What Is Nursing Outcomes Classification All About?

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Written by Marie Hasty, BSN, RN Content Writer, IntelyCare
Two nurses reviewing nursing outcomes classification on a laptop

As nursing has evolved as a profession, clinicians have searched for ways to measure outcomes that are directly linked to nursing care. NOC, meaning nursing outcomes classification, is a way of doing just that. Healthcare agencies, educational programs, and researchers use these standardized tools to evaluate nursing interventions and use evidence-based guidelines in practice.

First developed by research teams in the late ’90s, NOCs have been continually refined by the Center for Nursing Classification and Clinical Effectiveness. They’re a critical component in the final step of the nursing process, a five-part framework that forms the practice model for all nurses:

  1. Assessment of mental, physical, and/or psychosocial status
  2. Diagnosis using NANDA-approved guidelines
  3. Planning interventions based on the patient’s needs
  4. Implementation of the nursing interventions
  5. Evaluation of patient outcomes after nursing interventions

Nursing outcomes classifications are a close relative of nursing interventions classification (NIC). The NIC standardizes nursing interventions, while NOC measures patient responses to those interventions. Whether you work in post-acute or acute care, outpatient or ambulatory settings, or another nursing role, NOCs help guide care.

What to Know About Nursing Outcomes Classification

An outcome is a measurable behavior demonstrated by the patient responsive to nursing interventions. The NOC is a standardized classification system that defines nursing outcomes for patients, family, and the community. These outcomes are used in documentation systems, clinical informatics, and furthering nursing knowledge for working nurses and students. It’s also one of the standardized languages recognized by the American Nurses Association.

The latest nursing outcomes classification book lists 612 outcomes that fall under seven domains:

  1. Functional health: The individual’s ability to perform activities of daily living (ADLs) and maintain a level of independence in daily life.
  2. Physiological health: The physical well-being of an individual, including vital signs, organ function, and overall physical health status.
  3. Psychosocial health: The emotional and social aspects of an individual’s well-being, including mental health, relationships, and coping mechanisms.
  4. Health knowledge and behavior: The individual’s understanding of health-related information and their ability to make informed decisions and engage in behaviors that promote well-being.
  5. Perceived health: The individual’s subjective assessment of their own health, including their perceptions of symptoms, comfort, and overall sense of well-being.
  6. Family health: The well-being of the family unit as a whole, considering the dynamics and interactions among family members.
  7. Community health: The well-being of a community or population, considering factors such as access to healthcare, health education, and community resources.

Each of these published outcomes includes:

  • Definition of the outcome
  • List of indicators for evaluating that outcome
  • Target outcome rating
  • 1–5 measurement scale to measure patient status
  • Short list of references used to develop the outcome

Nurses use these standards to guide care for individual patients, their families, and the community. Healthcare administrators, physicians, and other professionals may use NOC to measure outcomes.

Nursing Outcomes Classification Example

NOC: Patient Engagement Behavior, under the domain of health knowledge and behavior.

Definition: Personal actions to actively participate in one’s health care through shared decision-making with health professionals. The patient’s goal may be to maintain or increase their rating based on this number scale:

1: Never demonstrated

2: Rarely demonstrated

3: Sometimes demonstrated

4: Often demonstrated

5: Consistently demonstrated

The NOC lists several indicators that can reflect improvement in this objective, including:

  • Obtains reputable health information
  • Follows a healthy lifestyle
  • Monitors treatment effects
  • Discusses personal health priorities with health professional
  • Discusses plan of care with health professional
  • Chooses among treatment options
  • Obtains test results
  • Manages personal health care
  • Uses health care resources consistent with need

To put this NOC into practice, let’s say you’re in a community mental health clinic assisting in the care of a patient who has struggled with depression and apathy. At the patient’s last visit, you went over their medication side effects and gave them forms to fill out to apply for assisted insurance. They didn’t ask any questions, and while you educated them about lifestyle changes for better mood, they didn’t seem interested in these changes. At this visit, you would have given them a 1 in each of these domains, with a goal of 2.

Today, this patient is back, and they now have questions about their medications. They inquire about changing to a new antidepressant, and they say they’ve enrolled in assisted insurance. They don’t yet have a primary care provider, so you give them information about finding one in-network. These improvements mean that you can now rate the patient at a 3. Remember, this patient will need to consistently show these behavior changes before moving up to a 5.

Like all clinical practice, NOCs are not one size fits all, and you’ll need to tailor these outcome measurements to the appropriate patients. For example, for a patient with dementia, it may not be appropriate to expect them to manage their healthcare or choose among treatment options. Their health knowledge and behavior goals may be oriented towards keeping themselves safe, like not getting up without assistance.

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