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CNC - NOC Publications

Annotated Publications

The Classification :

Iowa Outcomes Project. M. Johnson, M. Maas & S. Moorhead (Eds.). (2000). Nursing Outcomes Classification (NOC) (2nd ed.). St. Louis: Mosby.

The second edition of NOC contains 260 outcome labels with corresponding definitions, measures, indicators, and references. All of the outcomes have been assigned numerical codes. This edition also includes the NOC taxonomic structure (7 domains and 29 classes), linkages with NANDA diagnoses and linkages with Gordon's Health Patterns.

Articles and Chapters :

Johnson, M., Maas, M. (1999). Nursing-sensitive patient outcomes: Development and importance for use in assessing health care effectiveness. In E. Cohen & V. DeBack (Eds.). The Outcomes Mandate, Case Management in Health Care Today , (pp. 37-48). St. Louis: Mosby.

Patient outcomes have emerged as essential measures of health care quality in managed care systems. Standardized, nursing-sensitive patient outcomes are important for assigning nursing accountability for the development of clinical information systems and knowledge development.

Moorhead, S., Head, B., Johnson, M. & Maas, M. (1998). The nursing outcomes taxonomy: Development and coding. Journal of Nursing Care Quality 12 (6), 56-63.

The concepts and taxonomic structures of nursing diagnoses, interventions, and outcomes provide vertical columns onto which the concepts of the middle-range theories can be placed to ultimately build the substantive structure of nursing practice. This article focuses on the taxonomic structure of the Nursing Outcomes Classification (NOC); the final standardized language needed to complete the requirements of the mid-range theory model.

Donahue, M.P. & Brighton, V. (1998). Nursing outcome classification: Development and implementation. Journal of Nursing Care Quality , 12(5).

Describes NOC development and implementation in several hospital settings, a long term care facility and in education.

Maas, M., Johnson, M., & Moorhead, S. (1996). Classifying nursing-sensitive patient outcomes. Image-Journal of Nursing Scholarship 28 , (4), 295-301.

Discusses how NOC completes the Nursing Minimum Data Set (NMDS). Discusses resolution of conceptual and methodological problems that define the inductive approach taken to develop the NOC, strategies used to develop NOC, and examples of outcomes.

Additional Readings:


Schoenfelder, D., Swanson, E., Specht, J., Johnson, M. & Maas, M. (2000). Outcome indicators for direct and indirect caregiving. Clinical Nursing Research 9 (1),47-69.

This articles describes the Family Caregiver focus group outcome development and content validity findings for three NOC outcomes: Caregiver Role Performance: Direct Care and Caregiver Role Performance: Indirect Care.

Maas, M., Moorhead, S., Specht, J., Schoenfelder, D., Swanson, E.A., Johnson, M. (2000). Concept development of nursing-sensitive patient outcomes. In B. Rogers & K. Knafl (Eds.). Concept Analysis in Nursing Research , (pp. 387-400). New York: Springer Publishing Company.

This article describes the NOC development process including the concept analysis, methods and content validity analysis.


Maas, M., Kerr, P. (1999). Risk adjustment in nursing effectiveness research. Outcomes Management for Nursing Practice 3 (2), 50-52.

This column examines another important aspect of nursing effectiveness research: The role of risk adjustment.


Maas, M., Delaney, C. & Huber, D. (1998). Contextual variables and assessment of the outcome effects of nursing interventions. . Outcomes Management for Nursing Practice 3 (1), 4-6.

The article discusses the importance of the inclusion of the NMMDS in nursing clinical and management information systems, combined with standardized nomenclatures for the nursing process elements of the NMDS.

Goode, C. (1998, November). About identifying nurse-specific cardiac outcomes. Nursing Management 29 (11), 72.

AONE's expert answers question related to accountability for cardiac service line challenges. The author recommends NOC to measure these indicators because it includes outcomes that are more influenced by nursing, such as client knowledge and behaviors, safety, use of resources, home maintenance, and caregiver status.

Johnson, M. (1998). Overview of the Nursing Outcomes Classification (NOC). On-line Journal of Nursing Informatics, 2 (2). [On-line]. Available:

This article is an overview of the Nursing Outcomes Classification (NOC).

Maas, M. & Head, B. (1998). Moving to measurement. Outcomes Management for Nursing Practice 2 (4), 139-142.

The article discusses the need for outcomes for individuals, populations, families, organizations, communities, other providers, and payers to be measured.

McCloskey, J.C. & Maas, M. (1998). Interdisciplinary team: The nursing perspective is essential. Nursing Outlook 46 , 157-163.

This article discusses the trend toward interdisciplinarity in health care and its tendency to conceal the identity and contributions of nursing professionals. Authors urge nurses to maintain a nursing perspective while participating collaboratively on interdisciplinary teams. The value of nurses' knowledge of NIC and NOC is highlighted since these languages are among the most well-developed standardized languages in health care and potentially useful for the development of standardized languages for other disciplines

Johnson, M. & Maas, M. (1998). Nursing outcomes classification. In Encyclopedia of Nursing Research, pp. 378-379. Edited by J.J. Fitzpatrick. New York: Springer.

Describes the Nursing Outcomes Classification (NOC) development, usefulness and future plans for development.

Maas, M. (1998). Nursing's role in interdisciplinary accountability for patient outcomes. Outcomes Management for Nursing Practice 2 (3), 92-94.

Discusses the importance of nursing remaining visible in an interdisciplinary environment. Encourages nurses to strengthen the discipline, and gain the tools needed to be visible and accountable.

Rankin, M., Donahue, P., Davis, K., Katseres, J., Wedig, J.A., Johnson, M. & Maas, M.(1998). Dignified dying as a nursing outcome. Outcomes Management for Nursing Practice 2 (3), 105-110.

Describes the development and use of one NOC outcome, Dignified Dying, and its importance to maintaining a quality end of life.

Johnson, M. & Maas, M. (1998). Implementing the in a practice setting. Outcomes Management for Nursing Practice 2 (3), 99-104.

Describes the Nursing Outcomes Classification (NOC) in a practice setting. Discusses the need for nursing to standardize the language and measurement of patient outcomes.

Scherb, C.A., Rapp, C.G., Johnson, M., & Maas, M. (1998). The (NOC): Validation by rehabilitation nurses. Journal of Rehabilitation Nursing 23 (4), 174-191.

Measuring patient outcomes is important to rehabilitation nurses and the patients they serve. This article describes research conducted at the University of Iowa College of Nursing to develop the Nursing Outcomes Classification (NOC) and the validation of this research by surveys conducted through specialty nursing organizations, including the Association of Rehabilitation Nurses. Nurses responded to surveys designed to validate (a) the importance of outcome indicators to the achievement of an outcome and (b) nursing's contribution to the achievement of the indicators. The results of the surveys indicated that rehabilitation nurses believe that nursing makes a substantial contribution to most outcomes and indicators.

Maas, M. & Johnson, M. (1998). Outcome Data Accountability. Outcomes Management for Nursing Practice 2 (1), 3-5.

Describes the need for standardized nursing languages in computerized information systems for nursing outcomes accountability.

Maas, M. & Johnson, M. (1998). Structure and process constraints on nursing accountability. Outcomes Management for Nursing Practice 2 (2), 51-53.

Describes the implications of structure, process, and policy induced compromises of nursing's accountability for the outcomes of its interventions and in the use of electronic patient records and development of large, local and national data bases should be of serious concern to the nursing community.

Garand, L., Gerdner, L.A., Buckwalter, K.C., & Wakefield, B. (1998). Neuropsychiatric Disorders. In M.A. Boyd and M.A. Nihart (Eds.). Psychiatric Nursing. Philadelphia, PA: Lippincott Co., pp. 612-666.

This Chapter covers the epidemiology, etiology, pharmacologic interventions, & nursing management of delirium, Alzheimer's type dementia, vascular type dementia, & other dementia's caused by general medical conditions (HIV, Parkinson's disease, head trauma, Pick's disease, Creutzfeldt-Jakob disease, substance-induced, and amnestic disorders). The Nursing management sections cover assessment (biological, psychological, functional, & social) and rating scales, risk factors, nursing diagnosis (NIC and NANDA) and outcomes (NOC) are identified for each disorder covered.


Daly, J., Maas, M. & Johnson, M. (1997). Development of play and leisure nursing-sensitive patient outcomes. Journal of Clinical Geropsychology 3 (4), 267-273.

This article describes the development of two NOC outcome labels titled Leisure Behavior and Play Behavior.

Head, B., Maas, M. & Johnson, M. (1997). Outcomes for home and community nursing in integrated delivery systems. Caring Magazine, 16 (1), 50-56.

This article is a comparison of the Nursing Outcomes Classification (NOC) and three other client outcome classifications

Prophet, C., Dorr, G.G., Gibbs, T.D. & Porcella, A.A. (1997). Implementation of standardized nursing languages (NIC, NOC) in on-line care planning and documentation. Informatics: The Impact of Nursing Knowledge on Health Care Informatics. Amsterdam : IOS Press, 395-400.

This article describes the implementation process at the University of Iowa Hospitals and Clinics (UIHC) of NIC and NOC.

Maas, M. & Johnson, M. (1997). Advancing nursing's accountability for outcomes. Outcomes Management for Nursing Practice 1 (1), 3-4.

Describes the current status of nursing accountability for outcomes effectiveness and explores actions needed to improve the demonstration of accountability.

Maas, M. (1997). Nursing-sensitive outcomes classification (NOC): Completing the essential comprehensive languages for nursing. Classification of Nursing Diagnosis: Proceedings of the 12th Conference North American Nursing Diagnosis Association (NANDA), Pittsburgh, PA, 40-47.

Describes the importance of the development of standardized outcomes and standardized measurement procedures.

Swanson, E., Jensen, D.P., Specht, J., Saylor, D., Johnson, M. & Maas, M. (1997). Caregiving: Concept analysis and outcomes, Scholarly Inquiry for Nursing Practice: An International Journal 11 , (1), 65-76.

Describes family caregiving and the analysis of Caregiver role performance in both direct and indirect care, linking outcomes and indicators to enable nurses to assist caregivers in their caregiving role.

Daly, J., Maas, M. & Johnson, M. (1997). Nursing-sensitive outcomes classification (NOC): An essential element in data sets for nursing and health care effectiveness. Computers in Nursing, 15 (2) (Suppl. 1), 82-86.

Discusses why NOC is a "perfect fit" for the Patient Information System Patient Care Data Set (PCDS), a new concept being introduced as a joint venture by a private software vendor and faculty at Wright State University College of Nursing and Health. Concludes that the inclusion of the NOC in the PCDS patient health record will provide the standardized data needed to monitor and assess the response of individual patients to interventions, to advance health care knowledge, and to evaluate nursing and health care effectiveness across patient populations and settings.


Maas, M., Johnson, M., & Kraus, V. (1996). Nursing sensitive patient outcomes classification. In K. Kelly (Ed.), Series on nursing administration: Outcomes of effective management practices: Vol. 8. (pp. 20-35). Thousand Oaks, CA: Sage Publications.

Provides an overview of NOC, a historical review of outcome measurement is highlighted in relation to the current emphasis on patient outcomes. It includes the aims and methods of the project, example of work in progress and discusses conceptual issues related to outcome measurement.

Johnson, S.L., Brady-Schluttner, K., Ellenbecker, S., Johnson, M., Lassengard, E., Maas, M., Stone, J. Westra, B.L. (1996). Evaluating physical functional outcomes: One category of the system. MEDSURG Journal of Nursing 5 , 157-162.

Discusses the development of NOC with specific results related to physical functional status and implications of NOC for nursing practice.


Johnson, M. & Maas, M. (1995). Classification of nursing-sensitive patient outcomes. In ANA ,Nursing data systems: The emerging framework (pp. 177-183). Washington, DC: American Nurses Association.

Reports on the NOC research, includes: specific aims of the research, progress of the research, definition of terms, and rules for standardization of Nursing-Sensitive Patient Outcome labels.


Johnson, M. & Maas, M. (1994). Nursing-focused patient outcomes: Challenge for the nineties. In J.C. McCloskey and H. Grace (Eds.), Current Issues in Nursing (4th ed., pp. 136-142). St. Louis: Mosby.

Discusses issues that will influence nursing's future role in health care as well as the development of nursing science.