Nursing Outcomes Classification

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The Nursing Outcomes Classification ( NOC , dt. Care result classification ) is a classification for the description of patient-related results, consisting care actions result. In its classification, the NOC describes the patient's / resident's condition, abilities, behaviors, perceptions and descriptions of experiences (van der Bruggen 2002). The NOC describes neutrally formulated indicators that are rated on a Likert scale with regard to the observed characteristics. Nursing-related indicators of a patient's outcome are understood as the variable state, behavior, or perception of a patient or a person involved in the care process. On the basis of a literature analysis by the research team, the definitions for “care-related patient outcome” and “care-related indicator of a patient outcome” were developed. These are defined as follows:

Nursing-related patient outcome:

“An assessable condition, behavior or perception of a patient or family is conceptualized as a variable that can be traced back to and is essentially influenced by nursing interventions. A care-related patient outcome is on a conceptual level. In order to be assessed, a result requires the identification of a number of specific indicators. Nursing-related patient outcomes define the general patient condition, behavior or perception that result from nursing interventions. "

- Johnson et al. 2005: 62

Nursing-related indicator of a patient outcome:

“A variable specifically related to a care-related patient outcome that can be traced back to a care intervention. An indicator is an observable patient condition, behavior or self-reported perception or evaluation. Nursing-related indicators of a patient result characterize a patient's condition on a specific level ... "

- Johnson et al. 2005: 62

NOC is one of the standardized languages ​​recognized by the American Nurses' Association (ANA). As a recognized language, it meets the language guideline standards ANA Nursing Information and Data Set Evaluation Center (NIDSEC) set for information system houses. NOC is included in the National Library of Medicine Metathesaurus for a Unified Medical Language and in the Cumulative Index to Nursing Literature (CINAHL) and has been approved for the use of Health Level 7 Terminology (HL7).

Stories

In August 1991 , a 17-member development team was formed at the Center for Nursing Classification at The University of Iowa College of Nursing .

The development took place in five phases:

  • Phase I: pilot study to test a method (1992–1993)
  • Phase II: Construction of the nursing results (1993–1996)
  • Phase III: Construction of the taxonomy and field test (1996–1997)
  • Phase IV: Evaluation of the measuring scales (1997-2000)
  • Phase V: Optimization and application (1997 to today)

To develop the taxonomy, the strategies of the cluster method were used, as they were also used in the NIC development. There are 7 areas in the German publication (functional health, physiological health, psychosocial health, knowledge about health and behavior, perceived health, family health, health care situation in a community), 29 classes (A – X), 260 results and per result around 15–30 indicators are formulated. A total of 17 different scales were developed to assess the indicators, all of which are scaled 5. The indicators are assessed on Likert scales. With the NOC formulation “status of the swallowing process”, for example, the evaluation of the indicators on a scale with the evaluation criteria is intended to be extremely endangered, largely endangered, moderately endangered, slightly endangered and not endangered. A rating of '5' is always the best possible result and '1' is always the worst possible result. The classification is continuously revised in order to add new care results or to review old care results based on new research. The innovations are published in a four-year cycle.

In addition, there is currently a lot of work being done to integrate the NOC into an overall system of care classifications, which in turn describe various aspects of the care process. In particular are the NANDA Taxonomy II and the Nursing Interventions Classification (NIC, dt. Care measures classification ) to name. The latter was also launched by the University of Iowa.

Scope and structure

The taxonomy of the Nursing Outcomes Classification is currently in its fifth publication.

It is essentially divided into three levels of abstraction:

  • The top level with seven domains ,
  • the middle level with 33 classes,
  • the lowest level with 490 NOC outcomes.

In addition, each care result was assigned a unique code number so that the NOC can be used in computerized hospital information systems (HIS). It was precisely for this purpose that the NOC was registered with the HL7 .

Each care result consists of:

A total of 26 different scales were developed. Both the indicators and the scales are assigned to the care results and are outside the classification.

The computerized application simplifies statistical evaluations of the nursing effectiveness and quality of nursing activities, and is therefore of interest for nursing research and quality management .

The encryption structure of NOC is explained below using an example: IC0204013 means

Domain Functional Health I.
Cass Mobility (C)
Outcome 0204 Imobility consequences: Physiological
Indicator 01 Pressure sore
Moderate 3

Example of a NOC

The outcome shown below is a translation of the current NOC version

Self-care: Body washing / bathing 0301 (Self-Care: Bathing)

Definition: Personal measures for independent cleaning of the body with or without aids. (Personal actions to cleanse own body independently with or without assistive device.)

indicator Severely impaired Substantially impaired Moderately impaired Medium impaired Not affected
Get in and out of the bathroom 1 2 3 4th 5
Obtains care utensils / washing additives 1 2 3 4th 5
Receives wash water 1 2 3 4th 5
Turn on the water 1 2 3 4th 5
Regulates the water temperature 1 2 3 4th 5
Regulates the water jet 1 2 3 4th 5
Washes at the sink 1 2 3 4th 5
Washes in the bathtub 1 2 3 4th 5
Washes in the shower 1 2 3 4th 5
Washes his face 1 2 3 4th 5
Washes the upper body 1 2 3 4th 5
Wash the lower body 1 2 3 4th 5
Washes the genital area 1 2 3 4th 5
Dries the body 1 2 3 4th 5

Goodness of the NOC

The research team assumes a certain quality of the NOC, since the sources that the NOC relies on in development had to meet quality requirements. Content-related validations were carried out by nursing experts. The nursing professionals were asked to examine the results and indicators to see if they could meet the requirements in their facilities. The experts assessed each nursing outcome with regard to the importance and the relationship to nursing interventions. The evaluation took place on a five-point scale, with weights as suggested by Fehring (5 = 1; 4 = 0.75; 3 = 0.5; 2 = 0.25; 1 = 0). All care results that were rated with a weight of at least 0.6 by the experts have been included in the NOC. With the validation efforts carried out by the NOC so far, it remains unclear whether these care results are specific outcome indicators for care or are subject to other influences. Reliability studies were not found. Likewise, no criterion validity studies or validity studies in a specific setting could be found. There are references in the literature that NOC is used in software, e.g. B.

Web links

literature

  • Marion Johnson, Meridean L. Maas, Sue Moorhead: Nursing Outcome Classification (NOC). Verlag Hans Huber, Bern 2005, ISBN 3-456-83057-2

Individual evidence

  1. ↑ Johnson, M., ML Maas, et al., Eds. (2005). NOC care outcome classification. Bern, Hans Huber publishing house
  2. ↑ Moorhead, S., M. Johnson, et al. (2013). Nursing Outcomes Classification (NOC) Measurement of Health Outcomes. St. Louis, Missoure, Elsevier Mosby Publishing
  3. ^ Johnson, Marion; Meridean L. Maas; Sue Moorhead (ed.): NOC care outcome classification. 1st edition, Bern: Verlag Hans Huber, 2005: 136
  4. ^ Johnson, Marion; Meridean L. Maas; Sue Moorhead (ed.): NOC care outcome classification. 1st edition, Bern: Verlag Hans Huber, 2005
  5. ↑ Moorhead, S., M. Johnson, et al. (2013). Nursing Outcomes Classification (NOC) Measurement of Health Outcomes. St. Louis, Missoure, Elsevier Mosby Publishing
  6. ↑ Moorhead, S., M. Johnson, et al. (2013: 465 and 466). Nursing Outcomes Classification (NOC) Measurement of Health Outcomes. St. Louis, Missoure, Elsevier Mosby Publishing
  7. ↑ Johnson, M., G. Bulechek, et al. (2001: 80). Nursing Diagnoses, Outcomes & Interventions. NANDA, NOC and NIC Linkages. St. Louis, Missouri, Mosby Inc
  8. ↑ Johnson, M., G. Bulechek, et al. (2001: 82) Nursing Diagnoses, Outcomes & Interventions. NANDA, NOC and NIC Linkages. St. Louis, Missouri, Mosby Inc
  9. ^ Prophet, CM, GG Dorr, et al. (1997). "Implementation of Standardized Nursing Languages ​​(NIC, NOC) in On-line Care Planning and Documentation." Studies in health technology and informatics 46: 395-400