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1. Nursing Interventions Classification (NIC) Source Information
Authority
The Nursing Interventions Classification (NIC) was developed and is maintained by the
University of Iowa College of Nursing.
Purpose
NIC provides a standardized classification system for treatments performed by nurses.
Description
NIC interventions are grouped hierarchically into 30 classes within seven domains. The
seven domains are:
1. Behavioral
2. Community
3. Family
4. Health System
5. Physiological: Basic
6. Physiological: Complex
7. Safety
Domains, classes, and interventions include definitions. Interventions also include sets of
activities to carry out the interventions and references for background reading.
Audience
NIC is used by health care agencies, nursing education programs, and researchers.
Update Frequency
NIC is updated irregularly; it was last updated in 2008.
Metathesaurus Update Frequency
NIC was last updated in the Metathesaurus in 2007.
Sites Consulted
1. Overview of NIC [Internet]. Iowa City (IA): The University of Iowa; [cited 2010 Feb 4].
Available from:
http://www.nursing.uiowa.edu/excellence/nursing_knowledge/clinical_effectiveness/nicove
rview.htm
2. NIC is a comprehensive, research-based, standardized classification of interventions that nurses
perform. It is useful for clinical documentation, communication of care across settings, integration
of data across systems and settings, effectiveness research, productivity measurement,
competency evaluation, reimbursement, and curricular design. The Classification includes the
interventions that nurses do on behalf of patients, both independent and collaborative
interventions, both direct and indirect care.
The NIC is a comprehensive listing of nursing interventions that are grouped based on labels that
describe nursing activities. It is divided into seven domains and 30 classes. The system was

2. created to be used in various nursing and healthcare settings. NIC can be used with various
other languages. There is a linking mechanism from NIC to the North American Nursing
Diagnosis Association (NANDA) nursing diagnosis language. The Nursing Outcomes
Classification (NOC) also links with the NIC items.
3. The seven domains are as follows:
1. Physiological: Basic . . . . . . . . . . Supports physical functioning
2. Physiological: Complex . . . . . . . .Supports homeostatic regulation
3. Behavioral . . . . . . . . . . . . . . . . . . .Supports social function and life style changes
4. Safety . . . . . . . . . . . . . . . . . . . . . . Supports protection againts harm
5. Family . . . . . . . . . . . . . . . . . . . . . . Supports the family unit
6. Health System . . . . . . . . . . . . . . . .Supports use of the health care system
7. Community. . . . . . . . . . . . . . . . . . .Supports health of the community
4. The 30 classes are components of the above domains. Each class contains various numbers of
interventions. Each intervention has a label name and a set of activities that are identified as
steps to carry out the intervetnion. In addition, suggested background readings are listed for
further reference.
NIC is recognized by the American Nurses' Association (ANA) and is included as one data set
that will meet the uniform guidelines for information system vendors in the ANA's Nursing
Information and Data Set Evaluation Center (NIDSEC).
EVALUATION
Evaluation is the final step of the nursing process and will determine whether patient-
centered goals are being met. Thus, evaluation is directed at evaluating the outcomes of
care, not the plan of care or the delivery of care. It is difficult, however, to develop
evaluation measures for "at risk" nursing diagnoses because it is impossible to measure
what has been prevented. As a result, nurses often rely on the "absence" of a sign,
symptom, or condition to indicate that preventive care has been effective. When writing
evaluation goals, be sure to include time frames for evaluation. On the example tracking
form, the authors identified 2 patient-centered goals: one showing how to compensate for a
low subscale score on mobility and activity, and one on educating the patient and family
about pressure ulcer prevention (Figure 3).
Figure 3. OUTCOMES AND INTERVENTIONS TRACKING TOOL
Depending on frequency of change in status, evaluation measures should be conducted
every shift, daily, or more often as a patient's condition warrants (Table 6). Whenever
evaluation measures indicate that patient-centered goals are not being met, the prevention
plan should be reviewed and/or revised. Alternatively, if the prevention plan appears to be
sound but the goals still are not being met, then the implementation process needs to be
examined. Revise either the plan of care or implementation of the plan if outcomes are not
being met.
Table 6. TIPS FOR EVALUATION

3. STRENGTHENING THE PLANNING-IMPLEMENTATION-EVALUATION
CONNECTION
Preserving the connection between planning, implementation, and evaluation can be difficult
especially if the critical elements of the plan have not been written out or when evaluation
measures have not been developed. We recommend using a tracking sheet, such as the one
shown in Figure 3, to bring together on a single page the patient-centered goals of care,
risk-based interventions to achieve goals, and evaluation measures. The tracking sheet
shown in Figure 3 makes explicit the logical connections between planning, implementation,
and evaluation. Keeping the tracking sheet at the bedside will allow all team members to
readily review the plan as needed, evaluate outcomes during daily care, and make needed
revisions on the spot.
CONCLUSION
In this article, the authors have discussed pressure ulcer prevention within the context of
the nursing process. Tips on pressure ulcer risk assessment, diagnosis, prevention planning,
and evaluation were also provided. Specific recommendations were made to help strengthen
the assessment-diagnosis-planning connection, as well as the planning-implementation-
evaluation connection. It is hoped that these tips and recommendations will help nurses feel
more confident and capable when applying the nursing process to the problem of pressure
ulcer prevention. We all know that the absolute best defense against pressure ulceration is a
capable and caring nursing staff that is committed to the patient's welfare.
REFERENCES
IMPLEMENTATION
Implementation is the step of the nursing process where planned nursing care is actually
delivered to the patient. The nurse implements the plan of care by initiating and completing
planned nursing interventions to achieve patient-centered goals and outcomes. Nursing
interventions may be direct or indirect. Direct care interventions involve a direct interaction
between the nurse and the patient, such as repositioning the patient. Indirect interventions
occur when the nurse delegates care to another (eg, delegating turning to a nursing
assistant) or consults others (eg, consulting a dietitian) to achieve patient-centered goals.
Effective implementation of a pressure ulcer prevention plan is not easy (Table 5). It
requires, above all else, commitment to the patient's welfare as well as perseverance and
vigilance. Being strongly committed to patients' welfare by protecting them from the pain
and suffering that comes from having pressure ulcer can help motivate nurses to carefully
implement their plan of care. Perseverance is another important quality. No one will argue
that repositioning resistive and/or obese patients, cleaning up after frequent bouts of
incontinence, and changing linens on an occupied bed are hard work. It takes a special
strength of character to persevere in doing these activities repeatedly over the course of an
8-, 10-, or 12-hour shift. Vigilance is needed to ensure that the prescribed preventive
interventions are carried out correctly and in a timely manner. Vigilance is especially
important when it comes to indirect care that is delegated to others. As RNs, it is important
to ensure that the interventions are delegated to qualified staff and are performed as
prescribed.

4. Table 5. TIPS FOR IMPLEMENTING THE PRESSURE ULCER PREVENTION PLAN
Time is always a barrier to implementation and is sometimes used as an excuse. Because it
is impossible to make more time to get things done, one must make good use of the time
available. A good way to use time more efficiently is by clustering prevention interventions
and preparing for care. For example, interventions, such as reapplication of barrier creams,
padding between bony prominences, and floating heels off the mattress, often can be
clustered with regularly scheduled turning of the patient. Then, "prepare for care" by having
skin cleansing products, barrier creams, and protective underpads bundled together and
readily accessible at the bedside.
Other strategies that seem to help with implementation include using visual cues and going
public with a prevention plan. Visual cues, such as posting a turning clock in the room or
leaving a barrier cream visible on the bedside stand, help to remind all team members
about specific elements of the prevention plan. "Going public" means that the plan of care is
communicated to all stakeholders including nursing staff, patients, and families. In
communicating the plan to team members, remember to discuss and agree upon certain
expectations regarding what needs to be done, who will perform specific tasks, and what
tasks will be carried out together. Once the family understands the plan of care, they will
hold the nurse accountable for the plan. But in most cases, the family is eager to participate
in the plan of care. Family members often want to do something to help the patient, but
they do not know what to do or how to do it. Some tasks are completely within their
capabilities. For example, with only minimal instruction, family members can be taught how
to use pillows or foam wedges to float the heels off the mattress or reposition the patient off
a reddened area of skin.
Understand the differences between indirect-care and direct care intervention
Nursing interventions are actions, based on clinical judgment and nursing knowledge,
that nurses perform to achieve client outcomes. Interventions are also referred to as
nursing actions, measures, strategies, and activities.
A direct-care intervention is one performed through interaction with the client(s).
Direct-care activities include physical care, emotional support, and patient teaching.
An indirect care intervention is performed away from the client but on behalf of a
client or group of clients. Indirect care activities include advocacy, managing the
environment, consulting with other members of the healthcare team, and making
referrals.
What is differentiates an independent nursing intervention from other types of
interventions (health promotion, treatment, and assessment interventions).
Nurses work collaboratively with other healthcare providers. Some things you do for
patients will require a physician's order; many will not. Sometimes the activities of care
providers overlap.
An independent intervention is one that registered nurses are licensed to prescribe,
perform, or delegate based on their knowledge and skills. It does not require a
provider's order. Knowing how, when, and why to perform an activity makes the action

5. autonomous (independent). As a rule, nurses prescribe and perform independent
interventions in response to a nursing diagnosis. Understand you are accountable
(answerable) for your decisions and actions with regard to nursing diagnoses and
independent interventions.
A dependent intervention is one that is prescribed by a physician or advanced
practice nurse but carried out by the bedside nurse. Dependent interventions are usually
orders for diagnostic tests, medications, treatments, IV therapy, diet, and activity. In
addition to carrying out medical orders, you will be responsible for assessing the need
for the order, explaining the activities to the patient, and evaluating the effectiveness
of the order.
An interdependent (collaborative) intervention is one that is carried out in
collaboration with other health team members (e.g., physical therapists, dietitians, and
physicians). Because
nurses care for the whole person, their responsibilities often overlap with those of other
team members.