Nursing Interventions Classification (NIC)

NIC/NOC Newsletter
Nursing Interventions Classification/Nursing Outcomes Classification Vol. 6 No. 1 Feb 1998
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.

MOSBY YEAR BOOK IS SPONSOR OF NEWSLETTER

We are pleased to announce that, beginning with this issue, Mosby Year Book has assumed the sponsorship of The NIC/NOC Letter. Mosby is the publisher for both the NIC and NOC books and we are pleased that they are lending their support to this newsletter. In exchange for the sponsorship, we will feature a one page Mosby ad in each issue.

The current contacts at Mosby related to purchasing, licensing, and copyright needs are as follows:

Barbara Cullen, NIC and NOC Executive Editor (1-800-866-6250, ext. 3059) Department of Electronic Sales and Licensing (314-523-4917) Till Davenport, Permissions (314-872-8370/ fax 314-432-1380) Joyce Owen/ Kathy Krieg, Marketing (1-800-325-4177, ext. 4671)

To order NIC or NOC books, call 1-800-426-4545. Ask for 26018 NIC book code or 30588 NOC book code.

To inquire about a licensing agreement, contact the Department of Electronic Sales and Licensing. The licensing process has been simplified. Once an agreement for the use of NIC, NOC or both has been signed, Mosby will provide upon request on disk, the classifications in their entirety. The format can be either as a word-processing document or as an ancii file.

CENTER OPEN HOUSE FEBRUARY 6

On February 6, the College celebrated the Center's new offices and the appointment of Joanne McCloskey as Director of the Center with an open house. Dean Melanie Dreher offered remarks during a brief ceremony about the importance of classification research to the profession of nursing. Dr. McCloskey has been Principal Investigator of the NIC research for the past 10 years and Consultant on the NOC research. She will work closely with the other PIs of NIC and NOC, Gloria Bulechek, Marion Johnson, Meridean Maas, and Sue Moorhead, to plan for the Center's future. The new offices are on the 4th floor of the College of Nursing. NIC and NOC staff now share adjoining space and a common conference room. Lori Penaluna is the Program Associate in the Center and Barbara Head is a Research Associate.

PREMIER NANDA, NIC, NOC CONFERENCE A SUCCESS

The conference was held in St. Charles, IL on Nov. 7-9. More than 300 individuals attended, including approximately two dozen from other countries. Keynote speakers were Kathleen McCormick, "The vocabulary needs for evaluating quality of care in future computerized medical records", and Leah Curtain, "How we say what we say matters--a lot!" The conference featured presentations by a variety of users of the standardized languages. The networking and general interest by all was very motivating for all those who attended. Joe Braden from NurseCom, who organized and sponsored the conference, recently visited Iowa City to share the evaluations and discuss possible future plans. The feedback was that the content was excellent but the facility and room arrangements were crowded. There is much interest in a future conference; beginning ideas to have a second conference in March of 1999 were discussed.

NOC GRANT

The NOC research team received a high priority score for their grant entitled "Evaluation of Nursing-Sensitive Patient Outcome Measures." This competing renewal builds upon previous research to identify, standardize, and classify patient outcome measures sensitive to nursing practice. The primary purpose of the new study is to refine and validate measurement scales for nursing-sensitive patient outcomes developed and tested earlier and included in the Nursing Outcomes Classification (NOC). The specific aims of the research are to:

1) Describe the outcomes that are most relevant for patients in specialty nursing practice areas and in selected field sites representing the continuum of health care.

2) Assess the adequacy of measures (reliability, validity, sensitivity, specificity, and practicality) for the NOC outcomes in specialty practices and settings across the care continuum.

3) Describe the relationship of selected patient characteristics and the level of patient achievement for core outcomes to develop risk adjustment factors.

4) Describe the linkages among nursing diagnoses, interventions, and outcomes in clinical decision making.

5) Continue to develop, validate, and classify outcomes and outcome measures for individuals and families.

The clinical sites will be The University of Iowa Hospitals and Clinics (UIHC), Iowa City; IA; Alverno Health Care Facility, Clinton, IA; Genesis Medical Center, Davenport, IA; Mayo Clinic, Rochester, MN; and Parish Nursing Service, Advocate Health Care, Oak Brook, IL. A subcontract with The University of Michigan under the direction of Dr. Gail Keenan will provide the following community sites: Huron Valley Visiting Nurse Association, Ann Arbor, MI; Pontiac-Oakland Visiting Nurse Association, Waterford, MI; and University of Michigan Nursing Center, Ann Arbor, MI. We are grateful for all who agreed to participate.

WILLIAM DONAHUE LEAVES

We regret to inform people that Bill Donahue who had been with the NIC Project for the past 7 years recently left the project to accept a position in the College of Nursing as Program Associate for one of the new areas of study (departments). Some of his duties will be assumed by Barbara Head who has been hired part-time as Research Associate. We will miss Bill and thank him for all his help and enthusiasm over the years.

RECENT PUBLICATIONS ABOUT NIC AND NOC

Blegen, MA & Tripp-Reimer, T (1997). Implications of nursing taxonomies for middle-range theory development, Advances in Nursing Science, 19 (3), 37-49. Given the broad acceptance for the need to develop middle-range theory to support nursing practice, this article describes how the concepts in the newly developing taxonomies of nursing knowledge (NANDA diagnoses, NIC interventions, and NOC outcomes) can be used as the building blocks for the theories.

Blegen, MA & Tripp-Reimer, T (1997). Nursing theory, nursing research and nursing practice: Connected or separate? In JC McCloskey & HK Grace (Eds.) Current issues in nursing. (5th ed.) (pp. 68-74). St. Louis, MO: Mosby Year Book. Discusses why the three categories of nursing knowledge (theory, research, practice) should be kept separate to be fully developed; yet in order to build a coherent, shared body of knowledge, connections among categories should be strengthened--by building bridges of middle range theory and taxonomies of nursing knowledge.

Daly, JM, Button, P, Prophet, CM, Clarke, M, & Androwich, I (1997). Nursing Interventions Classification issues in five test sites, Computers in Nursing, 15 (1), 23-29. Describes the implementation of NIC in five test sites:: Dartmouth-Hitchcock Medical Center, Lebanon NH; Genesis Medical Center, Davenport IA; Loyola University Medical Center, Maywood, IL; Oaknoll Retirement Residence, Iowa City, IA; and The University of Iowa Hospitals and Clinics, Iowa City, IA. A description of NIC is provided along with a discussion of implementation issues and recommendations for implementation.

Daly, JM, Maas, M, & Buckwalter, K(1997). What interventions do nurses use in long term care? The Director, 5 (3), 108-111. Describes results of a survey of Directors of Nursing in nursing homes that support the implementation and usefulness of NIC in long term care. Results of the study validate that NIC is appropriate for use in long term care.

Delaney, C. & Moorhead, S. Synthesis of methods, rules, and issues of standardizing nursing intervention language mapping. Nursing Diagnosis, 8 (4), 152-156. Describes and compares methods used to "map" nursing orders/interventions of two hospital information systems to the NIC. Outlines decision rules to support intervention mapping; considers issues in mapping.

Iowa Intervention Project. (1997). Defining nursing's effectiveness: Diagnoses, interventions, and outcomes. In MJ Rantz & LP LeMone (Eds.) Classification of nursing diagnoses: Proceedings of the twelfth conference (NANDA). (pp. 293-303). Glendale, CA: CINAHL Information Systems. Presents a model (also see the next listing) that illustrates how nursing practice data (diagnoses, interventions, and outcomes) can be used at three levels: individual patient level, nursing unit/health care agency level, and regional, state, and national databases level. Depicts how nursing diagnoses, interventions, and outcomes aggregated for all patients can be used for resource allocation, costing, effectiveness research, and staff education. Includes 24 variables with their definitions and possible measures that need to be collected to conduct effectiveness research.

Iowa Intervention Project (1997). Proposal to bring nursing into the information age. Image: Journal of Nursing Scholarship, 29(3), 275-281. Addresses issues related to documentation of nursing care and proposes a model that illustrates how nursing practice data, collected through use of standardized languages, are useful to staff nurses, nurse administrators, researchers, and policy makers. Indicates three challenges: the level of detail to document, the inclusion of nursing language in critical paths, and the need for articulation among different nursing classifications.

Maas, M & Johnson, M (1997). Advancing nursing's accountability for outcomes. Outcomes Management for Nursing Practice 2(1), 3-4. The article emphasizes the importance of standardized language to document the outcomes of nursing interventions for nurses to be accountable for their practice.

Maas, M. (1997). Nursing-sensitive outcomes classification (NOC): Completing the essential comprehensive languages for nursing. In MJ Rantz & LP LeMone (Eds.) Classification of nursing diagnoses: Proceedings of the twelfth conference (NANDA). (pp. 40-47). Glendale, CA: CINAHL Information Systems. Overviews the development of the classification of nursing-sensitive patient outcomes. The NOC provides outcomes for the third nursing process element for the Nursing Minimum Data Set.

Moorhead, S. & Delaney, C. Mapping nursing intervention data into the nursing interventions classification (NIC): Process and rules. Nursing Diagnosis, 8 (4), 137-144. Describes the process of "mapping" non standardized nursing intervention data from one hospital information system to standardized nursing intervention language using the NIC. Provides examples of intervention terms mapped for 3 common NANDA diagnoses. Concludes that mapping is possible and describes usefulness of NIC to do this..

Swanson, E, Jensen, DP, Specht, J, Saylor, D, Johnson, M, & Maas, M (1997). Caregiving: Concept analysis and outcomes, Scholarly Inquiry for Nursing Practice: An International Journal 11, (1), 65-76. The article briefly overviews the work of the outcomes research team at The University of Iowa and then focuses on the group work in the area of family caregiving. The article discusses the group work on the outcomes, Caregiver Performance: Direct Care and Caregiver Performance: Indirect Care.

ENDOWMENT CONTRIBUTORS

The Center's endowment has reached $170,000, on the way to our goal of $ 1,000,000. Interest from the endowment will be used to support Center personnel who will assist with ongoing research and upkeep of the Classifications. The Center is one of the six areas targeted by the College of Nursing for the Centennial Campaign for Nursing Education which will be celebrated in April of this year. Please send your contribution to Alsatia Mellecker at The University of Iowa Foundation (1-800-618-6973), P.O. Box 4550, Iowa City IA 52244. Checks should be made out to the Center for Nursing Classification. We thank those who have contributed to the endowment since June of 1997:

American Nurses' Association, Washington, DC Ammerman, Suzanne, River Falls, WI, in honor of Prof. Myrtle Aydelotte Aquilino, Mary and Steven, Iowa City, IA in honor of Prof. Myrtle Aydelotte Baber, Ardeth, Bettendorf, IA, in memory of Mrs. Rathert and in honor of Prof. Myrtle Aydelotte Bellinger, Sandra, Moline, IL. Buxton, Joan, Iowa City, IA, in memory of Mr. Richard Buxton. CINAHL Information Systems, Pravikoff, Diane, Glendale, CA Cutright, Shirley, Carmichael, CA Cuttler, Charles and Betty Monroe, Iowa City, IA, in honor of Prof. Myrtle Aydelotte Davis, Rita, Iowa City, IA Denger, Sue, Wichita, KS, in honor of Prof. Myrtle Aydelotte deVries, Chris, (ANA), Washington, DC, in honor of Prof. Myrtle Aydelotte Donahue, Patricia, North Liberty, IA, in honor of Prof. Myrtle Aydelotte Emergency Nurses Association, Park Ridge, IL Farrington, Susan K., St. Petersburg Beach, FL Foerstner, Elsie M., Iowa City, IA Freeman, Janet, Iowa City, IA, in honor of Prof. Myrtle Aydelotte Gelfand, Lawrence and Miriam, Iowa City, IA in honor of Prof. Myrtle Aydelotte Glick, Orpha, Iowa City, IA Grandon, Eugene and Carleen, Cedar Rapids, IA, in honor of Prof. Myrtle Aydelotte Hale, Henrietta, Nevada, IA Havel, Marie, Iowa City, IA, in honor of Prof. Myrtle Aydelotte Head, Barbara, Iowa City, IA. Hockett, Franklin and Anita, St. Charles, MO Hollenbeck, Ralph and Jane, Salinas, CA Hoskins, Paul and Lois, Ashton, MD Iowa Nurses Foundation, West Des Moines, IA Ives, Major Robert and Lois, Fayetteville NC Izenstark, Barbara, Chicago, IL, in memory of Mr. Burton Izanstark Jacox, Ada, Ann Arbor, MI, in honor of Prof. Myrtle Aydelotte Johnson, Jone, Coralville, IA Johnson, Marion, Coralville, IA Kacena, Carolyn and James, Burlington, IA Kansas University School of Nursing, in honor of Prof. Myrtle Aydelotte Kratoska, Nicki, Hopkins, MN Lagorio, Valerie, Iowa City, IA, in honor of Prof. Myrtle Aydelotte Markovetz, Nicollet, Iowa City, IA., in memory of Dr. Allen Markovetz Matthews, Gail, Redlands, CA McCardell, Nancy Chandler, Pass Christian, MS McCloskey, Joanne, Swisher, IA Mercy Health Services, Farminton Hills, MI Monsanto, for Joan Carter, St. Louis, MO Moore, Barbara, Mercy Health Services, Farmington Hills, MI Moorhead, Sue and Donald, Davenport, IA, in honor of Prof. Myrtle Aydelotte Mullane, Dean Mary K., Naple, FL National Association of School Nurses, Inc., Scarborough, ME NOC Health, Attitudes and Behavior Focus Group, Iowa City, IA, in memory of Dr. Kathleen Kelly Noehren, Elizabeth, Upland, CA, in honor of Prof. Myrtle Aydelotte Nursecom, Inc., Braden, Joseph, Philadelphia, PA Opdahl, Deborah, Dallas, TX Parris, Nancy, Flowery Branch, GA Persons, Stow and Dorothy, Iowa City,IA, in honor of Prof. Myrtle Aydelotte Prophet, Colleen,Iowa City,IA Proudfit Wells, Kathleen, Des Moines, IA, in honor of Prof. Myrtle Aydelotte Rankin, Margaret, Iowa City, IA, in memory of Mrs. Margaret Harding Rodgers, Gretchen, Des Moines, IA, in honor of Prof. Myrtle Aydelotte Rosenberg, Guy and Martha Craft, Iowa City, IA, in honor of Prof. Myrtle Aydelotte Rowley, Mary, Lombard, IL, in honor of Prof. Myrtle Aydelotte Ryan, Gerald and Judith, Iowa City, IA Scheffel, Annette, Iowa City, IA Scherb, Cindy and Glenn, Kiester, MN Schmidt Chandler, Joan, Orchard, IA, in honor of Prof. Myrtle Aydelotte Schwartz, Jean, Littleton, CO, in honor of Prof. Myrtle Aydelotte Speed, Beverly, Greenfield, IA, in honor of Prof. Myrtle Aydelotte Stolley, Jacqueline, Davenport, IA Tarbox, Mary,Cedar Rapids, IA Tedford, Alberta, Washington, IA Tigges, Joanne, North Liberty, IA, in honor of Prof. Myrtle Aydelotte Volpp, Hollace, Fresno, CA Wedig, JoAnn, Davenport, IA Widmer, Rudolph, Munsingen, SWITZERLAND

LISTSERV INFORMATION

The Classification Listserv is alive and well with Janice Denehy, Assistant Professor in the College recently taking over as manager. The listserve was established to facilitate communication related to NIC and NOC and their use in practice, education, and research. Currently the list has 202 subscribers from 33 states plus Washington, DC and 10 foreign countries: Australia, Canada, England, Germany, Hong Kong, Iceland, Netherlands, Saudi Arabia, Spain, and Switzerland If you wish to subscribe to the listserve, please send a message to janice-denehy@uiowa.edu and she will instruct you on how to do this.

UNIVERSITY OF MARYLAND IDENTIFIES CORE COMPETENCIES

Material sent to us and used with permission of Robert Welton, Professional Development Coordinator, University of Maryland Medical System, Baltimore, MD.

The department of nursing at the University of Maryland Medical Center has used NIC to identify competencies for the 1800 employed staff. Three types of competencies were identified: core--required and expected of all staff nurses, regardless of where they practice; population-based--required of staff who provide care for specific patient populations; and setting-based--required of staff because of the setting in which they practice. Core competencies include expectations in clinical care, age-related care, and equipment use. All nurses in all settings are tested on their competence on 24 clinical competencies (e.g. Bleeding Precautions, Fall Prevention), 6 developmental competencies (e.g. infant development, school age child) and 17 equipment competencies (e.g. analgesic pump, patient lift). Population-based competencies were identified and developed by specific units or clinical divisions to target care for their specific patient types, e.g. Abuse Protection, Conscious Sedation). Setting-based competencies were developed for five settings: Ambulatory, Critical Care, Emergency, Perioperative, and Recovery. Competencies are assessed using one or more of four methods: direct observation, simulation, case study discussion, and testing. For more information, contact Robert Welton. (410-328-6757).

IOWA NURSES ASSOCIATION ADOPTS RESOLUTION

At its October 1997 convention, the Iowa Nurses Association passes a resolution that supports the adoption and collection of standardized nursing language in all clinical and education sites in the State of Iowa. The resolution includes six "resolved statements", one of which is "Resolved, that the Iowa Nurses Association support adoption of NANDA, NIC, and NOC to support the collection of the NMDS data throughout all nursing clinical and educational sites in the State of Iowa." Iowa is now the second state to pass a resolution of this nature, following Michigan who passed a similar resolution last year.

Publications available from the Center for Nursing Classification
Nursing Outcomes Classification (NOC) Taxonomy

This 8 page booklet contains a 3 level organizing structure for the 195 outcomes contained in the Nursing Outcomes Classification (NOC). At the highest, most abstract level are the domains (6 domains). Each domain includes classes
(groups) of related outcomes (24 classes), which represent the second level of the taxonomy. Each domain and class has a definition that helps to place and locate specific outcomes. The third, most concrete, level of the taxonomy consists of the outcomes that nurses choose to use with particular patients. $8 per copy.

NIC & NOC Use Surveys

NIC Use Survey: A 20 page questionnaire formatted as an 8.5 x 11" bound booklet printed on cardstock. This questionnaire is designed to assist individuals in identifying the frequency with which they perform the NIC interventions. A one-page demographic section is included.

NOC Use Survey: A 20 page questionnaire formatted as an 8.5 x 11" bound booklet printed on cardstock. This questionnaire can be used to identify the outcomes that should be available on unit-specific information systems.

Both questionnaires could also be used by faculty to determine which interventions and outcomes should be taught in specific courses.

Both surveys are provided on a 3/5" disk (IBM format), as Microsoft Word for Windows documents (font imbedded). The electronic version facilitates construction of other questionnaires. Formatting will print correctly on HP laser printers only.

$25/both surveys on disk and one hard copy

To order, send your request with payment to:

Center for Nursing Classification NB 407 The University of Iowa Iowa City, IA 52242-1121 Ph: (319) 335-7051/353-5414 Pg 5. Full page add from Mosby (on film)