International Council of Nurses [ICNP® Kellogg Project]

Home Programme Areas Professional Practice ICNP^® ICNP^® Kellogg Project

ICNP^® country project Funded by the W. K. Kellogg Foundation
BACKGROUND
In early 1994, nurses from 10 countries in the Americas and Africa met in Tlaxcala, Mexico to consider proposals for the development of an informational tool to support community-based (CB) nursing programmes and primary health care (PHC) nursing systems. The meeting was organised by the International Council of Nurses (ICN) and funded by the W. K. Kellogg Foundation. This meeting was seen to be an important step in the ICN International Classification for Nursing Practice Project that had been initiated in 1991 by ICN.
Towards the end of the 1980's, nurses in many countries were voicing concern about their inability to name the problems or situations nursing deals with. They expressed the difficulties they have in finding a commonly recognised language to describe nursing's distinctive contributions to solving, alleviating and preventing health problems or to promoting healthy living. Current widely used international classifications such as the International Classification of Diseases (ICD) of the World Health Organisation (WHO) and its family of classifications identified few labels that may be applied to nursing's contribution to health care.
The necessity for nursing to develop an International Classification for Nursing Practice (ICNP^® ) was first proposed 1989 at ICN's Council of National Representatives in a resolution calling for ICN to encourage member national nurses' associations (NNAs) to become involved in developing classification systems for nursing care, nursing information management systems and nursing data sets in order to provide tools that nurses in all countries could use to identify nursing practice, and describe nursing and its contributions to health. In response to the resolution ICN initiated work on the development of an ICNP^® . No group is doing this work at an international level. ICN, given its worldwide network of member associations and other nursing groups, is in a good position to undertake this task. Consequently, ICN has made a long-term commitment to the project that will be continuous over many years.
Preliminary work identified that, in existing systems describing and classifying nursing practice, little of the material describes primary health care nursing and community-oriented practice. ICN believed that one way to fill this gap was to find approaches which will draw on the knowledge and experiences of nurses practising in these settings, nurses who are capable of describing what nurses do when providing community-based nursing programmes and primary health care (PHC) oriented nursing services to individuals, families, and the community. The meeting in Tlaxcala set out to identify the feasibility of such an approach and to explore strategies for drawing on the experience of practising nurses.
One of the discoveries of the Tlaxcala meeting was that nurses present were able to describe a number of attempts to label and classify nursing activities. They also agreed that any published classification systems they attempted to use were of limited value for PHC because their focus was largely individual and problem oriented and closely attached to tertiary care frameworks. Family and community oriented material was rarely available in current classification systems or literature. Few examples of terms, which related to strengths that need supporting in order to enhance health levels, were available.
The meeting confirmed that nurses can identify nursing labels. Moreover participants were convinced that without a language to describe nursing activities it was likely that health systems would strongly reflect only medical and political priorities. Issues related to PHC which nurses address in their everyday work may be poorly represented or absent.
Participants went on to identify that about 20% of what nurses do is recorded somewhere in a general health information system. However that 20% is mostly of a technical nature (e.g. immunisation, weighing, dressings), and excludes much of the work which is often nursing's special responsibility e.g. teaching, counselling, community mobilisation, family guidance, training education and supervision of other health workers etc. Therefore, what is recorded provides a false picture of the actual and potential contribution of nursing to PHC. Consequently this has had an impact on the way health priorities are set, policies are developed, resources allocated, services planned, the selection of content for nursing education programmes and the kind of topics researchers study.
The outcomes of the Tlaxcala meeting enabled ICN to identify a number of strategies to ensure that an International Classification for Nursing Practice (ICNP^® ) includes the full range of PHC terms. Therefore, building on the enthusiasm and commitment generated at the W. K. Kellogg Foundation sponsored meeting in ICN proposed to continue to work with groups from countries represented at that meeting:

to elicit processes nurses can use to elucidate the language of nursing in PHC nursing practice and community-based programmes;

to collect labels that reflect the range of activities nurses engage in when working in PHC or CB systems which can be incorporated into the ICNP^® .

This work is critical to the overall development of the ICNP^® (which ICN will be pursuing concurrently) as it will allow the inclusion of primary health care and community- oriented nursing terms hitherto not recorded. It will allow ICN, during the process of the evolution of the ICNP^® , to draw on the experience and knowledge of nurses who are intimately involved with a variety of PHC activities in their daily work life.
The ICN ICNP^® Country Project, funded by the W. K. Kellogg Foundation, enables ICN to provide appropriate consultation and co-ordination of the work of country groups.
Project Objectives
The objectives of the project are:

To elicit and disseminate model processes nurses in any country can use to elucidate the language of nursing in PHC and CB systems.

To collect and ensure the insertion of PHC and CB nursing terms into the ICNP^® .

To have a mechanism in place at country level that will enable participating countries to continue to contribute PHC and CB related nursing terms to the ICNP^® after the end of the project.

To increase recognition by the nursing profession and health authorities in the countries involved of the need to include data which relates to nursing practice in health information systems.

Methods
The methods for carrying out this project were developed after close consultation with representatives of the countries hoping to participate. (Consultations took place at W. K. Kellogg Foundation financed meetings in Los Angeles and Swaziland in January 1995).

Countries participating at the Tlaxcala meeting were invited to form country work groups with representation from appropriate nursing groups. Correspondence with Tlaxcala meeting participants during 1994 and the work done at the meetings in Los Angeles and Swaziland in early 1995 confirmed an interest and the will to form a group to steer the work in each country.

Groups, to initiate their work, used the guidelines on process to elucidate terms, prepared as an outcome of the Tlaxcala meeting. In addition, each group is encouraged to explore and develop other processes. Descriptions of any new processes developed by the groups, the context in which they were used, strengths and weaknesses will be recorded with view to elaborating and refining the guidelines mentioned earlier.

Discussion with participants from countries which were interested in participating indicate that they envisage that country work will be guided by a central steering committee of 8 to 10 persons. This group will work with different types of outreach and or resource groups. Their number will depend on the size of country and the resources and expertise available.

Networking and co-ordination of the various work groups is provided by several means:

a project consultant is provided by ICN to work with each group directly using actual contact meetings, phone, fax and mail consultation, etc. ICN maintains continuous contact with the country group, updating them on progress in ICNP^® development by the country groups, providing feedback to the ICNP^® development team on issues raised about the ICNP^® , and reviewing terms developed and methodologies used and insight gained by the ICNP^® country teams.

consensus meetings planned and implemented by ICN (regional and inter-regional) which brings together all work groups ( see below);

a six monthly informal newsletter in English and Spanish; and

involvement of existing region-wide networks (e.g. REAL in Latin America and ESCACON in Southern Africa) where possible.

Consensus Meetings. Two types of consensus meeting were planned:

Regional: Two were planned -- one for the Americas and the other for Southern Africa held in the second year of the project.

Purposes:

to share and refine the work - methodologies, labels; strategies - done at country level with the other countries in the region.

to critique the models in use, for the elucidation of nursing terms, from the perspective of international usefulness/value.

to compare and contrast the types of labels emerging from the country group work.

to share the progress in the on-going work on the ICNP^® as it progresses and to provide the ICN consultants with feedback.

to evaluate the progress made in the region and the project itself at this point in time.

to prepare for presentations regarding the country-level work on the ICNP^® for the ICN Congress in Vancouver, Canada (if timing works out).

Inter-Regional meeting. Only one will be held to wards the end of the project.

Purposes:

to discuss the overall progress of the ICNP^® to date and provide direct feedback to the ICN consultants working on the ICNP^® .

to share the work of the country work groups across regions with each other.

to explore the issues related to interpretation of the labels across countries.

to discuss and plan mechanisms to involve other countries in the ICNP^® work

to establish initial mechanisms to maintain the country-level work post project.

to discuss and determine means for early field testing of the ICNP^® .

Progress to date

Eight out of the ten countries present at the Tlaxcala meeting have developed country projects that have been funded by the W. K. Kellogg Foundation. As the funding was received at different times (as much as one and half years apart) countries are at different stages in the project. Some (Brazil, Chile Colombia, Mexico, Botswana and Zimbabwe) have set up the steering committee and outreach groups and have begun to train participants. They have developed their work plans, methodologies and instruments and have begun to identify and validate terms.

Each country has received two consultation visits from the ICN ICNP^® consultant. In the first year the consultant worked mainly to develop the work plans, methodology and instruments. Training was provided to the steering group.

Two regional meetings have been conducted. The country groups shared the methodologies and instruments developed for their country project, discussed the strategies that worked or failed and reported progress on the terms they are working on. ICN provided updates on the new ICNP^® developments and future plans for the next draft of the ICNP^® . Questions that relate to the structure of the ICNP^® and have implications for the future development of the classification were discussed at the meetings. They will be brought to the attention of those involved in its evolution.

Two issues of ICNP^® News have been published.

version française versión española

About ICNP® | ICNP® Version 1 | ICNP® Research & Development |
ICNP® Resources | Contact Us | ICNP® Home

© 1899 International Council of Nurses (ICN) Copying, downloading
and distribution of material from the ICN web page is permitted as long
as credit in print is given and that the material will not be used for
commercial or for-profit purposes without permission.

ICNP® country project Funded by the W. K. Kellogg Foundation

ICNP^® country project Funded by the W. K. Kellogg Foundation