Page 366 - Encyclopedia of Nursing Research

NuRSING DIAGNOSeS, INTeRveNTIONS, AND OuTCOMeS n 333

nursing process to five steps. A nursing diag- systems, and for the development of nursing
nosis is “a clinical judgment about individ- knowledge and the education of professional
ual, family or community responses to actual nurses. An outcome is defined as “a measur- N
or potential health problems/life processes. able individual, family, or community state,
A nursing diagnosis provides the basis for behavior or perception that is measured
selection of nursing interventions to achieve along a continuum and is responsive to
outcomes for which the nurse is accountable” nursing interventions” (Moorhead, Johnson,
(NANDA International, 2009, p. 410). In 2009, Maas, & Swanson, 2008, p. 30). The outcomes
the NANDA-I classification included 202 are developed for use in all settings and can
diagnoses, organized into 47 classes and 13 be used across the care continuum to follow
domains. A multiaxial system has been used patient outcomes throughout an illness epi-
to improve the flexibility of the taxonomy sode or over an extended period of care. The
and facilitate the addition of new or modified strength of this classification is its use of mea-
diagnoses (NANDA International, 2009). surement scales and the ability of the nurse
efforts to develop a vocabulary and clas- to calculate a change score from admission
sification of nursing interventions began to discharge. These scales have been tested
in 1987 with the formation of a research in clinical practice and are highly reliable
team at the university of Iowa led by for measuring change in the patient’s sta-
Joanne McCloskey Dochterman and Gloria tus. There are currently 385 NOC outcomes
Bulechek. The team developed the NIC, first organized in 31 classes and 7 domains in the
published in 1992 as a comprehensive, stan- fourth edition (Moorhead et al., 2008).
dardized classification of interventions that The history of standardized language
nurses perform (McCloskey & Bulechek, development mirrors the development of the
1992). In contrast to a nursing diagnosis or nursing process. The first major issue was
patient outcome in which the focus of con- to challenge the use of the term diagnosis as
cern is the patient, the focus of concern with a term only physicians could use. The early
nursing interventions is nurse behaviour, days of diagnoses development was contro-
and each intervention lists actions that assist versial even within the nursing profession,
the patient to progress toward a desired out- but the importance of developing problems
come. A nursing intervention is defined as that nurses treat was viewed as critical to
“any treatment, based upon clinical judg- knowledge development in nursing. These
ment and knowledge that a nurse performs early efforts by nurses who were members
to enhance patient/client outcomes. Nursing of the North American Nursing Diagnoses
interventions include both direct and indi- Association identified the need for classi-
rect care; those aimed at individuals, fam- fications focused on nursing interventions
ilies, and the community; and those for and patient outcomes to be used with nurs-
nurse-initiated, physician-initiated and other ing diagnoses. Today, the issues continue to
provider-initiated treatments” (Bulechek, focus on making the content of these clas-
Butcher, & Dochterman, 2008, p. xxii). The sifications robust and useful in practice. The
542 interventions in the fifth edition of NIC need for representation and classification of
are grouped into 30 classes and 7 domains the knowledge base of nursing continues to
for ease of use (Bulechek et al., 2008). be an issue for the profession (Kautz, Kuiper,
The NOC is a comprehensive, standard- Pesut, & Williams, 2006). Research to vali-
ized classification of patient/client outcomes date the NANDA-I diagnoses and NOC out-
developed to evaluate the effects of nurs- comes is needed to ensure their usefulness
ing interventions. Standardized outcomes across patient populations and care settings.
are necessary for documentation in elec- In addition, clinical tests of the effectiveness
tronic records, for use in clinical information of the nursing interventions are also needed