Nursing is entering a challenging new era - one that encourages gerontological and other nurses to adopt a standardized terminology to describe the interventions they perform with elderly clients. This taxonomy of nursing interventions, known as "NIC" (for Nursing Interventions Classification), is the outgrowth of years of collaborative work by a team of scholars and clinicians headed by Joanne C. McCloskey, PhD, RN, FAAN, and Gloria Bulechek, PhD, RN, at the University of Iowa College of Nursing.
The taxonomy is comprised of 3 levels. Level 1 (Domains) is the most abstract level and includes physiological (basic and complex), behavioral, family, health system, and safety. Level 2 (Classes) contains 26 groups or classes of related interventions, such as immobility management, patient education, family care, and nutrition support. Level 3 (Interventions) is the most concrete level of the taxonomy, from which gerontological nurses and others can select interventions for individual patients (McCloskey & Bulechek, 1992).
Each intervention comes with a definition, a set of activities that define exactly what it is that nurses do to carry out the intervention, and background readings. For example, in the "behavioral" domain, under the "cognitive therapy" class, nine interventions designed to reinforce or promote desirable cognitive functioning (or alter undesirable cognitive functioning) are listed. These include such interventions as reminiscence, anger control, reality orientation, cognitive restructuring, and cognitive stimulation. A comprehensive list of nursing activities accompanies each intervention.
Gerontological nurses are urged to become familiar with this new taxonomy of interventions, to have dialogue with its developers, and to participate in the refinement and expansion of the classification system by submitting new interventions for consideration. For example, Jeanette Daly, Director of Nursing at Oaknoll Retirement Center, recently proposed several additions to NIC based on her long-term care experiences. These involve interventions such as "Rectal Prolapse Management" and "Unilateral Neglect Management" that, after consultation and review by NIC team members, were accepted for inclusion in the taxonomy. Other interventions Dr. Daly suggested, including "Validation Therapy," "Smoking Precautions," and "Pass Facilitation," are in the NIC team's development stage.
Gerontological nurses who are interested in providing taxonomy feedback (eg, additions and modifications) or submitting potential geriatric nursing interventions should first familiarize themselves with NIC and the 336 intervention labels developed to date. After making sure that proposed interventions differ from those already in the taxonomy, the nurse should follow the feedback process outlined in Nursing Interventions Classification (NIC) (1992). Gerontological nurses can also become involved in this classification effort in a variety of other ways. Use of the interventions will help to determine the completeness, necessity and criticalness of each activity by determining for whom the intervention is effective, what resources it takes, and what outcomes it produces. Also, nurses can implement a computerized care planning and documentation system using the interventions and then report on the training required for success.
The standardized intervention terminology proposed by NIC is a timely and important step in enabling nursing to become an integral part of national and international data bases that drive reimbursement mechanisms, and to assist in communication with colleagues in other disciplines. Further, the development and refinement of an interventions classification system is a necessary step in translating nursing knowledge into expert clinical decision making. Let's make sure the interventions used by gerontological nurses are a visible and significant part of this new taxonomy!
- Iowa Intervention Project. In McCloskey, J.C., Bulechek, G.M. (Eds.). Nursing interventions classification (NIC). St Louis: Mosby Year-Book, 1992.