Nursing Interventions Classification (NIC) Source Information Authority The Nursing Interventions Classification (NIC) was developed and is maintained by the University of Iowa College of Nursing. Purpose NIC provides a standardized classification system for treatments performed by nurses. Description NIC interventions are grouped hierarchically into 30 classes within seven domains. The seven domains are:1. Behavioral2. Community3. Family4. Health System5. Physiological: Basic6. Physiological: Complex7. Safety Domains, classes, and interventions include definitions. Interventions also include sets of activities to carry out the interventions and references for background reading. Audience NIC is used by health care agencies, nursing education programs, and researchers. Update Frequency NIC is updated irregularly; it was last updated in 2008. Metathesaurus Update Frequency NIC was last updated in the Metathesaurus in 2007. Sites Consulted1. Overview of NIC [Internet]. Iowa City (IA): The University of Iowa; [cited 2010 Feb 4]. Available from: http://www.nursing.uiowa.edu/excellence/nursing_knowledge/clinical_effectiveness/nicove rview.htm 2. NIC is a comprehensive, research-based, standardized classification of interventions that nurses perform. It is useful for clinical documentation, communication of care across settings, integration of data across systems and settings, effectiveness research, productivity measurement, competency evaluation, reimbursement, and curricular design. The Classification includes the interventions that nurses do on behalf of patients, both independent and collaborative interventions, both direct and indirect care. The NIC is a comprehensive listing of nursing interventions that are grouped based on labels that describe nursing activities. It is divided into seven domains and 30 classes. The system was
created to be used in various nursing and healthcare settings. NIC can be used with various other languages. There is a linking mechanism from NIC to the North American Nursing Diagnosis Association (NANDA) nursing diagnosis language. The Nursing Outcomes Classification (NOC) also links with the NIC items. 3. The seven domains are as follows: 1. Physiological: Basic . . . . . . . . . . Supports physical functioning 2. Physiological: Complex . . . . . . . .Supports homeostatic regulation 3. Behavioral . . . . . . . . . . . . . . . . . . .Supports social function and life style changes 4. Safety . . . . . . . . . . . . . . . . . . . . . . Supports protection againts harm 5. Family . . . . . . . . . . . . . . . . . . . . . . Supports the family unit 6. Health System . . . . . . . . . . . . . . . .Supports use of the health care system 7. Community. . . . . . . . . . . . . . . . . . .Supports health of the community 4. The 30 classes are components of the above domains. Each class contains various numbers of interventions. Each intervention has a label name and a set of activities that are identified as steps to carry out the intervetnion. In addition, suggested background readings are listed for further reference. NIC is recognized by the American Nurses Association (ANA) and is included as one data set that will meet the uniform guidelines for information system vendors in the ANAs Nursing Information and Data Set Evaluation Center (NIDSEC).EVALUATIONEvaluation is the final step of the nursing process and will determine whether patient-centered goals are being met. Thus, evaluation is directed at evaluating the outcomes ofcare, not the plan of care or the delivery of care. It is difficult, however, to developevaluation measures for "at risk" nursing diagnoses because it is impossible to measurewhat has been prevented. As a result, nurses often rely on the "absence" of a sign,symptom, or condition to indicate that preventive care has been effective. When writingevaluation goals, be sure to include time frames for evaluation. On the example trackingform, the authors identified 2 patient-centered goals: one showing how to compensate for alow subscale score on mobility and activity, and one on educating the patient and familyabout pressure ulcer prevention (Figure 3). Figure 3. OUTCOMES AND INTERVENTIONS TRACKING TOOLDepending on frequency of change in status, evaluation measures should be conductedevery shift, daily, or more often as a patients condition warrants (Table 6). Wheneverevaluation measures indicate that patient-centered goals are not being met, the preventionplan should be reviewed and/or revised. Alternatively, if the prevention plan appears to besound but the goals still are not being met, then the implementation process needs to beexamined. Revise either the plan of care or implementation of the plan if outcomes are notbeing met. Table 6. TIPS FOR EVALUATION
STRENGTHENING THE PLANNING-IMPLEMENTATION-EVALUATIONCONNECTIONPreserving the connection between planning, implementation, and evaluation can be difficultespecially if the critical elements of the plan have not been written out or when evaluationmeasures have not been developed. We recommend using a tracking sheet, such as the oneshown in Figure 3, to bring together on a single page the patient-centered goals of care,risk-based interventions to achieve goals, and evaluation measures. The tracking sheetshown in Figure 3 makes explicit the logical connections between planning, implementation,and evaluation. Keeping the tracking sheet at the bedside will allow all team members toreadily review the plan as needed, evaluate outcomes during daily care, and make neededrevisions on the spot.CONCLUSIONIn this article, the authors have discussed pressure ulcer prevention within the context ofthe nursing process. Tips on pressure ulcer risk assessment, diagnosis, prevention planning,and evaluation were also provided. Specific recommendations were made to help strengthenthe assessment-diagnosis-planning connection, as well as the planning-implementation-evaluation connection. It is hoped that these tips and recommendations will help nurses feelmore confident and capable when applying the nursing process to the problem of pressureulcer prevention. We all know that the absolute best defense against pressure ulceration is acapable and caring nursing staff that is committed to the patients welfare.REFERENCESIMPLEMENTATIONImplementation is the step of the nursing process where planned nursing care is actuallydelivered to the patient. The nurse implements the plan of care by initiating and completingplanned nursing interventions to achieve patient-centered goals and outcomes. Nursinginterventions may be direct or indirect. Direct care interventions involve a direct interactionbetween the nurse and the patient, such as repositioning the patient. Indirect interventionsoccur when the nurse delegates care to another (eg, delegating turning to a nursingassistant) or consults others (eg, consulting a dietitian) to achieve patient-centered goals.Effective implementation of a pressure ulcer prevention plan is not easy (Table 5). Itrequires, above all else, commitment to the patients welfare as well as perseverance andvigilance. Being strongly committed to patients welfare by protecting them from the painand suffering that comes from having pressure ulcer can help motivate nurses to carefullyimplement their plan of care. Perseverance is another important quality. No one will arguethat repositioning resistive and/or obese patients, cleaning up after frequent bouts ofincontinence, and changing linens on an occupied bed are hard work. It takes a specialstrength of character to persevere in doing these activities repeatedly over the course of an8-, 10-, or 12-hour shift. Vigilance is needed to ensure that the prescribed preventiveinterventions are carried out correctly and in a timely manner. Vigilance is especiallyimportant when it comes to indirect care that is delegated to others. As RNs, it is importantto ensure that the interventions are delegated to qualified staff and are performed asprescribed.
Table 5. TIPS FOR IMPLEMENTING THE PRESSURE ULCER PREVENTION PLANTime is always a barrier to implementation and is sometimes used as an excuse. Because itis impossible to make more time to get things done, one must make good use of the timeavailable. A good way to use time more efficiently is by clustering prevention interventionsand preparing for care. For example, interventions, such as reapplication of barrier creams,padding between bony prominences, and floating heels off the mattress, often can beclustered with regularly scheduled turning of the patient. Then, "prepare for care" by havingskin cleansing products, barrier creams, and protective underpads bundled together andreadily accessible at the bedside.Other strategies that seem to help with implementation include using visual cues and goingpublic with a prevention plan. Visual cues, such as posting a turning clock in the room orleaving a barrier cream visible on the bedside stand, help to remind all team membersabout specific elements of the prevention plan. "Going public" means that the plan of care iscommunicated to all stakeholders including nursing staff, patients, and families. Incommunicating the plan to team members, remember to discuss and agree upon certainexpectations regarding what needs to be done, who will perform specific tasks, and whattasks will be carried out together. Once the family understands the plan of care, they willhold the nurse accountable for the plan. But in most cases, the family is eager to participatein the plan of care. Family members often want to do something to help the patient, butthey do not know what to do or how to do it. Some tasks are completely within theircapabilities. For example, with only minimal instruction, family members can be taught howto use pillows or foam wedges to float the heels off the mattress or reposition the patient offa reddened area of skin.Understand the differences between indirect-care and direct care interventionNursing interventions are actions, based on clinical judgment and nursing knowledge,that nurses perform to achieve client outcomes. Interventions are also referred to asnursing actions, measures, strategies, and activities.A direct-care intervention is one performed through interaction with the client(s).Direct-care activities include physical care, emotional support, and patient teaching.An indirect care intervention is performed away from the client but on behalf of aclient or group of clients. Indirect care activities include advocacy, managing theenvironment, consulting with other members of the healthcare team, and makingreferrals.What is differentiates an independent nursing intervention from other types ofinterventions (health promotion, treatment, and assessment interventions).Nurses work collaboratively with other healthcare providers. Some things you do forpatients will require a physicians order; many will not. Sometimes the activities of careproviders overlap.An independent intervention is one that registered nurses are licensed to prescribe,perform, or delegate based on their knowledge and skills. It does not require aproviders order. Knowing how, when, and why to perform an activity makes the action
autonomous (independent). As a rule, nurses prescribe and perform independentinterventions in response to a nursing diagnosis. Understand you are accountable(answerable) for your decisions and actions with regard to nursing diagnoses andindependent interventions.A dependent intervention is one that is prescribed by a physician or advancedpractice nurse but carried out by the bedside nurse. Dependent interventions are usuallyorders for diagnostic tests, medications, treatments, IV therapy, diet, and activity. Inaddition to carrying out medical orders, you will be responsible for assessing the needfor the order, explaining the activities to the patient, and evaluating the effectivenessof the order.An interdependent (collaborative) intervention is one that is carried out incollaboration with other health team members (e.g., physical therapists, dietitians, andphysicians). Becausenurses care for the whole person, their responsibilities often overlap with those of otherteam members.