Toward a National Health Information Infrastructure: A Key Strategy for Improving Quality in Long-Term Care. ICNP

The International Council of Nurses developed the International Classification of Nursing Practice (ICNP) as a way to facilitate the cross mapping of terms and existing nursing vocabularies and classifications such as those recognized by the American Nurses Association ( The ICNP was included in this study because of its focus on nursing care, an emphasis clearly related to the issue of quality in nursing homes.

Structurally, the ICNP exists as two multiaxial systems.13 At the highest level are the three classes of phenomena, actions, and outcomes. The axes associated with the phenomena class are focus, judgment, frequency, duration, topology, body site, likelihood, and bearer. By combining terms from these axes, statements can be composed that reflect the aspect of health (or problem/diagnosis) that is relevant to the nursing care provided. The outcomes class is a serial measure of these same phenomena statements, i.e. outcomes representing changes in phenomena over time. The actions class includes the axes of action type, target, means, time, topology, location, routes, and beneficiary. In a similar fashion, the goal is to compose statements that reflect actions taken by nurses in response to the problem/diagnosis statements composed. As a result of this structure, the ICNP could potentially support aggregation into higher-level categories for summarization, review, research, or administration. However as with ICF, there is no formal logic system by which to accomplish this. As an example, "1A." refers to a nursing focus of "walking," and a judgment of "1B.7.1.3" refers to "compromised to a high degree." A more complex expression can be post-coordinated by combining "walking" and "compromised to a high degree."

Across the multiple axes of the ICNP there is a somewhat uneven granularity of concepts. Most problematic from a computational perspective is that while some classes have clear hierarchical relationships among the terms in the axes, terms in other classes are arranged alphabetically. This is not problematic for human reading, but does create challenges for machine processing of the system. The ICNP is distributed as a book or CD, and a browser is available free of charge on the Web ( Spreadsheets containing the ICNP axes were made available by the ICNP for this study.

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