J Am Med Inform Assoc 8:212-221 doi:10.1136/jamia.2001.0080212
  • Focus on Informatics in Support of Evidence-Based Practice
  • Research Paper

Structural Validation of Nursing Terminologies

  1. Nicholas R Hardiker,
  2. Alan L Rector
  1. Affiliations of the authors: University of Salford, Greater Manchester, United Kingdom (NRH); University of Manchester, Manchester, United Kingdom (ALR)
  1. Correspondence and reprints: Nicholas R Hardiker, RN, MSc, Salford Health Informatics Research Environment, The Faculty of Health and Social Care, The University of Salford, Greater Manchester M6 6PU, UK; e-mail: <n.r.hardiker{at}>
  • Received 5 June 2000
  • Accepted 3 November 2000


Objective The purpose of the study is twofold: 1) to explore the applicability of combinatorial terminologies as the basis for building enumerated classifications, and 2) to investigate the usefulness of formal terminological systems for performing such classification and for assisting in the refinement of both combinatorial terminologies and enumerated classifications.

Design A formal model of the beta version of the International Classification for Nursing Practice (ICNP) was constructed in the compositional terminological language GRAIL (GALEN Representation and Integration Language). Terms drawn from the North American Nursing Diagnosis Association Taxonomy I (NANDA taxonomy) were mapped into the model and classified automatically using GALEN technology.

Measurements The resulting generated hierarchy was compared with the NANDA taxonomy to assess coverage and accuracy of classification.

Results In terms of coverage, in this study ICNP was able to capture 77 percent of NANDA terms using concepts drawn from five of its eight axes. Three axes—Body Site, Topology, and Frequency—were not needed. In terms of accuracy, where hierarchic relationships existed in the generated hierarchy or the NANDA taxonomy, or both, 6 were identical, 19 existed in the generated hierarchy alone (2 of these were considered suitable for incorporation into the NANDA taxonomy and 17 were considered inaccurate), and 23 appeared in the NANDA taxonomy alone (8 of these were considered suitable for incorporation into ICNP, 9 were considered inaccurate, and 6 reflected different, equally valid perspectives). Sixty terms appeared at the top level, with no indenting, in both the generated hierarchy and the NANDA taxonomy.

Conclusions With appropriate refinement, combinatorial terminologies such as ICNP have the potential to provide a useful foundation for representing enumerated classifications such as NANDA. Technologies such as GALEN make possible the process of building automatically enumerated classifications while providing a useful means of validating and refining both combinatorial terminologies and enumerated classifications.


  • * What we term in this article “enumerated classifications” are referred to by Ingenerf4 as “systematic taxonomic vocabularies.”

  • In this article, to prevent confusion, references to the terminology will be indicated by the abbreviation NANDA, whereas references to the association itself will be indicated by the full name North American Nursing Diagnosis Association.

  • See for further details. The designation ICNP is copyright © 1999 by ICN International Council of Nurses, 3 place Jean Marteau, CH-1201 Geneva, Switzerland.

  • § In this article, any reference to the NANDA taxonomy should be taken as a reference to the existing NANDA taxonomy unless “proposed taxonomy” is stated explicitly.

  • || See for further details.

  • # A similar study is planned using the proposed NANDA taxonomy in place of ICNP to generate a new taxonomic structure for comparison with the existing NANDA taxonomy. This study will serve as a validation of the proposed taxonomy.

  • ** What we term in this article “combinatorial terminologies” are referred to by Ingenerf4 as “combinatorial taxonomic vocabularies.”

  • †† The operator which is used for the creation, normalization, and classification of composite concepts.

  • §§ Composite GRAIL concepts may be named using the name operator.

  • |||| Any assessment of coverage should take into account the fact that NANDA was included in the original list of sources for the development of ICNP.22

  • ## See “Composing a Nursing Diagnosis” at for for further details.

  • *** The proposed NANDA taxonomy includes the concept “actual,” which is given as a sibling to “risk for.” The application of “actual” to all actual states would resolve this problem.

  • ††† To “force”” this classification according to the NANDA taxonomy would require a more intricate hierarchic structure in the Judgment axis; i.e., Interruption would need to be classified as an Ineffectiveness. This process would result in a richer taxonomic structure for any generated hierarchy.

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