The Nursing Interventions Classification (NIC) is a comprehensive, research-based, standardized classification of interventions that nurses perform.  It is useful for clinical documentation, communication of care across settings, integration of data across systems and settings, effectiveness research, productivity measurement, competency evaluation, reimbursement, and curricular design.  The Classification includes the interventions that nurses do on behalf of patients, both independent and collaborative interventions, both direct and indirect care.  An intervention is defined as “any treatment, based upon clinical judgment and knowledge, that a nurse performs to enhance patient/client outcomes” (Wagner et al, 2024, p. xix).   While an individual nurse will have expertise in only a limited number of interventions reflecting on their specialty, the entire classification captures the expertise of all nurses. NIC can be used in all settings (from acute care intensive care units, to home care, to hospice, to primary care) and all specialties (from critical care to ambulatory care and long-term care).  While the entire classification describes the domain of nursing, some of the interventions in the classification are also done by other health care providers. NIC can be used by other health care providers to describe their treatments as they document.

NIC interventions include both the physiological (e.g., Acid-Base Management) and the psychosocial (e.g., Anxiety Reduction).  Interventions are included for illness treatment (e.g., Hyperglycemia Management), illness prevention (e.g., Fall Prevention), and health promotion (e.g., Exercise Promotion).  Most of the interventions are for use with individuals but many are for use with families (e.g., Family Integrity Promotion), and some are for use with entire communities (e.g., Environmental Management: Community).  Indirect care interventions (e.g., Supply Chain Management, Research Protocol Management) are also included.  Each intervention as it appears in the classification is listed with a label name, a definition, a set of activities to carry out the intervention, and evidence-based background readings.

The 614 interventions in NIC (8th ed.) are grouped into thirty classes and seven domains for ease of use.  The 7 domains are: Physiological: Basic, Physiological: Complex, Behavioral, Safety, Family, Health System, and Community.  Each intervention has a unique number (code).  The classification is continually updated with an ongoing process for feedback and review.  In the back of the book, there are instructions for how users can submit suggestions for modifications to existing interventions or propose a new intervention.  All contributors whose changes are included in the next edition are acknowledged in the book.  New editions of the classification are planned for approximately every 4 to 6 years.  The classification was first published in 1992, the second edition in 1996, the third edition in 2000, the fourth edition in 2004, the fifth edition in 2008, the sixth edition in 2013, the seventh edition in 2018, and the eighth edition in 2024. 

The NIC has been used in clinical reasoning models, which enhance nursing decision-making.  Pesut and Herman (1999) developed the Outcome Present State Test (OPT) model of reflective clinical reasoning, and it was updated by Kuiper et al (2017) to include the NIC, applying it in neonatal, adolescent, young adult, women’s health, men’s health, older adult, and hospice and palliative care nursing situations. As such, it is a major advancement in the teaching and practice of clinical decision-making by applying a clinical reasoning structure and standardized nursing language. Research indicates the use of such modeling positively enhances the development of clinical reasoning in nursing students (Griggs et al., 2019).

NIC is one of the standardized languages recognized by the American Nurses' Association (ANA). NIC is included in the Unified Medial Language System (UMLS) in the National Library of Medicine (NLM) and in the Cumulative Index of Nursing and Allied Health Literature (CINAHL).  NIC is also included in The Joint Commission as one nursing classification system that can be used to meet the standard on uniform data. NIC has also been linked with the Healthy People 2030 Social Determinants of Health (Wagner et al, 2023).

Hundreds of health care agencies have adopted NIC for use in standards, care plans, competency evaluation, and nursing information systems; nursing education programs are using NIC to structure curriculum and identify competencies of graduating nurses; authors of major texts are using NIC to discuss nursing treatments; and researchers are using NIC to study the effectiveness of nursing care, as NIC provides standardized ways to document progress on achieving patients’ goals.  The evidence demonstrates that research conducted in health care organizations that use NIC produces meaningful data that are a valid representation of nursing care and amenable to efficient processing and analysis, demonstrate relationships between nursing care plan components and patient outcomes, and assist the care provider in targeting areas of need, such as social determinants of health (Wagner et al, 2023, p. 1870). 

The NIC has been featured in research publications linking nursing diagnoses (NANDA-I) and nursing outcomes (Nursing Outcomes Classification [NOC]). These three languages, known as NNN (NANDA-I, NIC, NOC) can be linked in determining patient plans of care.  As such, they have been used most often in research and secondary data analysis worldwide (Tastan et al., 2014; Fennelly et al., 2021; Macieira et al., 2019), are suitable for use in secondary analysis of EHR data (Macieira et al., 2019), and have sound taxonomic nursing structures (including definitions on all classification levels) (Müller Staub et al., 2017). Finally, the NNN are observable or measurable (Herdman, et al., 2021; Moorhead et al., 2024; Wagner et al., 2024), making them more amenable to mapping.

Interest in NIC has been demonstrated in several other countries, notably Brazil, Canada, Denmark, England, France, Germany, Iceland, Japan, Korea, Spain, Switzerland, and The Netherlands. NIC has been translated into Simplified Chinese, Traditional Chinese, Dutch, Estonian, French, German, Italian, Indonesian, Japanese, Korean, Norwegian, Portuguese, Spanish, and Turkish, and other translations are in progress. 

Sources: 

Fennelly, O., Grogan, L., Reed, A., & Hardiker, N. R. (2021). Use of standardized terminologies in clinical practice: A scoping review. International Journal of Medical Informatics, 149, 104431. https://doi.org/10.1016/j.ijmedinf.2021.104431 

Griggs, K., Arms, T., & Turrise, S. (2019). Outcomes Present State Test Model for expanding students’ clinical reasoning. Nurse Educator, 44(3), 174. https://doi.org/ 10.1097/NNE.0000000000000578

Herdnman, T. H., Kamitsuru, S., & Takáo Lopez, C. (2021). Nursing diagnoses: Definitions and classification 2021–2023 (12th ed.). Thieme.

Kuiper, R., Donnell, S., Pesut, D., & Turrise, S. (2017). The essentials of clinical reasoning for nurses: Using the Outcome Present State Test model for reflective practice, Sigma Theta Tau International.

Macieira, T. G. R., Chianca, T. C. M., Smith, M. B., Yao, Y., Bian, J., Wilkie, D. J., Dunn Lopez, K., & Keenan, G. M. (2019). Secondary use of standardized nursing care data for advancing nursing science and practice: a systematic review. Journal of the American Medical Informatics Association: JAMIA, 26(11), 1401–1411. https://doi.org/10.1093/jamia/ocz086

Moorhead, S., Swanson, E., & Johnson, M. (Eds.). (2024). Nurisng outcomes classification (NOC): Measurement of health outcomes (7th ed.). Elsevier.

Müller-Staub, M., Rappold, E. (2017). Klassifikationen/Systeme –Beurteilung anhand von Studien. In M. Müller-Staub, K. Schalek, & P. König (Eds.), Pflegeklassifikationen: Anwendung in Praxis, Bildungund elektronischer Pflegedokumentation (pp. 261–305). Hogrefe.

Müller-Staub, M., Lavin, M. A., Needham, I., & van Achterberg, T. (2007). Meeting the criteria of a nursing diagnosis classification: Evaluation of ICNP, ICF, NANDA and ZEFP. International Journal of Nursing Studies, 44(5), 702–713. https://doi.org/10.1016/j.ijnurstu.2006.02.001

Pesut, D., & Herman, J. (1999). Clinical reasoning: The art and science of critical and creative thinking. Delmar.

Tastan, S., Linch, G. C., Keenan, G. M., Stifter, J., McKinney, D., Fahey, L., Lopez, K. D., Yao, Y., & Wilkie, D. J. (2014). Evidence for the existing American Nurses Association-recognized standardized nursing terminologies: a systematic review. International journal of nursing studies, 51(8), 1160–1170. https://doi.org/10.1016/j.ijnurstu.2013.12.004 

Wagner, C. M., Butcher, H. K., Bulechek, G. M., Dochterman, J. M., & Wagner, Clarke, M. F. C. M. (Eds.). (2024). Nursing interventions classification (NIC) (8th ed.). Elsevier.

Wagner, C. M., Lopes, C.T., Jensen, G. A., Moreno, E. A. M., DeBoer, E., & Dunn Lopez, K. (2023). Removing the roadblocks to promoting health equity: Finding the social determinants of health addressed in nursing standardized classifications. Journal of the American Medical Informatics Association: JAMIA, 30(11), 1868–1877. https://doi.org/10.1093/jamia/ocad098 

For further information contact:

Center for Nursing Classification & Clinical Effectiveness
The University of Iowa, College of Nursing, 407 CNB
Iowa City IA 52242-1121
319-335-7051  
email: classification-center@uiowa.edu