The Use of NANDA,NIC,and NOC in the Identification and Measurement of Problems,Interventions,and Outcomes in Spinal Cord Injury

PURPOSE

To ascertain the possibility of identifying problems experienced by patients with spinal cord injury that are addressed by specific and independent nursing decisions and actions.

METHODS

A two-part study was undertaken. Part 1 used the Delphi method with an expert panel of nurses from the 11 spinal cord injury facilities in the U.K. to gain a consensus on presenting patient problems, patient problems with which nurses had major input into resolution, planned patient outcomes for those problems, and interventions undertaken to address the problems in order to achieve the outcomes. NANDA, NIC, and NOC classifications were used to assist the expert panel in defining the problems, interventions, and outcomes identified.

Part 2 was an analytic and evaluative, prospective, longitudinal cohort study using participant observation to test empirically the findings of the Delphi study. The care experiences of patient cohorts from two spinal cord injury facilities in the U.K. were examined to see if the patient problems addressed by nurses were identified, whether planned outcomes for those problems were identified, and what interventions were used to address those problems. Linkages were sought among the problems, interventions, and outcomes.

FINDINGS

There was general consensus on the patient problems, interventions, and planned outcomes addressed by specific nursing decisions and actions. There was a high level of agreement with the definitions of the problems using NANDA, the definition of the planned outcomes using NOC, and the nursing interventions using NIC. It was possible empirically to attribute patient outcomes for specific problems to the nursing interventions undertaken.

DISCUSSION

The study demonstrated that it is possible — in these times of multi-, inter-, and intradisciplinary approaches to care—to identify the contribution a single profession makes to the total care process. It may also be desirable to identify and measure the contribution a particular profession makes to patient outcomes because only thus can the value of the contribution be recognized. Also, the methods used allowed an assessment of outcomes to be undertaken without having to use a randomized control trial.

CONCLUSIONS

The study demonstrated both theoretically and empirically that the use of standardized nursing languages can help clarify nursing concepts underlying care processes in patients with spinal cord injuries. If problems, and the actions taken by nurses to address those problems, are identified, those actions can lead to outcomes that can be attributed to nursing activities. The use of standardized nursing languages illuminated aspects of nursing care that are at present hidden.