The International Classification of Functioning, Disability and Health (ICF) in nursing: Persons with spinal-cord injury as an example

The core aim of nursing practice is to improve or maintain the
person’s well-being and quality of life. The use of standardized
classifications and terminologies can contribute to this aim by
facilitating intra- and inter-professional communication.
Therefore, it is important to explore approaches that enhance
common use of the current standard classifications of all
health-care professions. The overall objective of this doctoral
thesis was to investigate whether the International Classification
of Functioning, Disability and Health (ICF) is a practicable and
useful classification for nurses - using spinal-cord injury (SCI)
nursing as an example. This doctoral thesis comprises the research,
results and conclusions of two original studies published in the
nursing journal “Journal of Advanced Nursing” first authored by the
doctoral candidate. The objective of the first study was to
identify the conceptual and practical relationships between the
inter-professional ICF and the nursing-specific NANDA-I Taxonomy II
for nursing diagnoses. The specific research questions were: (1)
What are the commonalities and differences between the conceptional
frameworks and assessment principles of the ICF and the NANDA-I
Taxonomy II? and (2) Can the two classifications serve as a
combined approach in SCI nursing practice? The discussion of the
conceptual and practical relationships between the ICF and the
NANDA-I Taxonomy II is based on (1) the most recently published
descriptions of both classifications and (2) the illustration of a
SCI-specific case example presenting the combined use of both
classifications. The objective of the second study was to analyse
the extent to which the intervention goals of nurses when caring
for persons with SCI can be expressed in the standardized language
of the ICF. The specific research questions were: (1) Which
problems, resources and aspects of the environment of persons with
SCI relevant to nurses can be translated into the ICF language? and
(2) Which problems, resources and aspects of the environment
relevant to nurses are still missing in the ICF? The method used to
answer these questions was a worldwide Delphi Survey with SCI
nurses. The results of this doctoral thesis shed light on the use
of the ICF in nursing practice. First, I discuss the commonalities
and differences between the ICF and the NANDA-I Taxonomy II that
should be taken into account when implementing both 10
classifications in nursing practice. Important clinical
requirements that are exclusive to nursing can be met with the
NANDA-I Taxonomy II. The application of the ICF helps nurses
communicate abbreviated nursing issues with other health
professionals in a common language. A combined application of the
ICF and the NANDA-I Taxonomy II is valuable, and they can
complement each other to enhance the quality of clinical teamwork
and nursing practice. Second, I provide a list of patients’
problems, patients’ resources or aspects of their environment
treated by SCI nurses that might be introduced in nursing practice
for a comprehensive standardized documentation and for a better
exchange of information in a common language with other health
professionals. Third, I show the strengths and weaknesses of the
ICF when used in nursing care specific to SCI and provide evidence
for the update and future revisions of the ICF. For example, I
propose to add two qualifiers, one for “Risk for” and one for
“Resource for” to the existing qualifier scale. Several
recommendations for future research are based on the results of
this doctoral thesis. First, there is a need to continue exploring
the simultaneous use of the ICF and NANDA-I Taxonomy II. A complete
linking of both classifications could reveal their commonalities
and differences in a more detailed way and identify all missing
elements in the ICF for nursing purposes. Second, the list of
patients’ problems, patients’ resources or aspects of their
environment treated by SCI nurses should be validated in different
nursing settings (e.g. acute hospital care, rehabilitative care and
community care). This list should also be compared with the
existing Comprehensive ICF Core Sets for SCI in the early
post-acute context and long-term context. Third, the personal
factors identified should be taken into account when developing the
ICF component Personal Factors.