ICNP - International Classification for Nursing Practice

ICNP®
INTERNATIONAL CLASSIFICATION FOR NURSING PRACTICE

Rossano C. Martinez Jr., R.N.
MI224 - Coding, Classification and Terminology in Medicine
Master of Science in Health Informatics (Medical Informatics)
College of Medicine – Medical Informatics Unit
University of the Philippines – Manila

• The ICNP® is a unified nursing language
system.

• It is a compositional terminology for
nursing practice that facilitates the
development of and the cross-mapping
among local terms and existing
terminologies.

ICNP®

The objectives of the ICNP, as set out in the initial ICN
publication, are:

1) to establish a common language for describing nursing
practice in order to improve communication among nurses and
between nurses and others;
2) to describe the nursing care of people (individuals, families,
and communities) in a variety of settings, both institutional and
non-institutional;
3) to enable comparison of nursing data across clinical
populations, settings, geographic areas, and time;
4) to demonstrate or project trends in the provision of nursing
treatments and care and the allocation of resources to patients
according to their needs based on nursing diagnoses;
5) to stimulate nursing research through links to data available in
nursing information systems and health information systems; and
6) to provide data about nursing practice in order to influence
health policy making.

ICNP®

VISION & GOALS OF ICNP®

VISION

• ICNP® is an integral part of the global information
infrastructure informing health care practice and policy to
improve patient care worldwide.

STRATEGIC GOALS

• Serve as a major force to articulate nursing’s contribution to
health and health care globally.
• Promote harmonization with other widely used classifications
and the work of standardization groups in health and nursing.

ICNP®

ICNP® makes a significant contribution to the
acquisition of data about health care delivery. As a
standardized terminology, ICNP® can generate
reliable and valid data about the work of nursing.

As a unifying framework, ICNP® can also map with
other terminologies to expand data sets for retrieval
and analysis.

Patient or client care outcomes can be examined in
relation to nursing diagnoses and nursing
interventions so that what nurses do and what makes
a difference in patient or client outcomes can be
quantitatively evaluated and compared across
points of care worldwide.

ICNP®

ICNP® Timeline
1989 - ICN Resolution for ICNP
1990 - ICNP Development Team
1993 - ICNP Working Paper
1995 - ICNP Alpha Version
1999 - ICNP Beta Version
2000 - ICNP Evaluation Committee & Review
2001 - ICNP Beta 2 Version
2005 - ICNP Version 1
2008 - ICNP Version 1.1 released with new Browser
- became a member of the WHO Family of International
Classifications
2009 - ICNP Version 2 launched at 24th Quadrennial ICN Congress,
Durban, South Africa
2011 - Version 2011 Released (Released date: 05/06/2011)

ICNP®

ICNP® Worldwide Participation
•National Nurses´ Associations
•ICNP Committees
•ICNP Reviewers
•Translators & Researchers
•Informatics Experts (IMIA-NI; ISO)
•ICNP Centers
•Governments/Software Vendors/Terminology Developers etc.

ICNP®

ICNP® ELEMENTS

• Nursing phenomena (nursing diagnoses)
• Nursing actions
• Nursing outcomes

ICNP®

Alpha Version (1995)

The initial alpha version of ICNP was organized into
three components:

Human Needs - included nursing problems, patient
problems, nursing factors and nursing phenomena.

What Nurses Do - included nursing interventions,
actions, and treatments.

Outcomes - included nursing outcomes and nursing-
sensitive patient outcomes.

ICNP®

The alpha version of ICNP® comprised:

1. Nursing Phenomena - arranged as a hierarchy:
A. Human being (functions and person)
B. Environment (human and nature).

2. Nursing Interventions - were organized along
multiple axes:
A. Action types
B. Objects
C. Approaches
D. Means
E. Body
F. Time/Place.

The developers noted that nursing outcomes would be
included with next version of ICNP.

ICNP®

Beta and Beta 2 Versions (1999, 2001)
The Beta version expanded on the use of a multi-axial approach. Two multi-
axial models were proposed:

1. 8-Axis Model for Nursing Phenomena
a. Nursing Practice
b. Judgement
c. Frequency
d. Duration
e. Topology
f. Body Site
g. Likelihood
h. Bearer

2. 8-Axis Model for Nursing Actions.
a. Action Type
b. Target
c. Means
d. Time
e. Topology
f. Location
g. Routes
h. Beneficiary

ICNP®

Beta 2 Versions

Definition for Nursing diagnosis, outcome
and action were developed, as were
guidelines for composing a nursing
diagnosis, nursing outcome and nursing
intervention using multi-axial models.

ICNP®

Nursing Phenomenon: aspect of health of relevance to
nursing practice.

Nursing diagnosis: label given by a nurse to the decision
about a phenomenon which is the focus of nursing
interventions. A nursing diagnosis is composed of concepts
contained in the Classification of Phenomenon axes.

Nursing Outcomes: the measure or status of a nursing
diagnosis at points of time after a nursing intervention.

Nursing Action: behavior of nurses in practice.

Nursing intervention: action taken in response to a nursing
diagnosis in order to produce a nursing a nursing outcome. A
nursing intervention is composed of concepts contained in
the Classification of Action axes.

ICNP®

While 'nursing phenomenon' was defined in
the beta versions, the transition from the
label 'phenomenon' to the label 'diagnosis'
was made during the development of the
beta versions. Similarly, nursing action was
defined but there was a transition from the
label 'action' to the label 'intervention' in
the beta versions.

ICNP®

ICNP®

Version 1.0 (2005)

Version 1.0 was developed using a representation language with
formal modeling rules (Web Ontology Language (OWL)). This
allowed automated reasoning to be applied to the terminology
to ensure consistency and accuracy of concepts.

The International organization for Standardization (ISO)
Technical Specification 17117 stipulated structural attributes for
terminologies that ICNP developers were determined to follow
(ISO 2002)

The structural attributes included concept-orientation, non-
redundancy, non-ambiguity, and non-vagueness and internal
consistency. The terminology would need to have context free
and unique identifiers, concept descriptions and established
processes for version control.

ICNP®

ICNP® 7-Axis Model
The development of version 1.0 allowed a
transition from the 8-axis classifications of
beta 2 to one 7-axis model.

The new structure greatly simplified the
representation and it resolved to a large
extent the redundancy and ambiguity
inherent in beta 2.

ICNP®

The axes are defined as follows:

Focus: The area of attention that is relevant to nursing (e.g., pain,
homelessness, elimination, life expectancy, knowledge).

Judgement: Clinical opinion or determination related to the focus of nursing
practice (e.g., decreasing level, risk, enhanced, interrupted, abnormal).

Client: Subject to which a diagnosis refers and who is the recipient of an
intervention (e.g., newborn, caregiver, family, community).

Action: An intentional process applied to or performed by a client (e.g.,
educating, changing, administering, monitoring).

Means: A manner or method of accomplishing an intervention (e.g., bandage,
bladder-training technique, nutritionist service).

Location: Anatomical and spatial orientation of a diagnosis or intervention (e.g.,
posterior, abdomen, school, community health centre).

Time: The point, period, instance, interval or duration of an occurrence (e.g.,
admission, child birth, chronic).

ICNP®

Semi-formal Foundation
(ICNP beta 2 examples)

Redundancy
– 2B.2.1.2.2.1 Dressing (Target)
– 2C.1.2.1 Wound Dressing (Means)

ICNP®

Semi-formal Foundation

Ambiguity
- 2A.3.4.2 Dressing (Action Type)
- 2B.2.1.2.2.1 Dressing (Target)

ICNP®

Semi-formal foundation

Context-laden Identifiers
- 1A.1.1.2.2.1.1.8.9 Ambulation
- 1A.1.1.2.2.1.1.8.9.2 Walking
- 1.A.1.1.2.2.1.1.8.9.2.1 Walking using device

ICNP®

Formal Foundation of Version 1.0
• Non-redundancy
– 10021227 Wound dressing
• Non-ambiguity
– 10016199 Putting on clothes
– 10021227 Wound dressing
• Context-free Identifiers
– 10012120 Mobilizing
– 10020886 Walking
– 10020903 Walking using device

ICNP®

Formal Model Advantages:

•Amenable to computer processing
•Eliminates redundancy, ambiguity in the
terminology
•Reduces context-laden identifiers
•Adds reliability to a combinatorial
terminology

ICNP®

ICNP® Version 1.0, 7-Axis Model, and Catalogues

ICNP developers recognized that nurses
using the classification at the point of care
needed more easily used resources for
clinically relevant, applicable diagnoses,
interventions and client outcomes.

ICNP catalogues were envisioned as subsets
of the classification.

ICNP®

ICNP® Version 1.1

Was released in mid-2008 and included new
concepts; a new, more user-friendly
browser; and the first catalogue of ICNP
pre-coordinated statements. Three hundred
and seventy-six (376) new concepts were
added to this version.

ICNP®

ICNP® Version 2
More than 400 new entities were added to
version 2. Many concepts were diagnosis
and intervention statements developed for
ICNP catalogues.

Distribution Formats for ICNP® Version 2
• OWL Representation
• 7-Axis Model
• ICNP Catalogues

ICNP®

ICNP® C-Space
(http://icnp.clinicaltemplates.org)

A new web based collaborative ICNP workspace, ICNP C-Space,
will be available with the release of Version 2.

Will be used initially for ICNP Catalogue and mapping projects.

ICNP® Browser - provides user and others who are interested in
ICNP options to browse and search the terminology.

Browser and BaT Tool
(http://docu.icnp-bat.de/doku.php)

A software tool that assists distributive work by translation teams
via internet.

ICNP®

ICNP® Version 2011

Version 2011 was released on May 06, 2011.

The 2011 release moves ICNP® forward with
the addition of new content, including many
new pre-coordinated nursing diagnosis,
intervention, and outcome statements.

ICNP®

The ICNP® Programme is organized in three
major areas, all attended to support the
vision of ICNP.

 Research & Development
– ICN-Accredited ICNP® Research and Development Centres
– ICNP® Catalogues
– ICNP® Translations
 Maintenance and Operations
 Dissemination and Education

ICNP®

ICNP® TRANSLATIONS

Translations are essential for implementing
ICNP® in practice. The translations are
usually accomplished on a voluntary basis by
nurses in cooperation with the National
Nursing Association.

ICNP®

ICNP® Maintenance and Operations

ICNP® is released every two years, to
coincide with the ICN Congress or
Conference.

ICNP®

PERMISSION TO USE ICNP®

ICNP® is owned and copyrighted by the International
Council of Nurses (ICN). ICN is interested in
facilitating access to ICNP® and promoting its use.

 Any use of ICNP®, be it commercial or not, requires
the signing of an agreement authorizing such use.
ICN is interested in protecting its copyright of
ICNP®. All those wanting to use ICNP® for any
purpose need permission from ICN.

ICNP®

ICN (International Council of Nurses) is currently developing
new tools and techniques for browsing and downloading
ICNP, as an alternative to the prototype platform C-Space.
These tools and techniques will support the 2013 release of
ICNP (Spring 2013).

ICNP®

References:
• http://www.icn.ch/pillarsprograms/international-classification-for-nursing-practice-icnpr/
• http://bioportal.bioontology.org/
• http://bioportal.bioontology.org/ontologies/1401
• http://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/ICNP/index.html
• http://www.who.int/classifications/icd/adaptations/icnp/en/index.html
• http://icnp.clinicaltemplates.org/icnp/v3_0/
• http://moodle.stoa.usp.br/file.php/863/2010_ICNP_Version_2001.pdf
• http://docu.icnp-bat.de/doku.php

ICNP®

Thank You!

ICNP®

ICNP - International Classification for Nursing Practice

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