The Usage Nursing Classification of NIC in the Intensive Care

Background: Implementation of the International Classification of NIC in conditions intensive care in the Czech Republic. Aim: e aim of this enquiry was the choice of interventions NIC of the classification system, which are marked by nurses as usable minimaxy once a week in the clinical practice of intensive care. is contribution maps the posibility of the usage of chosen interventions of classification system Nursing Interventions Classification NIC, which will be used for the future implementation in the intensive care sector. e aim of this enquiry was the choice of interventions NIC of the classification system, which are marked by nurses as usable minimaxy once a week in the clinical practice of intensive care. Methods: Reaches the specific interventions NIC 75% threshold for counting records in the category of daily and weekly care has been identified as an intervention NIC, which is applicable at least once a week in clinical care intensive care environment. e quantitative analysis of 386 records with 184 interventions NIC in the clinical practice, by 12 health service proveders in the Czech Republic. Pearson‘ s chi quadrat (p ≤ 0,05) was used for the statistic comparison of the data from the individual clinical workplaces. Results: By the quantitative analysis was confirmed 46 interventions NIC of Classification system which possible usage in clinical intensive care minimally once a week in the CR. In comparison with the data distribution at individual clinical workplaces, there were not found any significant differences in minimal weekly usage indication at 14 NIC intervention of the classification system. ere were found some differences in usage marking in 32 interventions NIC classification system by nurses at some workplaces. Higher frequency of presence was recorded by Anesthesiologic Resuscitation ward nurses. Conclusions: Analysis from 184 intervention NIC confirms the possibility 46 of serviceability of classification system NIC in our country. ere are interventions, which usage in clinical care workplaces Anesthesiologic Resuscitation ward, Intensive Care Unit surgery minimally once a week. ese interventions NIC undergo expert validation.


INTRODUCTION
On the international scale, there are standard terminologies in the field of nursing diagnostics NANDA-I, nursing interventions (NIC) and nursing results (NOC) oen cited in nursing.(6), including 554 NIC interventions.Nursing intervention is defined as any intervention that the nurse performed based on her own judgment and knowledge, aimed at improving the outcome of patient's health condition.It includes basic intervention usable in any healthcare sector, providing important information for care development and planning (1).Interconnection of standard language in the field of nursing interventions and nursing outcomes with selected clinical diagnoses is its main advantage.An example is the nursing outcomes, main and supporting (supplementary) nursing interventions in the clinical diagnosis of Diabetes Mellitus (7), which correspond to a content location of standard NOC and NIC classifications.Documentation of used interventions should allow monitoring and comparing the rate of use of specific interventions on specific workplace, as well as documentation of nursing diagnoses, and simultaneous monitoring of interventions that work best for a particular nursing diagnosis in clinical practice (6).English is an original language of the NIC classification system.NIC classification is translated into several languages (for instance French, German, Japanese, Chinese, Korean, Spanish, and Portuguese).Individual editions are available in the original language.e use of standardized language of NIC Classification in the Czech Republic will require negotiation of conditions for copyright licensing, comprehensive translation of interventions, its verification and validation of application possibilities in terms of clinical practice.

OBJECTIVE OF WORK
Identification of NIC interventions of the classification system (1), identified by the nurses as applicable in clinical practice of intensive care at least once a week.

SUBJECTS
e target group consisted of nurses who were asked to fill in the recording sheets with a range of translated NIC interventions (1).e condition was that these nurses worked in an environment where a specialized intensive nursing care was provided.Minimum size of set to fulfil the criteria of the project was 200 completed record sheets.12 hospitals were finally selected to complete them (7 faculty hospitals and 5 others).Selection of workplaces corresponded to the criteria of the project again (facility with more than 500 beds and inclusion of department of anaesthesiology and resuscitation inpatient clinical workplace and internal and surgical intensive care unit in particular healthcare provider

METHODOLOGY
is survey is part of a larger study.Participating subjects were asked for a written consent to implementation of the investigation procedure.Cover letter, which was distributed to the nursing management of selected facilities throughout the Czech Republic, contained a brief description of the project, a urpose of the survey of standard NIC terminology, criteria and model requirements for filling out the record sheets and the attached questionnaire.Written consent of nursing management, at the level of deputy chief nursing care or nurse, was a prerequisite for participating in the survey.Further communication proceeded by mail, via the managers of nursing care, who delegated the ward nurses to pass the record sheets and questionnaires at clinical workplace of department of anaesthesiology and resuscitation and ICU.General nurses of these workplaces were asked to record how oen they would use the presented interventions of NIC classification system.Investigation did not undergo prior approval by the ethics committee.General nurses marked into the recording sheet the interventions, which they would use: daily, at least once a week, once a month or occasionally in clinical intensive nursing care.Entries in categories daily and at least once a week were subsequently summed up.If a particular NIC intervention reached 75% limit of records in these categories, it was identified as a labelled NIC intervention, applicable at least once a week in clinical care of intensive care environment in the investigated group.Record sheet, as well as the procedure for selection of intervention with limit of 75% of labelled records, was based on the previous Iowa Intervention Project (3).is is intended to help the general nurses for determining the frequency of nursing intervention in practice.Record sheet of interventions was firstly verified in terms of clarity of the requirements for its completion.e participants had a compulsory choice to mark the possibility of using specific intervention.e analysis of quantitative and descriptive data was held by the Statistika Data Miner Cz statistical program, version 12. Pearson's chi-square was used for statistical comparison of records in the labelling of interventions at individual clinical workplaces for the 5% significance level (p ≤ 0.05).   1 shows an overview, including a dra translation of the title of NIC interventions into Czech.When comparing workplaces providing intensive care department of anaesthesiology and resuscitation, internal and surgical intensive care units, no significant differences were found among the 14 of NIC interventions records (Table 2).Table 3 shows significant differences in distribution of records on application of NIC interventions in the clinical environment at individual workplaces.32 interventions confirms the difference of records.General nurses from department of anaesthesiology and resuscitation labelled these NIC interventions in the recording sheet more oen as usable at least once a week in their care.138 of NIC interventions did not achieve the 75% frequency; therefore, they were not identified as applicable in clinical care in the monitored group at least once a week and were excluded from the following phase of investigation.

DISCUSSION
is survey identified 46 NIC interventions (1), identified by the general nurses as useful in clinical practice of intensive care of reference group at least once a week.e results highlighted the diversity of labelling of NIC interventions application among clinical departments of anaesthesiology and resuscitation and ICU.Sector for providing intensive nursing care at anaesthesiology and resuscitation and ICU workplaces is considerably extensive in the Czech Republic.Especially ICU workplaces may differ in the level and narrow specialization of providing care.However, the use of interventions of the classification system does not have to correspond to the competencies of care in our area.It is important to note the lack of studies carried out in an intensive care settings in our country, but also internationally and we suggest the need for further investigation in order to deepen understanding of the issue.e very translation from one language to another can create problems in the context of understanding the significance.Language developed in one culture cannot be automatically used in a different environment.oroddsen highlights the semantic equivalence of content and conceptual equivalence of a standardized language (8).Record sheet of our investigation included only independent Czech translations titles and definitions of included NIC interventions, not the individual activities/operations of particular interventions (because of the length of the text).We demonstrate an example of controlled independent translation into Czech, which may affect the assessment of an opinion on the frequency of use of the intervention, on the intervention 3350 Respiratory Monitoring.is was translated as Sledování dýchání.
In terms of content equivalence, monitoring →action of monitoring →verb to monitor → to record, to capture, to watch and record, to control (9).Term monitoring as an action is commonly used in the Czech specialized texts (10).NIC interventions in classes are listed alphabetically in each edition, which our presented translation Czech version does not allow, and therefore the clinical nurses may have problems with the content orientation.Authors Marečková and Tománková (11) promote the introduction of numerical codes of original versions the essential components of NANDA-I diagnostics of standard terminology.NIC classification system belongs to the standard terminology and it is necessary to accept the idea of numerical codes.erefore, also our investigation strictly respected the identification of the NIC interventions with the original numerical code.Cross-sectional study from Lucena (12) collects the data about nursing care at ICU from a computer database (a set of 991 hospitalized patients).Even this team of authors highlights the lack of studies in the intensive care settings.Cross mapping of the referred Brazilian study identifies 57 NIC interventions applicable in intensive care environment in the philosophy of a set standard taxonomy structure.Interventions were compared to documented clinical interventions at intensive care unit in relation to the category of nursing diagnostics (for instance risk of infection, inefficient breathing, and self-care deficit).e study has verified that most interventions were recorded as applicable in respect to taxonomic structure of NIC, at the level of basic physiological domain, and complex physiological domain.Defining of these domains is focused on the fundamental issues of impaired homeostatic regulation.Profile of critically hospitalized patients in intensive care is confirmed by findings of 10 NIC interventions in complex physiological domain, K class -Respiratory Management (1), that are associated with impaired respiratory function.e second highest number of similar conformity, as in our survey, was recorded at 9 NIC interventions in basic domain, in F class -Self Care Facilitation (1), relating to the essential basic nursing care, allowing saturation of daily needs and support of comfort.Interventions, which correspond to the type of specialized intensive nursing care, predominate in these domains.However, this published study lacks the numeric codes of described interventions and nursing diagnoses of standard terminology to verify a specific comparison of our survey.Authors in the investigation that involves acute air transports in connection with acute intensive care (13) confirm the usefulness of nomenclature of NIC taxonomy.ere were 1435 nursing interventions identified based on documented records during air transports.e authors state that 90% of them could be classified according to NIC taxonomic classification structure.Records during air transport also contained in particular interventions from basic physiological domain (9%), further interventions from the complex physiological domain (71%) and the domain of safety (16%).We noticed most NIC interventions in the physiological complex domain and basic physiological domain in our investigation as well.No record has not been identified in the domain relating to family (the same as in our investigation).e authors suggest that interventions in this domain are less typical in care for patient during air transport.Intravenous therapy has been confirmed as the most frequently recorded intervention in air transportation.In our survey, intervention 4200 Intravenous erapy was recorded by general nurses in 96%, as an applicable intervention within the minimal care once a week.Our investigation result of NIC intervention 2314, translated as Medication Administration: Intravenous, can be included in similar result.e authors of the article, unlike our investigation, followed the second edition of NIC (3), used the original English language and point out that this edition still does not reflect the advanced level of clinical practice with respect to the level of the internal structure of the NIC taxonomy.An example is, according to them, the NIC intervention Airway Suctioning 3160 (Physiological complex domain, K class), which is defined as an intervention.However, removal of secretion with support of coughing and suctioning of the airways is classified as an activity/action, given as part of the NIC intervention Airway Management 3140 (Physiological complex domain, K class).Detailed analyses of the so-called life-threatening interventions (for instance the already mentioned NIC intervention 3140 Airway Management), appear in the proposals for interventions, relating only to intensive care (14).e author is engaged in activities, which are rather perceived as interventions in a life-threatening situation, and suggests specification of the so-called critical interventions in standard terminologies.Partial steps for implementation of the standard terminology, specifically of the NIC classification into clinical practice, are described also in the default literary source, the original edition of NIC (1).Relevant survey to compare the results on the applicability of standard terminology of intensive care in our country is still at a lower level.Dolák (15) Team of McCloskey and Bulechek created the key textbook of nursing interventions in the mid-80s, which can be considered the beginning of the research process on the project of University of Iowa with the aim of standardization of nursing interventions.Noticeable development of standard terminology of nursing in-terventions is described in various editions of Nursing Interventions Classification (NIC): McCloskey & Bulechek (2), including 336 NIC interventions; McCloskey & Bulechek (3), including 433 NIC interventions; McCloskey & Bulechek (4), including 486 NIC interventions; Dochterman & Bulechek (5), including 514 NIC interventions; Bulechek & Butcher (1), including 542 NIC interventions; Bulechek & Butcher verified the classification of NIC and the expected results of the NOC classification in patients of intensive care, with nursing diagnosis 00032 Ineffective Breathing Pattern.He focused on activities/ actions of interventions 3350, 3390 and 3230 from the NIC classification system.A set for verification consisted of 20 general nurses, who met the modified criteria of an expert(16).e study used Fehring's DCV model.e results of the study showed that the nurses identified only 62 activities as important for use from a total of 158 activities/actions mentioned by NIC interventions.e author encourages further testing in clinical practice in the Czech Republic.Verifying of application of NIC interventions in home care (17) highlights the differences between real interventions and activities recorded in the nursing plan.Naming of nursing interventions by nurses of home care agency failed to reflect the terminology of NIC classification.is observation points to continuously low level of awareness of Czech clinical care nurses about the standard terminology (18).CONCLUSION ere were 46 of NIC interventions identified from the 184 interventions of NIC classification system (1), selected for the purpose of this investigation, identified by the general nurses as applicable in clinical practice in intensive care at least once a week.ese identified NIC interventions are designed for a validation expert evaluation, including incorporated independently compiled activities/actions.e results revealed differences of perception of designation of NIC interventions application among clinical anaesthesiology and resuscitation and ICU workplaces in the reference group.Sector for providing intensive nursing care at anaesthesiology and resuscitation and ICU workplaces is considerably extensive in the Czech Republic.Especially ICU workplaces differ by level of providing care and their narrow specialization.is allows affecting the designation of use of possible interventions, which may not correspond to the competencies of care in our country.Further detailed analysis of survey results of the project of Implementing of NIC interventions for surgical and anaesthesiology and resuscitation workplaces at inpatient facilities in Czech Republic are published gradually.ETHICAL ASPECTS AND CONFLICT OF INTEREST e survey was conducted as part of the research project and approved by Faculty of Medicine MU Brno.e authors declare that the research has no conflict of interest.is research survey yielded partial results of the project IGA MZČR NF 12078-4/2011, which supports the implementation of NIC classification system in surgical and anaesthesiology and resuscitation nursing care in clinical practice conditions of the Czech Republic.
). e analysed group consisted of 386 recording forms with NIC interventions.Complete record sheet contained 184 NIC interventions (1) with a numeric code, translated Czech title and definition (see translation and selection of NIC interventions of the classification system).

Table 1
(1)ected NIC interventions in the record sheet, including the proposed Czech translation of the title.(1)

NIC class NIC code NIC intervention NIC intervention translation n% 1. PHYSIOLOGICAL: BASIC DOMAIN
Legend: n = absolute frequency; n% = relative frequency

Table 2
e NIC interventions with recording higher than 75% at clinical workplaces Tabulka 3 e NIC interventions with recording higher than 75% at clinical workplaces