1.  Introduction

The International Classification of Nursing Practice (ICNP) Reference Set is a product agreed as part of a new collaboration agreement between the International Council of Nurses (ICN) and the International Health Terminology Standards Organisation (IHTSDO), trading as SNOMED International. ICNP content has been incorporated into SNOMED CT and being released as a reference set by SNOMED International on behalf of ICN - this Production release is based on ICNP 2019. To accompany the reference set, an equivalence table (ICNP content and equivalent SNOMED CT content) has been created to show the correspondence between ICNP 2019 content and the content in the SNOMED CT reference set to support migration and for those not using ICNP in SNOMED CT enabled systems.

2.  Background

ICN and SNOMED International have worked together since 2006 to advance terminology harmonisation and foster interoperability in health information systems. This work resulted in the release of an equivalence table between the International Classification for Nursing Practice (ICNP®) and SNOMED Clinical Terms (SNOMED CT®) for nursing diagnoses and an equivalence table between ICNP and SNOMED CT for nursing interventions which were released 6 monthly until 2018. ICN initiated a review of its role in health informatics globally, enabling them to develop a strategy for supporting nursing globally. It is this review which lead to the new agreement between ICN and SNOMED International, with the following key components:

• ICNP 2019 incorporated into SNOMED CT
• SNOMED International to maintain and distribute ICNP as a reference set on behalf of ICN
• ICN to retain ownership of ICNP – SNOMED International to retain ownership of SNOMED CT
• ICN to continue to lead on ICNP clinical development over time and its quality assurance through ICN governance processes
• Free for use in SNOMED International member countries and licensed by ICN in non-member countries

ICN has established the ICNP Editorial Board through which decisions on the content of ICNP will be made. The ICNP Editorial Board has put in place a mechanism for requesting change and additions to ICNP reference set - for more information please contact icnp@icn.ch.

3.  Motivation

The key drivers for this approach are:

• To ensure that nursing remains connected to the wider health information landscape globally
• To ensure that SNOMED CT continues to adequately reflect global nursing practice
• To ensure that information collected using ICNP can link to SNOMED CT encoded records and be shared with other healthcare professionals to support the care of individuals
• To capture nursing care in a standardised way thus avoiding local mapping which will lead to inconsistency
• To facilitate the sharing of ICNP-based information in a standardised way to support delivery of patient care, usage for research purposes and participation in health policy making

The ICNP, and therefore this reference set, is a terminology that enables nurses to describe and report their practice in a systematic way. The resulting information is used to support care and effective decision-making, and to inform nursing education and health policy. 

As ICNP is intended for use by and for nurses, ICN has been able to focus attention on the development of ICNP specifically for nursing practice. This has resulted in a rich and comprehensive resource that nurses can use to describe and report in detail the things that they assess (diagnoses e.g. nausea) and the things that they do (interventions e.g. counselling). The potential benefits of a consistent approach to capturing nursing data are far-reaching. However, nurses do not practice in isolation, they practice alongside many other disciplines. One of the potential risks of a specific nursing-focus is that nursing will be somehow disconnected from a larger health information landscape. 

4.  Design

The decisions about additions and changes to SNOMED CT as a result of the incorporation of ICNP 2019 into SNOMED CT has been directed by the advice given by subject matter experts from both organisations and also the new ICNP Editorial Board at ICN. To ensure fit with international requirements and other sources of terminology, the SNOMED International Nursing Clinical Reference Group has also provided advise and expertise.

This work has provided an opportunity for ICN to review and make decisions about the content of ICNP 2019. A small amount of content has been retired and there are some issues that need further review and discussion, and this content will be added to the ICNP reference set in October 2022, along with any new content ICN, through the ICNP Editorial Group, wish to add.

4.1. Versions

The version of ICNP used in this reference set is the May 2019 release.  

The version of SNOMED CT used is the July 2021 International Release.

5.  Content

The International Classification of Nursing Practice (ICNP) Reference Set is comprised of 1938 active concepts from the SNOMED CT Clinical Finding, Procedure and Situation with Explicit Context hierarchies. The concepts are those listed in the SNOMED CT to International Classification for Nursing Practice 2019 equivalence table.  

6.  Obtaining the reference set

This reference set covers content of ICNP 2019 and is published as a Production release in October 2021. The next release, with a few remaining terms from ICNP 2019 and new content outlined by ICNP Editorial Board, will be released in October 2022 by SNOMED International on behalf of ICN. It should be noted that at this point there will not be an equivalence table but a human readable list of the ICNP content. 

Access within SNOMED international member countries is provided by the Member National Release Centre in each country, via the relevant Member page. Users of ICNP in non-member countries need to gain a licence from ICN in the first instance and then will be able to gain access to the equivalence table now and then in the future the human readable versions, unless they are also SNOMED CT Affiliates in which case they will be able to access the files using their MLDS accounts. Please contact info@snomed.org and icnp@icn.ch for more information if required. 

7.  Feedback

Feedback should be sent jointly to info@snomed.org and icnp@icn.ch. Feedback should include any issues relating to implementation, suggestions for future content inclusion or general comments regarding the subset.

8.  Technical Notes

8.1. RF2 package format

The RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record).  The reason that these files are not removed from the package is to draw a clear distinction between:

1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and 
2. ...files that just happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.

This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.