Nursing Classification Systems

1. Nursing Classification Systems

2. Different textbooks have diffferent lists of interventions For treatment of Activity Intolerance: • Moorhouse, Geissler, & Doenges (1987) list six independent interventions (e.g. “Check vital signs before and immediately after activity.”) and one collaborative intervention (“Follow graded cardiac rehabilitation and activity program.”) • McFarland and McFarlane (1989) list three goals with 24 interventions (e.g. “Assess the patient’s past and present activity pattern.” and “Engage immobile patient in passive exercise regimen.”) • Carpenito (1989) lists eight major categories of interventions and 46 discrete activities (e.g., “Instruct person to practice controlled coughing four times a day.” and “Discuss the need for annual immunizations (against flu, bacteria).”)

3. too long list of interventions – difficult to make decisions of priority • incomplete chemes • inconsistency (for example, the same list includes the items of Anatomy/physiology, Nutritionist, and Supplies) • some labels are too abstract to be clinically useful

4. Four classification systems have been recognized by the ANA • The North American Nursing Diagnosis Association -NANDA • The Omaha System • The Home Health Care Classification-HHCC  • The Nursing Interventions Classification-NIC 

5. The North American Nursing Diagnosis Association  • Since 1991, NANDA has had the nursing diagnosis terms classified into patterns which provide an organizing framework • The taxonomy provides a begining classification scheme that can be used to categorize and classify nursing diagnostic labels. • The taxomony is arranged alphabetically and coded using the  International Classification of Disease (ICD) framework, which consists of a four character structure

6. The North American Nursing Diagnosis Association  • NANDA is a classification of nursing diagnosis by human response patterns. • Impared skin integrity, activity intolerance, knowledge deficit, and anxiety are examples of nursing diagnosis. • Related factors and defining characteristics are included for each diagnosis. 

7. The Omaha System: Applications for Community Health Nursing   • This is the oldest of the nursing classifications and was developed in the 1970s by Karen Martin and colleagues for use in community health • It was designed for nurses in community and public health services • It consists of three parts: problems, interventions, and outcomes.

8. The Omaha System: Applications for Community Health Nursing The Problem Classification Scheme consists of four domains: • Environmental • Psychosocial • Physiological • Health Related Behaviors It includes 40 problems or diagnoses. Modifiers for the diagnoses identify the problem as either an individual or family problem and as either a health promotion, potential, or actual problem. There are also signs and symptoms specific to each problem.

9. The Omaha System: Applications for Community Health Nursing The Intervention Scheme is composed of four categories: • Health Teaching • Guidance and Counseling • Treatments and Procedures • Case Management • Surveillance They include 62 targets defined as objects of health related interventions or activities.

10. The Omaha System: Applications for Community Health Nursing • The Problem Rating Scale for Outcomes, a simple 5 point, ordinal scale comprised of Knowledge, Behavior and Status subscales. • Each of the three concepts is rated for degree of response. • Ratings are done at appropriate intervals and when the patient is discharged from service.

11. The Home Health Care Classification  • The Home Health Care Classification was developed by Virginia Saba at Georgetown University in the late 1980s for use in home health care • It consists of two vocabularies for diagnoses and interventions

12. The Home Health Care Classification  • The diagnoses vocabulary consists of 50 major categories and 95 subcategories • The interventions vocabulary consist of 60 major categories and 100 subcategories • The two vocabularies are organized by twenty care components, similar to the classes of NIC and NOC and include a coding scheme

13. The Nursing Interventions Classification   • The Nursing Interventions Classification (NIC) is a comprehensive, research-based, standardized classification of interventions that nurses perform • The Classification includes the interventions that nurses do on behalf of patients, both independent and collaborative interventions, both direct and indirect care • An intervention is defined as "any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance patient/client outcomes." • NIC can be used in all settings (from acute care intensive care units, to home care, to hospice, to primary care) and all specialties (from critical care to ambulatory care and long term care).

14. The Nursing Interventions Classification NIC interventions include both the physiological (e.g. Acid-Base Management) and the psychosocial (e.g. Anxiety Reduction). Interventions are included for • illness treatment (e.g. Hyperglycemia Management) • illness prevention (e.g. Fall Prevention), • health promotion (e.g. Exercise Promotion). Most of the interventions are for use with individuals but many are for use with families (e.g. Family Integrity Promotion), and some are for use with entire communities (e.g. Environmental Management: Community). Each intervention as it appears in the classification is listed with a label name, a definition, a set of activities to carry out the intervention, and background readings.

15. The Nursing Interventions Classification The 514 interventions in NIC (4th ed.) are grouped into thirty classes and seven domains for ease of use : • Physiological: Basic • Physiological: Complex • Behavioral • Safety • Family • Health System, and • Community

16. Fluid Monitoring 4130 DEFINITION : Collection and analysis of patient data to regulate fluid balance ACTIVITIES : • Determine history of amount and type of fluid intake and elimination habits • Determine possible risk factors for fluid imbalance (e.g., hyperthermia, diuretic therapy, renal pathologies, cardiac failure, diaphoresis, liver dysfunction, strenuous exercise, heat exposure, infection, postoperative state, polyuria, vomiting, and diarrhea)

17. Monitor weight • Monitor intake and output • Monitor serum and urine electrolyte values, as appropriate • Monitor serum albumin and total protein levels • Monitor serum and urine osmolality levels • Monitor BP, heart rate, and respiratory status • Monitor orthostatic blood pressure and change in cardiac rhythm, as appropriate • Monitor invasive hemodynamic parameters, as appropriate • Keep an accurate record of intake and output • Monitor mucous membranes, skin turgor, and thirst

18. Monitor color, quantity, and specific gravity of urine • Monitor for distended neck veins, crackles in the lungs, peripheral edema, and weight gain • Monitor venous access device, as appropriate • Monitor for signs and symptoms of ascites • Note presence or absence of vertigo on rising • Administer fluids, as appropriate • Restrict and allocate fluid intake, as appropriate • Maintain prescribed intravenous flow rate • Administer pharmacological agents to increase urinary output, as appropriate • Administer dialysis, as appropriate, noting patient response

19. Another concept that the Committee endorsed was that of a Unified Nursing Language System (UNLS) in collaboration with the Unified Medical Language System (UMLS). • At this time, NANDA, NIC, and the Home Health Care Classification have been incorporated into the UMLS. • They can be utilized by the nursing profession as a seperate UNLS if pulled away from the UMLS. • The advantage to integrating nursing terms into the UMLS is to represent the language system as multidisciplinary, which is similar to the environment in which we practice, document care, and communicate outcomes of care.