Transcript Nursing Classification Systems

Nursing
Classification
Systems
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).”)
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
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Four classification systems have
been recognized by the ANA
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The North American Nursing Diagnosis
Association -NANDA
The Omaha System
The Home Health Care ClassificationHHCC
The Nursing Interventions ClassificationNIC
The North American Nursing
Diagnosis Association
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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
The North American Nursing
Diagnosis Association
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NANDA is a classification of nursing
diagnosis by human response patterns.
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Impared skin integrity, activity intolerance,
knowledge deficit, and anxiety are
examples of nursing diagnosis.
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Related factors and defining characteristics
are included for each diagnosis.
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.
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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.
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.
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.
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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
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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
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The Nursing Interventions
Classification
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The Nursing Interventions Classification (NIC) is a
comprehensive, research-based, standardized
classification of interventions that nurses perform
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The Classification includes the interventions that nurses
do on behalf of patients, both independent and
collaborative interventions, both direct and indirect care
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An intervention is defined as "any treatment, based upon
clinical judgment and knowledge, that a nurse performs to
enhance patient/client outcomes."
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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).
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.
The Nursing Interventions
Classification
The 514 interventions in NIC (4th ed.) are grouped
into thirty classes and seven domains for ease
of use :
1. Physiological: Basic
2. Physiological: Complex
3. Behavioral
4. Safety
5. Family
6. Health System, and
7. Community
Fluid Monitoring 4130
DEFINITION : Collection and analysis of patient data to
regulate fluid balance
ACTIVITIES :
1. Determine history of amount and type of fluid intake and
elimination habits
2. 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)
3. Monitor weight
4. Monitor intake and output
5. Monitor serum and urine electrolyte values, as
appropriate
6. Monitor serum albumin and total protein levels
7. Monitor serum and urine osmolality levels
8. Monitor BP, heart rate, and respiratory status
9. Monitor orthostatic blood pressure and change
in cardiac rhythm, as appropriate
10. Monitor invasive hemodynamic parameters, as
appropriate
11. Keep an accurate record of intake and output
12. Monitor mucous membranes, skin turgor, and
thirst
13. Monitor color, quantity, and specific gravity of
urine
14. Monitor for distended neck veins, crackles in the
lungs, peripheral edema, and weight gain
15. Monitor venous access device, as appropriate
16. Monitor for signs and symptoms of ascites
17. Note presence or absence of vertigo on rising
18. Administer fluids, as appropriate
19. Restrict and allocate fluid intake, as appropriate
20. Maintain prescribed intravenous flow rate
21. Administer pharmacological agents to increase
urinary output, as appropriate
22. Administer dialysis, as appropriate, noting
patient response
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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.