EN ISO 18104:2023

SLOVENSKI STANDARD
01-junij-2024
Nadomešča:
SIST EN ISO 18104:2014
Zdravstvena informatika - Kategorijske strukture za predstavitev prakse bolniške
nege v terminoloških sistemih (ISO 18104:2023)
Health informatics - Categorial structures for representation of nursing practice in
terminological systems (ISO 18104:2023)
Medizinische Informatik - Kategoriale Strukturen zur Darstellung der Pflegepraxis in
terminologischen Systemen (ISO 18104:2023)
Informatique de santé - Structures catégorielles destinées à la représentation des
pratiques de soins infirmiers dans les systèmes terminologiques (ISO 18104:2023)
Ta slovenski standard je istoveten z: EN ISO 18104:2023
ICS:
35.240.80 Uporabniške rešitve IT v IT applications in health care
zdravstveni tehniki technology
2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.

EN ISO 18104
EUROPEAN STANDARD
NORME EUROPÉENNE
December 2023
EUROPÄISCHE NORM
ICS 35.240.80 Supersedes EN ISO 18104:2014
English Version
Health informatics - Categorial structures for
representation of nursing practice in terminological
systems (ISO 18104:2023)
Informatique de santé - Structures catégorielles Medizinische Informatik - Kategoriale Strukturen zur
destinées à la représentation des pratiques de soins Darstellung der Pflegepraxis in terminologischen
infirmiers dans les systèmes terminologiques (ISO Systemen (ISO 18104:2023)
18104:2023)
This European Standard was approved by CEN on 17 November 2023.

CEN members are bound to comply with the CEN/CENELEC Internal Regulations which stipulate the conditions for giving this
European Standard the status of a national standard without any alteration. Up-to-date lists and bibliographical references
concerning such national standards may be obtained on application to the CEN-CENELEC Management Centre or to any CEN
member.
This European Standard exists in three official versions (English, French, German). A version in any other language made by
translation under the responsibility of a CEN member into its own language and notified to the CEN-CENELEC Management
Centre has the same status as the official versions.

CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,
Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway,
Poland, Portugal, Republic of North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Türkiye and
United Kingdom.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION

EUROPÄISCHES KOMITEE FÜR NORMUNG

CEN-CENELEC Management Centre: Rue de la Science 23, B-1040 Brussels
© 2023 CEN All rights of exploitation in any form and by any means reserved Ref. No. EN ISO 18104:2023 E
worldwide for CEN national Members.

Contents Page
European foreword . 3

European foreword
This document (EN ISO 18104:2023) has been prepared by Technical Committee ISO/TC 215 "Health
informatics" in collaboration with Technical Committee CEN/TC 251 “Health informatics” the
secretariat of which is held by NEN.
This European Standard shall be given the status of a national standard, either by publication of an
identical text or by endorsement, at the latest by June 2024, and conflicting national standards shall be
withdrawn at the latest by June 2024.
Attention is drawn to the possibility that some of the elements of this document may be the subject of
patent rights. CEN shall not be held responsible for identifying any or all such patent rights.
This document supersedes EN ISO 18104:2014.
Any feedback and questions on this document should be directed to the users’ national standards
body/national committee. A complete listing of these bodies can be found on the CEN website.
According to the CEN-CENELEC Internal Regulations, the national standards organizations of the
following countries are bound to implement this European Standard: Austria, Belgium, Bulgaria,
Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland,
Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Republic of
North Macedonia, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Türkiye and the
United Kingdom.
Endorsement notice
The text of ISO 18104:2023 has been approved by CEN as EN ISO 18104:2023 without any modification.

INTERNATIONAL ISO
STANDARD 18104
Third edition
2023-12
Health informatics — Categorial
structures for representation of
nursing practice in terminological
systems
Informatique de santé — Structures catégorielles destinées à la
représentation des pratiques de soins infirmiers dans les systèmes
terminologiques
Reference number
ISO 18104:2023(E)
ISO 18104:2023(E)
© ISO 2023
All rights reserved. Unless otherwise specified, or required in the context of its implementation, no part of this publication may
be reproduced or utilized otherwise in any form or by any means, electronic or mechanical, including photocopying, or posting on
the internet or an intranet, without prior written permission. Permission can be requested from either ISO at the address below
or ISO’s member body in the country of the requester.
ISO copyright office
CP 401 • Ch. de Blandonnet 8
CH-1214 Vernier, Geneva
Phone: +41 22 749 01 11
Email: copyright@iso.org
Website: www.iso.org
Published in Switzerland
ii
ISO 18104:2023(E)
Contents Page
Foreword .iv
Introduction . vi
1 Scope . 1
2 Normative references . 1
3 Terms and definitions . 1
3.1 General terms . 2
3.2 Categories of healthcare entities for nursing diagnoses . 4
3.3 Sub-categories of healthcare entities applicable to a clinical assessment including
nursing diagnoses . 5
3.4 Categories of healthcare entities for NursingActions not previously specified. 6
3.5 Sub-categories of healthcare entities for Nursing Actions and its sub-categories
not previously specified. . 7
3.6 Categories of healthcare entities for Nurse Sensitive Outcomes . 8
3.7 Sub-categories of healthcare entities for nurse sensitive outcomes . 9
4 Semantic links .10
4.1 ‘Representation relation’ to ‘Nursing Diagnosis’ . 10
4.2 ‘Representation relation’ to ‘nursing action’ . 13
4.3 List of domain constraints for nurse sensitive outcome, including its sub-
categories and their attributes . 15
5 Categorial structures — Requirements .17
6 Categorial structure for representing nursing diagnoses .17
7 Categorial structure for representing nursing actions .18
8 Categorial structure for representing nurse sensitive outcomes .19
Annex A (informative) Nursing diagnosis, nursing actions and nurse sensitive outcomes in
context .20
Annex B (informative) Guidance for using categorial structures .29
Bibliography .33
iii
ISO 18104:2023(E)
Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national standards
bodies (ISO member bodies). The work of preparing International Standards is normally carried out
through ISO technical committees. Each member body interested in a subject for which a technical
committee has been established has the right to be represented on that committee. International
organizations, governmental and non-governmental, in liaison with ISO, also take part in the work.
ISO collaborates closely with the International Electrotechnical Commission (IEC) on all matters of
electrotechnical standardization.
The procedures used to develop this document and those intended for its further maintenance are
described in the ISO/IEC Directives, Part 1. In particular, the different approval criteria needed for the
different types of ISO document should be noted. This document was drafted in accordance with the
editorial rules of the ISO/IEC Directives, Part 2 (see www.iso.org/directives).
ISO draws attention to the possibility that the implementation of this document may involve the use
of (a) patent(s). ISO takes no position concerning the evidence, validity or applicability of any claimed
patent rights in respect thereof. As of the date of publication of this document, ISO had not received
notice of (a) patent(s) which may be required to implement this document. However, implementers are
cautioned that this may not represent the latest information, which may be obtained from the patent
database available at www.iso.org/patents. ISO shall not be held responsible for identifying any or all
such patent rights.
Any trade name used in this document is information given for the convenience of users and does not
constitute an endorsement.
For an explanation of the voluntary nature of standards, the meaning of ISO specific terms and
expressions related to conformity assessment, as well as information about ISO's adherence to
the World Trade Organization (WTO) principles in the Technical Barriers to Trade (TBT), see
www.iso.org/iso/foreword.html.
This document was prepared by Technical Committee ISO/TC 215, Health informatics, in collaboration
with the European Committee for Standardization (CEN) Technical Committee CEN/TC 251, Health
informatics, in accordance with the Agreement on technical cooperation between ISO and CEN (Vienna
Agreement).
This third edition cancels and replaces the second edition (ISO 18104:2014), which has been technically
revised.
The main changes are as follows:
— more comprehensive representation of nursing practice;
— inclusion of nurse sensitive outcomes, its sub-categories representing known confounding variables
and their relationship with the care process;
— inclusion of reference to ISO 13606-2 and openEHR RIM;
— inclusion of reference to ICNP into the SNOMED CT® terminology;
— representation of the nursing action ‘Assessment’ as an Observation which is represented as a sub-
category of NursingAction;
— recognition of the collaborative roles of nurses (and midwives) with their subject of care to inform
actions and assessments;
— inclusion of a goal/ expected outcome category;
— inclusion of a number of specified sub-categories enabling the differentiation between Nursing
Actions and actions undertaken by others, as listed in a new category titled Outcome Causation;
iv
ISO 18104:2023(E)
— category definitions were reviewed and updated;
— definitions are provided for all new categories and sub-categories.
Any feedback or questions on this document should be directed to the user’s national standards body. A
complete listing of these bodies can be found at www.iso.org/members.html.
v
ISO 18104:2023(E)
Introduction
Development of terminological systems to support nursing has been motivated by multiple factors
including the need to:
— represent nursing concepts in electronic systems and communications, including systems that
support multi-professional team communications and personal health records;
— analyse data about the nursing contribution to subject of care and outcomes — for quality
improvement, research, resource and performance management, reimbursement, policy and other
purposes;
— describe nursing in order to educate and inform students and others.
Multiple terminologies exist to support representation of concepts for healthcare purposes; some of
these are relevant to the nursing domain. In the context of health informatics, there is a clear requirement
for both domain coverage and for interoperability among computer-processable terminological systems
that support nursing. These requirements are best represented by clinical information models. Nursing
terminologies, or those parts of healthcare-related terminologies that are relevant to nursing, include
concept representations for nursing assessments, a nursing action undertaken to determine a nursing
diagnoses (judgements). Nursing diagnoses inform the need for further nursing actions. Collectively
these concepts represent the provision of nursing services whilst nurse sensitive outcomes represent
the result of health services, including nursing services, delivered at any point in time.
A nursing diagnosis is used as an indicator of nursing service demand. Nursing actions represent
nursing service delivery components undertaken to meet the service demand. These concepts and the
scope of nursing practice are further elaborated in Annex A.
It was identified that nursing outcome definitions need to differentiate between conceptual, structural
or contextual viewpoints. A conceptual definition recognises that nurse-sensitive subject of care
outcomes are the result of a number of defining aspects. Nurse-sensitive health outcomes not only
pertain to individuals but also to groups, families, local communities and the population at large. This is
further elaborated in Annex A.
Nursing practice is best represented by terminological systems pertaining to three key categories, 1)
Nursing Diagnosis, 2) Nursing Actions and 3) Nurse Sensitive Outcomes. These concepts and the scope of
nursing practice reflect the nursing process, they are further elaborated in Annex A. The categories that
make up the nursing practice domain are shown in Figure A.1. Semantic links between categories are
shown in Figures 1, 2 and 3. As this document deals with populations and groups of individuals, as well
as individual subjects of care, the definition of ‘subject of care’ does not conform with ISO 13940:2015.
Many of the categories and subcategories included in this document are equally applicable to other
clinical disciplines. This categorial structure represents a common pattern for all types of clinical
practices. The terminologies association with each of these categories and sub-categories are likely to
differ to best represent each discipline’s knowledge base and service protocols.
Topics considered outside the scope of this document include
— complete categorial structures that would cover all the potential details that could appear in
expressions of nursing diagnoses, nursing actions and nurse sensitive outcomes,
— a detailed terminology of nursing diagnoses or nursing actions or nurse sensitive outcomes,
— a “state model” for nursing diagnoses or nursing actions or nurse sensitive outcomes — for example,
provisional nursing diagnosis or absent nursing diagnosis, planned nursing action or nursing action
not to be done — see Annex A,
— nursing diagnoses made and nursing actions undertaken by nurses working in other professional
roles — see Annex A, and
— knowledge relationships such as causal relationships between concepts — see Annex B.
vi
ISO 18104:2023(E)
NOTE 1 Throughout the main body of this document, where terms such as nursing diagnosis, nursing action
and nurse sensitive outcome are used, these refer to representation of these concepts in electronic systems, not
to the professional activity of making a diagnosis or performing an action or determining their relationship with
nurse sensitive outcomes.
This document is applicable to the following user groups:
— developers of terminologies that include nursing diagnosis, nursing action and nurse sensitive
outcome concepts;
— developers of categorial structures and terminologies for other healthcare domains, to support
clarification of a relationship to or overlap with nursing concepts;
— developers of models for health information management systems such as electronic health records
and decision support systems, to describe the expected content of terminological value domains
for particular sub-categories and data elements in the information models, including archetypes or
[45]
templates ;
— developers of information systems, including electronic health/medical records, that require an
explicit system of concepts for internal organization, data repository management or middleware
services;
— developers of software for natural language processing, to facilitate harmonization of their output
with coding systems.
It is not intended for use by clinical nurses without health informatics expertise. However, Annex B
provides an introduction to categorial structures to assist those without health informatics expertise
to contribute to its development, review, implementation and evaluation.
NOTE 2 Although the scope of testing and review of the first edition of this document has been limited to
nursing, the three categorial structures have features in common with the more general framework for clinical
[20]
findings [ISO/TS 22789, the domain-specific categorial structure for surgical procedures (ISO 1828),
[2]
ISO 13940 as well as with the WHO ICHI. ]This document can therefore inform development of other general
and domain-specific categorial structures in healthcare.
vii
INTERNATIONAL STANDARD ISO 18104:2023(E)
Health informatics — Categorial structures for
representation of nursing practice in terminological
systems
1 Scope
This document specifies the characteristics of categorial structures, representing nursing practice. The
overall aim of this document is to support interoperability in the exchange of meaningful information
between information systems in respect of nursing diagnoses, nursing actions and nurse sensitive
outcomes. Categorial structures for nursing diagnoses, nursing actions, nurse sensitive outcomes and
associated categories support interoperability by providing common frameworks with which to
a) analyse the features of different terminologies, including pre- and post-coordinated expressions,
those of other healthcare disciplines, and to establish the nature of the relationship between
[3][4][5][6][7][8]
them,
[9][10][11][12]
b) develop terminologies for representing nursing diagnoses, nursing actions, and nurse
sensitive outcomes,
[3][8][13]
c) develop terminologies that are able to be related to each other, and
d) establish relationships between terminology models, information models, including archetypes,
[14][15][16][45]
and ontologies in the nursing domain.
There is early evidence that the categorial structures can be used as a framework for analysing nursing
[17] [18][19]
practice, for developing nursing content of electronic record systems, document the value of
[16][36][47][50]
nursing services provided and to make nursing’s contribution visible .
2 Normative references
The following documents are referred to in the text in such a way that some or all of their content
constitutes requirements of this document. For dated references, only the edition cited applies. For
undated references, the latest edition of the referenced document (including any amendments) applies.
ISO 17115, Health informatics — Representation of categorial structures of terminology (CatStructure)
ISO/TS 22789, Health informatics — Conceptual framework for patient findings and problems in
terminologies
EN 12264, Health informatics — Categorial structures for systems of concepts
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
ISO and IEC maintain terminology databases for use in standardization at the following addresses:
— ISO Online browsing platform: available at https:// www .iso .org/ obp
— IEC Electropedia: available at https:// www .electropedia .org/
ISO 18104:2023(E)
3.1 General terms
3.1.1
concept
subset of knowledge constructed through combining characteristic (3.1.4)
Note 1 to entry: A concept can have one or more names. It can be represented using one or more terms, pictures,
icons or sounds.
3.1.2
categorial structure
minimal set of domain constraints (3.1.5) for representing concept systems in a precise domain to
achieve a precise goal (3.2.3)
Note 1 to entry: Annex B provides further explanation.
[SOURCE: ISO 17115:2020, 3.1.1 modified — “subject field” replaced by “precise domain to achieve a
precise goal”.]
3.1.3
category
division of sets of entities (3.1.6) regarded as having particular shared characteristics (3.1.4)
EXAMPLE 1 Parenteral route is more general than intravenous route.
EXAMPLE 2 ‘target’ (3.4.2) isA ‘site’ (3.3.3) which has attributes.
Note 1 to entry: Categories can be more or less general and include groups of individual subject of cares or carers.
Where one category is subsumed by another, the isA relation is asserted to obtain a hierarchy between the more
specific or subsumed category (sub-category) and the more general or subsuming category.
Note 2 to entry: Each entity (3.1.6) instantiates some category.
3.1.4
characteristic
abstraction of a property
EXAMPLE Fever is a characteristic symptom of flu.
Note 1 to entry: Characteristics are used for describing concepts (3.1.1) and for differentiating category (3.1.3).
3.1.5
domain constraint
rule prescribing the set of sanctioned characteristics (3.1.8) that are valid to specialize a concept
representation in a subject field
EXAMPLE ‘Administration of drug’ hasRoute ‘subcutaneous’ is used to describe the fact that drugs can be
administered subcutaneously in the specific context that the terminology applies to.
Note 1 to entry: Different levels of sanctioning are possible, e.g. conceivable, sensible, usually in the context of,
normal, necessary.
3.1.6
entity
concept (3.1.1) represented as a diagrammatic grouping of a concrete or abstract thing of interest
EXAMPLE As shown in a relational database entity-relationship diagram.
ISO 18104:2023(E)
3.1.7
representation relation
semantic link
formal representation of a directed associative relation or partitive relation between two concepts
(3.1.1)
EXAMPLE hasFocus; actsOn.
Note 1 to entry: a representation relation (3.1.7) always has an inverse, i.e. another representation relation
with the opposite direction. The inverse may or may not be explicitly stated. For example, isFocusOf (inverse of
hasFocus); isTargetOf (inverse of actsOn).
3.1.8
sanctioned characteristic
formal representation of a type of characteristic (3.1.4)
EXAMPLE hasFocus symptom; hasSite altered structure.
3.1.9
terminological system
structured human and machine-readable representation of clinical concepts (3.1.1) required directly or
indirectly to describe health conditions and healthcare activities, and allow their subsequent retrieval
or analysis
3.1.10
attribute
piece of information which determines the properties of a field or tag in a database
Note 1 to entry: Attributes may be represented by a terminology.
3.1.11
qualifier
limits or modifies the meaning of the category to which this belongs
3.1.12
information model
model that expresses in a standardized and reusable manner one or more healthcare or clinical concepts
and their context in a conceptual and logical model, specifying healthcare information as a discrete set
of data elements, their characteristics and relationships, and appropriate terminology bindings
[SOURCE: ISO 13972:2022, 3.1.13, modified]
3.1.13
nurse
specially trained individual who provides autonomous, collaborative and holistic healthcare for the
subject of care, carers and significant others in response to their health, behavioural, social and physical
situation at a point in time
Note 1 to entry: The subject of care may include individuals or all ages, families, groups and communities, sick or
well in any healthcare setting in accordance with their scope of practice.
Note 2 to entry: Nursing includes midwives and obstetric care and other specialist services provided in a nursing
context.
Note 3 to entry: Nurses provide support and comfort to subjects of care, carers and significant others in response
to health services received including treatment received.
3.1.14
significant other
friends, partners and family with close relationship to the subject of care
ISO 18104:2023(E)
3.2 Categories of healthcare entities for nursing diagnoses
3.2.1
observation
assessment of the status of a subject of care (3.2.2)
Note 1 to entry: It is a sub-category of nursing action (3.4.1).
Note 2 to entry: Assessment includes one or a combination of a measurement, evaluation or judgment that relates
to a variable pertaining to the status of a subject of care (3.2.2).
Note 3 to entry: Observation sub-category that are valid for representation of a type of assessment or activity,
including a nursing diagnosis (3.2.7), include, but are not limited to measure (3.3.12), status (3.3.13), site (3.3.3),
information from subject of care/carer (3.3.14) and from other care providers.
3.2.2
subject of care
one or more persons scheduled to receive, receiving, or having received a health service
Note 1 to entry: Subject of care category (3.1.3) valid for representation of a type of assessment or activity,
including nursing diagnosis (3.2.7), are subjected to associated individuals, e.g. personal carer, or subject of care
preferences and event objectives.
Note 2 to entry: Includes individuals, family, community or population groups.
3.2.3
goal
specified outcome or condition to be achieved in the process of subject of care (3.2.2) care
Note 1 to entry: Its sub-categories are focus of goal (3.3.7) and target timeframe (3.3.6).
3.2.4
event objective
determines data differentiation from other data required for a different user or use case
Note 1 to entry: Its sub-category is the use case type (3.3.8).
3.2.5
associated individual
person of significance to the subject of care (3.2.2)
Note 1 to entry: Its attribute (3.1.10) is the relationship to the subject of care (3.2.2).
3.2.6
choice
subject of care (3.2.2) preferred treatment or care option
3.2.7
nursing diagnosis
result of a nursing assessment following a nursing action (3.4.1)
Note 1 to entry: This result is used to inform nursing service delivery method (3.5.1) requirements at the point of
care or nurse sensitive outcome (3.6.1) at a subsequent point in time.
Note 2 to entry: A nursing diagnosis is a label assigned to a judgement based on an assessment finding, event,
situation or other health issue to indicate that it is considered to be noteworthy by the nurse and where possible,
the subject of care.
ISO 18104:2023(E)
3.3 Sub-categories of healthcare entities applicable to a clinical assessment including
nursing diagnoses
3.3.1
clinical course
characteristic (3.1.4) of the evolution of the health state over time in conjunction with medical treatment
EXAMPLE Acute, chronic, sudden.
Note 1 to entry: See Annex A for discussion of clinical course.
Note 2 to entry: Does not include time related expressions [see timing (3.5.6)].
Note 3 to entry: Refers to the individual’s response to medical treatment as observed at any point in time.
3.3.2
severity
degree of seriousness of clinical finding (3.7.1) or intensity
EXAMPLE Mild, moderate, severe.
Note 1 to entry: A number of scoring systems are in use to take into account factors that influence type and
timing (3.5.6) of nursing action (3.4.1) to be taken and their outcomes. Their use enables comparisons to be made
between subject of care (3.2.2).
3.3.3
site
anatomical structure
Note 1 to entry: Site category (3.1.3) that are valid for expressions of nursing diagnoses (3.2.7) are body
component, and altered structure (e.g. a wound).
3.3.4
related event
occurrence that can be considered as a symptom or a cause when correlated with a nursing diagnosis
(3.2.7)
Note 1 to entry: Events include an adversity such as post-operative infection, a fall, drug administration error or
another incident.
3.3.5
identifier
unique object, token, code or set of variables that differentiates between individual subjects of care
(3.2.2)
3.3.6
target timeframe
date/time of desired goal attainment of a change in, or termination of a nursing diagnosis (3.2.7) at a
subsequent point in time
EXAMPLE Desired discharge date.
3.3.7
focus of goal
area of attention
EXAMPLE Tissue integrity, body temperature, activity of daily living.
Note 1 to entry: Focus may be qualified by site (3.3.3), and measure (3.3.12) for example, movement of leg, tissue
integrity of left heel.
ISO 18104:2023(E)
3.3.8
use case type
usage scenario used in system analysis to identify, clarify and organize data retrieval to suit a specific
purpose
EXAMPLE Measure (3.3.12) operational effectiveness, clinical findings (3.7.1) relative to treatment/care
options, identify impact of nursing skill mix allocation.
Note 1 to entry: Measure the cause of a type of nurse sensitive outcome (3.6.1) to generate new knowledge for one
of many purposes to be used to improve an operational activity.
3.3.9
relationship to subject of care
way in which or purpose of another individual to be connected to the subject of care (3.2.2)
Note 1 to entry: This may be one or many of the following formal or informal connections, social, legal, financial,
practical, family to share with or meet the needs of a subject of care.
3.3.10
allergy
damaging immune response by the body to one or many substances
Note 1 to entry: A known likely physiological response to a medication or material such latex or wool or food
substance.
Note 2 to entry: Shall be differentiated from diet intolerance (3.3.11).
3.3.11
diet intolerance
difficulty digesting certain foods known to result in one or more damaging immune responses by the
body to one or more substances
3.3.12
measure
quantified size, amount, value or degree of (something) observed by using an instrument or device
marked in standard units
EXAMPLE Apgar score, pain scale.
Note 1 to entry: This includes qualitative observation (3.2.1) converted by using a standard scale.
Note 2 to entry: May be documented as an evaluative statement.
3.3.13
status
situation at a particular point in time during a process
Note 1 to entry: Observation (3.2.1) that form part of an assessment process, including potential of risk.
3.3.14
information from subject of care/carer
contributions provided by the subject of care and/or significant other
3.4 Categories of healthcare entities for NursingActions not previously specified
3.4.1
NursingAction
activity intended directly or indirectly to improve or maintain a health state
EXAMPLE Injection, teaching, dressing, removal.
Note 1 to entry: Includes assessments made to specify a Nursing Diagnosis as represented by observatory
activities.
ISO 18104:2023(E)
Note 2 to entry: Includes assessment, evaluation and planning actions as well as those that include the actions of
“caring for”, “administration”, “feeding”, “performance”.
Note 3 to entry: A nursing diagnosis is a label for the result of an action (observation (3.2.1) performed by or
under the direction of a nurse, with the intention of directly or indirectly improving or maintaining the health
and well being of a person, group or population, the precise scope of nursing actions being delineated in each
jurisdiction.
3.4.2
target
entity (3.1.6) that is affected by the nursing action (3.4.1) or that provides the content of the nursing
action
EXAMPLE 1 Entity affected by the Nursing Action: Wound, foreign body or insulin: as in debridement of
wound, removal of foreign body, injection of insulin.
EXAMPLE 2 Entity that provides the content of the Nursing Action: Vital signs or diabetes self care: as in
assessment of vital signs, diabetes self care education.
Note 1 to entry: Category (3.1.3) that are valid for expressions of target (3.4.2) are body component, device,
substance, resource, process, physical environment, individual, group, clinical finding (3.7.1), and other categories
that have the role of focus in the nursing diagnosis (3.2.7) categorial structure. A nursing diagnosis can also be
the target of a nursing action (3.4.1).
3.5 Sub-categories of healthcare entities for Nursing Actions and its sub-categories not
previously specified.
3.5.1
service delivery method
ways nursing values and human resources are used to care for and treat subject of care (3.2.2)
EXAMPLE Methods commonly referred to as team nursing, subject of care allocation, task allocation,
primary care, mobile care, total/special care.
3.5.2
action type
observatory or behavioural or physical or social or educational activity undertaken by one or more
actor
Note 1 to entry: Nursing action (3.4.1) are also known as nursing interventions which may be specified within a
nursing terminology.
3.5.3
action frequency
number of repeating occurrences of a nursing action (3.4.1)
3.5.4
technique
way of undertaking a particular task
3.5.5
tool used
piece of equipment or device used to support a nursing action (3.4.1)
EXAMPLE Toilet chair, lifting machine, electronic monitor, disposable vs recyclable items, automatic blood
pressure monitor, EMR system.
3.5.6
timing
choice, request, order or control of when an action must be and/or is undertaken
ISO 18104:2023(E)
3.5.7
location
place, position, point, spot or area targeted for a nursing action (3.4.1)
Note 1 to entry: Place refers to physical location.
3.5.8
record
semantically indivisible clinical statement which can be structurally large or small, but which loses
meaning if broken up
Note 1 to entry: An indivisible clinical statement represents a piece of evidence recorded in the record.
3.6 Categories of healthcare entities for Nurse Sensitive Outcomes
3.6.1
nurse sensitive outcome
state observed and/or measured directly or indirectly concerning a subject of care (3.2.2) and their
relationship with the environment at a point in time and documented to suit a use case
Note 1 to entry: For instance, to assess the performance of a method or service delivery process associated with
a nursing action (3.4.1) or an organization or subject of care (3.2.2).
Note 2 to entry: A single descriptor (e.g. anxiety, pain) can serve the role of the sub-category, focus of goal
(3.3.7) target timeframe (3.3.6) and clinical finding (3.7.1). Such clinical finding expressions are also valid for the
representation of a type of assessment, including a nursing diagnosis (3.2.7).
Note 3 to entry: Measures include the application of a standard or indicators making use of one or more
dimensions of performance, such as timeliness or availability.
Note 4 to entry: Result of observation (3.2.1) made pertaining to a set of processes associated with the delivery of
health and nursing services, as determined by nursing action (3.4.1) taken and influenced by one or more of the
outcome causation (3.6.2) sub-categories
Note 5 to entry: The health outcome status referred to here is within the context of admission health status, one
or many causations, social determinants of health and other environmental factors associated with the subject of
care (3.2.2) relevant to a specified time period.
Note 6 to entry: The correct manner is determined by the current state of knowledge, to achieve the desired or
projected outcome for the subject of care (3.2.2).
Note 7 to entry: A nurse sensitive outcome (3.6.1) is a label assigned to the status of a nursing diagnosis (3.2.7)
at points of time after one or more nursing action (3.4.1) which may be referred to as interventions by a
terminological system in use.
Note 8 to entry: A nurse sensitive outcome (3.6.1) identifies the extent of change in a finding or nursing diagnosis or
the achievement of goals/expected outcomes or the value of nursing services delivered, including modifications
made due to the constraints that were outside the control of the nursing service provided.
3.6.2
outcome causation
way by which one of its sub-categories were demonstrated to have contributed to (causality) necessary
modifications of one of the action category’s attributes resulting in the nurse sensitive outcome (3.6.1)
EXAMPLE Inability to take a risk mitigation action due to non-availability of equipment or device.
ISO 18104:2023(E)
3.7 Sub-categories of healthcare entities for nurse sensitive outcomes
3.7.1
clinical finding
clinical assessment, including a nursing diagnosis (3.2.7), resulting from assessment observation (3.2.1)
made
Note 1 to entry: This is data that includes measured or observed results relative to provider and/or recipient(s)
desired or projected outcome goal (3.2.3), actual outcome state at a point in time.
Note 2 to entry: Includes a clinical (evaluative statement) reported outcome: Assessment of subject of care (3.2.2)
outcomes made by a clinician. These outcomes are usually based on objective or subjective data evaluated by the
clinician.
Note 3 to entry: Can be qualified by site (3.3.3), and measure (3.3.12) for example, movement of leg, tissue
integrity of left heel, size of wound.
3.7.2
medical diagnosis
determination of which disease or condition explains a person’s signs and symptoms
Note 1 to entry: Provisional diagnosis may change during the episode of care and may be coded based on the ICD
terminology.
3.7.3
treatment impact
causal effect of the chosen set of all clinical actions (treatment) undertaken by teams of health
professionals on an outcome
Note 1 to entry: Treatment options usually have evidence-based protocols or clinical guidelines.
3.7.4
confounding factor
third variable that might have contributed to the primary cause and effect relationship
EXAMPLE Language difficulties, religious or cultural beliefs, resistance to adopt recommended actions.
3.7.5
supply availability
provision of necessary, surgical, linen, nutritional or medication supplies at the time and location when
required to support an action
3.7.6
local environment
prevailing circumstances, locality and setting that support or hinder nursingActions (3.4.1) to be taken
EXAMPLE 1 Subject of care falls in bathroom, physical boundaries limit use of lifting machine or optimal
lifting technique.
EXAMPLE 2 Non availability of negative air pressure, single room with or without ensuite, airflow, isolation
unit, a hospital department or community setting, translation service, subject of care’s family member(s)
behaviour.
EXAMPLE 3 Information system downtime.
Note 1 to entry: Environment refers to physical, social and/or cultural phenomena, including medical dominance,
organizational culture, entity specific ethical, philosophical or moral determinants.
Note 2 to entry: This also includes social determinants.
ISO 18104:2023(E)
3.7.7
scheduling issues
match between required additional services and subject of care (3.2.2) needs
Note 1 to entry: Human resources and specialist services, such as a diagnostic test or specialist treatment option
availability. Non-availability when required influences nursing action (3.4.1).
3.7.8
tool availability
provision of desirable or necessary equipment or devices required to support action
Note 1 to entry: Tools include lifting machines, alternating pressure mattresses, IV pumps, monitors.
3.7.9
risk minimization
initiatives taken or omitted to be taken as strategies to positively influence subject of care (3.2.2) or
provider actions known to minimize or prevent harm
Note 1 to entry: Many nursing action (3.4.1) are designed to prevent harm based on known evidence-based risk
minimization actions documented in, for example, procedure manuals.
Note 2 to entry: A risk is a potential for a negative diagnosis, an opportunity (or chance) is a potential for a
positive diagnosis.
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