International Classification of Nursing Practice
The International Classification for Nursing Practice (ICNP®) is a standardized terminology developed by the International Council of Nurses as a multi-axial terminology. It was recognized by the ANA in 2000. Originally designed as a reference terminology, it includes terms useful for nursing diagnoses, interventions, and outcomes. The ICNP serves as an international standard that assists with the aggregation and analysis of nursing practice across the world. It represents international nursing practice specialties, languages, and cultures. New versions are released every two years.1.
The ICNP resulted from a failure by the North American Nursing Diagnoses Association (NANDA) to have the NANDA nursing diagnoses accepted for the Tenth Version of the International Classification of Disease (ICD 10). They were turned down, not for poor content, but because it was believed that that to include work that had been developed in a single country could be construed as cultural imperialism. 2 Thus, in 1989, the American Nurses Association (ANA) proposed a resolution to the International Council of Nurses National Representatives in Seoul which led in 1990 to the International Council of Nursing (ICN) project to develop the ICNP.3
The objectives were “…to develop a standardised vocabulary and classification of nursing phenomena (nursing diagnoses), nursing interventions, and nursing outcomes which can be used in both electronic and paper records to describe and compare nursing practice across clinical settings.”2 (Second paragraph under The International Classification for Nursing Practice Project.) In 1996 the Alpha Version of the ICNP Nursing Phenomenon (diagnosis) and Nursing Interventions was released for field testing. An outline for classification of Nursing Outcomes was released in 1997. Classification experts as well as nurses from around the world were invited to participate in the development of the Beta Version2 which was released in 1999.3
One of the original goals was to “provide a structure for information globalization by ensuring the availability of uniform nursing data for several purposes.”4(p 324) another goal was to ensure that the ICNP was “…compatible with and complementary to the WHO Family of Classifications, and the work of other standardisation groups such as the International Organisation for Standardisation (ISO) and related groups including the ComiteEuropean de Normalisation (CEN), and to secure inclusion of ICNP in relevant classifications” and to “…achieve utilisation of ICNP by nurses at country level for the development of national databases.”2 (In The International Classification for Nursing Practice Project section.)
To fulfill the aim of unifying and building on existing nursing classifications work one of the first steps of the ICNP developers was to collect and compare all the nursing concepts in existing nursing terminologies. “The aim was to build on and unify the existing work in nursing classifications, rather than to create something that would not be complementary to efforts already underway in nursing. In addition to promoting comparable nursing data, the ICNP is intended to facilitate comparison of nursing data with data from other health disciplines.”3 (under What Is the ICNP?)
The ICNP is a compositional terminology because full terms are created by selecting terms from the seven axes and combining them into one term. However, the ICNP is moving toward providing “pre-coordinated” terms for (also known as post-coordinated terms) nursing diagnosis, outcomes, and interventions for use in documentation (personal communication, Amy Coenen 9/17/2014). These pre-coordinated terms make up subsets or catalogs and are created by experts in various nursing specialties who select a term from lists in the seven axes that make up the ICNP. For example, a subset might have a term for “intermittent extreme pain left leg.” The experts create it by selecting terms such as “pain” from the focus axis, “extreme” from the judgment axis, “intermittent” from the time axis, and “left leg” from the location axis. The subsets provide ease of documentation while maintaining the ICNP reference terminology and formal model. The ability to create terms from various axes makes it a compositional terminology and leaves the option for creating new terms available to users (List of currently available catalogs)
The 2013 ICNP release includes 783 nursing diagnoses/outcomes pre-coordinated terms and 809 for nursing interventions (Personal communication, Amy Coenen, November 4, 2013). ICN has formal harmonization agreements with the International Health Terminology Standards Development Organisation’s (IHTSDO), SNOMED, SabaCare (CCC), and WHO (ICF, ICHI). ICN has made a commitment to maintaining the equivalency tables for those terminologies or classifications with which they have a formal relationship.
Rules for creating an ICNP diagnosis/outcome:
Must include terms from Focus + Judgment + Potentiality. May include additional concepts from the Focus, Judgment or other axes as needed.
Rules for constructing an ICNP intervention:
Action + Target are required. A Target can be a concept from any axis except the Judgment Axis). May include additional concepts as needed form the Action or other axis.
Revisions
Due to the ongoing revisions of ICNP and based on our users request, we have pre-coordinated many of each type of statement. In the new release of 2015 ICNP, there will be:
more than 800 pre-coordinated Diagnostic and outcome statements, and more than 1000 pre-coordinated Intervention statements. Each of the pre-coordinated statement have a unique code.
References
1 Coenen A. ICNP Catalogues for Supporting Nursing Content in Electronic Records in Studies In Health Technology And Informatics In: Mantas J, Andersen KS, Mazzoleni MC, Blobel B, Quaglini S, Moen A, editors. Stud Health Technol Inform. Amsterdam, Netherlands: IOS Press; 2012. p. 1075-8.
2 Clark J. The International Classification For Nursing Practice Project. Online Journal Nursing Informatics; 1998.
3 Coenen A. The International Classification for Nursing Practice (ICNP®) Programme: Advancing a Unifying Framework for Nursing. Online Journal of Issues in Nursing. 2003;8(2).
4 Nunes ST, Rego G, Nunes R. The Experience of an Information System for Nursing Practice: The Importance of Nursing Records in the Management of a Care Plan. Computers Informatics Nursing. 2014;32(7):322-32
Additional Resources for the ICNP
Dykes PC, Collins SA. Building Linkages between Nursing Care and Improved Patient Outcomes: The Role of Health Information Technology. Online Journal Issues in Nursing; 2013.
Cho I, Park HA. Evaluation of the expressiveness of an ICNP-based nursing data dictionary in a computerized nursing record system. Journal of the American Medical Informatics Association. Jul-Aug 2006;13(4):456-464.
Cho I, Park H-A. Development and evaluation of a terminology-based electronic nursing record system. Journal of Biomedical Informatics. 2003;36(4):304-312.
Clark J. The International Classification For Nursing Practice Project. Online Journal Nursing Informatics; 1998.
Doorenbos, A. Z., Juntasopeepun, P., Eaton, L. H., Rue, T., Hong, E., & Coenen, A. (2013). Palliative care nursing interventions in Thailand. [Research Support, N.I.H., Extramural]. J Transcult Nurs, 24(4), 332-339. doi: 10.1177/1043659613493439.
Doorenbos, A. Z., Abaquin, C., Perrin, M. E., Eaton, L., Balabagno, A. O., Rue, T., & Ramos, R. (2011). Supporting dignified dying in the Philippines. [Research Support, N.I.H., Extramural]. Int J Palliat Nurs, 17(3), 125-130.
Jo K-H, Doorenbos AZ, Sung K-W, Hong E, Rue T, Coenen A. Nursing interventions to promote dignified dying in South Korea Int J Palliat Nurs. 2011;17(8):392–397.
Kim, T. Y., Hardiker, N., & Coenen, A. (2014). Inter-terminology mapping of nursing problems. J Biomed Inform, 49, 213-220.
Nytun, J. P., & Fossum, M. (2014). Information model for learning nursing terminology. Stud Health Technol Inform, 205, 181-185. doi: 10.3233/978-1-61499-432-9-181.
Min YH, Park HA, Lee JY, JOa SJ, CHOI SY, Chung E. Automatic generation of nursing narratives from entity-attributevalue triplet for electronic nursing records system. In: Saranto K, ed. Nursing Informatics 2014. Taipei, Taiwan: IOS Press; 2014:452-460.
Coenen, A., Kim, T. Y., Bartz, C. C., Jansen, K., & Hardiker, N. (2012). ICNP Catalogues for supporting nursing content in electronic health records. Stud Health Technol Inform, 180, 1075-1078.
Choromanski, L., Collins, B. J., Hart, C. M., Westra, B., & Delaney, C. (2012). Creating an ICNP subset: children with HIV/AIDS in developing countries. Comput Inform Nurs, 30(4), 183-189. doi: 10.1097/NCN.0b013e3182388655
NUNES ST, REGO G, NUNES R. The Experience of an Information System for Nursing Practice: The Importance of Nursing Records in the Management of a Care Plan. CIN. 2014;32(7):322-32 doi 10.1097/CIN.0000000000000060
Park, H. A., Cho, I., & Chung, E. (2011). Exploring use of a clinical data repository containing international classification for nursing practice-based nursing practice data. [Research Support, Non-U.S. Gov't]. Comput Inform Nurs, 29(7), 419-426. doi: 10.1097/NCN.0b013e3181f9dc6e.
Park H-A, Cho I, Byeun N. Modeling a terminology-based electronic nursing record system: An object-oriented approach. International Journal of Medical Informatics. 2005;76(10):735-746.
Created September 24, 2014:Updated April 30, 2015
