Applying Standardized Terminology In Practice – NANDA , NOC And NIC

Standardized terminologies in nursing have made very unique contributions to the systemic development of the nursing knowledge. The nurses select nursing outcomes, diagnoses and interventions so as to link the standardized nursing terminologies(Tripp-Reimer, Woodworth, McCloskey, & 1996). The use of nursing terminologies such as NANDA, Nursing Outcomes Classification (NOC) and Nursing Interventions Classifications (NIC) ensures the provision of an effective process so as to increase the accuracy of the nursing care plans in a particular care setting and thus improve the outcomes(Lunney, 2006c). NANDA-I, NOC and NIC all provide uniform terminologies for the purpose of documentation of diagnosis, intervention as well as the outcome components. This thus enables the nurses to be able to use same clinical terms in the description and communication of clear patient care situation to the others in the same field(Vizoso, Lyskawa, & Couey, 2008)

The scenario I chose on was a study that was done to identify the NANDA-I diagnoses that were frequently used, the NIC interventions, the NOC outcomes and the NNN linkages that existed for the patients with CHF. It was carried out at a Midwestern community hospital based in Iowa where 272 patient records were analyzed. The results would provide very valuable data that would be used for clinical information systems(Tripp-Reimer et al 1996). The NIC interventions that are frequently used were also identified during the analysis.

The scenario to be discussed in this case is in regards to the patients diagnosed with Congestive Heart Failure (CHF). According to the U. S. Health News, 2006,the patients under the research had an average of 5.41 nursing diagnoses. In the nursing diagnoses, the most prevalent ones were cardiac output alteration, knowledge deficit, airway clearance ineffective, activity intolerance, tissue integrity impaired, pain acute, nutrition less than body requirements altered and fluid volume deficit. These diagnoses accounted for 90% of the diagnoses for the patients with CHF. Top four on the list which can be looked at deeply include Cardiac Output Alteration, Airway Clearance Ineffective, Knowledge Deficit and Airway Clearance Ineffective which accounted for about 50% of the CHF cases.

The examination of these results were made by making comparisons of the frequency of the NANDA-I diagnoses by use of domains of the NANDA-I Taxonomy II(Von-Krogh, 2008). Safety/Protection and Activity/Rest are basically the most frequently used domains by the patients suffering from CHF. The least domains used for this purpose are Health Promotions and Life Principles. This data thus depicts the diagnoses from 10 of the 13 present domains. There were no diagnoses from domain 8(Sexuality), 6 (Self Perception) or 13 (Growth) that were chosen for the sample of the patients suffering from CHF when they were hospitalized. For patients suffering from CHF, the top ten NANDA-I diagnoses are Protection/ Safety (40%), Nutrition (20%), Rest/Activity (20%) and Cognition/ Perception (10%)(Van De Castle, 2003).Some of the related factors and symptoms/signs which are associated with each of the mentioned diagnoses were chosen by the nurses for the patients with CHF. For the related factors, unfamiliarity with the information i.e.  Lack of recall, lack of exposure etc. was used frequently for Knowledge deficitinadequate primary defenses(traumatized tissue, Brocken skin, invasive procedure, and change in the Ph secretions) for the cardiac output, activity tolerance and infection risk (Vizosoet al2008).

Some of the most prevalent symptoms for the diagnoses were:-

  1. Adventitious sounds of breath
  2. Verbal report of weakness or fatigues
  3. External dyspnea or discomfort
  4. The verbalization of problems

Some NOC outcomes were chosen for these patients. In this research, a total of 63 different NOC outcomes were selected. 50% of the total were accounted for by six NOC outcomes.

  • Knowledge: Treatment regimen accounted for 11.15%
  • Cardiac Pump Effectiveness accounted for 8.11%
  • Risk control accounted for 8.52%
  • Safety behavior: Fall Prevention accounted for 9.02%
  • Tissue Integrity: Skin & Mucous Membranes accounted for 8.25%
  • Fluid Balance accounted for 7.84%

These results were examined by making comparison of the frequency seen on the NPC outcomes by use of the domains contained in the NOC Taxonomy. Physiologic Health happens to be the most frequently selected domain at 35% followed by Behavior & Health Knowledge at 30%, Functional Health at 21%, Psychological Health at 8%, Family Health at 3% and finally Perceived Health is the least selected domain at 3%. Community health was the only domain that wasn’t selected for the patients with CHF (Tripp-Reimer et al 1996)

There are several interventions that were chosen by nurses to be used on the patients who were hospitalized with CHF. The nurses selected one hundred and forty-three NIC interventions. There are 7 domains in the NIC taxonomy. These include the Physical: Basic, Complex, Behavioral, safety, family and the Health System. The community domain was left out in this selection for the patients with CHF (Van De Castle, 2003).

For this research, there are several linkages between NANDA-I, NOC and NIC for the patients with CHF. The top five of the linkages in the list include:

  1. Knowledge deficit-Knowledge: Treatment Regimen-Teaching: Treatment/Procedure (N=94)
  2. Cardiac Output Alteration-Cardiac Pump Effectiveness-Cardiac Care (N=83)
  3. Injury High risk for-Safety behavior: fall prevention-Fall prevention (N=76)
  4. Cardiac Output Alteration-Cardiac Pump Effectiveness-Fluid Monitoring (N=71)
  5. Injury High risk for-Risk Control-Fall Prevention (N-58) (Vinson, Rich, Sperry, Shah, McNamara, 1990).

For this research, the nursing diagnosis for Injury High Risk and the Cardiac Output Alteration was the highest selected among the NNN linkages and it was linked to different NICs and NOCs.The NOC change score was calculated between the admission and discharge times. This was calculated in terms of the pain difference between the time the patient was admitted and the time he/she was discharged. Among the top ten scores, the NOC outcomes score was ranging from 2.6 to 3.3 at the time of admission to 3.1 to 3.9 at the time of discharge.

From this discussion, it is thus clear that NANDA, NOC and NIC are interrelated and dependent on each other. This is because once a diagnosis has been made and classified, the outcomes have to be given and later on an intervention has to be done in order to counteract the outcomes.

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