Introduction
The International Classification of Nursing Practice (ICNP) Reference Set is a product agreed as part of a 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 is being released as a reference set by SNOMED International on behalf of ICN. This production release is based on ICNP 2019 as was the release in October 2021.
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. It also resulted in the SNOMED CT Nursing Activities Reference Set and SNOMED CT Nursing Health Issues Reference Set which were released until October 2021. No further releases of these reference sets are planned.
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 SNOMED 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 are made. The ICNP Editorial Board has put in place a mechanism for requesting changes and additions to ICNP reference set - for more information please contact icnp@icn.ch.
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, hence the integration of ICNP into SNOMED CT.
Future releases
The SNOMED ICNP reference set is released October 2022 as planned. It has been agreed with ICN that the next release of the SNOMED ICNP reference set will be April 2024 and then annually in April. This supports changes to the release cycles of derivatives at SNOMED International and will also allow ICN a further period to collect and agree additions to ICNP which are being proposed by users through the ICNP Editorial Board. This heralds the start of an annual update cycle by ICN, ensuring that the ICNP refset remains current and in line with global nursing practice.
It should be noted that the content of the ICNP refset (October 2022) will be included in the free for use Global Patient Set which will be issued in October 2022 by SNOMED International, replacing the Nursing Health Issues and Nursing Activities reference sets.
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 members of 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 provided an opportunity for ICN to review and make decisions about the content of ICNP 2019.
Versions
The version of ICNP used in this reference set is the May 2019 release.
The version of SNOMED CT used is the January 2024 International Release.
Content
The 2024 International Classification of Nursing Practice (ICNP) Reference Set is comprised of 2120 active concepts from the SNOMED CT Clinical Finding, Procedure and Situation with Explicit Context hierarchies. Changes to the membership of the reference set for the 2024 release includes replacements for inactivated concepts as well as the addition of new concepts. The table below details the changes.
Concept | Status | Replaced by | Status of Replacement concept |
---|---|---|---|
103693007 |Diagnostic procedure (procedure)| | Concept inactivated - no longer an active reference set member | 386053000 |Evaluation procedure (procedure)| | New refset member |
1144845004 |Risk of suicide decreased (finding)| | Concept inactivated - no longer an active reference set member | 394687007 |At low risk for suicide (finding)| | New refset member |
16386004 |Dry skin (finding)| | Concept inactivated - no longer an active reference set member | 52475004 |Xeroderma (disorder)| | New refset member |
191816009 |Drug dependence (disorder)| | Concept inactivated - no longer an active reference set member | 1254812006 |Substance dependence (disorder)| | New refset member |
249475006 |Thirst symptom (finding)| | Concept inactivated - no longer an active reference set member | 289159000 |Thirst finding (finding)| | New refset member |
313332003 |Dressing patient (procedure)| | Concept inactivated - no longer an active reference set member | 1230126004 |Performing dressing activity for full body of subject (procedure)| | New refset member |
399122003 |Swallowing problem (finding)| | Concept inactivated - no longer an active reference set member | 288939007 |Difficulty swallowing (finding)| | New refset member |
402863005 |Venous stasis ulcer of leg (disorder)| | Concept inactivated - no longer an active reference set member | 1237117000 |Venous ulcer of lower leg (disorder)| | New refset member |
409041001 |Reproductive risk (finding)| | Concept inactivated - no longer an active reference set member | No replacement | |
409043003 |Infertility risk (finding)| | Concept inactivated - no longer an active reference set member | 1269478006 |At increased risk for male infertility (finding)| 1269477001 |At increased risk for female infertility (finding)| | New refset member New refset member |
409044009 |Contraception risk (finding)| | Concept inactivated - no longer an active reference set member | 1279828000 |At increased risk for disorder due to contraceptive use (finding)| | New refset member |
409046006 |Perinatal risk (finding)| | Concept inactivated - no longer an active reference set member | 1269553009 |At increased risk for perinatal disorder (finding)| | New refset member |
1269476005 |At increased risk for complication during labor and delivery (finding)| | New member | New refset member | |
409048007 |Labor risk (finding)| | Concept inactivated - no longer an active reference set member | 1269476005 |At increased risk for complication during labor and delivery (finding)| | New refset member |
409049004 |Delivery risk (finding)| | Concept inactivated - no longer an active reference set member | 1269476005 |At increased risk for complication during labor and delivery (finding)| | New refset member |
1269562006 |At increased risk for postpartum disorder (finding)| | New member | ||
409050004 |Postpartum risk (finding)| | Concept inactivated - no longer an active reference set member | New refset member | |
1284867003 |Education about relaxation technique (procedure)| | New member | New refset member | |
410304007 |Relaxation/breathing techniques education, guidance, and counseling (procedure)| | Concept inactivated - no longer an active reference set member | New refset member | |
1296884009 |At increased risk of exposure to communicable disease (finding)| | New member | New refset member | |
443999008 |Risk of exposure to communicable disease (situation)| | Concept inactivated - no longer an active reference set member | New refset member | |
1286875007 |At increased risk for unplanned pregnancy (finding)| | New member | New refset member | |
52651000119105 |At risk of unplanned pregnancy (situation)| | Concept inactivated - no longer an active reference set member | New refset member | |
22791000175108 |At increased risk of intimate partner violence (finding)| | New member | New refset member | |
706892001 |At risk of intimate partner abuse (finding)| | Concept inactivated - no longer an active reference set member | New refset member | |
40617009 |Artificial ventilation (regime/therapy)| | New member | New refset member | |
266700009 |Assisted breathing (regime/therapy)| | New member | ||
11140008 |Respiratory assist, manual (procedure)| | New member | ||
710976005 |Maintaining ventilation (procedure)| | Concept inactivated - no longer an active reference set member | New refset member | |
1254959003 |Monitoring substance withdrawal (regime/therapy)| | New member | New refset member | |
710986006 |Monitoring drug withdrawal (regime/therapy)| | Concept inactivated - no longer an active reference set member | ||
713103003 |Giving encouragement to be urinary continent (procedure)| | Concept inactivated - no longer an active reference set member | ||
713105005 |Giving encouragement to be bowel continent (procedure)| | Concept inactivated - no longer an active reference set member | ||
87502001 |At risk for imbalanced body temperature (finding)| | Concept inactivated - no longer an active reference set member | ||
199312002 |Finding related to risk factor in pregnancy (finding)| | No longer an active reference set member | No replacement | |
370773004 |Administration of prescribed medications and solutions (procedure)| | No longer an active reference set member | 18629005 |Administration of drug or medicament (procedure)| | Existing refset member |
370774005 |Administration of prescribed medications based on arterial blood gas results (procedure)| | No longer an active reference set member | 18629005 |Administration of drug or medicament (procedure)| | Exisiting refset member |
13197004 |Uses contraception (finding)| | New member | ||
282298003 |Able to balance (finding)| | New member | ||
871870009 |Able to demonstrate health literacy (finding)| | New member | ||
300199007 |Able to hear (finding)| | New member | ||
301570003 |Able to mobilize using mobility aids (finding)| | New member | ||
706954003 |Able to perform intermittent urethral self-catheterization (finding)| | New member | ||
705075002 |Able to see (finding)| | New member | ||
609328004 |Allergic disposition (finding)| | New member | ||
87486003 |Aphasia (finding)| | New member | ||
424167000 |At increased risk for unstable blood glucose level (finding)| | New member | ||
715238005 |At increased risk of electrolyte imbalance (finding)| | New member | ||
248279007 |Frailty (finding)| | New member | ||
74506000 |Bereavement due to life event (finding)| | New member | ||
131148009 |Bleeding (finding)| | New member | ||
48782003 |Delivery normal (finding)| | New member | ||
871869008 |Difficulty demonstrating health literacy (finding)| | New member | ||
102835006 |Difficulty passing urine (finding)| | New member | ||
3006004 |Disturbance of consciousness (finding)| | New member | ||
288784001 |Does communicate needs and wishes (finding)| | New member | ||
129882008 |Dysfunctional coping using self defense mechanisms (finding)| | New member | ||
300463007 |Efficient emptying of urinary bladder (finding)| | New member | ||
449892005 |Feeling safe (finding)| | New member | ||
271591004 |Fully conscious (finding)| | New member | ||
418363000 |Itching of skin (finding)| | New member | ||
278040002 |Loss of hair (finding)| | New member | ||
405273008 |Manic mood (finding)| | New member | ||
123640000 |Mucous membrane dryness (finding)| | New member | ||
169961004 |Normal birth (finding)| | New member | ||
45332005 |Normal capillary filling (finding)| | New member | ||
271720007 |Normal intracranial pressure (finding)| | New member | ||
162081000 |Not constipated (finding)| | New member | ||
301146007 |Peripheral pulse palpable (finding)| | New member | ||
228151002 |Personal care disability (finding)| | New member | ||
764816006 |Physically prepared to undergo surgery (finding)| | New member | ||
161047009 |Poor adaptation to disability (finding)| | New member | ||
301179007 |Poor venous access (finding)| | New member | ||
47295007 |Psychomotor agitation (finding)| | New member | ||
416751004 |Reduced drugs misuse (finding)| | New member | ||
286688002 |Splitting - mental defense mechanism (finding)| | New member | ||
226077000 |Therapeutic diet (finding)| | New member | ||
110483000 |Tobacco user (finding)| | New member | ||
418107008 |Unconscious (finding)| | New member | ||
95930005 |Victim of neglect (finding)| | New member | ||
271398006 |Weight steady (finding)| | New member | ||
65971000052100 |Acute psychosis (disorder)| | New member | ||
87715008 |Xerostomia (finding)| | New member | ||
432843002 |Acute rejection of cardiac transplant (disorder)| | New member | ||
17226007 |Adjustment disorder (disorder)| | New member | ||
781474001 |Allergic disorder (disorder)| | New member | ||
271737000 |Anemia (disorder)| | New member | ||
266154004 |Candidiasis of mouth and esophagus (disorder)| | New member | ||
698247007 |Cardiac arrhythmia (disorder)| | New member | ||
213151004 |Heart transplant failure and rejection (disorder)| | New member | ||
213152006 |Heart-lung transplant failure and rejection (disorder)| | New member | ||
8765009 |Hematemesis (disorder)| | New member | ||
128139000 |Inflammatory disorder (disorder)| | New member | ||
262890007 |Injury of urinary tract proper (disorder)| | New member | ||
2901004 |Melena (disorder)| | New member | ||
386033004 |Neuropathy (disorder)| | New member | ||
75478009 |Poisoning (disorder)| | New member | ||
33910007 |Postoperative infection (disorder)| | New member | ||
58126003 |Postoperative wound infection (disorder)| | New member | ||
69322001 |Psychotic disorder (disorder)| | New member | ||
46742003 |Skin ulcer (disorder)| | New member | ||
213148006 |Transplanted organ rejection (disorder)| | New member | ||
386502009 |Acid-base regulation: metabolic acidosis (procedure)| | New member | ||
431695009 |Administration of drug or medicament to skin via topical route (procedure)| | New member | ||
386351006 |Administration of drug or medicament via enteral tube (procedure)| | New member | ||
406172003 |Administration of drug or medicament via nasal route (procedure)| | New member | ||
386353009 |Administration of drug or medicament via ophthalmic route (procedure)| | New member | ||
386359008 |Administration of drug or medicament via oral route (procedure)| | New member | ||
225286008 |Alternating the patient's position (procedure)| | New member | ||
386516004 |Anticipatory guidance (procedure)| | New member | ||
14766002 |Aspiration (procedure)| | New member | ||
64374001 |Assessment and interpretation of higher cerebral function, aphasia testing (procedure)| | New member | ||
473207004 |Assessment of need for interpreter (procedure)| | New member | ||
443693006 |Assessment of self medication (procedure)| | New member | ||
1177155004 |Assessment of side effects of medication (procedure)| | New member | ||
428211000124100 |Assessment of substance use (procedure)| | New member | ||
20565007 |Bathing patient in shower (procedure)| | New member | ||
302787001 |Bilirubin measurement (procedure)| | New member | ||
30381006 |Bleeding precautions (procedure)| | New member | ||
400921004 |Corneal light reflex test (procedure)| | New member | ||
243067002 |Counseling about coping strategies (procedure)| | New member | ||
736601004 |Demonstration of inhaler technique (procedure)| | New member | ||
167197004 |Digestive function tests (procedure)| | New member | ||
182882002 |Drug intake observed (procedure)| | New member | ||
171047005 |Drugs of addiction education (procedure)| | New member | ||
1263932002 |Education about sleep (procedure)| | New member | ||
439035007 |Education about sleep hygiene behavior (procedure)| | New member | ||
713607003 |Enhancement of self-efficacy (procedure)| | New member | ||
225991001 |Ensuring mobility aid available (procedure)| | New member | ||
1449002 |Epilation (procedure)| | New member | ||
1269479003 |Female perineal care management (procedure)| | New member | ||
276026009 |Fluid balance regulation (procedure)| | New member | ||
390906007 |Follow-up encounter (procedure)| | New member | ||
12894003 |Functional assessment (procedure)| | New member | ||
225285007 |Giving oral fluid (procedure)| | New member | ||
225885004 |Health assessment (procedure)| | New member | ||
110462006 |Health technology assessment procedure (procedure)| | New member | ||
84100007 |History taking (procedure)| | New member | ||
171410002 |Individual general health examination (procedure)| | New member | ||
310866003 |Informing patient (procedure)| | New member | ||
225103006 |Intermittent urethral catheterization (procedure)| | New member | ||
77248004 |Infection control procedure (procedure)| | New member | ||
1237094009 |Informing health care professional of presence of implantable cardiac device (procedure)| | New member | ||
371586004 |Learning assessment (procedure)| | New member | ||
1269480000 |Male perineal care management (procedure)| | New member | ||
737856008 |Management of vaginal blood loss (procedure)| | New member | ||
271347000 |Measurement of ketones in urine using dipstick (procedure)| | New member | ||
396073008 |Medication administration assessment (procedure)| | New member | ||
410265008 |Medication administration education, guidance, and counseling (procedure)| | New member | ||
385796006 |Medication prefill preparation (procedure)| | New member | ||
58707002 |Oral hygiene education (procedure)| | New member | ||
104847001 |Oxygen saturation measurement (procedure)| | New member | ||
71192002 |Peritoneal dialysis (procedure)| | New member | ||
398636004 |Physical activity assessment (procedure)| | New member | ||
431182000 |Placing subject in prone position (procedure)| | New member | ||
1230179009 |Positioning subject in lateral decubitus position (procedure)| | New member | ||
1230176002 |Positioning subject in supine position (procedure)| | New member | ||
275826003 |Preventing injury (procedure)| | New member | ||
1172583004 |Promotion of sleep hygiene (procedure)| | New member | ||
228620008 |Provision of communication aid (procedure)| | New member | ||
444894008 |Provision of stoma care equipment (procedure)| | New member | ||
445075008 |Request for language interpreter service (procedure)| | New member | ||
410305008 |Rest/sleep education, guidance, and counseling (procedure)| | New member | ||
444686003 |Restriction of oral fluid (procedure)| | New member | ||
182836005 |Review of medication (procedure)| | New member | ||
133916000 |Role clarification (procedure)| | New member | ||
430880004 |Self-confidence enhancement (procedure)| | New member | ||
1234812003 |Shaving of hair (procedure)| | New member | ||
226060000 |Stress management (procedure)| | New member | ||
225337009 |Suicide risk assessment (procedure)| | New member | ||
384762007 |Transportation procedure (procedure)| | New member | ||
386329003 |Treatment of hypothermia (procedure)| | New member | ||
169251004 |Ultrasonography of urinary bladder (procedure)| | New member | ||
252908007 |Urinary frequency volume chart (procedure)| | New member | ||
386494000 |Visitation facilitation (procedure)| | New member | ||
225074002 |Application of lubricant to lips (regime/therapy)| | New member | ||
225316001 |Bedrest (regime/therapy)| | New member | ||
385715006 |Cardiac care (regime/therapy)| | New member | ||
225356004 |Care of equipment and devices (regime/therapy)| | New member | ||
386262008 |Dysreflexia management (regime/therapy)| | New member | ||
386275008 |Electrolyte monitoring (regime/therapy)| | New member | ||
792805006 |Fasting (regime/therapy)| | New member | ||
113148007 |Fluid intake encouragement (regime/therapy)| | New member | ||
76168009 |Group psychotherapy (regime/therapy)| | New member | ||
410390008 |Growth/development surveillance (regime/therapy)| | New member | ||
386342003 |Kangaroo care (regime/therapy)| | New member | ||
225417009 |Intermittent observation (regime/therapy)| | New member | ||
386369002 |Newborn monitoring (regime/therapy)| | New member | ||
386279002 |Peripheral embolus care (regime/therapy)| | New member | ||
423687009 |Peripheral intravenous catheter care (regime/therapy)| | New member | ||
443425001 |Preparation for procedure (regime/therapy)| | New member | ||
386397008 |Providing presence (regime/therapy)| | New member | ||
423785008 |Provision of interpreter/translator services (regime/therapy)| | New member | ||
182809008 |Renal function monitoring (regime/therapy)| | New member | ||
243117007 |Sibling support (regime/therapy)| | New member | ||
386451005 |Substance use treatment: overdose (regime/therapy)| | New member | ||
61420007 |Tube feeding of patient (regime/therapy)| | New member | ||
386485006 |Unilateral neglect care (regime/therapy)| | New member | ||
388962008 |Weight maintenance regimen (regime/therapy)| | New member | ||
871480003 |No psychosis present (situation)| | New member | ||
860635002 |No anemia present (situation)| | New member | ||
401187007 |No itch (situation)| | New member | ||
314529007 |Medication review due (situation)| | New member |
Obtaining the reference set
This reference set covers content of ICNP 2019 and is published as a Production release in May 2024. It should be noted that SNOMED International is not providing an equivalence table as part of the 2024 release. For further information regarding a human readable version of the current equivalence table please contact icnp@icn.ch
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, 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.
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.
Technical Notes
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:
- ...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
- ...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.
RF2 Delta files removed from the package
Delta files have been removed from both International and Managed Service release packages, and are now being removed from all Derivative products in line with this new Standard.
The Delta files have therefore been removed from this 2022 ICNP Nursing Practice Release package. Please contact support@snomed.org if you have any questions about these improvements.
Metadata now incorporated into the Derivative Packages
After consultation in 2023, SNOMED International are in the process of migrating the Metadata components for Derivative product from the International Edition to the Derivative release packages themselves.
These Derivatives are solely single refsets/maps, and so don’t mean anything to end users without the supporting terms and other components from the International content. The nature of these products is therefore such that we necessarily create Derivative packages that are inherently dependent on the relevant International Edition content. Previously, therefore, we have always created the metadata components (refset/module concepts, descriptions, relationships, etc) in the International Edition release packages, with the Derivative products being dependent on the relevant International content.
Whilst this dependency on the International content would continue, the transition would include the metadata components in the Derivative packages themselves, rather than in the International Edition packages – this will involve:
- Inactivation (but not complete removal) of the current components in the International Edition
- Activation of the Metadata components in each of the Derivative release packages
The consensus is that moving the Metadata components into the Derivative packages will bring benefits to both the Derivative maintainers, and also to the end users who will no longer need to pull this particular data down from the dependent International Edition in order to use the Derivative products. It enables maintainers to move to a more efficient model of hosting the Derivative content in termServer branches, rather than importing Delta files from external tools.
Therefore in this ICNP Refset release, we are including the following components in the Derivative release package:
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Approvals
Final Version | Date | Approver | Comments |
---|---|---|---|
1.0 | Jane Millar | Approved | |
1.0 | Cathy Richardson | Approved |
Download .pdf here:
Draft Amendment History
Version | Date | Editor | Comments |
---|---|---|---|
0.1 | 23/02/2024 | Andrew Atkinson | Initial Version |
0.2 | Cathy Richardson | Revised minor edits | |
1.0 | Andrew Atkinson | New technical updates included |