Received: 1 March 2021 Revised: 2 April 2021 Accepted: 10 April 2021

DOI: 10.1111/2047-3095.12326

ORIGINAL ARTICLE

Electronic nursing care plans through the use of NANDA, NOC,

and NIC taxonomies in community setting: A descriptive study
in northern Italy

Marianna Aleandri RN1 Sandra Scalorbi RN1 Maria Cristina Pirazzini RN2

1
IRCCS Azienda Ospedaliero-Universitaria di Purpose: To carry on a descriptive analysis of nursing standardized language through the
Bologna, Italy
use of a software within outpatient facilities in northern Italy, organized according to the
2
Nurse Management, Division of Outpatient
Care (Ausl Bologna), Bologna, Italy Chronic Care Model (CCM) and called Community Health Centers (CHC).
Methods: A descriptive design was adopted for the study. NANDA-I, NOC, and NIC tax-
Correspondence
onomies have been used to analyze care plans pulled from the software. Both qualitative
Marianna Aleandri, IRCCS Azienda
Ospedaliero-Universitaria di Bologna, Italy and quantitative data were analyzed.
E-mail: [email protected]
Findings: The average of nursing diagnosis correctly identified with respect to the nursing
Information of Financial Support: This study assessment is 83.7% (SD 29.9%). Class 4 diagnoses from Domains 4 have been identified
was not financially funded. as the most prevalent (22.4%), followed by risk for unstable blood glucose level 00179
Trial registration number: N◦
(16.4%) and risk for overweight 00234 (13%). The main nursing outcomes were vital signs
119/2018/OSS/AUSLBO
0802 (22.5%), blood glucose level 2300 (16%), and weight loss behavior 1627 (11%). The
most prevalent nursing interventions are wound care 3660 (27%), medication adminis-
tration: intramuscular 2313 (19%), and health education 5510 (14%). The analysis shows
ability in identifying nursing diagnoses, but a larger variability with outcomes and inter-
ventions. The study highlights the nursing role within CHC and identifies the main areas
of expertise in chronic disease management: prevention and health education.
Conclusions: Nurses’ role is fundamental for chronic disease management within CHC;
NANDA-I taxonomy helps to analyze care plans.
Implications for nursing practice: - A taxonomy such as NANDA-I represents a valid
opportunity to make more visible how much nursing skills affect the achievement of a
higher level of health in chronic patients.
- This study is useful in the further training of outpatient nurses who works in CHC.
- The study represents the starting point for future research to deepen the development
of a standardized nursing language in outpatient facilities.

KEYWORDS
nursing care plan, nursing taxonomy, standardized nursing language, community nursing, long-term
care, electronic health records

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2021 The Authors. International Journal of Nursing Knowledge published by Wiley Periodicals LLC on behalf of NANDA International

72 wileyonlinelibrary.com/journal/ijnt Int J Nurs Knowl. 2022;33:72–80.

 73

Scopo: Effettuare un’analisi descrittiva del linguaggio infermieristico standardizzato

attraverso l’utilizzo di un software all’interno di strutture ambulatoriali del nord Italia,
organizzate secondo il Chronic Care Model (CCM) e denominate Case della Salute (CdS).
Metodi: Per lo studio è stato adottato un disegno descrittivo. Le tassonomie NANDA-I,
NOC e NIC sono state utilizzate per analizzare i piani di assistenza estratti dal software.
Sono stati analizzati dati sia qualitativi che quantitativi.
Risultati: La media delle diagnosi infermieristiche correttamente identificate rispetto
all’accertamento infermieristico è dell’83,7% (DS 29,9%). Le diagnosi di classe 4 dominio
4 sono state identificate come le più prevalenti (22,4%), seguite da 00179 (16,4%) e
00234 (13%). I principali esiti infermieristici sono stati 0802 (22,5%), 2300 (16%) e 1627
(11%). Gli interventi infermieristici più diffusi sono 3660 (27%), 2313 (19%) e 5510 (14%).
L’analisi di adeguatezza mostra la capacità di identificare le diagnosi infermieristiche, ma
una maggiore variabilità con i risultati e gli interventi. Lo studio evidenzia il ruolo infer-
mieristico all’interno delle CdS e identifica le principali aree di competenza nella gestione
delle malattie croniche: prevenzione ed educazione sanitaria.
Conclusioni: Il ruolo degli infermieri è fondamentale per la gestione delle malattie
croniche all’interno delle CdS; La tassonomia NANDA-I aiuta ad analizzare i piani di cura.
Implicazioni per la pratica infermieristica: - L’utilizzo di una tassonomia condivisa e stan-
dardizzata come NANDA-I nella creazione dei piani di assistenza rappresenta una valida
opportunità per rendere più visibile quanto le competenze infermieristiche influenzino il
raggiungimento di un livello più alto di salute e benessere nei pazienti cronici trattati nelle
CdS.
- Questo studio è utile per la formazione degli infermieri ambulatoriali e per quelli che
lavoreranno lì.
- Lo studio rappresenta il punto di partenza per future ricerche per approfondire ulterior-
mente, magari a livello multicentrico, lo sviluppo di un linguaggio infermieristico standard-
izzato attraverso la creazione di piani di assistenza infermieristica basati sulla tassonomia
NANDA-I.

INTRODUCTION to the lack of a common language between health care professionals

cause mistakes during patient care.
The need to build a common language among nurses is well docu- The NANDA-I taxonomy is an example of standardized nursing lan-
mented in the literature, although some studies report that sometimes guage that provides a uniform terminology for nursing practice, edu-
terminologies in care plans are very heterogenous (Törnwall & Jansson, cation, research to express in an accurate way the nursing clinical judg-
2017; Bompan et al., 2020; Wang et al., 2011) and that there are no suf- ment (NANDA-I, 2018). The NANDA-I taxonomy is well known through
ficient researches to affirm whether a standardized nursing record sys- Italian nurses both in the university programs and in the clinical set-
tem affects nursing outcomes or not (Urquhart et al., 2018). The use of tings and the standardized language has been officially translated in
a uniform terminology has numerous implications: (a) to improve com- Italian. There are few studies on NANDA-I application and use in Italy
munication between nurses and other healthcare professionals; (b) to (Cioce et al., 2019; Bertocchi et al., 2020; Marcotullio et al., 2020).
increase nursing visibility; (c) to improve patient care; (d) to systemat- The use of a shared and uniform language is especially important
ically evaluate nurses care outcomes; (e) to ensure greater adherence in setting where chronic patients are complex and with comorbidities
to standards of care (Rutherford, 2008). and need to be taken care longtime by nurses and other health care
A report from the Italian Ministry of Health (Protocollo di monitor- professionals (Cárdenas-Valladolid et al., 2012). The constant increase
aggio degli Eventi Sentinella – 4◦ rapporto (settembre 2005–dicembre in chronic diseases and the related change in the health needs of
2011), Ministero della Salute, 2013) also reports that problems related the population in terms of prevention and health promotion, together
74 ALEANDRI ET AL .

with the need to optimize costs in relation to the services offered by ware it has been possible to analyze through a database the language
the National Health System, led to the development and implementa- used by the health care professionals in the nursing care plans, related
tion of outpatient territorial facilities called Community Health Cen- to the achievement of healthcare outcomes such as “moods, behaviors,
ters (CHC; “Case della Salute” in Italian) throughout the north of Italy perceptions of an individual, family, community measured along a con-
(Brambilla & Maciocco, 2016; Odone et al., 2016). tinuum in relation to the nursing intervention” (Moorhead et al., 2020).
CHC have the task of managing the complexity of chronic patients in The aim of the “Case della Salute” software is to improve nursing
the area to avoid further hospitalizations and were created on the basis documentation, to make more visible and quantifiable the professional
of the Chronic Care Model (CCM) to ensure prevention and continuity activity carried out by nurses in the area and to improve the follow-up
of care (Barletta et al., 2016; Boehmer et al., 2018; Davy et al., 2015; of the chronic patients over time.
Stellefson et al., 2013; Yeoh et al., 2017). Another key point of the CCM The software consisted of three different section selectable through
is the computerized management of clinical documentation to opti- a drop-down menu; in this study only the care plans that came from
mize chronic patient care in a community context, as reported in litera- the section about chronic patients followed by the outpatient nurses
ture (Siminerio, 2010; Richardson & Abramson, 2012) (Gammon et al., has been analyzed, as the other two sections do not provide for the
2015; Sockolow & Liao, 2012). This can also help in creating a standard- creation of a care plan. Each care plan is made up of five sectors
ized language among nurses who work in CHC. No studies have been (“need,” “objectives,” “actions,” “timing,” and “result”) that can be filled
found at a national level about electronical health record implementa- via drop-down menus (“needs” and “timing”) or with free text (“objec-
tion in a community context and there is also a lack of sources describ- tives,” “actions,” and “result”).
ing the nursing role and the impact of nursing care. The terms used within the nursing care plans have been agreed
between nurse directors in Healthcare Trust, head nurses, and outpa-
tient nurses involved after meetings and group works, with some dif-
STUDY OBJECTIVES ferences compared to the terminology in the NANDA-I, NOC, and NIC
taxonomies. “Needs” are similar to the definition of nursing diagnosis,
The general objective of the study is to carry out a descriptive analysis “objectives” to outcomes and “actions” to interventions.
of nursing standardized language in the outpatient setting and within
CHC in the north of Italy through the use of the “Case della Salute”
software. Specifically, the part concerning the nursing care plans for Design/sampling method
the care of chronic patients has been investigated with the help of the
NANDA-I taxonomy. A descriptive design was adopted for the study.
Further specific objectives have been identified, such as: (a) to evalu- Data analysis covered all the CHC of the Bologna district area (in
ate the accuracy of the identified “needs” through the correspondence the north of Italy) where the use of the “Case della Salute” software has
with data collected during the nursing assessment (in a statistically been implemented, starting from the first day of use by nurses (January
significant sample); (b) to evaluate whether “objectives” and “actions” 26, 2016) up to November 16, 2017.
identified by nurses are consistent with the definition provided by the
NIC and NOC taxonomies (“states, behaviors, perceptions of an indi-
vidual, family, community measured along a continuum in relation to Data collection
the nursing intervention” and “treatment that the nurse implements
in order to improve the results obtained from care”) (Butcher et al., The computer technician created a database through an excel file with
2020; Moorhead et al., 2020); (c) to classify and group “objectives” and all the extrapolated data to proceed with the analysis. The section
“actions” according to a thematic analysis; (d) to describe the “needs” “needs” not followed by any other item that composes the nursing care
identified by nurses through the “Case della Salute” software; (e) to plan was not included in the study analysis.
identify the most frequent nursing diagnoses, outcomes, and interven- Furthermore, a statistically significant sample has been defined to
tions in this setting according to the NANDA-I, NOC and NIC tax- compare the consistency between nursing assessment and the identifi-
onomies. cation of nursing diagnosis, through a validated tool for assessing care
planning (Dammiano et al., 2019). There is no evidence for statistical
calculation in literature, so the sample was calculated starting from the
METHODOLOGY prevalence (69.35%) of the care plans found to be correct in a prelimi-
nary study carried out by Dammiano in 2017.
Study setting Patients in the period between May 16, 2017 and November 16,
2017 were considered for the sample calculation since compared to
Starting from January 2016 a new software called “Case della Salute” the available database it is the most recent time interval in which
was implemented within all the outpatient facilities of the Bologna area all the CHC used the tool uniformly. Patients in the database are
(in the north of Italy) for the nursing documentation management and uniquely identified with a code called XMPI (see Ethical Considera-
to start the use of a computerized nursing record. Thanks to this soft- tions paragraph). In the selected time interval, 751 XMPI codes were
 75

identified; 141 of these were excluded because the plans contained All items correctly identified as nursing outcomes and interventions
“needs” not followed by “objectives” and “interventions” or because have been sorted alphabetically. Some terms occurred more frequently
among the “needs” identified there was also a “need” called “other,” than others and were therefore identified and further grouped using
which cannot be evaluated through the tool. The result was therefore as a threshold value, in agreement among the researchers, 1% of the
a population of 610 patients, from which a sample of 213 patients was presence of a given expression or sentence within the single section.
obtained through the use of online software. The XMPI codes referring Despite the wide variability of the lexicon reported, some terms were
to patients were then randomized through an online software and repeated in both categories in considerable percentages, well beyond
only afterwards the data concerning the care plans were compiled, the agreed threshold value. In this way it was possible to create macro-
compared with the data in the assessment section of the software categories of prevailing terms. These categories were then compared
referring to the given patient. The data emerged from the tool were with NOC and NIC taxonomies with a cross-checked analysis made by
then expressed in the form of mean and standard deviation. three researchers.
To systematically compare care plan terms reported in the software
with the NANDA-I, NOC, and NIC taxonomies a cross-checked analysis
Ethical consideration has been carried out by three members of the research group. Compar-
ative tables have been created in which the NANDA diagnoses with the
The regional Ethical Committee authorized the developing of this study respective definitions have been inserted in order to be linked with one
and permission was also given by the local health authority. or more “needs”; each researcher compiled the table separately and
Patients followed by nurses in Community Health Centers and subsequently the data that emerged were compared in order to arrive
for whom nurses created a specific care plan are associated with an at the definitive version of the analysis presented in Table 1. The same
alphanumeric code (XMPI) in the software “Case della Salute.” The analysis was then carried out for “objectives” and “actions” with NOC
researchers did not know the identity of the patients or how the XMPI and NIC taxonomy.
code was decoded, therefore the data in the records remain strictly
confidential. Furthermore, the researchers were in possession of only
some of the data present in the software, represented only by the nurs- Findings
ing care plans.
The results of the study have been represented through the nursing
process: assessment, diagnosis, planning, implementation, and evalua-
Data analysis tion.
Data reported in Table 1 express the percentage agreement that the
The data analyzed in the study were both qualitative and quantita- elements given in the assessment are correctly used in the diagnosis
tive. As for the quantitative ones, they have been grouped through a identification procedure through the use of a planning evaluation tool
descriptive statistical analysis (absolute, relative and percentage fre- (Dammiano et al., 2019). Tough a wide variety emerged from the care
quency, mean, and standard deviation) based on specific objectives. plans of 213 patients (identified with XMPI codes) extracted from the
At the same time, a qualitative analysis has been carried out on statistically significant sample and randomized, no cases were excluded
the language used by nurses in defining “objectives” and “actions.” This from the results to give a realistic description of the phenomenon. The
choice is motivated by the fact that in the software the care plan sec- average of nursing diagnosis correctly identified with respect to the
tions “objectives” and “actions” are filled in by nurses with free text. nursing assessment is 83.7%, with a standard deviation of 29.9%. In
As regards the “objectives” sections, four categories have been iden- Table 1 the percentage of agreement with nursing assessment is ade-
tified in which to subdivide the items, starting from the definition of quately identified and divided by each diagnosis.
nursing outcomes (Moorhead et al., 2020) in the NOC taxonomy: (a) In some cases, there were no data in the nursing assessments to
nursing outcomes (58%); (b) outcomes with nurse as the subject (4%); evaluate whether a diagnosis has been correctly identified or not, that
(c) ambiguous outcomes, with subject unclear (5%); (d) nonoutcomes to explain blank cells in Table 1.
(13%). The drop-down menu of the section “needs” was composed by 22
It should be noted that in 20% of cases the section “objectives” was different “needs” and in the period of time considered in the research
left blank. nurses identified 3150 of them; the percentage frequency analysis is
The analysis of terms in the “actions” section led to the identification reported in Table 2.
of five categories, starting from the definition of nursing interventions NANDA-I taxonomy has been used to further analyze the “needs”
intended as treatment that the nurse implements in order to improve section. Definitions and titles of diagnoses have been linked to a “need”
the results obtained from the caring process (Butcher et al., 2020) and his frequency with a cross-checked analysis. Seventeen different
as reported in the NIC taxonomy: (a) nursing interventions (32%); (b) diagnoses have been chosen. In some cases, one diagnosis is linked to
interventions with patient as the subject (16%); (c) ambiguous inter- more than one “need” because the definition suited, after the agree-
vention, with subject unclear (24%); (d) non-interventions (16%). Sec- ment between the researchers. For example, diagnosis ineffective
tion “actions” was left blank in 12% of cases. health management 00078 is linked to four “needs” that deal with the
76 ALEANDRI ET AL .

TA B L E 1 Percentage agreement with the assessment

Agreement with the

Nursing Diagnosis NEEDS assessment (%)

Class 4 Domain 4 Vital signs monitoring 86.8

Risk for imbalanced fluid volume 00025 Water retention risk
Risk for deficient fluid volume 00028 Dehydration risk 60
Risk for infection 00004 Peripheral and central venous access management
Urinary catheter management
Impaired skin integrity 00046 Skin lesions 80
Risk for caregiver role strain 00062 Caregiver: training 100
Ineffective health management 00078 Inadequate management of medical aids 60
Integration with other healthcare services / clinics
Inadequate diabetic foot care
Inadequate therapeutic adherence 30.8
Bathing self-care deficit 00108 Inadequate personal hygiene 0.0
Inadequate foot care
Powerlessness 00125 Psychological support 33.3
Acute pain 00132 Inadequate pain management 25
Chronic pain 00133
Sedentary lifestyle 00168 Incorrect lifestyle related to movement 62
Risk for unstable blood glucose level 00179 Glycemic control 92.9
Risk-prone health behavior 00188 Incorrect lifestyle related to alcohol use 66.7
Incorrect lifestyle related to smoking 60
Risk for bleeding 00206 Bleeding risk
Risk for overweight 00234 Incorrect lifestyle related to nutrition 76.9
Risk for unstable blood pressure 00267 Electrocardiogram/urgent or control BP monitoring

same theme. In other cases, one “need” is linked to more than one diag- DISCUSSION
nosis; for example, diagnosis acute pain 00132 and chronic pain 00133
are both linked to “inadequate pain management” to enclose all types of The use of the planning assessment tool showed that in more than 80
pain. “Vital sign monitoring” is the only one linked to Class 4 diagnoses percent of cases there was concordance between assessment data and
from Domains 4 because this “need” is related to all diagnoses concern- subsequent identification of nursing diagnoses (Table 1). This implies
ing vital sign and hemodynamic control. This diagnoses group has been a good ability of nurses to identify patient needs. However, the large
identified as the most prevalent in the software database (22.4%), fol- standard deviation shows that there is a lot of variability between
lowed by risk for unstable blood glucose level 00179 (16.4%) and risk the various diagnoses, both due to the lack of data collection in the
for overweight 00234 (13%). assessment phase, and to the nonidentification of the diagnosis. As
Further analysis showed that there were also incomplete nursing regards the identification of nursing outcomes and interventions, the
care plans in the software. In other terms each “need” was not always analyzed data showed a lower range of adequacy: correctly identified
followed by an outcome and an intervention: 13.4% (11.1 SD) of the nursing outcomes were 58%, with 20% of outcomes left empty, while
planification were incomplete. nursing interventions only 32%, with 12% of interventions left empty.
Regarding outcomes and interventions, a prevalence analysis These data show excellent skills of nurses in the community context in
has been made. In accordance with the “needs” section, the main correctly identifying the prevailing needs of patients and the necessity
nursing outcomes identified were vital signs 0802 (22.5%), blood to improve nurses training and skills with respect to identifying the
glucose level 2300 (16%) and weight loss behavior 1627 (11%). the correct outcomes and interventions. 13.4% (SD 11.1%) of the care
analysis of the “actions” section showed instead that the most preva- plans were incomplete; in other words, not all diagnoses were correctly
lent nursing interventions are wound care 3660 (27%), medication followed by outcomes and interventions. The standard deviation value
administration: intramuscular 2313 (19%), and health education 5510 shows a lot of variability between diagnoses in the care plans. It should
(14%). be checked whether the nurses’ difficulty lies in developing the plan for
TA B L E 2 Percentage analysis of the care plans

Nursing Diagnosis Needs % Frequency Nursing Outcomes Objectives % Frequency Nursing Interventions Actions % frequency

Class 4 Domain 4 Vital signs monitoring 22.4 Vital signs 0802 Maintain vital signs 22.5 Vital signs monitoring Vital signs 2
in the ranges 6680 measurement
agreed with GP
Risk for imbalanced Water retention risk 0.7 Self-management: acute Self-monitoring 1 Teaching: disease Health education 2
fluid volume 00025 illness 3100 process 5602
Self-management:
Risk for deficient fluid Dehydration risk 0.1
chronic disease 3102
volume 00028
Risk for infection 00004 Peripheral and central venous 0.6
access management
Urinary catheter management 0.3
Impaired skin integrity Skin lesions 9.2 Tissue integrity: skin Healing 8 Wound care 3660 Making dressings 27
00046 and mucous
membrane 1101
Risk for caregiver role Caregiver: training 0.3
strain 00062
Ineffective health Inadequate management of 0.3 Compliance behavior Adhere to therapy 1 Teaching: Health education 2
management 00078 medical aids 1601 procedure/treatment (therapeutic
5618 education)
Integration with other 0.4
healthcare services / clinics
Inadequate diabetic foot care 0.2
Inadequate therapeutic 10.8
adherence
Bathing self-care deficit Inadequate personal hygiene 0.4
00108
Inadequate foot care 1.0

(Continues)
77
 78

TA B L E 2 (Continued)

Nursing Diagnosis Needs % Frequency Nursing Outcomes Objectives % Frequency Nursing Interventions Actions % frequency

Powerlessness 00125 Psychological support 0.9

Acute pain 00132 Inadequate pain management 1.0 Pain control 1605 Low back pain 1 Medication Intramuscular 19
healing administration: injection
Chronic pain 00133
intramuscular 2313
Sedentary lifestyle Incorrect lifestyle related to 11.3 Compliance behavior: Increase physical 3.5 Health education 5510 Health education 12
00168 movement prescribed activity activity (lifestyle talks)
1632
Weight loss behavior Lose weight 11
1627
Risk for unstable blood Glycemic control 16.4 Blood glucose level Maintain blood 16 Capillary blood sample Glycemic control 1
glucose level 00179 2300 glucose values in 4035 through
the ranges agreed capillary blood
with the GP sampling
Risk-prone health Incorrect lifestyle related to 0.4
behavior 00188 alcohol use
Incorrect lifestyle related to 2.8 Smoking: cessation Stop smoking 1 Health education 5510 Health education 2
smoking behavior 1625 (lifestyle talks)
Risk for bleeding 00206 Bleeding risk 0.1
Risk for overweight Incorrect lifestyle related to 13.0 Acceptance behaviour: Improve nutrition 2 Nutrition management Food education 3
00234 nutrition prescribed diet 1622 5246
Risk for unstable blood Electrocardiogram/urgent or 0.2
pressure 00267 control BP monitoring
ALEANDRI ET AL .
 79

that diagnosis or if the difficulty also includes identifying the diagnosis CONCLUSION
itself. It may therefore be necessary for nurses to acquire more skills
to improve diagnostic accuracy. This study carried out a descriptive analysis of nursing standardized
Data extrapolated from the software (Table 2) showed that the pre- language in the outpatient setting and within CHC in the north of
vailing nursing diagnoses in CHC are those about vital sign monitoring Italy through the use of the “Case della Salute” software. It is the
(Class 4 Domain 4), glycemic control (00179) and health promotion and first example of research about nursing language in this setting that
education (00234, 00168, 00078). These data also correspond to those is very important in the care of chronic patients in Italy. NANDA-I,
emerging from the analysis of nursing outcomes: the most prevalent NOC, and NIC taxonomies, being the best-known standardized
nursing outcomes identified have been the maintenance of vital param- nursing language in Italy, have been used to analyze data from the
eters (0802) and blood glucose (2300) within preestablished ranges software. The agreement between nursing diagnoses and the nursing
and the weight loss (1627). The most prevalent nursing interventions assessment have been tested through the use of a validated tool,
are the ones about wound care (3660), intramuscular injections (2313) bringing out good ability of nurses to identify patient needs. The
and health education (5510). These data provide an overview of the analysis of outcomes and interventions instead showed the need
main activities carried out by nurses within CHC and represent one of for greater training and acquisition of skills regarding nursing care
the first examples of research in community context in Italy. The main planning. Monitoring of vital signs, blood glucose, and health education
needs of chronic patients followed in CHC emerge, such as monitor- were the prevailing needs identified through the analysis of nursing
ing of vital parameters and health education to avoid the exacerba- diagnoses and outcomes. The management of complex dressings and
tion of chronic diseases. The nursing care plans concerning vital signs intramuscular injections are the most frequent nursing interventions.
monitoring, regardless of the patient’s underlying pathology, place the The study therefore made it possible to better delineate the role of the
emphasis on the needs of the person, on his quality of life and not on nurse within the CHC as a fundamental figure for the chronic disease
the pathology he is suffering from. In CHC nurses focus on managing management.
chronicity to avoid rehospitalization. What is been said is completely in
line with the constitutive pillars of the CCM, which focuses above all on
self-management support and constant follow-up of patients directly IMPLICATION FOR NURSING
in the community (Barletta et al., 2016; Stellefson et al., 2013).
Health education has also emerged as prevalent within nursing plan- -The use of a shared and standardized taxonomy such as NANDA-
ning, both as patient needs and as a nurse intervention. To support the I in the creating nursing care plans represents a valid oppor-
management of chronicity it is in fact necessary for the nurse to imple- tunity to make more visible how much nursing skills affect
ment educational interventions on various aspects of health such as: the achievement of a higher level of health and well-being
health promotion in the absence of pathologies, focusing on habits and in chronic patients treated in CHC, in accordance with the
lifestyles; education in monitoring signs and symptoms at home, teach- CCM. Health education interventions and signs and symptoms
ing on aids and procedures necessary for the management of certain of chronic disease exacerbations monitoring, for example,
chronic syndromes (Scalorbi, 2012). are among the nursing interventions that have been preva-
All nursing outcomes and interventions emerged from the study are lent in the software data analysis. Without a computerized
in line with clinical area groupings provided by the NOC and NIC tax- tool for managing nursing documentation and a standard-
onomies: “outpatient nursing care” and “primary care and public health ized language shared by nurses, it would have been impossi-
nursing care.” The only exceptions are the outcome tissue integrity: ble to quantify these data, thus limiting nursing care to only
skin and mucous membrane 1101 and the intervention wound care performance-related activities.
3660 which concern the management of complex dressings. This indi- -This study is useful in the further training of outpatient nurses
cates that nurses in CHC have developed expert skills in the treatment who works in CHC and nurses who are going to work there.
of complex wounds and dressings more thoroughly. Training sessions have been taken place after the study to
The study has some limit: involve nurses and to discuss the changings of some terms
used in care plans to avoid language fragmentation using the
- The data that can be extrapolated from the software are extremely NANDA-I, NOC, and NIC taxonomies.
numerous and it will not be possible to analyze all of them, therefore -The study represents the starting point for future research
the study put the focus exclusively on those declared. to further deepen, perhaps at a multicentric level, the
- There is not direct interaction with patients attending CHC to verify development of a standardized nursing language through
the correctness of the collected data in the assessment phase. the creation of nursing care plans based on NANDA-I
- Taxonomies have not been used by nurses in CHC, but only by taxonomy.
researchers to analyze software’s care plans.
- Nurses’ level of experience has not been investigated, so it is not CONFLICT OF INTEREST
known their level of competence in clinical reasoning. The authors declare no conflict of interest.
80 ALEANDRI ET AL .

ORCID NANDA-I. (2018). Diagnosi infermieristiche – definizione e classificazione

Marianna Aleandri RN https://orcid.org/0000-0002-8820-8732 2018/2020. CEA.
Odone, A., Saccani, E., & Chiesa, V. (2016). The implementation of a commu-
nity health centre-based primary care model in Italy. The experience of
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