1 Does NIC cover treatments used by nurses practicing in specialty areas?

Definitely yes. Many of the interventions in NIC require advanced education and experience in a clinical practice. For example, the following interventions may reflect the practice of a certified nurse working in obstetrics: Amnioinfusion, Birthing, Electronic Fetal Monitoring: Antepartum, Grief Work Facilitation: Perinatal Death, High-Risk Pregnancy Care, Labor Induction, Labor Suppression, Reproductive Technology Management, and Ultrasonography: Limited Obstetric. A similar list can be identified for most specialties.

2 Does NIC include the important monitoring functions of the nurse?

Very definitely yes. NIC includes many monitoring interventions (e.g., Electronic Fetal Monitoring: Antepartum, Health Policy Monitoring, Intracranial Pressure [ICP] Monitoring, Neurologic Monitoring, Surveillance, Surveillance: Late Pregnancy, Vital Signs Monitoring). These interventions consist mostly of monitoring activities but also include some activities to reflect the clinical judgment process, or what nurses are thinking and anticipating when they monitor. These interventions define what to look for and what to do when an anticipated event occurs. In addition, all interventions in NIC include monitoring activities when these are done as part of the intervention. We use the words monitor and identify to mean assessment activities that are part of an intervention. We have tried to use these words rather than the word assess in this intervention classification because assessment is the term used in the nursing process to refer to those activities that take place before diagnosis.

3 Does NIC include interventions that would be used by a primary care practitioner, especially interventions designed to promote health?

Yes indeed. Although these are not grouped together in one class, NIC contains all of the interventions nurses use to promote health. Examples include: Anticipatory Guidance, Decision-Making Support, Developmental Enhancement: Adolescent, Developmental Enhancement: Child, Exercise Promotion, Health Education, Health Screening, Immunization/Vaccination, Management, Learning Facilitation, Nutrition Management, Weight Management, Oral Health Promotion, Parent Education: Adolescent, Parent Education: Childrearing Family, Parent Education: Infant, Risk Identification, Smoking Cessation Assistance, Substance Use Prevention, and Self-Responsibility Facilitation. Medication Prescribing is an intervention used by many advanced practice nurses working in primary care.

4 Does NIC include alternative therapies?

We assume this question refers to treatments that are not part of mainstream medical practice in this country. Interventions in NIC that might be listed as alternative therapies include Aromatherapy, Autogenic Training, Biofeedback, Healing Touch, Hypnosis, Meditation Facilitation, Guided Imagery, Reiki, Relaxation Therapy, and Therapeutic Touch. Many of these interventions are located in the class “Psychological Comfort Promotion.” Other alternative therapies will be added to NIC as they become part of accepted nursing practice.

5 Does the classification include administrative interventions?

The Classification includes indirect care interventions done by first-line staff or advance practice nurses but does not include, for the most part, those behaviors that are administrative in nature. An indirect care intervention is a treatment performed by a direct care provider away from the patient but on behalf of a patient or group of patients; an administrative intervention is an action performed by a nurse administrator (nurse manager or other nurse administrator) to enhance the performance of staff members to promote better patient outcomes. Some of the interventions in NIC, when used by an administrator to enhance staff performance, would then be administrative interventions. Most of these are located in the taxonomy in the Health System domain. It should be noted that the borders between direct, indirect, and administrative interventions are not firm and some NIC interventions may be used in various contexts. For example, the nurse in the hospital may provide Caregiver Support as an indirect intervention administered to a relative of the patient being cared for, but the nurse in the home, treating the whole family, may provide this intervention as direct care. With the addition of more interventions for communities, we have added interventions that are more administrative in nature, for example, Cost Containment and Fiscal Resource Management. These are, however, delivered by the primary care nurse in the community setting or by the case manager.

6 How do I find the interventions I use when there are so many interventions in NIC?

At first glance, NIC, with over 550 interventions, may seem overwhelming. Remember, however, that NIC covers the practice domain of all nurses. An individual nurse will use only a portion of the interventions in NIC on a regular basis. These can be identified by reviewing the classes in the taxonomy that are most relevant to an individual’s practice area or by reviewing the list of core interventions for one’s specialty (see Part Four). In those agencies with nursing information systems, the interventions can be grouped by taxonomy class, nursing diagnosis, patient population (e.g., burn, cardiac, maternity), nursing specialty area, or unit. Many computer systems will also allow individual nurses to create and maintain a personal library of most used interventions. We have been told by nurses using the Classification that they quickly identify a relatively small number of interventions that reflect the core of their practice.

7 How do I decide which intervention to use when one intervention includes an activity that refers to another intervention?

In some NIC interventions there is reference in the activity list to another intervention. For example, the intervention of Airway Management contains an activity that says “Perform endotracheal or nasotracheal suctioning, as appropriate.” There is another intervention in NIC, Airway Suctioning, which is defined as “Removal of secretions by inserting a suction catheter into the patient’s oral, nasopharyngeal, or tracheal airway” and has more than 20 activities listed under it. Another example is the intervention of Pain Management, which contains an activity that says “Teach the use of nonpharmacologic techniques (e.g., biofeedback, TENS, hypnosis, relaxation, guided imagery, music therapy, distraction, play therapy, activity therapy, acupressure, hot/cold application, and massage) before, after, and, if possible, during painful activities; before pain occurs or increases; and along with other pain relief measures.” Nearly all of the techniques listed in the parentheses of this activity are listed in NIC as interventions, each with a definition and a set of defining activities. The two examples demonstrate that the more abstract, more global interventions sometimes refer to other interventions. Sometimes one needs the more global intervention, sometimes the more specific one, and sometimes both. The selection of nursing interventions for use with an individual patient is part of the clinical decision-making of the nurse. NIC reflects all possibilities. The nurse should choose the intervention(s) to use for a particular patient using the six factors discussed in the next chapter.

8 When is a new intervention developed?

Why do we believe that each of our interventions is different from others in the Classification? Maybe they are the same but are called something different? We developed the guiding principle that a new intervention is added if 50% or more of the activities are different from another related intervention. Thus, each time a new intervention is proposed, it is reviewed against other existing interventions. If 50% or more of the activities are not different, it is not viewed as significantly different and therefore is not added to the Classification.

With interventions that are types of a more general intervention (e.g., Sexual Counseling is a type of Counseling; Tube Care: Gastrointestinal is a type of Tube Care), the most pertinent activities are repeated in the more concrete intervention so that this intervention can stand alone. This should not be all the activities, rather just those that are essential to carrying out the intervention. In addition the intervention must have at least 50% new activities.

9 In a care plan, what’s the structure for nic and noc? what do you choose and think about first?

The answer to this reflects the clinical decision-making of the provider planning and delivering the care. Individuals have different approaches to this, reflecting how they learned to do this in school refined by what they find works best for them and their typical patient population. As a general approach we suggest first making the diagnosis (or diagnoses), then select outcomes and indicators, rate the patient on these, then select the interventions and appropriate activities, implement these, and then rate the outcomes again. If you want to set goals, these can be derived from the NOC outcomes, for example, the patient is at 2 on X outcome and by discharge he should be at a level of 4. Sometimes, in some situations, this process is not possible or even desirable and one would want to use a different order. For example, in a crisis one would move immediately to the implementation of the intervention with the diagnosis and outcome left for later. The advantage of the standardized classifications is that they provide the language for the knowledge base of nursing. Educators and others can now focus on teaching and practice of skills in clinical decision-making; researchers can focus on examining the effects of interventions on patient outcomes in real practice situations. See the model in the next chapter that shows how standardized language can be used at the individual level, the unit/organizational level, and the network/state/country level.

10 Why are certain rather basic activities included in the activity list for some interventions but not others?

For example, why should an activity related to documentation be included in Discharge Planning and Referral and not in every intervention? Or, why should an activity related to evaluation of outcomes be included in Discharge Planning and not in all interventions? Or, why should an activity on establishing trust be included in Reminiscence Therapy or Support Group but not in other interventions?

Basic activities are included when they are critical for the implementation of that intervention (i.e., absolutely essential to communicate the essence of the intervention). They are not included when they are part of the routine but not a critical piece of the intervention. For example, hand washing is a routine part of many physical interventions but is not critical to interventions such as Bathing or Skin Care: Topical Treatments. (We are not saying that washing your hands should not be done for these interventions, just that this is not a critical activity.) Hand washing is a critical part, however, of such interventions as Infection Control and Contact Lens Care.

For the first time in this edition, we have included Patient Identification as an intervention. Although the identification of the patient is a critical activity for most interventions, the importance of doing this for current safety initiatives and the use of many new techniques and electronic devices have elevated this activity to intervention status.

11 Can I change the activities in an intervention when I use it with my patient?

Yes. The standardized language is the label name and the definition, and these should remain the same for all patients and all situations. The activities can be modified to better reflect the needs of the particular situation. These are advantages of NIC: it provides both a standardized language that will help us communicate across settings about our interventions and it allows for individualized care. The NIC activities use the modifiers as appropriate, as needed, and as indicated to reflect the fact that individuals are unique and may require different approaches. The NIC activities include all ages of patients, and, when used with adults, some of the activities directed at children may not be appropriate (and vice versa). In this case these can be omitted from an agency’s list of activities. Also, the NIC interventions are not at the procedure level of specificity, and some agencies may wish to be more specific to reflect particular protocols developed for their populations. The activities can easily be modified to reflect this. At the same time that we believe that the activities can and should be modified to meet individual needs, we caution that activities should not be changed so much that the original NIC list is unrecognized. If this is done, then the intervention may in fact not be the same. Any modified or new activities should fit the definition of the intervention. In addition, when an activity is being added consistently for most patients and populations, then it may be needed in NIC’s general listing of activities. In this case, we would urge the clinician to submit the proposed activity addition or change. In this way the activity list continues to reflect the best of current practice and is most useful in teaching the interventions to new practitioners.

12 Why are the activities not standardized?

Increasingly, as NIC is put into computer systems, we get asked this question. Those who design computer systems would like similar activities listed under different interventions to be worded the same so that it would be easier for them to create and use databases. So, we recently launched a project to systematically evaluate the feasibility of standardizing the activities. Two approaches were used. First, all of the nearly 13,000 activities in NIC were printed alphabetically using the first word (a verb) in the activities. One of the team members reviewed all of these and brought a sample to the NIC team for review. This approach revealed a small number of editorial concerns (e.g., missing commas before “as appropriate” or “as needed”) and a very limited number of activities whose wording could be made identical to similar activities without changing the meaning. The second approach was to identify frequently addressed topics (nouns) such as: referral, medication side effects, environment, procedure or treatment, intake and output, privacy, approach, trust, listener, relationship, support, and vital signs. Using a computer search program, activities that included the identified topic (e.g., referral) were printed. These topic searches resulted in lists of anywhere from 100 to several hundred activities. One of the team members reviewed the topic listings and two of these were taken to the NIC team for discussion. Various approaches to standardization were proposed but team members agreed that rewording activities would result in loss of meaning and content. After this systematic review and deliberation, it was decided not to pursue standardization of activities any further.