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Excerpt
Dr. Vezeau expresses concern that identifying our interventions will promote the substitution of nurses with unlicensed assistants. Yes, having a language will make it easier to know what should be delegated, just as it will make it easier to understand that nurses can assume some tasks performed by physicians. Such substitutions at both the staff nurse and the advanced practitioner levels of practice are going on right now, but without a clear basis for decisions.
Yes, NIC names the treatments nurses give-and it's about time we did so. All professionals should be able to communicate the skills and knowledge they bring to the table in an interdisciplinary team environment. Naming what we can do does not detract from collaboration; it enhances it. A strong team is only as strong as the members of the group. We are not recommending that nursing ignore client outcomes; indeed, following our lead in language development, another Iowa research team will soon publish the Nursing-Sensitive Outcomes Classification (NOC), a system for determining the effectiveness of nursing interventions.
As for documenting care without context, we agree with Dr. Vezeau that teaching differs when a patient does not speak English. In her example,"Teaching: Infant Care" would remain the same conceptually, with additional interventions required by the situation. For example, the nurse might also use "Teaching: Individual" (planning, implementation, and evaluation of a teaching program designed to address a patient's particular needs) or"Culture Brokerage" (bridging, negotiating, or linking the orthodox health care system with a patient and family of a different culture). A medical analogy might be a surgeon performing an appendectomy, who encounters tough skin, scar tissue, or excessive adipose tissue. Although he might vary his technique, the appendectomy is conceptually the same-the surgical removal of the appendix. Just as the surgeon would, the nurse using NIC decides which interventions to use for a particular patient, when to use them, and how to tailor them to fit that patient's needs.
Recent changes in our health care system, including health care reform, computerized records, and the ever-evolving role of the nurse, all require standard classifications for documenting care. With NIC, we are identifying what nurses have to offer-no more, no less.
