title: Evidence for the existing American Nurses Association-recognized standardized nursing terminologies: a systematic review.
abstract: OBJECTIVE
  To determine the state of the science for the five standardized nursing terminology sets in terms of level of evidence and study focus.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Keyword search of PubMed, CINAHL, and EMBASE databases from 1960s to March 19, 2012 revealed 1257 publications.
  
  
  METHODS
  From abstract review we removed duplicate articles, those not in English or with no identifiable standardized nursing terminology, and those with a low-level of evidence. From full text review of the remaining 312 articles, eight trained raters used a coding system to record standardized nursing terminology names, publication year, country, and study focus. Inter-rater reliability confirmed the level of evidence. We analyzed coded results.
  
  
  RESULTS
  On average there were 4 studies per year between 1985 and 1995. The yearly number increased to 14 for the decade between 1996 and 2005, 21 between 2006 and 2010, and 25 in 2011. Investigators conducted the research in 27 countries. By evidence level for the 312 studies 72.4% were descriptive, 18.9% were observational, and 8.7% were intervention studies. Of the 312 reports, 72.1% focused on North American Nursing Diagnosis-International, Nursing Interventions Classification, Nursing Outcome Classification, or some combination of those three standardized nursing terminologies; 9.6% on Omaha System; 7.1% on International Classification for Nursing Practice; 1.6% on Clinical Care Classification/Home Health Care Classification; 1.6% on Perioperative Nursing Data Set; and 8.0% on two or more standardized nursing terminology sets. There were studies in all 10 foci categories including those focused on concept analysis/classification infrastructure (n=43), the identification of the standardized nursing terminology concepts applicable to a health setting from registered nurses' documentation (n=54), mapping one terminology to another (n=58), implementation of standardized nursing terminologies into electronic health records (n=12), and secondary use of electronic health record data (n=19).
  
  
  CONCLUSIONS
  Findings reveal that the number of standardized nursing terminology publications increased primarily since 2000 with most focusing on North American Nursing Diagnosis-International, Nursing Interventions Classification, and Nursing Outcome Classification. The majority of the studies were descriptive, qualitative, or correlational designs that provide a strong base for understanding the validity and reliability of the concepts underlying the standardized nursing terminologies. There is evidence supporting the successful integration and use in electronic health records for two standardized nursing terminology sets: (1) the North American Nursing Diagnosis-International, Nursing Interventions Classification, and Nursing Outcome Classification set; and (2) the Omaha System set. Researchers, however, should continue to strengthen standardized nursing terminology study designs to promote continuous improvement of the standardized nursing terminologies and use in clinical practice.
authors.affiliation: School of Nursing, Gulhane Military Medical Academy, Ankara, Turkey.
authors.forename: Sevinc
authors.initials: S
authors.lastname: Tastan
authors.affiliation: Department of Nursing, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.
authors.forename: Graciele C F
authors.initials: GC
authors.lastname: Linch
authors.affiliation: Department of Health System Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Gail M
authors.initials: GM
authors.lastname: Keenan
authors.affiliation: Department of Health System Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Janet
authors.initials: J
authors.lastname: Stifter
authors.affiliation: Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Dawn
authors.initials: D
authors.lastname: McKinney
authors.affiliation: Department of Health System Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Linda
authors.initials: L
authors.lastname: Fahey
authors.affiliation: Department of Health System Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Karen Dunn
authors.initials: KD
authors.lastname: Lopez
authors.affiliation: Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States.
authors.forename: Yingwei
authors.initials: Y
authors.lastname: Yao
authors.affiliation: Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States. Electronic address: diwilkie@uic.edu.
authors.forename: Diana J
authors.initials: DJ
authors.lastname: Wilkie
mesh_terms: D015588:Observer Variation; D012956:Societies, Nursing; D009626:Terminology as Topic; D014481:United States
keywords: Electronic health record; Nursing diagnosis; Systematic review; Terminology