Use of NANDA,NIC,and NOC as a Framework for Cyclic Perimenstrual Pain and Discomfort

BACKGROUND

Since its formation in 1969, the Association of Women's Health and Obstetric and Neonatal Nursing (AWHONN) has strongly promoted excellence in nursing practice. This commitment to excellence is demonstrated by AWHONN's Research-Based Practice Project. This program involves gathering research and studies performed in a particular area and developing and testing an evidence-based guideline that can be readily incorporated into the nurse's daily practice.

The organizing framework of standardized nursing language using the specific standardized nursing languages of NANDA, NIC, and NOC (NNN) was added in this fifth AWHONN Research-Based Project, “Cyclic Perimenstrual Pain and Discomfort (CPPD).” Based on the literature, evidence, and science, an assessment and data collection process was developed and tested in five sites with a final sample of 230 subjects.

MAIN CONTENT POINTS

No other national guideline work using an evidence-based approach has integrated NNN into the structure and documentation of a clinical practice guideline. The decision to incorporate NNN as the project's framework was based on a good fit between the goals of the project and the usefulness of standardized nursing language. The project goals were to (a) identify the problem with a “quick screen” tool, (b) provide assessment strategy to determine parameters of pain and symptoms, (c) implement a nursing plan of care or referral, and (d) evaluate the intervention for effectiveness.

Benefits of using standardized nursing language include (a) use of a common language for nursing practice by basic and advanced RNs in all settings, (b) complete and consistent documentation, (c) streamlined paper system using SNL with user satisfaction as a necessary precursor to a viable computerized paper record, and (d) potential for costing of nursing care and reimbursement for nursing services using standardized documentation and cross mapping with major clinical databases and reimbursement codes.

The evidence-based documentation forms and aids for assessment, diagnosis, expected outcomes, planned and actual interventions, and evaluation of actual outcomes were developed with the assistance of clinical site coordinators and tested in practice. Labels and definitions of NICs and NOCs were not changed. NIC activities were referred to in the forms as “Intervention Activities for Cyclic Perimenstrual Pain and Symptoms.” The final practice guideline is available for purchase at http://www.AWHONN.org.

CONCLUSIONS

The NNN framework as an organizing structure was evaluated favorably for usefulness. CPPD was found to be a very complex health problem with many variables requiring sound assessment and individualized planning. The most important implication for practice is the need for computerized charting integrated into the flow of the practice setting to properly implement the use of the evidence-based practice forms.