Standardized Nursing Languages: The Road to better patient care

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CCC

C-HOBIC

ICNP

LOINC

Minimum Data Sets

NANDA-I

NIC

NOC

Omaha System

PNDS

SNOMED

Resources for More Information About Standardized Nursing Terminologies

NOTE: References that apply only to the individual terminologies are listed on the page for each of the ANA recognized standardized nursing terminologies.

Some of the articles listed as "closed" may be freely available if you explore more than one source. Also, all articles in the Journal of the American Medical Informatics Association are open access one year after publication.

Given the growing popularity of open access publishing and the appearance of "predatory publishing," or so called journals who will publish anything for a fee, journals whose articles are listed here have been checked to be sure that they are NOT on Bealls List (See List of publishers and List of Standalone Journals) of predatory journals. This list is as updated as possible. If you find anything listed here that is a product of a predatory publisher, please contact me.

Open Access

Closed Access

Open Access

Azzolin, K., Mussi, C. M., Ruschel, K. B., de Souza, E. N., de Fatima Lucena, A., & Rabelo-Silva, E. R. (2013). Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC. [Research Support, Non-U.S. Gov't]. Appl Nurs Res, 26(4), 239-244. doi: 10.1016/j.apnr.2013.08.003

This study demonstrated that 8 of 11 NIC interventions showed significant improvement between the first and fourth visit based on scores for six outcomes.

Bowman S. Myths of ICD-10-CM/PCS. Journal of AHIMA. 2014;85(8):40-44.

Explanation of why ICD-9 must be replaced as well as that SNOMED CT is not a substitute for ICD-10 or wait for ICD-11.

Cardenas-Valladolid, J., Salinero-Fort, M. A., Gomez-Campelo, P., de Burgos-Lunar, C., Abanades-Herranz, J. C., Arnal-Selfa, R., & Andres, A. L. (2012). Effectiveness of standardized Nursing Care Plans in health outcomes in patients with type 2 Diabetes Mellitus: a two-year prospective follow-up study. [Clinical Trial Research Support, Non-U.S. Gov't]. PLoS One, 7(8), e43870. doi: 10.1371/journal.pone.0043870.

This study evaluated the effectiveness of standardized nursing care plans using the North American Nursing Diagnosis Association and Nursing Interventions Classification to improve metabolic, weight, and blood pressure control of type II Diabetes Mellitus patients.

Fehring, Richard. Methods to Validate Nursing Diagnoses November 1997. Marquette University ePublications.

Althought date in time, the methods are current. Pertains to the North American Nursing Diagnosis Association (NANDA) content, would be useful in validating any nursing diagnosis.

Hardiker, N. R., Casey, A., Coenen, A., & Konicek, D. (2006). Mutual enhancement of diverse terminologies. [Comparative Study]. AMIA Annu Symp Proc, 319-323

A study of mapping the NANDA-I nursing diagnoses to the ICNP (Version 1.0) and comparing the result and relationships to SNOMED-CT.

Henry SB, Mead CN. Nursing Classification Systems: Necessary but not Sufficient for Representing “What Nurses Do” for Inclusion in Computer-based Patient Record Systems. JAMIA. 1997 May 1, 1997;4(3):222-32.

These authors argued that taxonomic, combinatorial vocabularies capable of coding atomic-level nursing activities are required to effectively capture in a reproducible and reversible manner the clinical decisions and actions of nurses, and that, without such vocabularies and associated grammars, potentially important clinical process data is lost during the encoding process. This was written before the first version of the International Classification of Nursing Practice (ICNP) was released. It was, however, the second version of the ICNP before a combinatorial vocabulary was created.

Henry SB, Warren JJ, Lange L, Button P. A Review of Major Nursing Vocabularies and the Extent to Which They Have the Characteristics Required for Implementation in Computer-based Systems. JAMIA. 1998 July 1, 1998;5(4):321-8.

The International Medical Informatics Association (IMIA) yearbooks.

These are available free of charge. There are informatics yearbooks, not confined to nursing or standardization, but very valuable.

Matney S. ICNP/SNOMED CT Nursing Terminology Collaboration. In: 3M Health Information Systems, editor.; 2014.

Information about the mapping between ICNP and SNOMED-CT with information about mapping to other terminologies.

Matney S. Using Information and Terminology Standards to Improve Care. 3M Health Information Systems,; 2014.

Discussion focusing on the use of LOINC and SNOMED in structured nursing documentation with examples of a detailed clinical model.

Matney, S. A., DaDamio, R., Couderc, C., Dlugos, M., Evans, J., Gianonne, G., . . . Saba, V. K. (2008). Translation and Integration of CCC Nursing Diagnoses into ICNP. Journal of the American Medical Informatics Association, 15(6), 791-793. doi: 10.1197/jamia.M2801

Report of efforts to translate and integrate nursing diagnosis concepts from the Clinical Care Classification system version 2.0 to the diagnostic phenomenon in the International Classification for Nursing Practice.

Nursing Classification: What's in a Name? Issue 7 in OJIN

A series of articles related to standardized terminologies by various well known terminology authors.

McCormick KA, Lang N, Zielstorff R, Milholland DK, Saba V, Jacox A. Toward Standard Classification Schemes for Nursing Language: Recommendations of the American Nurses Association Steering Committee on Databases to Support Clinical Nursing Practice. JAMIA. 1994 November 1, 1994;1(6):421-7.

Provides a historical perspective on the ANA programs to recognized standardized terminologies. Includes the original criteria used in evalating the terminologies. Information about the then recognized terminologies and information about the Unified Nursing Langauge which never became a reality.

Müller-Staub, M., Needham, I., Odenbreit, M., Lavin, M. A., & van Achterberg, T. (2007). Improved quality of nursing documentation: results of a nursing diagnoses, interventions, and outcomes implementation study. International Journal Nursing Terminology Classification, 18(1), 5-16.

A 179 page study on the use of NANDA nursing diagnoses, and ICNP interventions and outcomes in nursing documentation.

Rutherford, M. (2008). Standardized Nursing Language: What Does It Mean for Nursing Practice? OJIN: The Online Journal of Issues in Nursing, 13(1).

This article presents examples of the usefulness of standardized languages to direct care/bedside nurses,a definition of standardized languages and nursingand a description of how standardized nursing languages can be applied in the clinical setting.

Tastan, S., Linch, G. C., Keenan, G. M., Stifter, J., McKinney, D., Fahey, L., . . . Wilkie, D. J. (2014). Evidence for the existing American Nurses Association-recognized standardized nursing terminologies: a systematic review. [Research Support, N.I.H., Extramural]. International Journal of Nursing Studies, 51(8), 1160-1170. doi: 10.1016/j.ijnurstu.2013.12.004

Reports on the number of studies for each of the ANA recognize nursing specific terminologies. Includes information about what is already known about standardized terminologies.

Warren JJ, Casey A, Konicek D, Lundberg C, Correia C, Zingo C. Where Is the nursing in SNOMED CT®? CTGFN has the answer. American Medical Informatics Association; 2003; Washington, DC; 2003. p. 1047.

Westra, B. L., Bauman, R., Delaney, C. W., Lundberg, C. B., & Petersen, C. (2008). Validation of concept mapping between PNDS and SNOMED CT. [Comparative Study Research Support, Non-U.S. Gov't]. AORN Journal, 87(6), 1217-1229. doi: 10.1016/j.aorn.2007.11.036.

This study evaluated the placement of the Perioperative Nursing Data Set concepts in the SNOMED-CT hierarchy.

Closed

Buckley, J. (2012). Case study: a woman who hemorrhages 24 hours post tonsillectomy. [Case Reports]. Int J Nurs Knowl, 23(2), 114-116. doi: 10.1111/j.2047-3095.2011.01204.x

Cardaci, R. (2011). A case study of teen parenting. [Case Reports]. Int J Nurs Terminol Classif, 22(1), 40-43. doi: 10.1111/j.1744-618X.2010.01176.x

Crespo-Fierro, M., & Lunney, M. (2011). Supporting breast-feeding when a woman is homeless. Int J Nurs Terminol Classif, 22(2), 103-107. doi: 10.1111/j.1744-618X.2010.01170.x

Dehmer, M., Hackl, W. O., Emmert-Streib, F., Schulc, E., & Them, C. (2013). Network nursing: connections between nursing and complex network science. [Research Support, Non-U.S. Gov't]. Int J Nurs Knowl, 24(3), 150-156. doi: 10.1111/j.2047-3095.2013.01246.x

Escalada-Hernandez, P., Munoz-Hermoso, P., Gonzalez-Fraile, E., Santos, B., Gonzalez-Vargas, J. A., Feria-Raposo, I., . . . Garcia-Manso, M. (2014). A retrospective study of nursing diagnoses, outcomes, and interventions for patients with mental disorders. Applied Nursing Research. doi: 10.1016/j.apnr.2014.05.006.

Friedman E. Troubled past of "invisible" profession. Journal of the American Medical Association. 1990;264(22):2851-7.

The above article is a very interesting history of nursing that sheds light on why we are where we are in terms of professionalism.

Head, B. J., Scherb, C. A., Reed, D., Conley, D. M., Weinberg, B., Kozel, M., . . . Moorhead, S. (2011). Nursing diagnoses, interventions, and patient outcomes for hospitalized older adults with pneumonia. [Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't]. Res Gerontol Nurs, 4(2), 95-105. doi: 10.3928/19404921-20100601-99

Huber, D., Schumacher, L., & Delaney, C. (1997). Nursing Management Minimum Data Set (NMMDS). J Nurs Adm, 27(4), 42-48. doi: http://dx.doi.org/10.1097/00005110-199704000-00011.

International Journal of Nursing Knowledge. This Journal is devoted to articles regarding NANDA, NIC and NOC.

Jenkins, M. (2011). Sexually transmitted disease in a female young adult. [Case Reports]. Int J Nurs Terminol Classif, 22(4), 170-174. doi: 10.1111/j.1744-618X.2011.01193.x.

Kim, T. Y., Hardiker, N., & Coenen, A. (2014). Inter-terminology mapping of nursing problems. [Research Support, Non-U.S. Gov't]. J Biomed Inform, 49, 213-220. doi: 10.1016/j.jbi.2014.03.001

Kinnunen, U. M., Saranto, K., Ensio, A., Iivanainen, A., & Dykes, P. (2012). Developing the standardized wound care documentation model: a Delphi study to improve the quality of patient care documentation. [Research Support, Non-U.S. Gov't
Validation Studies]. J Wound Ostomy Continence Nurs, 39(4), 397-407; discussion 408. doi: 10.1097/WON.0b013e318259c45b

Kunkel, D. E., Westra, B. L., Hart, C. M., Subramanian, A., Kenny, S., & Delaney, C. W. (2012). Updating and normalization of the Nursing Management Minimum Data Set element 6: patient/client accessibility. CIN: Computers, Informatics, Nursing, 30(3), 134-141. doi: 10.1097/NCN.0b013e31823eb913.

Lopes Jde, L., Meneguim, S., Soares Muniz, C. C., & Palomo Jda, S. (2011). Special report: Nursing diagnoses and interventions for a child with dilated cardiomyopathy requiring intra-aortic balloon pump support--case report. [Case Reports]. Int J Nurs Terminol Classif, 22(1), 23-32. doi: 10.1111/j.1744-618X.2010.01172.x.

Meum, T., Ellingsen, G., Monteiro, E., Wangensteen, G., & Igesund, H. (2013). The interplay between global standards and local practice in nursing. Int J Med Inform, 82(12), e364-374. doi: 10.1016/j.ijmedinf.2013.02.005.

Minthorn, C., & Lunney, M. (2012). Participant action research with bedside nurses to identify NANDA-International, Nursing Interventions Classification, and Nursing Outcomes Classification categories for hospitalized persons with diabetes. Appl Nurs Res, 25(2), 75-80. doi: 10.1016/j.apnr.2010.08.001.

Park, H., & Lee, E. (2014). Incorporating Standardized Nursing Languages Into an Electronic Nursing Documentation System in Korea: A Pilot Study. Int J Nurs Knowl. doi: 10.1111/2047-3095.12038.

Pena, S. B., Guimaraes, H. C., Bassoli, S. R., Casarin, S. N., Herdman, T. H., & de Barros, A. L. (2013). Nursing diagnoses in pemphigus vulgaris: a case study. Int J Nurs Knowl, 24(3), 176-179. doi: 10.1111/j.2047-3095.2013.01250.x

Reyes, D. (2013). A composite case study of a woman with human immunodeficiency virus: integration of nursing research and theory with practice. Int J Nurs Knowl, 24(1), 59-62. doi: 10.1111/j.2047-3095.2012.01232.x

Roecklein, N. (2012). Using standardized nursing languages in end-of-life care plans. Int J Nurs Knowl, 23(3), 183-185. doi: 10.1111/j.2047-3095.2012.01211.x

Sawicki, D. E., & Machado, M. A. (2013). NANDA-I with NIC NOC'n on heaven's door. Int J Nurs Knowl, 24(2), 64-65. doi: 10.1111/j.2047-3095.2013.01238.x

Scherb, C. A., Head, B. J., Maas, M. L., Swanson, E. A., Moorhead, S., Reed, D., . . . Kozel, M. (2011). Most frequent nursing diagnoses, nursing interventions, and nursing-sensitive patient outcomes of hospitalized older adults with heart failure: part 1. [Comparative Study Multicenter Study Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't]. Int J Nurs Terminol Classif, 22(1), 13-22. doi: 10.1111/j.1744-618X.2010.01164.x

Westra BL, Delaney CW, Konicek D, Keenan G. Nursing standards to support the electronic health record. Nursing outlook. 2008 Sep-Oct;56(5):258-66 e1.