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

PURPOSE

To compare and contrast student and expert clinical content associations (linkages) of NANDA, NIC, NOC.

METHODS

All undergraduate students (288) were asked to voluntarily submit their care plans, with nursing diagnoses, associated interventions, and associated outcomes. The criterion for care plan inclusion was use of official NANDA diagnoses, NIC interventions, and NOC outcomes. A total of 235 care plans were submitted; 203 met the criteria. Students participated from four clinical rotations: childbearing family, child health, adult physical health, and adult emotional health. A database was created to allow entry of the expert's choices for interventions and outcomes based on a given nursing diagnosis as published in the NIC and NOC textbooks. Another database was created to enter the student NANDA/NIC/NOC links obtained from care plans. The two files were compared to assess differences between linkage sets.

FINDINGS

Fifty-six percent of students chose interventions or outcomes outside of the provided links in the NIC and NOC texts. This finding corresponds with data found in an earlier study.

The interventions and outcomes chosen reflect current care priorities emphasized in acute care management. A total of 50 different nursing diagnoses were chosen by the students using 606 interventions (338 nonduplicated), and 244 outcomes (145 nonduplicated). The most frequent diagnosis chosen was knowledge deficit, the most frequent NOC was Pain Level, and the most frequent NIC was “discharge planning.”

DISCUSSION

These findings suggest that students using this type of care plan structure and resource are developing critical thinking skills. Choosing interventions and outcomes from a generic list and not from a prepared list can demonstrate clinical decision making. Faculty can evaluate student application of course objectives by the type and frequency of the diagnoses, interventions, and outcomes cited. For instance, the above finding of “discharge planning” as the most frequent intervention told faculty that the strategies used to encourage student incorporation of discharge planning was effective.

CONCLUSIONS

This study showed that students are going beyond the provided linkages in the NIC and NOC texts and choosing appropriate interventions and outcomes. Critical thinking skills are being used in developing care plans. More research assessing clinically derived linkages among NANDA, NIC, and NOC is needed, but should be expanded to linkages created by nurses. Additionally, clinical information systems linking diagnoses, interventions, and outcomes should not be limited to predetermined linkages but should allow for flexibility to include additional choices appropriate to specific patient management concerns. An ongoing assessment of clinical information systems using any of the nursing classifications is key to developing clinically appropriate and culturally sensitive linkages.