International Classification of Functioning, Disability and Health

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The International Classification of Functioning, Disability and Health ( ICF ) is a classification by the World Health Organization that was first created and published in 2001. It is available in German translation under the title “ International Classification of Functioning, Disability and Health ”.

task

Its purpose is to describe the

  • functional health,
  • the disability ,
  • social impairment as well
  • the relevant environmental factors of people.

This specific objective of the classification is concretized and made measurable ( operationalized ) in the sub-classifications “ body functions and body structures ”, “ activities and social participation ” and “ context factors ” (environmental as well as personal factors ).

application

With the help of the ICF, the current functionality of every person (or their impairment) can be described and classified. The state of health and the states associated with the state of health are described. The ICF “does not classify people”; the description of a disability refers explicitly to both a person's body and the specific situation, e.g. B. a specific job, the current place of residence or the home environment, where the functional disabilities of a person become visible.

Contrary to a popular misconception, the ICF is not only applicable to people with disabilities. Rather, it can be applied to any person. However, the ICF does not cover circumstances unrelated to health. If there is an impairment of participation (participation) for other reasons, e.g. For reasons of gender, socio-economic or ethnic origin, for example, the ICF is not applicable.

The ICF sees itself as a classification that is equally applicable in all societies and cultures. This requirement was already problematized in the development phase. A broad 5-year study by the educational scientist Gottfried Biewer , financed by the Austrian Science Fund FWF, pursues this claim in three socially and culturally very different countries. A series of several surveys carried out in Austria, Thailand and Ethiopia with the same design focused on factors such as poverty and culturally specific notions of disability, which can only be mapped to a limited extent using the ICF items.

Structure of the ICF

The ICF is divided into two parts, each of which in turn has two components:

1. Functionality and disability

The functionality or disability in the following areas is described:

body

This area relates to the human organism as a whole, including the brain and its (mental and spiritual) functions. A distinction is made between:

  • Body functions , d. H. the physiological functions of body systems (including psychological functions). Which is described modification of physiological structures (z. B. of vision).
  • Body structures , d. H. anatomical parts of the body such as organs, limbs and their components. Which will be described change of anatomical structures (eg. As the eye).

A functional and structural integrity or damage (impairment of a body function or structure, such as a significant deviation or loss) can be described in each case. The damage is described in terms of its deviation from the population norm (five-point scale from "not present" to "fully developed"). Damage does not necessarily mean disease; H. the term is broader. The cause and development of the damage are also not taken into account here.

Activities and participation (participation)

This is about aspects of functionality (performance) from an individual and social perspective. Describes the presence or absence of impairments that are experienced when carrying out a task or action ( activity ) or when being involved in a life situation ( participation or participation ). The following areas are described in the ICF:

  • Learning and application of knowledge
  • General tasks and requirements
  • communication
  • mobility
  • Self-sufficiency
  • Domestic life
  • Interpersonal interaction and relationships
  • Significant areas of life (education, work and employment, economic life)
  • Community, social and civic life

For each area, assessment criteria were defined, which are assessed on a five-point scale with regard to the constructs of performance (carrying out tasks in the present, actual world) and performance ( capacity , highest possible level of functionality in a standardized environment, e.g. test) (" Problem does not exist "to" Problem fully developed "). A discrepancy indication of the influence of environmental factors (eg. As when an HIV -Kranker due to the social stigma can not work, even though he no damage has and in peak performance is).

2. Contextual factors

Environmental factors

External influences on functionality and disability are described here. The ICF provides a comprehensive list of environmental factors, which are subdivided into areas and sorted according to their proximity to the individual (immediate environment to more distant environment). The areas classified in the ICF are:

  • Products and Technologies
  • Natural and human-modified environment
  • Support and relationships
  • Settings
  • Services, systems and principles of action

For each environmental factor (on a five-point scale from "not available" to "fully developed") it should be indicated to what extent it is a barrier or a support factor from the perspective of the individual.

Personal factors

"Inner" influences on functionality and disability are to be described here, i. H. Influences of characteristics of the person that are not themselves part of the health problem or condition (e.g. gender, ethnicity, age, other health problems, fitness, lifestyle, habits, upbringing, coping styles, social background, education and training, occupation as well past or present experiences / events, general behavior patterns and character, individual psychological performance).

prehistory

With its resource-oriented bio-psychosocial approach, the ICF expanded the first medical classification of disabilities created by the WHO in 1980, the ICIDH ( International Classification of Impairments, Disabilities and Handicaps ), which was based on the disease consequences model, a disorder and deficit-oriented approach. With ICIDH-2 working drafts were referred to the ICF.

The ICIDH distinguished the terms

  • Impairment ( damage )
  • Disability ( ability disorder ) and
  • Handicap ( social impairment ).

In the ICF, the term handicap was abandoned and the term disability (now: handicap ) introduced as a generic term for all three aspects (body, individual and society).

Legal anchoring

The Ninth Book of the Social Security Code (SGB IX, Rehabilitation and Participation of Disabled People) takes up parts of the ICF. The "Guidelines on Medical Rehabilitation Services" according to § 92 SGB V of the Federal Joint Committee are based on the ICF, as is the joint recommendation according to § 13 Para. 1 S. 2 SGB IX i. V. m. Section 26, Paragraph 2, No. 7 of Book IX of the Social Code for the implementation of assessments by the Federal Association for Rehabilitation.

The ICF has not yet been comprehensively implemented in German law for severely disabled people . With the Federal Participation Act (coming into force in particular on January 1, 2018 and January 1, 2020), the legislature now expects that the future assessment procedures for integration assistance benefits will have to be based on the ICF (Section 142 (1) sentence 2 SGB XII , from January 1, 2020 as § 121 SGB IX). This mandate is being implemented to varying degrees by the individual federal states.

ICF as part of care

No studies could be found in the Cinahl and Pub Med databases that validated the ICF in the context of care. Heerkens et al. 2003 conclude that although previous and current applications of the ICIDH or ICF are proving valuable, the level of detail required to map nursing does not currently exist. There are some studies and technical papers dealing with the application of the ICF in the context of nursing. B. Bartholomeyczik et al. 2006 or van Grunsven et al. 2006. Different problems are identified in the studies.

In their study, the authors Boldt et al. Discuss the following central restrictions on the use of the ICF. Potential nursing problems cannot be represented by the current qualifiers of the ICF. The mapping of potential care problems is also a central basis for care activities. Likewise, the patient's resources cannot be mapped via the ICF. These are also central elements of the care documentation. In the study by Heinen et al., Nursing diagnoses with characteristics and causes were taken from anonymous patient files and transferred to ICF categories. The consistency of the agreements regarding the appropriate ICF components was described as moderate. The agreements between the “3-digit level” of the codes, on the other hand, were few. Overall, less than 7–11% of the items could not be mapped using the ICF. It was difficult to find an agreement if the nursing diagnoses were a combination of e.g. B. Include activity and body functions. The question is asked whether these distinctions make sense for the nursing mapping of patient conditions. It turns out that the ICF was not developed for nursing and thus explains the difficulties in using the ICF for mapping nursing diagnoses. The question arises as to whether the ICF in the context of nursing should not be understood more as an initial assessment and whether nurses come to their nursing diagnosis on the basis of this collection of information.

There are currently no links with care goals / outcomes and care measures. However, Boldt found in a post-acute rehabilitation setting, among other things, that the ICF could fundamentally be linked to the care measures and goals. Most of the validation work related to the ICF was carried out from the perspective of other professional groups e.g. B. In these studies it becomes clear that the ICF is not yet complete in all areas.

Example of care documentation

An example to assess the degree of abstraction and to reflect on the possible uses of the ICF formulations for nursing process documentation:

Chapter 5: Self-Sufficiency
d510 wash yourself
d5100 wash body parts
Use water, soap and other substances to clean parts of the body such as hands, face, feet, hair or nails
d5101 Wash the whole body
Use water, soap and other substances to cleanse your whole body, such as bathing or showering

Assessment criteria: The assessment criteria can be used to describe the extent of a problem. So a caregiver could e.g. For example, describe a personal care self-care deficit as follows:

d5101 Wash the whole body with the assessment criterion "problem considerably pronounced"

See also

literature

  • German Institute for Medical Documentation and Information (DIMDI) (ed.): International Classification of Functioning, Disability and Health (ICF). WHO, Geneva 2005.
  • The Federal Working Group for Rehabilitation (BAR): Framework recommendations for outpatient rehabilitation for mental and psychosomatic illnesses. Self-published, Frankfurt am Main 2004.
  • Sabine Grotkamp u. a .: Person-related context factors, Part 1 - A first attempt at the systematic, commented listing of ordered clues for the socio-medical assessment in the German-speaking area. In: Healthcare. 68 (12), 2006, pp. 747-759. DOI: 10.1055 / s-2006-927328 .

Web links

German Institute for Medical Documentation and Information ( DIMDI )

Federal Association for Rehabilitation ( BAR )

Other

Individual evidence

  1. ↑ German Institute for Medical Documentation and Information , dimdi.de: ICF - International Classification of Functioning, Disability and Health ( Memento of the original from March 29, 2015 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. ("As of October 2005", last accessed: November 29, 2015) @1@ 2Template: Webachiv / IABot / www.dimdi.de
  2. ↑ ICF, 2005, p. 14.
  3. ↑ a b ICF, 2005.
  4. ^ TB Üstün et al.: Disability and culture: Universalism and diversity. Seattle 2001.
  5. ^ Classifications of disabilities in the field of education (CLASDISA). CLASDISA project website at the University of Vienna
  6. ↑ ICF, 2005, p. 144.
  7. ^ MF Schuntermann: Limits of the ICD and approach of the ICF. In: G. Schmid-Ott, S. Wiegand-Grefe, C. Jacobi, G. Paar, R. Meermann, F. Lamprecht (eds.): Rehabilitation in psychosomatics. Schattauer, Stuttgart 2008, pp. 9-20.
  8. ↑ Health Care Ordinance - Introduction by the BMAS . Website of the Federal Ministry of Labor and Social Affairs . Retrieved August 17, 2012.
  9. ↑ Federal Law Gazette . Retrieved December 26, 2018 .
  10. ↑ Y. Heerkens, Y. van der Brug, H. ten Naples, D. van Ravensberg: Past and future use of the ICF (former ICIDH) by nursing and allied health professionals. In: Disability and Rehabilitation. Vol. 25, 11/12/2003 (Jun 3-17), pp. 620-627.
  11. ^ S. Bartholomeyczik, C. Boldt, E. Grill, P. Konig: Development and use of the ICF from the nursing point of view - a position statement of the German speaking working group "ICF and Nursing". In: Pflege Z. Jg. 59, 9/2006 (Sep), p. Suppl 2-7
  12. ^ Arno van Grunsven, Rianne Bindels, Chel Coenen, Ernst de Bel: Developing an Integrated Electronic Nursing Record Based on Standards. In: Stud Health Technol Inform. Vol. 122, 2006, pp. 294-297.
  13. ↑ Christine Boldt, Mirjam Brach, Eva Grill, Anne Berthou, Karin Meister, Monika Scheuringer, Gerold Stucki: The ICF categories identified in nursing interventions administered to neurological patients with post-acute rehabilitation needs. In: Disability and Rehabilitation. Vol. 27, 7/8/2005, pp. 431-436.
  14. ↑ MM Heinen, T. van Achterberg, G. Roodbol, CMA Frederiks: Applying ICF in nursing practice: classifying elements of nursing diagnoses. In: International Council of Nurses . Vol. 52, International Nursing Review / 2005, pp. 304-312.
  15. ↑ MM Heinen, T. van Achterberg, G. Roodbol, CMA Frederiks: Applying ICF in nursing practice: classifying elements of nursing diagnoses. In: International Council of Nurses. Vol. 52, International Nursing Review / 2005, pp. 304-312.
  16. ↑ Stephanie Berno: Validation of the Comprehensive ICF Core Set for Multiple Sclerosis: The perspective of physicians. Dissertation . Ludwig Maximilians University, Munich 2010. (online at: edoc.ub.uni-muenchen.de )
  17. ↑ Andrea Glaessel, Inge Kirchberger, Gerold Stucki, Alarcos Cieza: Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer capture the problems in functioning treated by physiotherapists in women with breast cancer? In: Physiotherapy. Vol. 97, 2011, pp. 33-46.