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Original Article

Identification of Major Nursing Diagnosis, Nursing Outcomes, and Nursing Interventions (NNN) Linkage for Cancer Patients Undergoing Chemotherapy

Su Mi Song1, Hyangsook So2, Minjeong An2
Korean Journal of Adult Nursing 2014;26(4):413-423.
Published online: August 31, 2014

1Chosun University Hospital, Gwangju

2College of Nursing, Chonnam National University, Gwangju, Korea

Corresponding author: An, Minjeong College of Nursing, Chonnam National University, 160 Baekseo-ro, Dong-gu, Gwangju 501-84, Korea. Tel: +82-62-530-4946, Fax: +82-62-225-3307, E-mail: anminjeong@gmail.com
• Received: March 27, 2014   • Accepted: August 4, 2014

Copyright © 2014 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This study was aimed to identify NANDA-NOC-NIC linkage in cancer patients receiving chemotherapy.
  • Methods
    This study was a descriptive study conducted in three steps. First, nursing diagnoses were identified from the electronic nursing records. Second, content validity of nursing diagnoses and outcomes were evaluated. Third, major nursing interventions associated with expected nursing outcomes were collected from 97 nurses who worked in the oncology unit. Data were analyzed using descriptive statistics.
  • Results
    Four major nursing diagnoses were identified: acute pain, knowledge deficit, health seeking behaviors, and ineffective protection. Associated with each respective diagnosis, 3 major outcomes (pain level, pain control, and comfort state) for acute pain, 8 major nursing outcomes(diet, disease process, treatment regimen, illness, ostomy care, prescribed activity, health behavior, and infection management) for knowledge deficit, 4 major outcomes (health promoting behavior, health promotion, health belief, and knowledge: health resource) for health seeking behaviors, and 3 major outcomes (fatigue level, immune status, and nutritional status) for ineffective protection were identified. In addition, nursing interventions frequently used in clinical practice for each major nursing outcome were identified.
  • Conclusion
    The identified NANDA-NOC-NIC linkage can contribute to improving the applications of nursing process and care plans.
  • Key Words: Neoplasm; Nursing process; Nursing diagnosis; Chemotherapy
Table 1.
Demographic Characteristics of Nurses
Characteristics Categories Total (N=97) Group A (n=44) Group B (n=53) x2 p
n (%) n (%) n (%)
Age (year) 20~35 72 (74.2) 34 (77.3) 38 (71.7) 0.39 .532
＞35 25 (25.8) 10 (22.7) 15 (28.3)
Education Diploma 52 (53.6) 20 (45.5) 32 (60.4) 4.84 .089
Bachelor 31 (32.0) 14 (31.8) 17 (32.1)
Master 14 (14.4) 10 (22.7) 4 (7.5)
Clinical experience (year) 1~3 31 (32.0) 14 (31.8) 17 (32.1) 0.08 .994
4~6 23 (23.7) 11 (25.0) 12 (22.6)
≥7 43 (44.3) 19 (43.2) 24 (45.3)
Oncology nursing experience (year) 1~3 65 (67.0) 28 (63.6) 37 (69.8) 0.42 .813
4~6 16 (16.5) 8 (18.2) 8 (15.1)
≥7 16 (16.5) 8 (18.2) 8 (15.1)
Learning opportunity about NOC and NIC Yes 72 (75.8) 31 (73.8) 41 (77.4) 0.16 .688
No 23 (24.2) 11 (26.2) 12 (22.6)
Confidence regarding ENR use ≥Confident 47 (50.5) 20 (45.6) 27 (55.1) 0.86 .353
＜Confident 46 (49.5) 24 (54.4) 22 (44.9)

NOC=nursing outcome classification; NIC=nursing intervention classification; ENR=electronic nursing record.

Table 2.
Summary of NNN Linkage for Acute Pain (N=53
NANDA NOC NIC
Label CVI Label CVI Label n (%)
Acute pain .88 Pain level .93 Pain management 49 (92.5)
Medication administration: IV 48 (90.6)
Medication management 48 (90.6)
Medication prescribing 48 (90.6)
Medication administration: IM 46 (86.8)
Analgesic administration 44 (83.0)
Medication administration 42 (79.2)
Medication administration: oral 42 (79.2)
Heat/cold application 41 (77.4)
Analgesic administration management 38 (71.7)
Environmental management: comfort 36 (67.9)
Anxiety reduction 35 (66.0)
Positioning 32 (60.4)
Reduced gas production 27 (50.9)
Relaxation therapy 24 (45.3)
Pain control .90 Medication administration 49 (77.4)
Medication management 39 (73.6)
Pain management 38 (71.7)
Teaching: prescribed medication 35 (66.0)
Reconciliation PCA assistance 30 (56.6)
Teaching: procedure/treatment 29 (54.7)
Health screening 27 (50.9)
Teaching: disease process 26 (49.1)
Sleep enhancement 26 (49.1)
Interaction goal setting 25 (47.2)
Patient contracting 23 (43.4)
Relaxation therapy 20 (37.7)
Self-modification assistance 18 (34.0)
Comfort state .85 Medication administration 47 (88.7)
Medication administration: IV 46 (86.8)
Pain management 46 (86.8)
Medication administration: oral 45 (84.9)
Medication management 44 (83.0)
Environmental management: comfort 43 (81.1)
Emotional support 42 (79.2)
Medication administration 42 (79.2)
Analgesic administration 40 (75.5)
Analgesic administration management 39 (73.6)
Medication: IM 35 (66.0)
Humor 33 (62.3)
Positioning 33 (62.3)
Presence 30 (56.6)

NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome classification; NIC=nursing intervention classification.

Table 3.
Summary of NNN Linkage for Knowledge Deficit: Chemotherapy (N=44)
NANDA NOC NIC
Label CVI Label CVI Label n (%)
Knowledge deficit: chemotherapy .88 Diet .88 Teaching: prescribed drug 34 (77.3)
Promote learning 21 (47.7)
Teaching: prescribed diet 20 (45.5)
Health education 16 (36.4)
Education: individual 15 (34.1)
Disease progress .83 Teaching: prescribed drug 26 (59.1)
Teaching: activity/exercise 23 (52.3)
Teaching: prescribed diet 22 (50.0)
Education: individual 17 (38.6)
Health education 14 (31.8)
Treatment regimen .83 Education: activities/exercise 30 (68.2)
Teaching procedure/treatment 30 (68.2)
Medication management 29 (65.9)
Teaching: prescribed drug 28 (63.7)
Learning facilitation 27 (61.4)
Illness care .83 Teaching: prescribed drug 26 (59.1)
Teaching procedure/treatment 25 (56.8)
Education: individual 23 (52.3)
Education: activities/exercise 22 (50.0)
Education: preoperative 21 (47.7)
Ostomy care .83 Skin surveillance 27 (61.4)
Skin care: topical treatment 24 (54.5)
Education: individual 14 (31.8)
Ostomy care 14 (31.8)
Teaching: psychomotor skill 14 (31.8)
Prescribed activity .80 Learning preparation improvement 28 (63.6)
Exercise promotion 16 (36.4)
Education: activities/exercise 14 (31.8)
Education: individual 14 (31.8)
Health behavior .80 Teaching: individual 19 (43.2)
Learning preparation improvement 17 (38.6)
4. Prediction supervise 17 (38.6)
6. Parent education: Infant 17 (38.6)
8. Active listening 16 (36.4)
Infection managemen t .80 10. Risk identification 35 (79.5)
12. Teaching: prescribed drug 32 (72.7)
14. Infection control 32 (72.7)
Medication management 31 (70.5)
Teaching procedure/treatment 29 (65.9)
Teaching: disease process 28 (63.6)

NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome Classification; NIC=nursing intervention classification.

Table 4.
Summary of NNN Linkage for Health Seeking Behaviors (N=53)
NANDA NOC NIC
Label CVI Label CVI Label n (%)
Health seeking behaviors .80 Health promoting behavior .88 Risk identification 36 (67.9)
Self-responsibility facilitation 34 (64.2)
Health education 34 (64.2)
Smoking cessation assistance 31 (58.5)
Emotional support 31 (58.5)
Exercise promotion 31 (58.5)
Weight management 28 (52.8)
Exercise promotion: strength training 25 (47.2)
Behavior modification 24 (45.3)
Exercise promotion: height 23 (43.4)
Immunization/vaccination management 23 (43.4)
Health promoting .83 Teaching: prescribed activity/exercise 37 (69.8)
Teaching: prescribed drug 37 (69.8)
Health education 30 (56.6)
Teaching: Individual 27 (50.9)
Learning facilitation 27 (50.9)
Teaching: Prescribed diet 27 (50.9)
Learning preparation improvement 23 (43.4)
Health beliefs .80 Self-modification assistance 29 (54.7)
Self-esteem enhancement 29 (54.7)
Health teaching 28 (52.8)
Risk identification 28 (52.8)
Values clarification 24 (45.3)
Counseling 24 (45.3)
Knowledge: health resource .80 Health education 40 (75.5)
Discharge planning 37 (69.8)
Learning facilitation 33 (62.3)
Teaching: individual 31 (58.5)
Support system enhancement 28 (58.5)
Learning preparation improvement 27 (50.9)
Health system guidance 26 (49.1)

NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome classification; NIC=nursing intervention classification.

Table 5.
Summary of NNN Linkage for Ineffective Protection (N=53)
NANDA NOC NIC
Label CVI Label CVI Label n (%)
Ineffective protection .80 Fatigue level .85 Pain management 38 (71.7)
Energy management 26 (49.1)
Nutrition management 26 (49.1)
Self-care assistance 25 (47.2)
Mood management 24 (45.3)
Sleep enhancement 20 (37.7)
Immune status .80 Teaching: Prescribed drug 43 (81.1)
Energy management 38 (71.7)
Medication management 38 (71.7)
Infection protection 37 (69.8)
Infection control 36 (67.9)
Teaching: Individual 35 (66.0)
Health education 35 (66.0)
Risk identification 35 (66.0)
Chemotherapy management 34 (64.2)
Weight management 32 (60.4)
Respiratory monitoring 32 (60.4)
Health screening 31 (58.5)
Purities management 30 (56.6)
Radiation therapy management 27 (50.9)
Nutritional status .80 Eating disorders management 35 (66.0)
Water/Electrolyte management 33 (62.3)
Teaching: prescribed diet 33 (62.3)
Self care assistance: Eating 32 (60.4)
Nutrition therapy 30 (60.4)
Nutrition management 30 (60.4)
Weight management 30 (60.4)
Nutrition counseling 28 (52.8)

NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome classification; NIC=nursing intervention classification.

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    Identification of Major Nursing Diagnosis, Nursing Outcomes, and Nursing Interventions (NNN) Linkage for Cancer Patients Undergoing Chemotherapy
    Korean J Adult Nurs. 2014;26(4):413-423.   Published online August 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.4.413
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    Identification of Major Nursing Diagnosis, Nursing Outcomes, and Nursing Interventions (NNN) Linkage for Cancer Patients Undergoing Chemotherapy
    Korean J Adult Nurs. 2014;26(4):413-423.   Published online August 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.4.413
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    Identification of Major Nursing Diagnosis, Nursing Outcomes, and Nursing Interventions (NNN) Linkage for Cancer Patients Undergoing Chemotherapy
    Identification of Major Nursing Diagnosis, Nursing Outcomes, and Nursing Interventions (NNN) Linkage for Cancer Patients Undergoing Chemotherapy

    Demographic Characteristics of Nurses

    Characteristics Categories Total (N=97) Group A (n=44) Group B (n=53) x2 p
    n (%) n (%) n (%)
    Age (year) 20~35 72 (74.2) 34 (77.3) 38 (71.7) 0.39 .532
    ＞35 25 (25.8) 10 (22.7) 15 (28.3)
    Education Diploma 52 (53.6) 20 (45.5) 32 (60.4) 4.84 .089
    Bachelor 31 (32.0) 14 (31.8) 17 (32.1)
    Master 14 (14.4) 10 (22.7) 4 (7.5)
    Clinical experience (year) 1~3 31 (32.0) 14 (31.8) 17 (32.1) 0.08 .994
    4~6 23 (23.7) 11 (25.0) 12 (22.6)
    ≥7 43 (44.3) 19 (43.2) 24 (45.3)
    Oncology nursing experience (year) 1~3 65 (67.0) 28 (63.6) 37 (69.8) 0.42 .813
    4~6 16 (16.5) 8 (18.2) 8 (15.1)
    ≥7 16 (16.5) 8 (18.2) 8 (15.1)
    Learning opportunity about NOC and NIC Yes 72 (75.8) 31 (73.8) 41 (77.4) 0.16 .688
    No 23 (24.2) 11 (26.2) 12 (22.6)
    Confidence regarding ENR use ≥Confident 47 (50.5) 20 (45.6) 27 (55.1) 0.86 .353
    ＜Confident 46 (49.5) 24 (54.4) 22 (44.9)

    NOC=nursing outcome classification; NIC=nursing intervention classification; ENR=electronic nursing record.

    Summary of NNN Linkage for Acute Pain (N=53

    NANDA NOC NIC
    Label CVI Label CVI Label n (%)
    Acute pain .88 Pain level .93 Pain management 49 (92.5)
    Medication administration: IV 48 (90.6)
    Medication management 48 (90.6)
    Medication prescribing 48 (90.6)
    Medication administration: IM 46 (86.8)
    Analgesic administration 44 (83.0)
    Medication administration 42 (79.2)
    Medication administration: oral 42 (79.2)
    Heat/cold application 41 (77.4)
    Analgesic administration management 38 (71.7)
    Environmental management: comfort 36 (67.9)
    Anxiety reduction 35 (66.0)
    Positioning 32 (60.4)
    Reduced gas production 27 (50.9)
    Relaxation therapy 24 (45.3)
    Pain control .90 Medication administration 49 (77.4)
    Medication management 39 (73.6)
    Pain management 38 (71.7)
    Teaching: prescribed medication 35 (66.0)
    Reconciliation PCA assistance 30 (56.6)
    Teaching: procedure/treatment 29 (54.7)
    Health screening 27 (50.9)
    Teaching: disease process 26 (49.1)
    Sleep enhancement 26 (49.1)
    Interaction goal setting 25 (47.2)
    Patient contracting 23 (43.4)
    Relaxation therapy 20 (37.7)
    Self-modification assistance 18 (34.0)
    Comfort state .85 Medication administration 47 (88.7)
    Medication administration: IV 46 (86.8)
    Pain management 46 (86.8)
    Medication administration: oral 45 (84.9)
    Medication management 44 (83.0)
    Environmental management: comfort 43 (81.1)
    Emotional support 42 (79.2)
    Medication administration 42 (79.2)
    Analgesic administration 40 (75.5)
    Analgesic administration management 39 (73.6)
    Medication: IM 35 (66.0)
    Humor 33 (62.3)
    Positioning 33 (62.3)
    Presence 30 (56.6)

    NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome classification; NIC=nursing intervention classification.

    Summary of NNN Linkage for Knowledge Deficit: Chemotherapy (N=44)

    NANDA NOC NIC
    Label CVI Label CVI Label n (%)
    Knowledge deficit: chemotherapy .88 Diet .88 Teaching: prescribed drug 34 (77.3)
    Promote learning 21 (47.7)
    Teaching: prescribed diet 20 (45.5)
    Health education 16 (36.4)
    Education: individual 15 (34.1)
    Disease progress .83 Teaching: prescribed drug 26 (59.1)
    Teaching: activity/exercise 23 (52.3)
    Teaching: prescribed diet 22 (50.0)
    Education: individual 17 (38.6)
    Health education 14 (31.8)
    Treatment regimen .83 Education: activities/exercise 30 (68.2)
    Teaching procedure/treatment 30 (68.2)
    Medication management 29 (65.9)
    Teaching: prescribed drug 28 (63.7)
    Learning facilitation 27 (61.4)
    Illness care .83 Teaching: prescribed drug 26 (59.1)
    Teaching procedure/treatment 25 (56.8)
    Education: individual 23 (52.3)
    Education: activities/exercise 22 (50.0)
    Education: preoperative 21 (47.7)
    Ostomy care .83 Skin surveillance 27 (61.4)
    Skin care: topical treatment 24 (54.5)
    Education: individual 14 (31.8)
    Ostomy care 14 (31.8)
    Teaching: psychomotor skill 14 (31.8)
    Prescribed activity .80 Learning preparation improvement 28 (63.6)
    Exercise promotion 16 (36.4)
    Education: activities/exercise 14 (31.8)
    Education: individual 14 (31.8)
    Health behavior .80 Teaching: individual 19 (43.2)
    Learning preparation improvement 17 (38.6)
    4. Prediction supervise 17 (38.6)
    6. Parent education: Infant 17 (38.6)
    8. Active listening 16 (36.4)
    Infection managemen t .80 10. Risk identification 35 (79.5)
    12. Teaching: prescribed drug 32 (72.7)
    14. Infection control 32 (72.7)
    Medication management 31 (70.5)
    Teaching procedure/treatment 29 (65.9)
    Teaching: disease process 28 (63.6)

    NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome Classification; NIC=nursing intervention classification.

    Summary of NNN Linkage for Health Seeking Behaviors (N=53)

    NANDA NOC NIC
    Label CVI Label CVI Label n (%)
    Health seeking behaviors .80 Health promoting behavior .88 Risk identification 36 (67.9)
    Self-responsibility facilitation 34 (64.2)
    Health education 34 (64.2)
    Smoking cessation assistance 31 (58.5)
    Emotional support 31 (58.5)
    Exercise promotion 31 (58.5)
    Weight management 28 (52.8)
    Exercise promotion: strength training 25 (47.2)
    Behavior modification 24 (45.3)
    Exercise promotion: height 23 (43.4)
    Immunization/vaccination management 23 (43.4)
    Health promoting .83 Teaching: prescribed activity/exercise 37 (69.8)
    Teaching: prescribed drug 37 (69.8)
    Health education 30 (56.6)
    Teaching: Individual 27 (50.9)
    Learning facilitation 27 (50.9)
    Teaching: Prescribed diet 27 (50.9)
    Learning preparation improvement 23 (43.4)
    Health beliefs .80 Self-modification assistance 29 (54.7)
    Self-esteem enhancement 29 (54.7)
    Health teaching 28 (52.8)
    Risk identification 28 (52.8)
    Values clarification 24 (45.3)
    Counseling 24 (45.3)
    Knowledge: health resource .80 Health education 40 (75.5)
    Discharge planning 37 (69.8)
    Learning facilitation 33 (62.3)
    Teaching: individual 31 (58.5)
    Support system enhancement 28 (58.5)
    Learning preparation improvement 27 (50.9)
    Health system guidance 26 (49.1)

    NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome classification; NIC=nursing intervention classification.

    Summary of NNN Linkage for Ineffective Protection (N=53)

    NANDA NOC NIC
    Label CVI Label CVI Label n (%)
    Ineffective protection .80 Fatigue level .85 Pain management 38 (71.7)
    Energy management 26 (49.1)
    Nutrition management 26 (49.1)
    Self-care assistance 25 (47.2)
    Mood management 24 (45.3)
    Sleep enhancement 20 (37.7)
    Immune status .80 Teaching: Prescribed drug 43 (81.1)
    Energy management 38 (71.7)
    Medication management 38 (71.7)
    Infection protection 37 (69.8)
    Infection control 36 (67.9)
    Teaching: Individual 35 (66.0)
    Health education 35 (66.0)
    Risk identification 35 (66.0)
    Chemotherapy management 34 (64.2)
    Weight management 32 (60.4)
    Respiratory monitoring 32 (60.4)
    Health screening 31 (58.5)
    Purities management 30 (56.6)
    Radiation therapy management 27 (50.9)
    Nutritional status .80 Eating disorders management 35 (66.0)
    Water/Electrolyte management 33 (62.3)
    Teaching: prescribed diet 33 (62.3)
    Self care assistance: Eating 32 (60.4)
    Nutrition therapy 30 (60.4)
    Nutrition management 30 (60.4)
    Weight management 30 (60.4)
    Nutrition counseling 28 (52.8)

    NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome classification; NIC=nursing intervention classification.
    Table 1. Demographic Characteristics of Nurses

    NOC=nursing outcome classification; NIC=nursing intervention classification; ENR=electronic nursing record.

    Table 2. Summary of NNN Linkage for Acute Pain (N=53

    NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome classification; NIC=nursing intervention classification.

    Table 3. Summary of NNN Linkage for Knowledge Deficit: Chemotherapy (N=44)

    NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome Classification; NIC=nursing intervention classification.

    Table 4. Summary of NNN Linkage for Health Seeking Behaviors (N=53)

    NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome classification; NIC=nursing intervention classification.

    Table 5. Summary of NNN Linkage for Ineffective Protection (N=53)

    NANDA=North America Nursing Diagnosis Association; NOC=nursing outcome classification; NIC=nursing intervention classification.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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