Use of standardized nursing language
will make nursing visible
by Gail M. Keenan, RN
Have you ever wished that all nurses used the same language
to chart, so you could easily understand what care was
provided? Authors of nursing texts and articles would
use the same names for nursing problems, so you wouldn't
have to figure out whether authors are describing the
same thing, but using different words? You had the data
needed to prevent nurse layoffs when you know patient
care is certain to suffer if layoffs occur?
Standardized language is now available for nurse use
to consistently describe nursing problems, treatments,
and outcomes. Nurses who learn and use standardized language
quickly recognize the benefits, which include providing
a mechanism to clearly define and evaluate nursing care
while promoting continuity of care. Recognition of the
benefits is fueling efforts to persuade all nurses in
Michigan to use common nursing language. The Michigan
Nurses Association is at the fore of this movement, working
with other nurse organizations in the state to educate
nurses about standardized language.
Why specific nursing language? Throughout the history
of the profession, nurses have documented their care using
individual and unit-specific methods such as narrative
descriptions, flow charts, and critical paths. Consequently,
there is a wide range of words and methods used to describe
the same care. This practice has resulted in misunderstanding
and misinterpretation of the care provided, making it
difficult to ensure continuity and evaluate care across
settings.
Standardized nursing languages were developed to address
this inconsistency by providing a common language, readily
understood by all nurses, to describe care. Communication
between nurses is made easier within and across units,
since there is no need to interpret or guess the meaning
of other nurses words. When standardized nursing language
is included in computerized documentation systems, it
can be combined with other data to determine optimal staffing
levels, support other resource-allocation decisions, and
identify the most effective nursing interventions.
Development of standardized languages for nursing began
over 25 years ago with the creation of a diagnoses language
by the North American Nursing Diagnosis Association (NANDA).
The work of NANDA continues today along with that of others,
including the Nursing Interventions Classification (NIC)
for nursing treatments, and the Nursing Outcomes Classification
(NOC) for nursing outcomes developed by research teams
at the University of Iowa College of Nursing. NANDA, NIC,
and NOC are three ANA-recognized nursing languages comprised
of comprehensive sets of terms and measures that represent
diagnoses, interventions, and outcomes for all nursing
units and specialties across the health continuum. Each
language is organized into a structure for ease in identification
of standardized terms.
NANDA
NANDA nursing diagnoses are clinical judgments about
individual, family, or community responses to actual or
potential health problems. The diagnoses reflect patient
states and can be used to help the nurse select desired
outcomes and interventions. There are currently 128 approved
diagnoses organized into a two-level structure. Each diagnosis
contains a definition, defining characteristics, and related
or etiological factors (NANDA, 1996).
Work by members of NANDA to expand and refine the classification
has been ongoing. Recently, NANDA and a team of researchers
at the University of Iowa College of Nursing, the Nursing
Diagnosis Extension Classification (NDEC) team, agreed
to work together to extend the diagnosis list and organize
it into a new structure.
NIC
The NIC team developed a comprehensive set of terms for
over 433 interventions provided by nurses in all types
of settings (McCloskey & Bulechek, 1996). The interventions
are organized into a three-level structure. The classification
includes both direct and indirect interventions. Each
intervention has a label name, definition, and set of
activities nurses perform to carry out the intervention.
A short list of background readings is also provided.
Recently NIC was found to be more precise and comprehensive
than the Physicians Current Procedural Terminology (CPT)
codes for classifying nursing treatments, supporting the
use of nurse classification systems for categorizing nursing
treatments in large data bases (Henry, Holzemer, &
Randall, 1997).
NOC
NOC is the most recently developed of the classifications.
It includes over 190 nursing-sensitive patient outcomes
(Johnson & Maas, 1997). Outcomes in NOC focus on the
recipient of care and include patient states, behaviors,
and/or patient perceptions that are sensitive to nursing
interventions. The NOC outcome measures are also organized
into a three-level structure. Each outcome has a label,
is defined, and has indicators that the nurse rates on
five-point scales.
Comprehensive standardized languages represent three
important nursing care variables (nursing diagnoses, interventions,
and outcomes) and have only recently become available
for use in all types of settings. NANDA, NIC, and NOC,
however, must be used in practice to realize the benefits
and support the ongoing refinement required to keep the
languages current. Consistent use of these nursing languages
will provide the information needed to build and expand
nursing knowledge and promote effective nursing practice.
Eventual computerization of standardized nursing documentation
at the point of care will facilitate the speed with which
clinical information is converted into useable knowledge.
All nurses must take responsibility for creating and
implementing standardized language in their nursing practice.
Nurses in Michigan have begun to embrace this challenge
and are providing leadership to ensure that all nurses
throughout the state learn and use standardized language
in practice. To learn more about what you can do to promote
the appropriate use of standardized languages, call Jan
Coye at the MNA (517/349-5640, ext. 35).
Gail M. Keenan, PhD, RN, is an assistant professor at
the University of Michigan College of Nursing. She teaches,
writes, and conducts research on the use and refinement
of NANDA, NIC, and NOC. Keenan is a member of the MNA
Standardized Language Task Force.
Bibliography
American Nurses Association (ANA) (1997). NIDSEC standards
and scoring guidelines. Washington, DC: American Nurses
Publishing.
North American Nursing Diagnosis Association (NANDA)
(1996). Nursing diagnoses: definitions and classification
1997-1998. Philadelphia: NANDA.
Henry, S. B., Holzemer, W. L., & Randall, C. (1997).
Comparison of nursing interventions classification and
current procedural terminology codes for categorizing
nursing activities. Journal of Nursing Science,
29, 133-138.
Huber, D. G., Schumacher, L., & Delancy, C. (1997).
Nursing management minimum data set. Journal of Nursing
Administration, 27, 42-48.
Johnson, M., & Maas, M. (1997). Nursing outcomes
classification. St. Louis: Mosby.
McCloskey, J. C., & Bulechek, G. M. (1996). Nursing
interventions classification (NIC) (2 ed.). St. Louis:
Mosby.
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