Concept Maps as a Tool for Learning Standardized Languages

PURPOSE. To gain understanding of how Icelandicnurses can be supported during a mandated change tothe use of NANDA and NIC in clinical documentationpractices.

METHODS. All members of the Icelandic Nurses As-sociation of working age were invited to participate in anInternet-based survey. Each nurse was assigned a uniquepassword mailed to his/her home along with informa-tion on how to access the survey Web site. Each nursecould submit answers only once. On submission, datawere automatically coded and saved in a database underencrypted numerical identifiers.

FINDINGS. A total of 463 nurses (18% response rate)participated by submitting answers. The sample was

32 International Journal of Nursing Terminologies and Classifications Volume 14, No. 4 Supplement, October-December, 2003

representative of the population in terms of demo-graphic characteristics. Information resources most val-ued when planning nursing care included text-basedprogress notes (77%), nursing care plans (52%), doctor�sorders (49%), verbal information (48%), and documentednursing diagnoses (37%). Of the participants, 58% saidNANDA was used in their workplace; 28% said no stan-dardized nursing documentation was used; 19% re-ported using NIC always or sometimes when document-ing nursing interventions; and 20% never used NIC.NOC use was reported only by researchers.

Of the sample, 86% reported that it is important ornecessary for nurses to standardize documentation prac-tices; 30% found NANDA useful in education; 56%

Presented Papers: Education and Implementation

Applying Standardized Nursing Language to Three Cardiac and Pulmonary RehabilitationPrograms in a Rural Setting

Cathleen K. Ahern

BACKGROUND. The need for travel between rural andtertiary hospitals for cardiopulmonary services is a real-ity many patients experience. Communication betweenhospitals is essential in providing the most effective andefficient patient care. This work involved incorporatingNANDA, NIC, and NOC into standard care plans andthe ongoing documentation expansion for the care of anoutpatient cardiopulmonary population.

MAIN CONTENT POINTS. This regional project in-volved cardiopulmonary rehabilitation programs fromthree Mayo Health System affiliates. Acute care hadbegun to use NANDA, NIC, and NOC for computerizeddocumentation. Cardiopulmonary services realized thebenefits of following acute care�s lead in applying stan-dardized nursing language to outpatients. The projectwas undertaken to enhance communication across thecare continuum.

Pertinent NANDA nursing diagnoses, NIC interven-tions, and NOC outcomes were identified, a process thatinvoked the discussion of the commonalities and differ-ences among the three taxonomies. This became benefi-cial in benchmarking the different program structuresand gleaning best practices. Through much discussion

the care plans were developed with subsequent revisionsas necessary.

Issues surrounding the project included getting used tothe terminology and computerization, getting bogged downin the details, trusting each other with information aboutprograms, building a group cohesiveness, seeing timely re-sults of our efforts, and communication among sites.

CONCLUSIONS. Benefits realized through this projectwere strengthening the comprehensiveness of the plan ofcare for cardiopulmonary patients and computerizingthe patient record. Through this process the interdisci-plinary cardiopulmonary practice was better defined.Communication was strengthened because standardizednursing language took the �fuzz� out of communicationbetween providers and across the care continuum. An-other outcome included establishing trust and collegial-ity among the three sites for future networking andproblem solving. Outcomes data can be used to test theeffectiveness of nursing interventions for the improve-ment of patient care. This research should encompassstudying the effectiveness of care provided within theprograms as well as across the care continuum.

Author contact: [email protected]

An Internet-Based Survey of Icelandic Nurses on Their Use of and Attitudes Toward NANDA, NIC, and NOC

Gyda Bjornsdottir and Ingibjorg Thorhallsdottir

PURPOSE. To estimate the time to perform and type ofpersonnel to deliver each of the 486 interventions listedand described in the third edition of NIC.

METHODS. Small groups of research team membersrated selected interventions in their area of expertise oneducation and time needed for each intervention. Educa-tion needed was defined as the minimal educationallevel necessary to perform the intervention in most casesin most states. Rating categories were (a) nursing assis-tant (NA/LPN/LVN/technician), (b) RN (basic educa-tion whether baccalaureate, associate degree, ordiploma), or (c) RN with post-basic education or certifi-cation. Time needed was defined as the average timeneeded to perform the intervention. Raters selected oneof five possible time estimates: (a) <15 minutes, (b)16�30 minutes, (c) 31�45 minutes, (d) 46�60 minutes, or(e) >1 hour. All ratings were reviewed across groups toensure overall consistency.

FINDINGS. Results of this exercise provide beginningestimates of the time and education needed for 486 NICinterventions. Twenty percent required <15 minutes, 30%required 16 � 30 minutes, 17% required 31 � 45 minutes,12% required 46�60 minutes, and 21% required >1 hour.More than 70% of the interventions were judged as need-ing basic RN education to perform. Raters judged RN

International Journal of Nursing Terminologies and Classifications Volume 14, No. 4 Supplement, October-December, 2003 33

post-basic education to be required to performi 16% ofthe interventions, and 14% were deemed appropriate forpersonnel with NA/LPN education to perform. Amonograph, Estimated Time and Educational Requirementsto Perform 486 Nursing Interventions, available [email protected]/cnc, includes lists of interven-tions appropriate for each time and education category,as well as time and education ratings according to NICdomains and classes.

DISCUSSION. The estimates of time and educationprovided by expert ratings provide a good beginning forcost estimates, resource planning, and reimbursement.The results of this study add to the small but growingbody of literature that demonstrates that estimates oftime to perform interventions by nurses who are familiarwith the interventions is an accurate and efficientmethod to determine time values. A description of howthis information can be used in a costing model is in theJuly/August 2001 issue of Nursing Economics.

CONCLUSIONS. NIC has identified the interventionsthat nurses perform. This study of time to perform andtype of personnel to deliver each of the NIC interven-tions can help nurse leaders make better-informed deci-sions about cost-effective nursing care.

Author contact [Bulechek]: [email protected]


found it useful for clinical work; 17% for research; and7% found it not useful at all. Nine percent believed thatNANDA diagnoses were not descriptive enough of pa-tients� problems, and 23% found their wording problem-atic. No statistically significant differences were foundbetween reported use of or attitudes toward NANDAand NIC when comparing nurses who use electronic pa-tient record systems that support NANDA and NIC doc-umentation and those who use paper documentationonly.

DISCUSSION. The sample may have been somewhat bi-ased toward computer use and classification system usefor standardized and computerized documentation. How-ever, results indicate that although Icelandic nurses givefree-text progress notes and verbal information a higherpriority than nursing diagnoses as an information re-

source for care planning, they have a positive attitude to-ward NANDA. NANDA and NIC are still used inconsis-tently in clinical practice, and 28% of participants claimednot to use any form of standardized documentation.

CONCLUSIONS. In an effort to standardize clinicaldocumentation among nurses, Icelandic health authori-ties must follow their documentation mandates with ed-ucational and technologic support to facilitate the use ofNANDA, NIC, and (after its translation) NOC in nursingdocumentation practices. Electronic patient record sys-tem developers must find ways to further facilitate stan-dardized nursing documentation because currently thereseems to be no difference between users and nonusers interms of how they use NANDA and NIC in their docu-mentation practices.

Author contact [Bjornsdottir]: [email protected]

Estimated Time and Educational Requirements to Perform NIC Interventions

Gloria M. Bulechek and Joanne McCloskey Dochterman

BACKGROUND. For the last 8 years, NANDA, NIC,and NOC have been successfully introduced to studentsin fundamentals courses at Bellin College of Nursing.As students progress through the curriculum, the classi-fications are expanded and applied to various clientpopulations in all settings. The faculty expect studentsto use NANDA, NIC, and NOC in a variety of ways:during preparation for care of clients, documentation of


client care, discussion of clients in postconference; in for-mal nursing process papers; and in the college labora-tory setting.

MAIN CONTENT POINTS. Through the use of stan-dardized languages, which address all steps of the nurs-ing process, students have been able to plan, implement,and evaluate nursing care in all settings, from primarycare to specialty care areas. Application of the NANDA,


Nursing Students� Self-Assessments and Opinions About Using Nursing Diagnosis in Clinical Practice

Firdevs Erdemir, Emine Altun, and Emine Geckil

PURPOSE. To determine student opinions about usingnursing diagnosis in their future clinical practice.

METHODS. The course described in this study was an11-credit hours course for third-year students, which in-cluded theory and clinical practice 22 hours/week. Theo-retical content covered fundamental concepts such as cri-sis, child and family development, current developmentsin nursing process and nursing diagnosis, descriptions ofthe disease process and its effects on child and family,NANDA diagnoses, functional health patterns, and col-laborative problems possibly associated with the dis-ease/situations. Simulated case studies were discussedby student groups. Practice areas were pediatric-neonatalcare units and pediatric outpatient clinics. Students carefor hospitalized children, infants, and their familiesunder the instructors� supervision. Students are assignedto patients and expected to identify relevant nursing di-agnoses, design care plans, and discuss the care planswith instructors during the daily conferences. The sam-ple was 57 students who had attended the course in full.

To evaluate students� opinions about using nursingdiagnoses in clinical practice and perceived confidence informulating/identifying nursing diagnoses, a two-partself-assessment tool was developed. Part 1 (5 items) wasfor self-assessment of the knowledge and skills related toidentifying and formulating nursing diagnosis; part 2had 5 items related to opinions about using nursing di-agnoses in nursing practice in general. Items were re-viewed by four nursing experts. Test-retest reliability ofitems was evaluated. The criterion used to decidewhether to retain an item was at least 50% agreement inresponse over time.

After the final examination of the course, the purposeof the study was explained to students and all studentswere asked to participate. Self-assessment instrumentswere distributed to all students. Completed forms wereleft in a box for collection by a research assistant. Dataanalysis involved calculating percentages.

FINDINGS. All 57 students completed and turned inthe self-assessment instruments. The majority of the stu-dents (85%) agreed/strongly agreed that they had agood understanding of nursing diagnosis and diagnosticreasoning, 64% did not have much difficulty with the ex-pression of patient care needs as nursing diagnoses, and87% said the course gave them a proper preparation onnursing diagnosis and diagnostic reasoning at a basiclevel.

Most of the students had a positive tendency towardusing nursing diagnosis in their future practice; 80%agreed/strongly agreed that, after graduation, if theywere asked to teach clinical nurses the formulation ofnursing diagnosis they would accept this responsibilitywith pleasure; if nursing administration asked them touse nursing diagnoses, 78% of students would. If acourse was offered in utilization of nursing diagnosis,75% of students indicated they would attend such acourse.

CONCLUSIONS. This study provided insight into theeffects of knowledge on tendency of the students towardutilization of nursing diagnoses. Findings also indicatedthere might be a very effective potential if the under-graduate programs were revised by considering the uti-lization of nursing classification systems.

Author contact [Erdemir]: [email protected]

Use of NANDA, NIC, and NOC in a Baccalaureate Curriculum

Cynthia Finesilver and Debbie Metzler

BACKGROUND. Students in the undergraduate andgraduate programs at Saginaw Valley State University(SVSU) are taught to use NANDA, NIC, and NOC toguide their practice. The nursing faculty developed apopulation-focused, phenomenon-based curriculum in-corporating standardized nursing languages. The popula-tion focus of the undergraduate program changes eachsemester. Students begin by learning to intervene with in-dividuals, and spend their final semester focusing on spe-cial populations and health systems. The graduate pro-gram expands on previous learning, focusing onleadership activities with special populations, communi-ties, and health systems. Students in both undergraduateand graduate programs build competence in systemschange while completing assignments based on the NICHealth System and Community Domains. The complex-ity of assignments and expected outcomes vary by thelevel of student, with undergraduates learning how to in-fluence health system transformation and graduate stu-dents learning how to lead the transformation process.

MAIN CONTENT POINTS. Seniors in the nursing pro-gram have three assignments that provide experiencewith health system transformation. The professional is-sues class has an assignment based on the NIC interven-tion of �health policy monitoring,� which is found in theclasses of �information management� and �communityhealth promotion.� Students learn to access action alertson nursing organization Web sites and use them as aguide for communicating with legislators, with the goalof transforming health policy. In the practicum course,seniors use case studies to describe how NANDA, NIC,and NOC guide their clinical practice related to the sev-eral NIC classes, including those of �health system medi-ation� or �health system management.� Another


practicum assignment requires utilization of �health pol-icy monitoring� interventions for health system transfor-mation that is community based and population specific.

Master�s students also have multiple assignments pro-viding experience with health system transformation. Oneof the required core courses contains an assignment com-parable to that used to teach seniors to influence healthpolicy, but also provides the opportunity to develop skill inpolicy analysis. In addition to analyzing legislative policy,all graduate students learn to evaluate and develop organi-zational policy using national standards (including theHealth System Domain of NIC) as a guide. Students in theHealth System Specialist track are preparing for positionsin nursing administration, education, and informatics.They have a three-part assignment that requires analysis ofNIC�s usefulness for decision support by nurse educators,administrators, and informaticists. They evaluate learningprocess and management process roles as they relate to se-lected NIC �health system management� interventions.They also evaluate the information process role as it relatesto selected NIC �health system management� and �healthinformation management� interventions.

CONCLUSIONS. The learning activities engaged inprovide experience in practical application of standard-ized language. This model of applied learning can beused in any setting to facilitate staff or student under-standing of NIC�s applicability to situations where sys-tem improvement is desired. NANDA, NIC, and NOChave been well developed when it comes to guiding clin-ical practice. While NIC has incorporated Health Sys-tems and Community into its taxonomic structure, thelinkages of those interventions with diagnoses and out-comes need further refinement.



NOC, and NIC frameworks into a baccalaureate curricu-lum is desirable because the classifications are researchbased, comprehensive, and based on current nursingpractice. NOC and NIC include physiologic, psychoso-cial, illness prevention and treatment, health promotion,and alternative therapies. Because of the universal andclinically meaningful language, students are able to com-municate and document nursing activities in diverse set-tings and better define the unique actions and value ofnursing.

Feedback from students and faculty has been positive.

Faculty members are encouraged to refine and altercourse expectations related to NANDA, NOC, and NICas needed. Students in the fundamentals courses adapteasily to NANDA, NOC and NIC during small groupwork and during discussion of common client problems,such as constipation.

CONCLUSIONS. Although the frameworks are notused as part of the organizing framework, they are usedto teach nursing process and increase students� criticalthinking and problem-solving capabilities.

Author contact [Finesilver]: [email protected]

Teaching Systems Transformation

Margaret M. Flatt

PURPOSE. To orient nurses caring for critically illemergency patients to a standardized nursing lan-guage�based protocol system in the field.

METHODS. An experimental learning program wasdeveloped and conducted by a nurse consultant. Nurs-ing process�oriented, theoretical-practical classes focusedon the analysis of real clinical situations with the pur-pose of generating a reflective process in the nurses� con-ceptual schemes and incorporating standardized nursinglanguage in their clinical practice.

FINDINGS. The expansion of nursing process�orientedclinical sessions and the retrospective clinical analysis ofindividualized patients has occurred in 7 of the 8 leadingcities of the region (in one of them the teaching programhas not been performed yet). Nine courses have beentaught to a total of 185 RNs. The mean satisfaction rate re-ported was 90%, and one externally funded research pro-ject was initiated in regard to implementing nursing pro-cess in emergency prehospital care and taught to 75nurses. A qualitative-quantitative research project fundedby the health department of the Andalusian government


was initiated by one of these nurses with respect to nurs-ing process implementation in emergency services.

The Quality and Accreditation Center developed anevaluation system that included nurse perfomance. Twoof 11 nurses participating as educators were designatedas members of the evaluation board. The evaluation de-scribed impediments in determining the specific contri-bution of nurses to the overall process. The 2 nurses pro-posed that incorporating standardized nursing languagewas the best way to evaluate nursing performance. As aconsequence, a nursing record based on the initial onedesigned in the research project was implemented. Thisrecord is divided into assessment, diagnosis, outcomes,and interventions based on Henderson�s 14 needs,NANDA, NIC, and NOC. The electronic record will setthe standards for evaluating the dimensions of the nurs-ing data set established by the Nursing Information andData Set Evaluation Center: nomenclature, clinical con-text, clinical data repository, and general system charac-teristics. The electronic record has been implemented inall the main cities of Andalusia and will be a main com-


Transcultural Adaptation of NANDA Taxonomy II to a Brazilian Context

Jeanne Liliane Marlene Michel and Alba Lucia Botura Leite de Barros

PURPOSE. To translate NANDA Taxonomy II intoBrazilian Portuguese.

METHODS. Semantic equivalence was obtained througha process of translation and back translation, supervised bya professor (RN and PhD) expert in using nursing diag-noses taxonomy both in teaching and in clinical practice.Conceptual equivalence was attained by presenting theoriginal text, the translation and the back translation of thelabels, definitions, defining characteristics or risk factors,and related factors to a group of expert nurses from differ-ent specialties who are proficient in English in order to ana-lyze them and to verify if the terms presented in each diag-nosis are suitable to the Brazilian nurses� practice reality,making suggestions as appropriate. The results of thisanalysis and the suggestions were then discussed by acommittee with expertise in this kind of work and nursingdiagnosis until consensus could be reached.

FINDINGS. Some difficulties were found in the trans-lation process because of the structural differences be-

tween English and Portuguese, and also because manydiagnostic concepts are presented in different ways inthe book. With the Portuguese translation, trouble oc-curs because of alphabetical order. Even if this is only amatter of organization, when discussing which onecould be the correct form of these diagnostic concepts, amore important question emerged: What really com-poses the concept? We believe the concept is general,and should not contain components from the other axes.For instance, we think incontinence is better than bowelincontinence, because �bowel� is on the axis topology.We await a response from NANDA in order to continuethe work.

CONCLUSIONS. Providing Brazilian nurses withNANDA Taxonomy II adapted to Brazilian nursingpractice will allow them to continue clinical applica-tion of this classification, as well as develop researchprojects.

Author contact [Michel]: [email protected]

Implementing a Standardized Nursing Language System in the Prehospital Emergency Care Setting

Juan Miguel Morales, R. Azañón, M.M. Rodríguez, J. Palma, and M. Rodríguez

PURPOSE. To design a record containing �traditional�and nursing process�related data, adapted to prehospitalemergency care.

METHODS. In the course of conducting a research pro-ject about nursing process implementation strategies inprehospital emergency care, a pilot electronic patientrecord was designed by expert critical care nurses. A pre-hospital emergency service of a leading city in the An-dalusian region in Spain was chosen to test the initial im-plementation of the record using a qualitative approachthat included semistructured interviews and record eval-uation, plus a 1-week education program about clinicaluse of nursing process. The record included assessmentparameters, NANDA, NIC, and NOC standardizednursing terminologies as the main focus of clinical rea-soning, care planning, and delineating outcomes and in-terventions.

FINDINGS. Twelve prehospital emergency care nurseswere trained with a specific nursing process program.They all applied the electronic record during their clini-cal perfomance and related high satisfaction with it intheir interviews, although they reported some initial dif-


ficulties with terminology. After this pilot phase, therecord was extended to the other seven leading cities inthe region following a presentation by two expert nurses.The record has been included as a formal component ofthe hospital information system and the NOC labels willbe used as criteria when evaluating the prehospitalemergency nurses. A copy of each record is deposited atthe admission hospital.

DISCUSSION. The enrichment of an information sys-tem with nurse-sensitive data is crucial for emergencyservices where the nurse offers complex but often never-documented services. The difficulties of combining easilyrecordable forms and exhaustive data gathering can beovercome with qualitative techniques and education ac-tivities that highlight the benefits of standardized nurs-ing language and critical paths prior to implementation.

CONCLUSIONS. The aim of developing a nursingrecording system based on standardized nursing lan-guage must be balanced against a lack of a nurse-ori-ented conceptual framework among emergency nursesand their unfamiliarity with nurse terminology.

Author contact [Morales]: [email protected]


ponent of the Critical Patient Clinical Dossier that inte-grates both medical and nursing records.

DISCUSSION. Implementation of standardized nursinglanguage requires an adequate orientation program withdefined objectives. The simple addition of nursing termi-nology to clinical areas or guidelines development notonly offers some difficulties in their usage, but also createsa conceptual conflict among nurses with a biomedicalparadigm orientation. Using standardized nursing lan-guage presupposes a paradigm shift among nurses andmanagers. Nursing process and standardized nursing lan-guage are not always the primary focus of healthcare sys-tems; it is necessary to demonstrate the lack of sensitivity

present in information systems regarding nursing practice,nursing resources evaluation, and competency design.This situation cannot be modified piecemeal, and collabo-ration between nurses and administration is critical.

CONCLUSIONS. A nursing information system is notonly a recordkeeping system and a software application;it needs also a qualitative transformation of the nurses�conceptual point of view and adequate linkage betweentheory and clinical practice. A patient-centered, long-term evaluation of the nursing process implementation isneeded to assess the effectiveness of this reorientation ofnurses� clinical practice.

Author contact [Morales]: [email protected]

Nursing Records With Standardized Nursing Language in Prehospital Emergency Care: From Utopia to Reality

Juan Miguel Morales, M.M. Rodríguez, J. Terol, A. Torres, and J.M. Álvarez

BACKGROUND. After analyzing the relationship be-tween 10 medical diagnoses and the NANDA classifica-tion, a set of related links between medical diagnosesand nursing diagnoses was drafted for the medical/surgical unit. Because one nursing diagnosis is related tomany nursing interventions, the relationships estab-lished by the NIC study team between NANDA diag-noses and NIC interventions was used.

MAIN CONTENT POINTS. System programs are di-vided into five modules: user interface, managementof standardized data, searching expected nursing di-agnoses and interventions, management of nursing ac-tivities, and statistics retrieval. The database consists


of two parts: knowledge and activity. All data main-tained by the modules for management of standard-ized data are stored in the knowledge database. Themodules for searching expected nursing diagnosesand interventions also use the knowledge database.All data produced by the modules for management ofnursing activities and the modules for retrievingstatistics on nursing activities are stored in the activitydatabase.

The system will be operated in connection with anorder communication system currently in use in hospi-tals. Therefore, development tools were selected consid-ering this connection.


NIC: An Orientation Program for Long-Term Care

Joanne O�Gara

BACKGROUND. An organized, comprehensive orien-tation program enables new nurses to adjust to their newwork environment and feel a part of the organization.The orientation program at the Alverno Health Care Fa-cility, a 135-bed long-term care facility in Clinton, IA, wasbased on state and federal requirements and job descrip-tions. The familiarity of having included NANDA, NIC,and NOC in resident care plans for years prompted theintegration of standardized nursing language into the ex-isting orientation.

MAIN CONTENT POINTS. Successful implementation ofNIC requires organizational commitment. The revampingof the orientation began with meetings of the nursingmanagement team consisting of the chief executive offi-cer, nursing supervisors, infection control nurse, continu-ous quality improvement nurse, and inservice director.

During the initial phase of development, the NIC in-terventions most applicable to long-term care were iden-tified. From this list, each team member selected 25 inter-ventions based on regulations, frequency, and high risk.These interventions were compared to the topics in theexisting orientation program. Job descriptions were re-viewed for key roles to identify topics that correlated tothe interventions. Data were queried from the care plansto determine the frequency of nursing diagnoses, inter-ventions, and outcomes. In addition, federal require-ments were itemized with the corresponding interven-tion identified for each area.

The team collated the data from the existing orienta-tion, job descriptions, care plans, and federal regulationsto select 25 care competencies to include in the nursingorientation program. The team agreed to designate sevenactivities most applicable to long-term care for each in-tervention. Staff nurses were included in the selectionprocess. Some activities listed in the third edition of NICwere altered to be more specific to long-term care. Theresults were compiled and used as the foundation for thenurses� orientation and performance evaluation.

The orientation program was designed to be completedwithin 4 weeks, with week 1 addressing federal and OSHArequirements. A preceptor was assigned to each new nurseto enhance the learning opportunities. Various methods ofpresentation were constructed using the principles of adultlearning to foster interest and retention of information.Classes were interspersed with clinical orientation.

CONCLUSIONS. Including NIC interventions in thenursing orientation program provided an opportunity tosupport standardized nursing language, conveyed a senseof teamwork and commitment to the organization, anddefined expectations in the standards of care. The generalorientation for all departments was enhanced by incorpo-rating NIC into required topics of safety, infection control,abuse prevention, body mechanics, resident rights, anddementia management. Further, the NIC-based orienta-tion was used as a basis for the hiring process.


Development of a System for Nursing Diagnosis and Intervention Management

Sung Ae Park, Jung Ho Park, Myun Suk Jung, Hiye Ja Lee, Mi Kyoung Joo, and Sung Hee Park

BACKGROUND. Concept maps have been shown to bean effective teaching strategy in a number of differentsettings and with various age groups. Concept maps linka number of concepts through the use of propositions tomake meaningful relationships. These linkages provide aclear, visual road map of the material the student mustassimilate. Concept maps also create patterns, whichBenner�s research has shown are an important means bywhich the novice student moves to become an expert innursing practice. Finally, this strategy also encouragescritical thinking, provides an additional means to evalu-ate student learning, and allows the student experiencein using the standardized nursing languages, even if thestudent is not in a clinical setting where these languagesare used.

In one baccalaureate nursing program, students areintroduced to nursing diagnosis in a freshman nursingcourse. Then, in the sophomore year, students use nurs-ing diagnoses in developing nursing care plans, and areintroduced to NIC and NOC. In the junior year, in addi-tion to studying nursing theory, students studyNANDA, NIC, and NOC in depth. It is with this basisthat a pediatric didactic course then integrates the nurs-ing standardized languages of NANDA, NIC, and NOCwith concept maps to help students understand the pe-diatric patient�s response to illness and the developmentof a patient plan of care.

MAIN CONTENT POINTS. Beginning with the patient�smedical diagnosis or disease, the student links the patho-physiology of the disease to the patient�s signs andsymptoms, then to lab tests and x-rays that confirm thediagnosis. Based on these linkages, the medical, nursing,and other healthcare providers� plans of care are dis-cussed. The nursing care plan uses the standardized lan-guages of NANDA, NIC, and NOC. Linkages betweenthe signs/symptoms the patient is experiencing with the


signs/symptoms listed in NANDA provide the first pat-tern recognition for the students. From there, outcomesare identified that are specific to that patient, and nursingactivities and intervention labels are utilized to helpmove the patient toward optimal outcome(s).

The phrases used between concepts are key in helpingthe student understand the relationship among concepts,which are placed on a flow diagram-type chart to makethe visual road map. A concept map cannot be drawnhere, but can be visualized according to the followingbrief example. Each concept is identified in bold, and inan actual concept map would be listed in a box. Thephrases are in italics and link the concepts. Diabetes is ev-idenced by pancreatic cells� inability to produce insulin,which is manifested in the patient by increased urination,weight loss, confirmed by elevated blood sugar andtreated by medical treatment plan (insulin) and the nurs-ing treatment plan, which includes nursing diagnoses(e.g., risk for injury, knowledge deficit), NOC (e.g., BloodGlucose Control, Symptom Control; Knowledge: Dia-betes Management), nursing activities (e.g., monitorblood sugars, dietary changes, exercise program, give in-sulin), and NIC labels (e.g., �hyperglycemia manage-ment,� �teaching: disease process and prescribed diet�)to help the patient move toward optimal outcomes. Thedetails for each concept would be expanded as neededfor the topic covered.

CONCLUSIONS. The nursing literature is replete withexamples of the use of concept maps as teaching andlearning tools in didactic and clinical courses. They alsoserve as another means of student evaluation. Conceptmaps using the standardized nursing languages ofNANDA, NIC, and NOC help students find patternsand use metacongition skills to visually link a patient�sresponses to disease with the plan of care for that patient.

Author contact [Pehler]: [email protected]


The menus for system operations are divided intofour parts: management of master data, management ofpatient and nurse information, management of nursingactivity, and retrieving statistics on nursing activity. Thepart for management of master data consists of five sub-menus: medical diagnosis, nursing diagnosis, nursing in-terventions, relationships between medical diagnosisand nursing diagnosis, and relationships between nurs-ing diagnosis and nursing intervention. Through the

user interface screen, nurses select medical diagnosesand then confirm the nursing diagnoses suggested.

CONCLUSIONS. The system will help nurses performtheir nursing processes more efficiently. However, fur-ther studies of the system are mandatory. After verifyingthe usefulness of the system, further analysis of the rela-tionship between medical diagnoses and nursing diag-noses is also necessary.

Author contact [S.A. Park]: [email protected]

Concept Maps as a Tool for Learning Standardized Languages

Shelley-Rae Pehler and Katherine Bodenbender



Comparisons of NANDA/NIC/NOC Linkages Between Nursing Experts and Nursing Students

Barbara Van De Castle

PURPOSE. To compare and contrast student and ex-pert clinical content associations (linkages) of NANDA,NIC, NOC.

METHODS. All undergraduate students (288) wereasked to voluntarily submit their care plans, with nurs-ing diagnoses, associated interventions, and associatedoutcomes. The criterion for care plan inclusion was useof official NANDA diagnoses, NIC interventions, andNOC outcomes. A total of 235 care plans were submit-ted; 203 met the criteria. Students participated from fourclinical rotations: childbearing family, child health, adultphysical health, and adult emotional health. A databasewas created to allow entry of the expert�s choices for in-terventions and outcomes based on a given nursing di-agnosis as published in the NIC and NOC textbooks.Another database was created to enter the studentNANDA/NIC/NOC links obtained from care plans.The two files were compared to assess differences be-tween linkage sets.

FINDINGS. Fifty-six percent of students chose inter-ventions or outcomes outside of the provided links in theNIC and NOC texts. This finding corresponds with datafound in an earlier study.

The interventions and outcomes chosen reflect currentcare priorities emphasized in acute care management. Atotal of 50 different nursing diagnoses were chosen bythe students using 606 interventions (338 nondupli-cated), and 244 outcomes (145 nonduplicated). The mostfrequent diagnosis chosen was knowledge deficit, the most

frequent NOC was Pain Level, and the most frequentNIC was �discharge planning.�

DISCUSSION. These findings suggest that studentsusing this type of care plan structure and resource are de-veloping critical thinking skills. Choosing interventionsand outcomes from a generic list and not from a preparedlist can demonstrate clinical decision making. Faculty canevaluate student application of course objectives by thetype and frequency of the diagnoses, interventions, andoutcomes cited. For instance, the above finding of �dis-charge planning� as the most frequent intervention toldfaculty that the strategies used to encourage student in-corporation of discharge planning was effective.

CONCLUSIONS. This study showed that students aregoing beyond the provided linkages in the NIC andNOC texts and choosing appropriate interventions andoutcomes. Critical thinking skills are being used in devel-oping care plans. More research assessing clinically de-rived linkages among NANDA, NIC, and NOC isneeded, but should be expanded to linkages created bynurses. Additionally, clinical information systems linkingdiagnoses, interventions, and outcomes should not belimited to predetermined linkages but should allow forflexibility to include additional choices appropriate tospecific patient management concerns. An ongoing as-sessment of clinical information systems using any of thenursing classifications is key to developing clinically ap-propriate and culturally sensitive linkages.


Documents

Concept Maps as a Tool for Learning Standardized Languages