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CNC - Strengths: Nursing Outcomes Classification (NOC)

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Comprehensive – The NOC contains outcomes for individuals, caregivers, families, and communities that can be used with all clinical specialties in numerous settings. Although there are still outcomes to develop, the outcomes in the fifth edition are useful for the entire scope of nursing practice.

Research-based – The research, conducted by a large team of University of Iowa College of Nursing faculty and students in conjunction with clinicians from a variety of settings, began in 1991. Both qualitative and quantitative strategies were used to develop the classification. Methods included content analysis, concept analysis, survey of experts, similarity analysis, hierarchical clustering analysis, multidimensional scaling, and clinical field site testing. The outcomes were evaluated for inter-rater reliability, validity, and usefulness in 10 clinical sites representing the care continuum.

Developed inductively and deductively – Sources of data for the initial development of outcomes and indicators were nursing textbooks, care plan guides, nursing clinical information systems, standards of practice, and research instruments. Research team focus groups reviewed outcomes in eight broad categories that were drawn from the Medical Outcomes Study and nursing literature. Based on a review of literature, outcomes were grouped in broad categories and refined through concept analysis.

Grounded in clinical practice and research – Developed initially from nursing texts, care plan guides, and clinical information systems, the outcomes were reviewed by clinical experts, and many were tested in clinical field sites. Feedback from clinicians and educators was solicited through a defined feedback process. Beginning work on core NOC outcomes for specialty practice was first included in the third edition. This grounding in clinical practice continues with the fifth edition as numerous outcomes were developed by clinical experts and forwarded to the authors.

Has an easy-to-use organizing structure – The taxonomy has five levels: domains, classes, outcomes, indicators and measurement scales. All five levels have been coded for use in practice. New outcomes are added to the taxonomy as the classification is further developed. This structure aids nurses in identifying outcomes to use in their clinical practice and provides a framework for teaching NOC to students in educational settings.

Allows outcomes to be shared by all disciplines – Although the NOC emphasizes outcomes that are most responsive to nursing interventions, the outcomes describe patient, family, or community states at a conceptual level. Thus the NOC provides a classification of patient outcomes that are potentially influenced by all health care disciplines. Use of the outcomes by all members of the interdisciplinary team provides standardization, yet allows the selection of indicators that are most responsive to each discipline. Field testing demonstrated that the outcomes were useful to interdisciplinary teams in practice.

Optimizes information used for the evaluation of effectiveness – The outcomes and indicators are variable concepts. They allow for measurement of the patient, family or community outcome at any point on a continuum from most negative to most positive and at different points in time. Rather than the limited information of whether a goal is met or unmet, NOC outcomes can be used to monitor the extent of progress, or lack of progress, throughout an episode of care and across different care settings. Change in outcome ratings can be reported and recorded as a result of nursing interventions instituted across time and care setting.

Funded by extramural grants – To date, the NOC research has received nine years of peer-reviewed grant funding: one year from Sigma Theta Tau International and eight years from the National Institute of Nursing Research (NINR).

Tested in clinical field sites – Testing of the NOC has been conducted in a variety of clinical field sites, including tertiary care hospitals, intermediate care hospitals, a nursing home, home health care settings, nurse managed clinics, and a parish nursing organization. The field tests have provided important information about the clinical usefulness of the outcomes and indicators; linkages between nursing diagnoses, interventions, and outcomes; and the process of implementing the outcomes in clinical nursing information systems.

Dissemination emphasized – Information about the classification, its development, and its use is available in the fifth edition (published by Elsevier every 4 to 5 years) and in numerous journal articles and book chapters. A listserv is maintained to share information about the NOC and for dialogue with interested users. The NOC work has been disseminated in numerous national and international presentations. Although developed in the United States, nurses in other countries are finding the classification useful. Translations are available for the following languages:  Chinese (simplified and traditional), Dutch, French, German, Italian, Japanese, Korean, Norwegian, Portuguese. and Spanish.

Linked to other nursing languages – Linkages have been developed by the NIC and NOC research teams to assist nurses with the use of the classifications and to facilitate use in clinical information systems. Linkages with NANDA International diagnoses and Gordon’s Functional Health Care Patterns are included in the book. Linkages among NANDA-I diagnoses, NOC outcomes, and NIC interventions are available in the book NOC and NIC Linkages to NANDA-I and Clinical Conditions: Supporting Critical Reasoning and Quality Care, published by Elsevier in 2012. In addition linkages have been developed between the International Classification of Functioning, Disability and Health (ICF) and NOC in an attempt to explore the components of ICF and identify the relevant concepts to promote language development in nursing. In addition, ICF was chosen due to its international and interdisciplinary use. 

Included in initiatives for electronic clinical record – Concepts for NOC are included in SNOMED Clinical Terms, a reference terminology for use in clinical information systems. NOC has been registered with Health Level 7, a U.S. standards organization dedicated to simplifying the exchange, management, and integration of clinical and administrative data in health records. A growing number of vendors have licensed NOC for inclusion in their software.

Developed as companion to the NIC – Experience with the NIC at Iowa has aided the NOC research.  Both classifications are comprehensive and research-based, and reflect current clinical nursing practice.  They are both housed in the Center for Nursing Classification and Clinical Effectiveness.

Recipient of national recognition – NOC is recognized by the American Nurses Association (ANA), included in the Metathesaurus for a Unified Medical Language at the National Library of Medicine, included in the CINAHL index, and listed as one of the languages that meets the standards set by ANA’s Nursing Information and Data Set Evaluation Center (NIDSEC).

Structured for continued development and refinement – The classification continues to be evaluated, developed, and refined by the NOC research team. Continued refinement will be facilitated through the Center for Nursing Classification and Clinical Effectiveness, the College of Nursing, and the University of Iowa. In addition to seeking continued grant support, a $1 million endowment is being raised to ensure a solid financial foundation for supporting further development of both NIC and NOC.  Revenue from the sales of the book and licensing are used to support the staff and work of the Center for Nursing Classification and Clinical Effectiveness.

Source: Moorhead, S., Johnson, M., Maas, M., & Swanson, E. (Eds.). (2013). Nursing Outcomes Classification (NOC): Measurement of Health Outcomes (5th ed.). St. Louis, MO: Elsevier.