by Marjory Gordon, PhD, RN, FAAN

Article originally published Sept. 30, 1998

Introduction

The world is complex. Human beings tend to manage the complexity by breaking up experiences into manageable components that have meaning. These components are stored as mental representations, or concepts, that permit thinking when the object is not present. Naming of concepts permits recognition and communication with others; grammatical rules for combining concepts permits thoughts to be shared through language, and concepts within a classification system permit organization of ideas.

A fundamental part of learning concerns concepts, categories, and classification systems. Saying "that is a dog and this is a cat" requires classifying sensory impressions. To know that both of these fall into the taxonomic category of animals is even higher level classification and to know that angry dogs bite involves accessing a network of concepts. This is similar to the situation in nursing practice when patients are deemed "difficult" or when a health problem is classified as preoperative fear. Recognition occurs when what is observed is placed into previously learned classes, or categories, on the basis of observed characteristics. Human beings think of ideas as related to each other and the world as a somewhat orderly place.

The relationship among concepts is the basis for a hierarchical classification system and the organization of knowledge in a discipline. Science develops formal concepts to classify animals, plants, chemicals, minerals, and other things of scientific interest. In a science when concepts are considered important they become formal, standardized classifications within a system. For example, classifying a person as a citizen of the United States is important for determining rights and responsibilities. Similarly classifying signs and symptoms as "High Risk for Pressure Ulcer" or "Risk for Other-Directed Violence" is important for identifying risk management activities in nursing. In the last half of the 20th century, nursing has recognized the importance of its clinical science and has constructed concepts, theories, and classification systems to further scientific development and patient care. These developments come nearly 100 years since Nightingale wrote that the "very elements of nursing are all but unknown" (Nightingale, 1859).

The purpose of this paper is to examine from a historical perspective the development of classification systems in nursing and the interdisciplinary and intradisciplinary issues that influence development. The focus will be limited to

1. three major classifications used in practice in the United States and
2. the developing international classification.