The International Council Of Nurses (ICN) in Geneva is preparing an International Classification for Nursing Practice (ICNP) that eventually will be submitted to the World Health Organization for classification of conditions necessitating nursing care. WHO will be use this coding schema for statistical purposes. Dr. Margarita M. Styles, Chair of the ICN Professional Services Committee began the project in 1991 and supported it through her Presidency in the years that followed. Through the leadership of Dr. Styles, and Dr. Fadwa Affara, the work of consultants Drs. Norma Lang (USA), June Clark (UK), and Randi Mortensen (Denmark) and advisors, G. Neilsen (Denmark) and M. Murphy and M. Wake (USA) an alpha version of the ICNP is available (International Council of Nurses, 1996).

The ICN is very aware that "without a language, nursing is invisible in health care systems and its value and importance go unrecognized and unrewarded" (1993, p.2). They have emphasized the importance of the work to every country and Lang has said that "If we cannot name it, we cannot control it, finance it, research it, teach it, or put it into public policy" (International Council of Nurses, 1993, p.2). An ICNP requires the collaboration of all nations. International interest is high and regional groups, similar to NANDA, have formed to work on classification. For example, there is a European organization, including formal organizations of Francophone nurses (Europe and Quebec) and Spanish nurses (Spain and Cuba). For a number of years Japan has had a national organization for classification and plans to develop an all-Asia organization. Debate is lively among nurses from various nations at conferences (Japan Academy of Nursing Science, 1997), in unversities, and in health care agencies. The high participation of internationals in the biennial NANDA classification conferences and the participation of Americans in European and Asian conferences provide opportunities for sharing ideas.

Concept Development and Classification

The elements to be classified in the ICNP are diagnoses, interventions, and outcomes. This will foster hypotheses about linkages. Classifications from all member countries were collected and comprised the elements for the alpha classification (International Council of Nurses, 1993;1996). Principles of division, rules, and procedures have been developed for classification. These are described in the European Telenurse Project that has been funded by the European Union for Telematics in Health Care to study the validity of the elements and classification system in European nurses clinical practice (Mortensen, 1996). (A comparable validation project in North America will have to be done eventually.)

The architecture of the alpha version is based on classification principles but appears complex (ICN, 1995) in comparison with the alphabetical listing of the first report (ICN, 1993). Key concepts for organizing elements are neutral. The orginal definitions of diagnoses and interventions are concise and are available for all terms at all levels of the classification. The beta version of ICNP is due for publication in the near future. As the ICN has stated the ICNP "provides a vocabulary, a new classification for nursing and a framework into which existing vocabularies and classifications can be cross-mapped to enable comparison of nursing data collected using other recognised nursing vocabularies and classifications. For this reason the ICNP is referred to as A Unifying Framework" (International Council of Nurses, 1996, p.13).

Summary

Discussion has focused on historical perspectives in diagnosis, intervention and outcome classification in nursing and the current status of the major developers' projects. These classifications supplement medical classifications and will permit statistical coding of functional problems that are so common in an aging population.

Classifiers in North America have encountered the major types of problems identified by van Mechelen and his colleagues (1993, p.2): creating categories (clustering problems) and inducing general classification rules from descriptions of members and non-members (rule induction problems). Classification of the phenomena of concern in nursing is a complex task. It is complex because of the inherent complexity of persons, the phenomena of concern in nursing. It also is complex because it requires clarity of language; concepts and definitions that are understood in North America may be unknown or unclear in other countries and the opposite is also true. If regional groups around the world are to contribute to an international classification used by nurses in many language groups, attention has to be paid to the construction of clear, concise, translatable terms. Countries adopting nursing classifications from regions and cultures, other than their own, have to determine the cultural-sensitivity of the concepts. This has been evident as countries have adopted the North American work. Clarity of the work is also an important factor in developing information systems which are being developed world-wide.

Will historians say that in the last half of the 20th century the developing classifications revolutionized nursing practice? Perhaps so. Nursing diagnosis encouraged thinking to move from the notion of a work-task to a conceptualization of a patient's problem. It provided a language to communicate and a tool for critical thinking at a time when documentation was characterized by statements such as "appears to be bleeding" or "appears to be dead." The development of a language for interventions and outcomes revolutionized the "work-tasks" at a time when nurses thought of intervention as "provide emotional support" and outcomes as "slept well." The profession has come a long way in this past century. One wonders what the 21st century will bring.