The Importance of Standardized Nursing Terminology and Classification Systems

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A female nurse in blue scrubs analyzes her patient’s x-ray results.

Nursing has its own language, including unique terminology and classifications that facilitate the efficient delivery of high-quality health care. It’s important that advanced practice nurses have an acute understanding of the standardized nursing terminology lists and classification systems, as this knowledge can potentially establish the line that separates an efficient health care organization from an inefficient one.

A Look at Terminology and Classification

Building a vocabulary of nursing terminology is important because it establishes a shorthand form of communication that can efficiently communicate key information about patient data and the regulations that govern the nursing profession. This efficiency can make it easier for nurse administrators and other advanced practice nurses to convey detailed care strategies to staff members and providers, ultimately leading to better patient outcomes.

The use of classification systems to effectively track care and administrative activities is also a crucial component of quality care delivery. Systematic categorizations can make it easy for staff members and health care providers to obtain broad yet fundamental metrics on a patient — data that is often essential in establishing and executing health care strategies. As technology and tech-driven data delivery become even more integrated in health care, it is increasingly important for nurses to leverage these systems.

Because nursing terminology and classification systems are so critical to health care delivery, students pursuing advanced nursing degrees, such as a Doctor of Nursing Practice, will often enroll in courses that cover the fundamentals of both topics. Common areas of concentration for DNP students include nurse education, health policy, health informatics, and nursing leadership.

The Purpose of Terminology and Classification

Ideally, nursing terminology lists and classification systems work concurrently to enable nursing professionals to deliver care. Health care professionals can deploy both to dispense various elements of patient data to other providers accurately and efficiently. Such elements can relate to diagnoses, but they can also pertain to a patient’s medical history, current medications, medical coverage, and other key information. These resources can prove to be crucial for nurses as they work with other health care professionals to build comprehensive short-term and long-term care strategies. The standardization of such data can further minimize the chance of misinterpreted information.

The Two Types of Terminology Systems

There are two main standard terminology systems in nursing: enumerative and combinatorial. An enumerative system organizes a strictly controlled list of universal terms and phrases to provide generalized data on a patient. In an enumerative list of diagnoses, for example, each entry would likely include a conceptual label, an informal definition, common associative traits, and risk factors. This could be effective in establishing the building blocks of a health care strategy.

A combinatorial system parses broader terms and phrases, with word-by-word breakdowns. These breakdowns can allow nurses to add unique details to a patient’s data and establish more complex, intricate care strategies.

Benefits of Terminology Lists and Classification Systems

Nurses who are well-versed in these lists and systems can obtain and interpret systematic data from an electronic health record (EHR), for example, without needing clarification from an external source. This efficiency can lead to other benefits, such as improved immediate care delivery and an optimized ability to create effective long-term care strategies.

While there are numerous benefits to this system, there are a few potential drawbacks. For example, the restrictiveness inherent in enumerative systems can make it challenging for nurses and physicians to build detailed strategies tailored to a specific patient. Conversely, the potentially large and widespread data associated with combinatorial systems may make utilizing the process much more time-consuming, which may hinder an organization’s efficiency.

Emerging Systems

Because of the potential challenges that enumerative and combinatorial systems entail, alternatives have emerged to help nurses administer care. A formal terminology system, for example, is a computer-based method that analyzes a patient’s situational metrics and determines if a generalized system or an intricate one should be used. The added flexibility that this process provides could further improve a facility’s caregiving efficiency.

Regardless of what nursing terminology list or classification system is utilized, they all provide fundamental tools that can improve clinical operations significantly. As a result, facilities can more easily reach the ultimate goal of providing their patients with the highest level of care possible. Learn more about how Regis College’s programs for advanced practice nurses can prepare you to utilize nursing terminology and classification systems to their fullest potential.

Recommended Readings:
Top Reasons to Get Your DNP Degree
What Can I Do with a Doctor of Nursing Practice (DNP)
How a Doctor of Nursing Practice Degree Can Lead to Better Patient Outcomes

HIMSS, “Exemplars for Advancing Standardized Terminology in Nursing to Achieve Sharable, Comparable Quality Data Based Upon Evidence”
NCBI, “Understanding the Use of Standardized Nursing Terminology and Classification Systems in Published Research: A Case Study Using the International Classification for Nursing Practice”
The Office of the National Coordinator for Health Information Technology, Standard Nursing Terminologies: A Landscape Analysis
The Online Journal of Issues in Nursing, “Informatics: The Standardized Nursing Terminologies: A National Survey of Nurses’ Experience and Attitudes – SURVEY II: Participants’ Education for the Use of Standardized Nursing Terminology “Labels”
The Online Journal of Issues in Nursing, “Nursing Nomenclature and Classification System Development”
The Online Journal of Issues in Nursing, “Standardized Nursing Language: What Does It Mean for Nursing Practice?”
Regis College, Doctor of Nursing Practice: MSN to DNP
Science Direct, “Formal Nursing Terminology Systems: A Means to an End”