President's Message
Validatingnursingwith "NANDA,NIC,
and NOC"
K. S u e H o y t , RN, MN, CEN, E1 C a j o n ,
I r e c e n t l y a t t e n d e d t h e 21st Q u a d r e n n i a l C o n g r e s s
of the I n t e r n a t i o n a l C o u n c i l of N u r s e s in Vancouver,
C a n a d a . T h e p r o g r a m w a s titled, "Sharing t h e Health
Challenge." T h e c o n f e r e n c e h a d m a n y w o n d e r f u l
speakers a n d provided a n o p p o r t u n i t y to "participate
in s e t t i n g future d i r e c t i o n s for the profession . . . . "t
Definition of nursing and International
Classification of Nursing's Project
C o n s t a n t t h e m e s t h r o u g h o u t t h e p r o g r a m were,
"What is it t h a t n u r s e s do? Do the a c t i o n s of n u r s e s
h a v e a n i m p a c t on the results t h a t are a c h i e v e d for
p a t i e n t s ? H o w does n u r s i n g e n h a n c e the care of oth-
ers? H o w c a n n u r s e s b e s t c o n t r i b u t e to t h e total
group c a r i n g for p a t i e n t s ? ''2 C o n f e r e n c e p a r t i c i p a n t s
also talked a b o u t a clearer definition of n u r s i n g . In the
words of N o r m a Lang, "If y o u c a n ' t n a m e it, you c a n ' t
control it, f i n a n c e it, r e s e a r c h it, t e a c h it, or p u t it into
public policy. ''s T h a t p h r a s e w a s q u o t e d t h r o u g h o u t
the w e e k at several other talks. 3
Another conference discussion centered around
the q u e s t i o n , "Just w h a t do n u r s e s do?" But it's n o t
j u s t w h a t n u r s e s do. "Being able to d e s c r i b e w h a t
n u r s e s do, for w h a t sort of conditions, a n d w i t h w h a t
sort of effects is the v i s i o n of t h e I n t e r n a t i o n a l
Classification of N u r s i n g ' s Project (ICNP)." Its m i s s i o n
is to develop a n i n t e r n a t i o n a l classification for n u r s -
i n g practice. "The aim of t h a t project is n o t to define
n u r s i n g b u t to develop a v o c a b u l a r y a n d a classifica-
tion s y s t e m t h a t c a n b e u s e d in n u r s i n g d o c u m e n t a -
tion a n d i n electronic records b y n u r s e s in a clinical
s e t t i n g a n d i n every c o u n t r y of the world to d e s c r i b e
their n u r s i n g a n d to e n s u r e that it's visible i n all the
i n f o r m a t i o n s y s t e m s t h a t are i n c r e a s i n g l y u s e d to
describe, m a n a g e , a n d define health care. ,,3
W h a t d i s t i n g u i s h e s t h e ICNP from classifications
J Emerg Nurs 1997;23:507-9.
Copyright © 1997 by the Emergency Nurses Association.
0099-1797 $5.00 + 0 18/61/85601
California
d e v e l o p e d for other d i s c i p l i n e s is t h a t it i n c l u d e s and,
m o s t importantly, will "link the three d i m e n s i o n s of
w h a t n u r s e s do, w h y (for w h a t p r o b l e m s or condi-
tions), a n d w i t h w h a t effect. To u n d e r s t a n d w h a t
n u r s e s do, you h a v e to u n d e r s t a n d w h y t h e y are d o i n g
it. N u r s i n g i n t e r v e n t i o n s c a n n o t b e u n d e r s t o o d with-
out reference to n u r s i n g d i a g n o s e s , for it's t h e n u r s i n g
d i a g n o s e s w h i c h give t h e p u r p o s e a n d t h e focus to t h e
n u r s i n g i n t e r v e n t i o n s a n d m a k e s it n u r s i n g . ''s
Center for Nursing Classification
T h e Center for N u r s i n g Classification, w h i c h is
l o c a t e d at the U n i v e r s i t y of Iowa College of Nursing,
h a s d e v e l o p e d s t a n d a r d i z e d l a n g u a g e s for n u r s i n g
i n t e r v e n t i o n s a n d o u t c o m e s - - h e a r that, i n t e r v e n t i o n s
a n d o u t c o m e s . If n u r s i n g , as a discipline, is to exist in
years to come, n u r s e s n e e d to d e m o n s t r a t e t h a t their
i n t e r v e n t i o n s m a k e a difference in t h e o u t c o m e s of
their p a t i e n t s . F a c u l t y a n d staff in the C e n t e r are
w o r k i n g w i t h health care a g e n c i e s to u s e t h e lan-
g u a g e s to d o c u m e n t a n d s t u d y the cost a n d effec-
t i v e n e s s of n u r s i n g care. This u n i q u e r e s e a r c h c e n t e r
will h a v e far-reaching effects for t h e n u r s i n g profes-
sion a n d health care c o n s u m e r s .
What are NANDA, NIC, and NOC?
N A N D A is t h e N o r t h A m e r i c a n N u r s i n g
D i a g n o s i s Association. A t a x o n o m y of n u r s i n g diag-
n o s e s has b e e n d e v e l o p e d t h a t i n c l u d e s r e s p o n s e
p a t t e r n s . 4 T h e s e d i a g n o s e s , for example, h a v e b e e n
i n c o r p o r a t e d into m a n y of ENA's t e a c h i n g materials
i n c l u d i n g s u c h courses as the T r a u m a N u r s i n g Core
Course a n d the E m e r g e n c y N u r s i n g Pediatric Course.
T h e N u r s i n g I n t e r v e n t i o n s Classification (NtC) is
a c o m p r e h e n s i v e s t a n d a r d i z e d l a n g u a g e to d e s c r i b e
t h e t r e a t m e n t s t h a t n u r s e s perform. 5 This has major
i m p l i c a t i o n s for ENA. W h e t h e r you are a staff n u r s e or
a n a d v a n c e d p r a c t i c e nurse, w h e t h e r you work in a
p r e h o s p i t a l s e t t i n g or t r a u m a unit, you are p r o b a b l y
looking for s t a n d a r d i z e d m e t h o d s for d o c u m e n t i n g
and c o m m u n i c a t i n g nursing interventions.
December 1997 507
JOURNAL OF EMERGENCYNURS1NG/H0yt
The N u r s i n g O u t c o m e s Classification (NOC) is a
c o m p r e h e n s i v e s t a n d a r d i z e d l a n g u a g e to d e s c r i b e
p a t i e n t o u t c o m e s t h a t are s e n s i t i v e to n u r s i n g treat-
m e n t . T h e classifications are useful i n p l a n n i n g a n d
d o c u m e n t i n g c a r e - - i n c o m m u n i c a t i n g the e s s e n c e
of n u r s i n g to others. T h e classifications are also use-
ful i n the d e v e l o p m e n t of large d a t a b a s e s for r e s e a r c h
on the e f f e c t i v e n e s s of n u r s i n g care. R e s e a r c h t e a m s
at the U n i v e r s i t y of Iowa are d e v e l o p i n g the classifi-
c a t i o n w i t h s u p p o r t from the N a t i o n a l I n s t i t u t e of
N u r s i n g Research. 6 ENA c a n also incorporate NOC
into the d e v e l o p m e n t of pediatric a n d adult critical
p a t h s a n d into c o m p u t e r i z e d i n f o r m a t i o n s y s t e m lan-
g u a g e s . T h e Data E l e m e n t s for E m e r g e n c y Depart-
m e n t s (DEEDS) d o c u m e n t (see F e b r u a r y 1998 issue, J
E m e r g N u r s ) , w r i t t e n b y ENA a n d other associations,
is one s u c h example.
"If y o u c a n ' t n a m e it, y o u
c a n ' t c o n t r o l it, f i n a n c e it,
r e s e a r c h it, t e a c h it, or p u t it
i n t o p u b l i c policy."
Benefits of N|C and NOC
Benefits of NIC a n d NOC will i n c l u d e t h e fol-
lowing:
• Provide a s t a n d a r d i z e d l a n g u a g e for n u r s i n g
• Facilitate a p p r o p r i a t e s e l e c t i o n of n u r s i n g inter-
ventions
• Define a n d p r e d i c t o u t c o m e s n u r s e s c a n a c h i e v e
with patients
• Facilitate c o m m u n i c a t i o n of n u r s i n g t r e a t m e n t s to
other n u r s e s a n d other providers
• S t a n d a r d i z e a n d define the k~owle~dge b a s e for
n u r s i n g curricula a n d p r a c t i c e ..- ~.'~
• Facilitate t h e t e a c h i n g of clinical d e c i s i o n m a k i n g
to n o v i c e n u r s e s
• A s s i s t a d m i n i s t r a t o r s in effectively p l a n n i n g for
staff a n d e q u i p m e n t r e s o u r c e s
• E n a b l e r e s e a r c h e r s to e x a m i n e the effectiveness
a n d cost of n u r s i n g care
• A s s i s t e d u c a t o r s in d e v e l o p i n g curricula t h a t b e t t e r
conform w i t h clinical p r a c t i c e
• Promote the d e v e l o p m e n t of a r e i m b u r s e m e n t sys-
t e m for n u r s i n g services
• Facilitate the d e v e l o p m e n t of c o m p u t e r i z e d infor-
mation systems
• C o m m u n i c a t e t h e n a t u r e of n u r s i n g to t h e p u b l i c 7
508 Volume23, Number 6
"To define its practice, the n u r s i n g profession
addresses three complex intellectual tasks: first, to
describe those conditions in clients a n d p a t i e n t s that
are appropriate for nurses to attend; second, to indicate
the m e a n s b y w h i c h n u r s e s treat those conditions; and
third, to define the results to b e e x p e c t e d from that
attention. In the n u r s i n g profession, these tasks encom-
pass three knowledge d o m a i n s - - n u r s i n g diagnoses,
n u r s i n g interventions, a n d n u r s i n g outcomes. ''s
"Without a c o m m o n classification of t h e s e enti-
ties, n u r s e s are n o t able to record their i n t e r v e n t i o n s
a n d o u t c o m e s consistently; nor are t h e y able to m o n -
itor, over a n u m b e r of p a t i e n t s , w h i c h i n t e r v e n t i o n s
a n d o u t c o m e s are effective in i m p r o v i n g t h e quality
of care provided. Thus, s u c h classifications are basic
to n u r s e s ' ability to e v a l u a t e the q u a l i t y of care. ''9
National and international recognition
NIC is n o w r e c o m m e n d e d b y t h e J o i n t C o m m i s -
sion o n A c c r e d i t a t i o n for H e a l t h c a r e O r g a n i z a t i o n s as
o n e n u r s i n g classification t h a t c a n b e u s e d to m e e t the
s t a n d a r d on u n i f o r m data. In 1993, this classification
w a s one of the first two n u r s i n g l a n g u a g e s to b e in-
c l u d e d in the National Library of M e d i c i n e ' s M e t a t h e -
s a u r u s for t h e Unified Medical L a n g u a g e System.
Both the C u m u l a t i v e I n d e x to N u r s i n g a n d Allied
Health Literature a n d t h e Silver Platter h a v e a d d e d
NIC to their i n d e x e s for n u r s i n g literature. It is en-
dorsed b y the A m e r i c a n N u r s e s A s s o c i a t i o n . l °
Future implications
"The s t a n d a r d i z e d l a n g u a g e s d e v e l o p e d t h r o u g h
t h e C e n t e r for N u r s i n g Classification r e s e a r c h will
h a v e far-reaching significance, particularly for the
n u r s i n g profession a n d for c o n s u m e r s of h e a l t h care.
T h e u s e of a c o m m o n classification s y s t e m provides
for c o n t i n u i t y of care, e n h a n c i n g c o m m u n i c a t i o n
b e t w e e n n u r s e s , a n d a m o n g n u r s e s a n d other
providers. U s i n g s t a n d a r d i z e d l a n g u a g e to plan, doc-
u m e n t , a n d s t u d y n u r s i n g care will m a k e it possible
to d e t e r m i n e t h e effectiveness a n d costs of n u r s i n g
therapies. This k n o w l e d g e c a n b e u s e d to improve
t h e quality of health care. ''11
N o r m a L a n g is right; "If you c a n ' t n a m e it, you
c a n ' t control it, f i n a n c e it, r e s e a r c h it, t e a c h it, or p u t
it into p u b l i c policy. ''s This is emergency nursing's
future as w e l l - - i t s justification, a n d I believe, its ulti-
m a t e survival.
References
1. Styles M. Opening remarks. Proceedings of the 21st
Quadrennial Congress of the International Council of
Nurses; 1997 June 15-20; Vancouver, Canada.

2. Center for Nursing Classification. Iowa City (IA): The
University of Iowa, 1997.
3. Clark DJ. Virginia Henderson memorial Lecture.
Proceedings of the 21st Quadrennial Congress of the
International Council of Nurses; 1997 J u n e 15-20;
Vancouver, Canada.
4. North American Nursing Diagnosis Association
(NANDA). NANDA nursing diagnoses: Definitions and clas-
sification 1995-1996. Philadelphia: The Association; 1996.
5. Iowa intervention project. McClosky JC, Bulschek, GM,
editors. Nursing interventions classification (NIC). 2nd ed.
St. Louis: Mosby-Year Book; 1996. p.
6. Iowa outcomes project. Johnson M, Maas M, editors.
Nursing outcomes classification (NOC). St. Louis:
Mosby-Year Book; 1997.
Hoyt/JOURNALOF EMERGENCYNURSING
7. Center for Nursing Classification Research at the
University of Iowa College of Nursing. Unpublished data.
Iowa City (IA): The Center; 1997. p. 5.
8. Aydelotte MK. Center for Nursing Classification
Research at the University of Iowa College of Nursing.
Unpublished data. Iowa City (IA): The Center; 1997. p. 7.
9. Hinshaw AS. Center for Nursing Classification Research
at the University of Iowa College of Nursing. Unpublished
data. Iowa City (IA): The Center; 1997. p. 9.
10. Center for Nursing Classification Research at the
University of Iowa College of Nursing. Unpublished data.
Iowa City (IA): The Center; 1997. p. 4.
11. Felton G. Center for Nursing Classification Research at
the University of Iowa College of Nursing. Unpublished
data. Iowa City (IA): The Center; 1997. p. 2.
D e c e m b e r 1997 509