Coining and Defining Novel Nursing Terminology. Part 1: Critical Incident Nursing Diagnosis

PURPOSE.  In the first of a three-part series, a novel nursing terminology is introduced and proposed for inclusion in the North American Nursing Diagnosis Association (NANDA) International Classification—Critical incident nursing diagnosis (CIND)—defined as the recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication.
DATA SOURCES.  The literature, research studies, and meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article.
DATA SYNTHESIS.  The current nursing diagnoses in the NANDA International Classification are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations.
CONCLUSIONS.  Coining and defining a novel nursing terminology, CIND, for patient care during life-threatening situations are important and fill the gap in the current standardized nursing terminology.
IMPLICATIONS FOR NURSING PRACTICE.  Refining the NANDA International Classification will permit nursing researchers, among others, to conduct studies on nursing diagnoses in conjunction with the proposed novel nursing terminology: CIND. Parts 2 and 3 of this series will propose additional nursing terminology: critical incident nursing intervention and critical incident control, respectively.     

Coining and Defining Novel Nursing Terminology. Part 2: Critical Incident Nursing Intervention

PURPOSE. In the second of a three‐part series, a novel nursing terminology is introduced and proposed for inclusion in the Nursing Interventions Classification (NIC): Critical incident nursing intervention (CINI), defined as any indirect or direct care registered nurse–initiated treatment, based upon clinical judgment and knowledge that a registered nurse performs in response to a critical incident nursing diagnosis (CIND). A CIND is defined as recognition of an acute life‐threatening event that occurs as a result of disease, surgery, treatment, or medication. DATA SOURCES. The literature, research studies, meta‐analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article. DATA SYNTHESIS. The current nursing interventions in the NIC are inaccurate or inadequate for describing nursing care during life‐threatening situations. The lack of standardized nursing terminology creates a barrier that may impede critical communication and patient care during life‐threatening situations. CONCLUSION. Coining and defining novel nursing terminology, CINI, for patient care during life‐threatening situations is important and fills the gap in the current standardized nursing terminology. IMPLICATIONS FOR NURSING PRACTICE. Refining the NIC will permit nursing researchers, among others, to conduct studies on nursing interventions in conjunction with the proposed novel nursing terminology, CINI. The first article in this series (Part 1) introduced the novel nursing terminology: CIND; the present article (Part 2) introduces the novel nursing terminology: CINI; and the third article in this series (Part 3) will introduce the novel nursing terminology: critical incident control.     

Case Study: The Challenges of Self-Management of Exacerbation of Pulmonary Symptoms

PURPOSE.  This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self-management for a female veteran.
DATA SOURCES.  Data were obtained through the author's clinical practice in primary care nursing and research literature sources.
DATA SYNTHESIS.  The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA-International, the Nursing Interventions Classification, and the Nursing Outcomes Classification.
CONCLUSIONS.  This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations.
IMPLICATIONS FOR NURSING PRACTICE.  Employing the NANDA-International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.     

Case Study: Home Nursing Care for a 62-Year-Old Woman with Multiple Health Problems

PURPOSE.  This case study illustrates the characteristics of, and challenges for, a woman in the United States with multiple health problems.
DATA SOURCES.  Data were obtained through the authors' experience and knowledge of community health nursing and from published literature.
DATA SYNTHESIS.  NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification were utilized to identify appropriate nursing diagnoses, interventions, and outcomes for the client.
CONCLUSION.  This case study illustrates and provides appropriate nursing diagnoses, interventions, and outcomes relevant to a woman with many health concerns. It provides guidance for nurses in community health settings when caring for patients with multiple health problems.
IMPLICATIONS FOR NURSING PRACTICE.  Utilizing the standardized nursing languages of NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification can provide the necessary framework for enhancing and improving the management of care for patients with many health concerns in the community setting.     

Coining and Defining Novel Nursing Terminology. Part 3: Critical Incident Control

PURPOSE.  In the third of a three-part series, a novel nursing terminology is introduced and proposed for inclusion in the Nursing Outcomes Classification (NOC)—Critical incident control (CIC)—defined as a response that attempts to reverse a life-threatening condition. Critical incident nursing diagnosis (CIND), defined as recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication, and critical incident nursing intervention, defined as any indirect or direct care registered nurse–initiated treatment, based upon clinical judgment and knowledge that a registered nurse performs in response to a CIND, were introduced in Parts 1 and 2 of this series, respectively.
DATA SOURCES.  The current literature, research studies, meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article.
DATA SYNTHESIS.  The current nursing outcomes in the NOC are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations.
CONCLUSION.  Coining and defining novel nursing terminology, CIC, for patient care during life-threatening situations is important and fills the gap in the current standardized nursing terminology.
IMPLICATIONS FOR NURSING PRACTICE.  Refining the NOC will permit nursing researchers, among others, to conduct studies on nursing diagnoses in conjunction with the proposed novel nursing terminology, CIC.     

A Pilot Study to Validate the Priority Nursing Interventions Classification Interventions and Nursing Outcomes Classification Outcomes for the Nursing Diagnosis "Excess Fluid Volume" in Cardiac Patients

PURPOSE.  To validate the content of the priority Nursing Interventions Classification (NIC) interventions and Nursing Outcomes Classification (NOC)-suggested outcomes for cardiac patients with the nursing diagnosis excess fluid volume in the Brazilian context.
METHODS.  The content of the interventions and outcomes was scored by seven expert nurses using a Likert scale, using the Fehring model.
FINDINGS.  From the 83 activities of the priority NIC interventions, nine had scores lower than 0.5 (nonuseful) and 50 had scores higher than 0.8 (major); from the 53 indicators of the suggested NOC outcomes, eight scored lower than 0.5 and 26 had scores higher than 0.8.
CONCLUSIONS.  The majority of the NIC interventions and NOC outcomes were considered useful by the Brazilian Cardiology expert nurses.
IMPLICATIONS FOR PRACTICE.  Clinical studies are an important strategy for validation of the usefulness of North American Nursing Diagnosis Association, NIC, and NOC language in clinical protocols. Additional studies are necessary to confirm the findings of this pilot study.     

Sexually Transmitted Disease in a Female Young Adult

PURPOSE. This case study demonstrates the sexual health challenges experienced by a woman newly married and recently migrated to the United States. DATA SOURCES. Data were obtained through the author's clinical experiences in primary healthcare nursing and published sources. DATA SYNTHESIS. The nursing diagnoses, nursing interventions, and patient outcomes for this woman were identified using the classifications of NANDA‐International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. CONCLUSION. This case study demonstrates the appropriate nursing diagnoses, interventions, and outcomes that are relevant for an individual with a sexually transmitted infection. It provides a framework for nurse practitioners in primary health care when caring for individuals with sexually transmitted infections. IMPLICATIONS FOR NURSING PRACTICE. Based on the NANDA‐International standardized nursing diagnoses, the Nursing Interventions Classification, and the Nursing Outcomes Classification provided the needed structure to improve the care of a woman with issues involving sexual health.     

Helping a Man with Leprosy: A Case Study

PURPOSE.  This case study illustrates nursing diagnoses and interventions for a man with leprosy.
DATA SOURCES.  Data sources were published literature on the disease of leprosy, and the experience and expertise of the authors in working with people with leprosy.
DATA SYNTHESIS.  Data were synthesized using the standardized nursing languages of North American Nursing Diagnosis Association International and the Nursing Interventions Classification. The accuracy of the diagnoses and the appropriateness of the nursing interventions were supported by the positive health outcomes of the patient.
CONCLUSIONS.  Although leprosy has been eradicated in some countries, the risk of new cases is present anywhere that Mycobacterium leprae still exists. The recommended treatment of multibacilar polychemotherapy has lowered the rate of new cases in Brazil.
IMPLICATIONS FOR NURSING PRACTICE.  Nurses need to incorporate evidence-based practice interventions for leprosy-based wound care, and nurses should encourage persons with leprosy to maintain regular medical care with multibacilar polychemotherapy.     

Current Knowledge Related to Intelligence and Thinking With Implications for the Development and Use of Case Studies

PURPOSE. This paper reviews current knowledge regarding intelligence and thinking, and relates this knowledge to learning to diagnose human responses and to select health outcomes and nursing interventions. DATA SOURCES. Knowledge from relevant literature sources was summarized. DATA SYNTHESIS. The provision of high‐quality nursing care requires use of critical thinking with three elements of nursing care: nursing diagnosis, health outcomes, and nursing interventions. Metacognition (thinking about thinking) should be used with knowledge of the subject matter and repeated practice in using the knowledge. Because there are limited clinical opportunities to practice using metacognition and knowledge of these nursing care elements, case studies can be used to foster nurses’ expertise. CONCLUSIONS. Simulations of clinical cases are needed that illustrate application of the nursing knowledge represented in NANDA International, Nursing Outcomes Classification, and Nursing Interventions Classification. IMPLICATIONS. The International Journal of Nursing Terminologies and Classifications will promote the dispersion of case studies as a means of facilitating the implementation and use of nursing languages and classifications.     

Case Study: A Woman Who Hemorrhages 24 Hours Post Tonsillectomy

PURPOSE. This case study focused on the emergency nursing care of a 32‐year‐old female, less than 24 hours post operatively from a tonsillectomy. The purpose is to identify the priority nursing diagnoses, patient outcomes, and nursing interventions that guided nursing care during this emergency. DATA SOURCES. Data were obtained through the author's clinical practice in emergency nursing and literature sources. DATA SYNTHESIS. NANDA International Classification, the Nursing Outcomes Classification, and the Nursing Interventions Classification were used to identify the appropriate nursing diagnosis, patient outcomes, and nursing interventions of an adult with a postoperative hemorrhage. CONCLUSIONS. This case study provides emergency nurses and students with the pertinent nursing diagnoses, patient outcomes, and nursing interventions for persons with post‐op hemorrhage after tonsillectomy.     

Using Standardized Nursing Languages in End‐of‐Life Care Plans

PURPOSE: This case study demonstrates the challenges to achieve dignified life closure and a comfortable death for a middle‐aged woman with terminal cancer and her family. DATA SOURCES: Data were obtained from a patient known through the author's clinical experiences, personal family experiences, and published sources. DATA SYNTHESIS: The appropriate nursing diagnosis, patient outcomes, and nursing interventions were identified through the use of NANDA‐International, the Nursing Outcomes Classification, and the Nursing Interventions Classification. CONCLUSIONS: This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with emotional distress at the end of life. IMPLICATIONS FOR NURSING PRACTICE: Employing the NANDA‐International standardized nursing diagnosis, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for considering and improving a dying patient's care in a primary and home setting.     

An Oncology Case Study Demonstrating the Use of Rogers's Science of Unitary Human Beings and Standardized Nursing Languages

PURPOSE.  The purpose of this paper is to present an oncology case study focusing on a woman's journey through breast cancer treatment and survivorship and a nurse's journey to provide wholistic care using standardized nursing languages and Rogers's Science of Unitary Human Beings (SUHB).
DATA SOURCES.  Published literature, experience, and expertise of the author were used as data sources.
DATA SYNTHESIS.  The data were clustered to formulate oncology nursing care based on the standardized nursing languages of NANDA International, Nursing Outcomes Classification, and Nursing Interventions Classification (NNN) from the theoretical foundation of Rogers's SUHB.
CONCLUSIONS.  The use of Rogers's SUHB, NNN, and the extant literature provided a theoretical, evidence-based, and practical approach to providing holistic care for a woman journeying through breast cancer treatment and survivorship.
IMPLICATIONS FOR NURSING PRACTICE.  Nurses can use standardized nursing languages and Rogers's SUHB to facilitate personal well-being and quality of life for breast cancer survivors.     

Consensus‐Validation Study Identifies Relevant Nursing Diagnoses,Nursing Interventions,and Health Outcomes for People with Traumatic Brain Injuries

A consensus‐validation study used action research methods to identify relevant nursing diagnoses, nursing interventions, and patient outcomes for a population of adults with traumatic brain injury (TBI) in long‐term care. In meetings totaling 159 hours to reach 100% consensus through group discussions, the three classifications of NANDA International's (NANDA‐I's) approved nursing diagnoses, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) were used as the basis for three nurses experienced in working with adults with TBI to select the elements of nursing care. Among almost 200 NANDA‐I nursing diagnoses, 29 were identified as relevant for comprehensive nursing care of this population. Each nursing diagnosis was associated with 3–11 of the more than 500 NIC interventions and 1–13 of more than 300 NOC outcomes. The nurses became aware of the complexity and the need for critical thinking. The findings were used to refine the facility's nursing standards of care, which were to be combined with the interdisciplinary plan of care and included in future electronic health records.     

Case Study: The Challenges of Self‐Management of Exacerbation of Pulmonary Symptoms

PURPOSE. This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self‐management for a female veteran. DATA SOURCES. Data were obtained through the author's clinical practice in primary care nursing and research literature sources. DATA SYNTHESIS. The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA‐International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. CONCLUSIONS. This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations. IMPLICATIONS FOR NURSING PRACTICE. Employing the NANDA‐International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.     

Integrating Nursing Diagnoses, Interventions, and Outcomes in Public Health Nursing Practice

TOPIC. Applying standardized nursing language in public health nursing practice.
PURPOSE. To develop a charting format to document public health nursing practice based on standardized nursing language.
SOURCES. Literature review of documentation systems for public health nursing practice.
CONCLUSIONS. A task force of public health nurses developed a charting format based on Taxonomy I of Nursing Diagnosis (NANDA), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC).     

Case study: a young male with auditory hallucinations in paranoid schizophrenia

PURPOSE. The purpose of this case study is to demonstrate use of the nursing process and the standardized nursing languages of NANDA International (NANDA‐I), the Nursing Outcomes Classification (NOC), and the Nursing Interventions Classification (NIC) to assist a young male with paranoid schizophrenia to deal with auditory hallucinations. DATA SOURCES. Data were obtained from the experience and expertise of the author and published literature. DATA SYNTHESIS. This case study demonstrates nurses' clinical decision making in providing care for an adolescent with mental illness. CONCLUSION. This case study provides the pertinent nursing diagnosis, patient outcomes, and nursing interventions for a young male with auditory hallucinations in paranoid schizophrenia. IMPLICATIONS FOR NURSING. The use of NANDA‐I, NOC, and NIC can provide the necessary framework for enhancing and improving the management of care with patients who experience auditory hallucinations in paranoid schizophrenia.     

Critical care nursing interventions and the time required for their completion in Intensive Care Units: A Delphi study

ObjectiveTo determine which interventions within the Nursing Interventions Classification are most often applied in intensive care units and to validate the time required for each.MethodologyA three-stage e-Delphi was conducted; 21 panelists were recruited, seven manager nurses and 14 clinical nurses with higher degrees and more than five years experience in intensive care nursing. The first round explored the most common interventions applied. Additionally, panelists were asked to propose others. In the second round, participants reflected on the interventions where no consensus was reached as well as to estimate the time required for each intervention. In the third, panelists were queried about the time required for the interventions for which consensus regarding the time was not reached.ResultsA total of 183 interventions were included; 50% of the “Physiological: Complex” domain. The list included 52 (90%) of the 58 “core interventions for critical care nursing” identified in the Nursing Interventions Classification. The time required for 89.1% of the interventions was the same as in the Nursing Interventions Classification seminal work recommendations.ConclusionResults provide a clear picture of nursing activity in general intensive care units, allows to tailor the Nursing Intervetions Classification in Catalonia context and to confirm findings of previous studies.     

The Use of the Nursing Interventions Classification (NIC) with Cardiac Patients Receiving Home Health Care

PURPOSE.  To identify Nursing Interventions Classification interventions (NICs) commonly provided to cardiac home care patients and to explore differences among patients with coronary artery disease, congestive heart failure, and patients with other cardiac disorders.
METHODS.  The NICs provided to cardiac home care patients were recorded and analyzed to determine differences in frequencies across cardiac diagnoses.
FINDINGS.  Frequent NICs provided in cardiac home care are similar across diagnoses, and include tissue perfusion management and patient education NICs. Variations can be detected and involve fluid monitoring/management, exercise promotion/teaching, and cardiac care NICs.
CONCLUSIONS.  Differences in nursing care among patients with similar medical diagnoses can be detected using NIC.
IMPLICATIONS FOR NURSING PRACTICE.  Relevant knowledge of nursing care can be gleaned from analyzing NIC data generated in practice and can be used to plan, evaluate, and determine the effectiveness of nursing care.     

Synthesis of Methods, Rules, and Issues of Standardizing Nursing Intervention Language Mapping

TOPIC. Nursing language mapping.
PURPOSE. To synthesize the methods, rules and issues described in two studies that mapped nonstandardized nursing orderslinterventions into the Nursing Interventions Classification (NIC).
SOURCES. The methods and results of studies conducted by Moorhead & Delaney and Coenen et al.
CONCLUSIONS. Results indicate that the NIC is an effective classification of mapping nursing orders/interventions to support across-site comparisons of nursing treatments. A set of decision rules to support mapping of interventions to the NIC is outlined.