continue the development of outcomes and outcome measures for individuals and families.

The co-principal investigators on the grant will be Marion Johnson, Meridean Maas and Sue Moorhead. Even if the competitive renewal is funded we will have a period of about six months without grant funds. Other funds are being sought to keep the NOC research office open during this interim.

BELLIN COLLEGE PUTS NIC AND NOC IN CURRICULUM

Submitted by Cynthia Finesilver and Susan Sorenson, both instructors at Bellin College of Nursing, Green Bay, WI.

The faculty at Bellin College of Nursing in Green Bay Wisconsin endorsed the use of NIC and NOC as part of the written clinical preparation tool during the fall 1996 and spring 1997 semesters. NANDA-NOC-NIC integration was by the junior students in the following acute care settings: peri-operative, pediatric, obstetric, medical and surgical settings. Students used the 2nd edition of the NIC book as well as the NOC materials. The clinical preparation tools included the five steps of the nursing process and varied slightly according to the client population. Most of the junior year nursing courses also required use of NOC and NIC in formal papers submitted for course grades.

As faculty analyzed the two semester experience, several advantages of this system were noted. Students' critical thinking abilities were increased and they were able to focus on client and family problems much more quickly. They also had a tendency to focus on discharge planning, psychosocial and family issues more than they had in the past. The students were able to focus on the primary problems with less writing. The Roy subsystem model integrated well with the NIC and NOC classification systems. The faculty will continue to refine and evaluate the classification systems during the next year and plan to do some research related to student use of NOC and NIC as part of clinical preparation.

RECENT PUBLICATIONS BY TEAM MEMBERS

Daly, J. (1997). How Nursing Interventions Classification fits into the patient information system patient core data set. Computers in Nursing, 15 (2), S577-S581 Supplement.

Daly, J, Maas, M. & Johnson, M. (1997). Nursing- sensitive outcomes classification (NOC): An essential element in data sets for nursing and health care effectiveness. Computers in Nursing, 15(2) (Supp.1), 82-86.

Iowa Outcomes Project. M. Johnson & M. Maas (Eds.). (1997). Nursing Outcomes Classification (NOC). St. Louis: Mosby.

OTHER RELEVANT PUBLICATIONS

Henry, S. B., Holzemer, W. L., Randell, C., Hsieh, S., & Miller T. J. (1997). Comparison of Nursing Interventions Classification and Current Procedural Terminology codes for categorizing nursing activities, Image: Journal of Nursing Scholarship, 29 (2), 133- 138.

Robbins, B. T. (1997). Application of Nursing Interventions Classification (NIC) in a cardiovascular critical care unit, Journal of Continuing Education in Nursing, 28 (2), 78-82.

RECENT PRESENTATIONS

March:

Tripp-Reimer, T. Models of nursing intervention research. Nurse Scientists in the Southern United States, Tampa, FL.

April:

Bulechek, G., Johnson, M., Maas, M. & McCloskey. Standardized interventions and outcomes, MNRS 21st Annual Conference, Minneapolis, MN.

Daly, J. Systematic evaluation of care plans in long-term care, MNRS 21st Annual Research Conference, Minneapolis, MN.

Denehy, J., Poulton, & Pavelka, L. Just in the NIC of time: Overview of the Nursing Interventions Classification; Integrating NIC in individualized health plans; NIC utilization study. Iowa School Nurse Spring Conference, Ames, IA.

Johnson, M. Overview of the nursing outcomes classification, University of Virginia.

Steelman, V., Laffoon, T. & Vincent, N. In the NIC of time: The Nursing Interventions Classification in perioperative nursing, 44th Annual AORN Congress, Anaheim, CA.

Tarbox, M. Implementing NIC in education, University of Texas Health Science Center, San Antonio, TX.

May:

Maas, M. NOC. Nursing Informatics Partnership Workshops: Linking Midwest Educators with Information Technology. Iowa City, IA.

McCloskey, J. NIC. Nursing Informatics Partnership Workshops: Linking Midwest Educators with Information Technology. Iowa City, IA.

McCloskey, J. Outcome measurement: Nursing Interventions: Proof of our worth. Ninth Annual Ambulatory Care Nursing Conference: Wave of the Future, San Diego, CA.

June:

Head, B., Eland, J.E. & Aquilino, M. Validation studies of selected outcome measures: Report on a community/home health subsample. 12th National Nursing Symposium on Home Health Care, Ann Arbor, MI.

Scherb, C. & Head, B. Nursing outcomes classification: An overview, Mount Mercy College, Cedar Rapids, IA.

ICN 21st QUADRENNIAL CONGRESS

Members of the NIC and NOC research teams who attended the International Council of Nurses conference in Vancouver, Canada, June 15-20, 1997 were: Gloria Bulechek, Marion Johnson, Lori Penaluna, Martha Craft-Rosenberg, and Toni Tripp-Reimer. NIC, NOC and NANDA shared a booth at the conference, a first time experience. Presentations included:

Symposium: International use of the Nursing Interventions Classification by Gloria Bulechek, U.S.; Young Hee Yom, Korea; Rudolf Widmer, Switzerland; Els Albersnagel-Thijssen, The Netherlands

Paper: Comparison of Korean and U.S. utilization of NIC interventions by Young Hee Yom.

Paper: Defining Nursing Effectiveness: Diagnoses, Interventions, and Outcomes by Gloria Bulechek.

Paper: Identification, Classification and Testing of Patient Outcomes by Marion Johnson.

Poster: Nursing Interventions Classification, Gloria Bulechek, Martha Craft-Rosenberg, and Toni Tripp-Reimer.

VISIT TO JAPAN AND KOREA

Gloria Bulechek and Joanne McCloskey will present on NIC in Japan and Korea. A two day workshop covering the development of NIC, development and validation of the NIC taxonomy, use of NIC in practice, use of NIC in education, and effectiveness research using NIC will be given in Tokyo, Japan on July 27 and 28; in Osaka, Japan on July 30 and 31 and in Seoul, Korea on August 1 and 2. The sponsor in Japan is Hironobu Ishikura, Director of the International Medical Nursing Congress Center in Tokyo and the sponsors in Korea are Eun-Ok Lee, Director of the Research Institute of Nursing Science and Sung-Ae Park, Professor, College of Nursing Seoul National University in Seoul.

JNCQ TO INCLUDE ISSUE ON NOC

The June, 1998 issue of JOURNAL OF NURSING CARE QUALITY (JNCQ) will be devoted to the Nursing-Sensitive Outcomes Classification (NOC). Patricia Donahue and Veronica Brighton, members of the NOC team, will be the co-editors of the publication. The authors for specific chapters have been decided. Further details will be provided at a later date.

NURSING OUTCOMES ACCOUNTABILITY

Submitted by Meridean Maas, Professor, College of Nursing University of Iowa and Co-PI, Nursing Outcomes Classification. The following passages are excerpts from her forthcoming column in Journal of Nursing Outcomes Management.

The lack of standardized nursing languages in clinical information systems is the most fundamental reason for the unavailability of data for nursing effectiveness research. Without standardized languages, no discipline's clinical decision, actions, and results can be electronically stored, processed, and retrieved. Further, if standardized uniquely for specific settings, the resulting data are not easily aggregated and compared across different settings.

Although there has been some progress in the use of the ANA recognized languages in nursing clinical information systems, locally unique nursing languages too often continue to be used. Health care organizations have been slow to develop computerized nursing information systems and fully integrated patient care systems. Nursing is often the last clinical service to be computerized. While this is easily understood given the slowness of standardized nursing languages to develop, the size and complexity of nursing services, and the lack of incentive to computerize the work of "non-revenue producing services", it is much more difficult to comprehend when the number of nurse providers, their centrality relative to all other disciplines, and the critical importance of their interventions to patient care are considered.

Standardized nursing-sensitive outcomes that enable the nurse to assess the patient's status at intervals over time and across the continuum of care in multiple care settings are essential to be accountable for care provided in the appropriate setting at the least cost. This requires that nurses move away from the tradition of defining outcomes as goals and documenting whether the goals are met or not met and to focus on intermediate as well as variable states that are measured and compared with a baseline over time so that all consequences of interventions are monitored.

Assessment of outcomes in organizations has focused on medical outcomes under the guise of interdisciplinary outcomes. Nurses are to believe that the identification of nursing-sensitive patient outcomes is not appropriate and that efforts to do so indicate that nursing is not a "team player". How ironic that this guilt trip be laid on the health care discipline that has historically been most desirous of interdisciplinary collaboration. Recognizing the need to identify and measure outcomes that are responsive to nursing interventions means that nursing desires to demonstrate the accountability of individual nurses and the collective of nurses for care that is delivered. This is the mark of a good team player and provides the information needed to be an accountable member of an interdisciplinary team.

Large database analysis is critically important for nursing outcomes effectiveness research and is an area

for which more nurse scientists need to be prepared. Yet, it follows that local large nursing databases will not be available and nursing data will not be extracted for large national datasets, if standardized nursing data are not included in computerized information systems. Clearly there is need for the use of standardized nursing languages in computerized information systems for nursing outcomes accountability. Nursing classifications are available for use, but also are works in progress. It is an opportunity and the responsibility of all nurses to expect their use in nursing information systems, to participate in the testing and refinement of the languages, and to lobby for the inclusion of nursing data in large, national datasets.

VISIT THE WORLD WIDE WEB FOR INFORMATION

Are you preparing to give a presentation about NIC or NOC? Do you desire the latest information? Consider visiting the Center's World Wide Web homepage at: http://www.nursing.uiowa.edu/cnc. Some of the contents currently found here are: information about the upcoming November conference, an overview of the Center, a list of publications, an overview of both NIC and NOC, Center products available for purchase, questions and answers about NIC and NOC, all 433 NIC interventions with their codes and definitions, an example of a NOC outcome, and copies of recent NIC/NOC newsletters.

"For the first time, the classification of NANDA, NIC, and NOC and their impact on, and use by, clinicians, educators, researchers, vendors, and patients will be discussed at the same time."

A conference to facilitate the use of NANDA, NIC & NOC . . .

Talking Your Language in this Era of Managed Care

The Premiere Conference on

Nursing Diagnoses,

Interventions, and

Outcomes

November 7-9, 1997 Chicago

Conference Office:

Resource Management Plus

1211 Locust St.

Philadelphia, PA 19107

215-545-1985, 800-408-8951

fax: 215-545-8107

tracy.trauger@nursecominc.com

Cassification Data Sets Standardization Communication Implementation.