什么代表护理：分类或术语？

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INTRODUCTION

The words ‘classification’, ‘taxonomy’ and ‘terminology’ are often used in the International Journal of Nursing Knowledge (IJNK). The aim of this editorial is to add clarity and support the scholarly use of the terms ‘classification’, ‘taxonomy’ and ‘terminology’. Standardized Nursing Languages (SNLs) is an umbrella term that covers classifications and terminologies. However, classifications and terminologies are not the same (Müller Staub, König, & Schalek, 2017; Olsen, 2001; Webster, 1984).

As the official journal of NANDA International, IJNK is “an essential information resource for healthcare professionals concerned with developing nursing knowledge and/or clinical applications of SNLs in nursing research, education, practice, and policy” (https://nanda.org/publications-resources/publications/international-journal-of-nursing-knowledge/). With this focus, the IJNK is unique and provides key knowledge of the nursing profession. Making nursing visible by focusing on human responses (the concepts of nursing diagnoses), it is an outstanding journal that describes which health problems nurses’ address: The individual care needs or health risks/vulnerabilities of patients/their families, resp. nursing diagnoses and related outcomes and intervention research.

Because the IJNK one of the few journals addressing standardized nursing languages, it is important that authors and reviewers correctly use the words ‘classification’, ‘taxonomy’ and ‘terminology’. Otherwise, how can it be a leading source of knowledge for nursing? After having studied classifications and terminologies over more than 23 years by reading, researching, publishing and teaching, I'm often perplexed on the unclear use – respectively on the confusion – between these words and their meaning. Isn't it a scholarly duty of authors and reviewers to describe things clearly, especially in this journal that formerly was named ‘International Journal of Nursing Terminologies & Classifications’?

BACKGROUND

In my professional background I was taught to make precise distinctions and be very clear in using language. I was educated in the EU with a strong focus on criteria that professions should meet. One of these is having an own professional language representing a clearly defined knowledge base that is composed of defined, validated concepts ordered in classifications and along a taxonomy (e.g. biology, medicine) (Van der Bruggen, 2002). Therefore, my academic nursing education focused on professionalism, ontology, and semantics (along with classification criteria, their measurability and the interoperability of validated concepts). Along with measurable concepts we focused on evidence-based nursing relaying on strong research methods to measure diagnostic accuracy, nursing intervention effectiveness and the quality of nursing-sensitive patient outcomes (e.g. with experimental designs) (Polit & Tatano Beck, 2021). We had two full semesters on solely the subject of what classifications are, and what the related terms/terminologies represent. My Master's degree education was fully by problem-based learning, and one semester was solely on nursing diagnoses classifications and another one on interventions and outcomes validity and research. For the first two semester weeks we focused on definitions (e.g. phenomenon, concept, concept analysis and validation, diagnosis, intervention, outcome, term/terminology, nomenclature, classification). First, we started with studying different definitions, then we had to figure out the ones with the best evidence.

Second, we had to name which definitions we used and why. We started by studying lexica, then compared different literature sources and their evidence. Next, we went on studying the original classification books along with basic works (Gordon, 1994), followed by research papers on the respective classifications. The literature was in English, and – due to problem-based learning – we summarized and presented 10–12 research articles per week. Our professors found it crucial for a profession to name and validate its knowledge base. The second part of these semesters was on criteria that classifications should meet. Harry van der Brugge – a classification specialist writing books on several nursing classifications – was one of our mentors. The classification criteria then were linked to the respective research methodologies, and for the final exams we had to submit own research on validating classifications. To prepare for exams, we had to study the full original works of the Omaha System, Clinical Care Classification, NANDA-I, NOC and NIC with related research papers.

In my education, nursing was seen in the social domain, not in the medical or information technology domains – which use different languages and schools of thought; this became obvious to me already then. We learned that the latter – along with HL7 and nurses’ associations as well as the WHO don't describe and use the wording well. Often, several „terminologies" were recognized without clearly studying and addressing their differences. Confusions are also published: even well accepted association classifications are named being a terminology (e.g. the International Classification of Nursing Practice (ICNP) is named "classification" but its aims state that it is a reference terminology!). Early on, specialists criticized this fact (Olsen, 2001) for the following reasons: It contains no defining characteristics and no linkages between concepts. It is ordered alphabetically, but not nursing content-related to reflect clinical nursing, and only among axes which don't describe nursing per se. It is not ordered into a nursing taxonomy, and linkages among ICNP diagnostic titles ( = terms) and interventions are missing (Müller-Staub, Lavin, Needham, & van Achterberg, 2007; Odenbreit, Müller-Staub, Brokel, Avant, & Keenan, 2012; Olsen, 2001).

The same is true for several competing, self-made, not validated German nursing terminologies with are sold by single authors or by Electronic Health Record (EHR) developers (Odenbreit et al., 2018). Research has shown that such systems miss conceptual validity, and non-evidence-based terms can't represent the nursing profession (Ingenerf & Linder, 2009; Müller Staub & Rappold, 2017; Odenbreit et al., 2012; Olsen, 2001; Tastan et al., 2014; Van der Bruggen, 2002).

The described education enlightened the flame in me to focus on nursing as a unique profession and on SNLs. Based on this background and my broad research on classifications I'm writing this editorial.

CLASSIFICATIONS DESCRIBE THE KNOWLEDGE OF PROFESSIONS

The aim of a classifications is to describe the special knowledge of a profession. For decades, classifications were developed to represent and describe the knowledge base – or in other words, the body of knowledge – of professions, and concepts are the corner stone of science and research (Avant, 1990; Odenbreit et al., 2018; Odenbreit et al., 2012; L. Walker & Avant, 2019; L. O. Walker & Avant, 2005).

Classifications show the content, the internal relations among concepts, the boundaries of, and the differences to other professions (Ingenerf & Giere, 1998; Ingenerf & Linder, 2009; Merriam-Webster, 2022; Müller Staub et al., 2017; Spencer-Brown, 1997; Van der Bruggen, 2002; Webster, 1984). However, classifications are not the same as terminologies – despite the word terminology is often “mis”-used. As professionals, nurses have the special knowledge and are responsible to state accurate nursing diagnoses in order to provide effective, evidence-based nursing interventions (Jones, Lunney, Keenan, & Moorhead, 2010). Since last year, Switzerland is the only country in which the nursing profession and its responsibility are named in the constitution (Schweizerische Eidgenossenschaft, 1999 & 2022). As initiative committee, we started the political process which was influenced by the literature on the Advanced Nursing Process which bases on valid classifications (Müller-Staub, Abt, Brenner, & Hofer, 2015): by stating accurate, relevant nursing diagnoses and performing effective nursing interventions, nursing-sensitive patient outcomes are achieved (Müller-Staub et al., 2015).

The core knowledge of our profession makes nursing visible so that it can be taught and researched. Despite the need for further developments and the current stage of evidence-levels, the NANDA-I classification of nursing diagnoses (Herdman, Kamitsuru, & Lopes, 2021); the Nursing Interventions Classification NIC (Butcher, Bulechek, Dochterman, & Wagner, 2018); and the Nursing Outcomes Classification NOC (Moorhead, Johnson, Maas, & Swanson, 2018) abbreviated as NNN, are the best researched, coded classifications (Ackley, Ladwig, & Flynn Makic, 2020; Anderson, Keenan, & Jones, 2009; Müller-Staub et al., 2015; Müller-Staub, König, & Schalek, 2017; Müller-Staub et al., 2007; Tastan et al., 2014; Van der Bruggen, 2002; von Krogh, Dale, & Naden, 2005; von Krogh & Naden, 2008).

Another coded classification example – of a profession related to nursing – is the International Classification of Diseases (ICD 11) that describes medical diagnoses/diseases. The ICD aims to describe the teaching content and the clinical and legal responsibility of the medical profession. It describes the domain knowledgebase and therefore also the boundaries of the profession of medicine. It makes clear, what medical students need to learn to become accurate medical diagnosticians to effectively treat patients’ illnesses/diseases. By naming medical diagnoses in a coded, internationally recognized classification, medical diagnoses became known, researchable, comparable, and statistically evaluable. Besides the ICD 11, for instance, also the medical procedures/treatments are described in the classification of surgical procedures (CHOP). The CHOP is coherently linked to the ICD 11. These classifications are internationally recognized, they provide the core content of medical education, and they lead medical research as well as systems to finance medical treatments/health care costs. No such internationally accepted and finance relevant classification exists for nursing (yet).

CLASSIFICATIONS ARE CONCEPT-BASED

Classifications are composed of defined, valid, and related concepts including their representations (defining characteristics) and related/causative factors. These concepts are coded and meaningfully organized in a well described taxonomic structure to describe scientific, professional knowledge (Ingenerf & Giere, 1998; Müller Staub et al., 2017; Van der Bruggen, 2002). Codes allow to retrieve, evaluate, compare and share information on concepts among settings. Their structure must follow coding principles allowing interoperability. Interoperability means the ability of computer systems or software to exchange and make use of information: interoperability between devices made by different manufacturers (Merriam-Webster, 2022; Müller Staub et al., 2017; Müller Staub & Rappold, 2017; Odenbreit et al., 2012). In this editorial, the focus is not on interoperability and therefore not further addressed. However, it is key that coded concepts are valid, as its not meaningful nor ethical to compare invalid concepts by interoperable codes – this would lead to flawed research.

Concepts are the building blocks of science. With their representational primitives, ordered into categories of genus and species along with their subordinated classes and attributes or properties, as well as including described relationships between representational primitives and instances, concept-based classifications describe knowledge. Research-based concepts provide the content of classifications and make clear, what and how concepts relate to each other, and what/how they differ. In other words, concepts describe what nurses do, why they do it and what they achieve (Polit & Tatano Beck, 2021; Sojer, Aronsky, Müller, & Ruch, 2011; L. Walker & Avant, 2019).

Concepts contain a title (term), but the title is only the concept label, and many terminologies exist without offering full concepts including definitions. Indeed, the title (term/label) of each nursing diagnosis is important and has to be supported by literature. Diagnostic titles/labels must be clear and followed by an explaining definition as required by NANDA-I (Herdman et al., 2021; Scroggins, 2012). Title and definition therefore belong together – without definitions, titles become meaningless and can be freely interpreted or misunderstood. What's more: titles without the full concept can't be taught, researched, compared. To state nursing diagnoses accurately, nurses need the full concept knowledge of the diagnoses including defining characteristics and related/risk factors and associated conditions. That's why NANDA-I requires evidence-based titles/labels and definitions of each nursing diagnosis along with these additions. Title and definitions of concepts per se are not visible in the real world. Therefore, diagnostic concepts include defining characteristics and related/risk factors. The defining characteristics are the observable phenomena in the empiric, real world. Empirics also allows clinical validation of nursing diagnoses, interventions and outcomes by doing research on real patients and across settings (Lunney & Müller-Staub, 2012; Müller Staub & Paans, 2020).

A taxonomy is the overall ordering system of a classification. ‘Taxonomy’ stems from Greek (táxis = order and nómos = law) and means the scientific theory of a classification and its systematic. In a systematic process, objects are classified according to certain criteria, i.e., placed in classes (also called taxa). Originally, taxonomy in the narrower sense refers to the science of classifying all living things (Merriam-Webster, 2022; Müller Staub et al., 2017; Müller Staub & Rappold, 2017; Müller-Staub et al., 2017; Van der Bruggen, 2002). Research and nomenclatures describe that the words ‘classification’ and ‘taxonomy’ are often used as synonyms, as they rely on each other: taxonomies describe the science of building and ordering classifications (Merriam-Webster, 2022; Müller Staub, 2021). Classifications are ordered meaningfully into a taxonomy. Taxonomies contain domains and classes (of diagnoses), which again are meaningfully linked to effective interventions and related outcomes e (Müller Staub, 2021).

NANDA-I, NIC and NOC are the only classifications with a sound taxonomic nursing structure (including definitions on all levels of the classification), and diagnoses contain defining characteristics and related/risk factors, along with associated conditions (Herdman et al., 2021; Müller Staub & Rappold, 2017; Müller-Staub et al., 2007). The NANDA-I, the NIC and the NOC are classifications, not terminologies: All three are concept-based classifications including definitions; and at the most concrete (granular) level, their descriptors are observable/measurable in the empiric world, such as: The defining characteristics/related or risk factors of nursing diagnoses, the nursing actions of intervention concepts in the NIC, and the outcome indicators of the outcome concepts in the NOC (Butcher et al., 2018; Moorhead et al., 2018).

TERMINOLOGIES ARE STANDARDIZED TERMS DESCRIBING LABELS/TITLES

A terminology describes the technical or special terms used in a business, art, science, or special subject (Merriam-Webster, 2022). The aim of terminologies is to provide standardized terms (titles) to be ordered alphabetically or according to linguistic axes, and/or to be coded and being used for interoperability. The literature indicates that terminologies do not aim to describe the body of knowledge of professions (Ingenerf & Giere, 1998; Ingenerf & Linder, 2009; Müller Staub, 2022; Müller Staub & Rappold, 2017; Van der Bruggen, 2002). Therefore, terminologies do not represent content knowledge for teaching or research. To give an example, the ICNP is a terminology “that provides an agreed set of terms … it provides a framework for sharing data about nursing and for comparing nursing practice across settings” (https://www.icn.ch/what-we-do/projects/ehealth-icnptm/about-icnp. The ICNP contains terms (resp. only titles), but it does not contain concepts of nursing diagnoses with validated related/risk factors and defining characteristics, nor are diagnostic terms related to nursing interventions. The ICNP does also not contain outcome concepts. Research has shown that such a terminology is not usable for care planning or for teaching, as it misses validated concepts and a taxonomic, professional structure describing the scope of nursing.

Therefore, with the ICNP it is not possible to measure the accuracy of diagnoses, the effectiveness of interventions and the related nursing-sensitive patient outcomes (Müller Staub, 2022; Müller Staub & Rappold, 2017; Olsen, 2001). A terminology can – as its best – be a part of a classification: The title of concepts are terms. For these reasons, it does not make sense using the word “terminology” when writing about a classification. In summary, terminologies are not the same as classifications – despite the word terminology is often “misused” – even in the literature (Müller Staub, 2022). Only concept-based classifications aim and can describe knowledge, terminologies (terms/labels only) can't!

CONCLUSION AND RECOMMENDATIONS

According to scientific classification literature, naming the NANDA-I, NIC and NOC being terminologies is incorrect and lowers their value. When doing so, the evidence of these classifications is diluted. The NANDA-I, NIC and NOC classifications are much more than terminologies. They represent the body of knowledge in nursing because their concepts are organized and linked in a taxonomy. Such coded concepts can be thoroughly compared by research, while terminologies lack defined, observable content and linkages to do so. Worse, without linkages it is impossible to evaluate the effect of interventions on nursing diagnoses and to measure outcomes. Without coded, concept-based classifications the effect of nursing cannot be made visible, nor can sound research methods measure it. From a scholarly viewpoint it is recommended that each article published in this journal is revised so that authors don't name classifications being terminologies. Hopefully, in the future all authors use the word classification/taxonomy when referring to the NANDA-I, NIC or NOC classifications.

全文翻译（仅供参考）

介绍

国际护理知识杂志 (IJNK) 中经常使用“分类”、“分类”和“术语”等词。这篇社论的目的是增加清晰度并支持学术上使用“分类”、“分类”和“术语”等术语。标准化护理语言 (SNL) 是一个涵盖分类和术语的总称。然而，分类和术语并不相同（Müller Staub, König, & Schalek, 2017; Olsen, 2001 ; Webster, 1984）。

作为 NANDA International 的官方期刊，IJNK 是“关注发展护理知识和/或 SNL 在护理研究、教育、实践和政策中的临床应用的医疗保健专业人员的重要信息资源”（https://nanda.org/出版物资源/出版物/国际护理知识杂志/）。有了这个重点，IJNK 是独一无二的，并提供了护理专业的关键知识。通过关注人类反应（护理诊断的概念）使护理可见，这是一本出色的期刊，描述了护士解决的健康问题：患者/他们的家人的个人护理需求或健康风险/脆弱性，resp。护理诊断及相关结果和干预研究。

因为 IJNK 是少数涉及标准化护理语言的期刊之一，所以作者和审稿人正确使用“分类”、“分类”和“术语”这些词很重要。否则，它怎么能成为护理知识的主要来源？在通过阅读、研究、出版和教学研究了超过 23 年的分类和术语之后，我经常对这些词及其含义之间的不明确用法感到困惑——分别是混淆。清楚地描述事物不是作者和审稿人的学术职责吗，尤其是在这个以前被命名为“国际护理术语和分类杂志”的期刊上？

背景

在我的专业背景下，我被教导要做出精确的区分，并在使用语言时非常清楚。我在欧盟接受教育，非常关注职业应该满足的标准。其中之一是拥有自己的专业语言来表示明确定义的知识库，该知识库由按分类和分类（例如生物学、医学）排序的已定义、经过验证的概念组成（Van der Bruggen，2002 年））。因此，我的学术护理教育侧重于专业性、本体论和语义学（以及分类标准、它们的可测量性和已验证概念的互操作性）。除了可衡量的概念外，我们还专注于循证护理，利用强大的研究方法来衡量诊断准确性、护理干预有效性和对护理敏感的患者结果的质量（例如通过实验设计）（Polit & Tatano Beck，2021）。我们有两个完整的学期只讨论什么是分类，以及相关术语/术语代表什么。我的硕士学位教育完全是基于问题的学习，一个学期只关注护理诊断分类，另一个学期关注干预和结果有效性和研究。在前两个学期，我们专注于定义（例如现象、概念、概念分析和验证、诊断、干预、结果、术语/术语、命名法、分类）。首先，我们从研究不同的定义开始，然后我们必须找出具有最佳证据的定义。

其次，我们必须说出我们使用了哪些定义以及为什么。我们从研究词汇开始，然后比较不同的文献来源及其证据。接下来，我们继续研究原始分类书籍以及基础著作（Gordon，1994)，然后是有关各自分类的研究论文。文献是英文的，并且——由于基于问题的学习——我们每周总结和提交 10-12 篇研究文章。我们的教授发现，对于一个专业来说，命名和验证其知识库至关重要。这些学期的第二部分是关于分类应该满足的标准。Harry van der Brugge 是一位分类专家，撰写了多种护理分类方面的书籍，是我们的导师之一。然后，分类标准与各自的研究方法相关联，对于期末考试，我们必须提交自己的关于验证分类的研究。为了准备考试，我们必须学习奥马哈系统、临床护理分类、NANDA-I、NOC和NIC的全部原创作品以及相关的研究论文。

在我的教育中，护理被视为社会领域，而不是医疗或信息技术领域——它们使用不同的语言和思想流派；这对我来说已经很明显了。我们了解到，后者以及 HL7 和护士协会以及 WHO 没有很好地描述和使用该措辞。通常，在没有明确研究和解决它们的差异的情况下识别出几个“术语”。还发表了混淆：即使是被广泛接受的关联分类也被命名为术语（例如，国际护理实践分类（ICNP）被命名为“分类”，但其目的声明它是一个参考术语！）。早期，专家批评了这一事实（Olsen，2001)，原因如下：它不包含定义特征，也没有概念之间的联系。它按字母顺序排列，但与反映临床护理的护理内容无关，并且仅在不描述护理本身的轴中。它没有被纳入护理分类，ICNP 诊断标题（= 术语）和干预措施之间的联系缺失（Müller-Staub、Lavin、Needham 和 van Achterberg，2007 年；Odenbreit、Müller-Staub、Brokel、Avant 和 Keenan ，2012 年；奥尔森，2001 年）。

对于由单一作者或电子健康记录 (EHR) 开发人员出售的几个相互竞争的、自制的、未经验证的德国护理术语也是如此（Odenbreit 等人，2018 年）。研究表明，此类系统缺乏概念有效性，并且基于非证据的术语不能代表护理专业（Ingenerf & Linder, 2009 ; Müller Staub & Rappold, 2017 ; Odenbreit et al., 2012 ; Olsen, 2001 ; Tastan等人，2014 年；范德布鲁根，2002 年）。

所描述的教育点燃了我的火焰，让我专注于护理这一独特的职业和 SNL。基于这一背景和我对分类的广泛研究，我正在撰写这篇社论。

分类描述专业知识

分类的目的是描述一个专业的特殊知识。几十年来，人们开发了分类来表示和描述专业知识库——或者换句话说，知识体系——而概念是科学和研究的基石（Avant, 1990 ; Odenbreit et al., 2018 ; Odenbreit等人，2012 年；L. Walker & Avant，2019 年；LO Walker & Avant，2005 年）。

分类显示内容、概念之间的内部关系、边界以及与其他专业的差异（Ingenerf & Giere, 1998 ; Ingenerf & Linder, 2009 ; Merriam-Webster, 2022; Müller Staub et al., 2017 ; Spencer-布朗，1997 年；范德布鲁根，2002 年；韦伯斯特，1984 年）。然而，分类与术语不同——尽管术语术语经常被“误用”。作为专业人士，护士具有专业知识，并有责任做出准确的护理诊断，以提供有效的循证护理干预措施（Jones、Lunney、Keenan 和 Moorhead，2010 年）。自去年以来，瑞士是唯一一个在宪法中提及护理专业及其职责的国家（Schweizerische Eidgenossenschaft，1999 和 2022 年）。作为倡议委员会，我们开始了政治进程，该进程受到基于有效分类的高级护理流程文献的影响（Müller-Staub、Abt、Brenner 和 Hofer，2015 年）：通过陈述准确、相关的护理诊断并执行有效护理干预，实现了对护理敏感的患者结果（Müller-Staub 等人，2015 年）。

我们专业的核心知识使护理可见，因此可以教授和研究。尽管需要进一步的发展和目前的证据水平，NANDA-I 护理诊断分类（Herdman, Kamitsuru, & Lopes, 2021）；护理干预分类 NIC （Butcher 、Bulechek、Dochterman 和 Wagner，2018 年）；和护理结果分类 NOC（Moorhead、Johnson、Maas 和 Swanson，2018 年）缩写为 NNN，是研究最好的编码分类（Ackley、Ladwig 和 Flynn Makic，2020 年；Anderson、Keenan 和 Jones，2009 年；Müller -Staub 等人，2015 年；Müller-Staub、König 和 Schalek， 2017 年；Müller-Staub 等人， 2007 年；塔斯坦等人， 2014 年；范德布鲁根， 2002 年；冯克罗、戴尔和纳登， 2005 年；冯克罗和纳登， 2008 年）。

另一个编码分类示例——与护理相关的专业——是描述医学诊断/疾病的国际疾病分类 (ICD 11) 。ICD旨在描述医学专业的教学内容以及临床和法律责任。它描述了领域知识库，因此也描述了医学专业的界限。它清楚地表明，医学生需要学习什么才能成为准确的医学诊断者以有效治疗患者的疾病。通过以编码的、国际公认的分类命名医学诊断，医学诊断变得已知、可研究、可比较和可统计评估。例如，除了 ICD 11 之外，医疗程序/治疗也在外科手术分类（CHOP）。CHOP 与 ICD 11 密切相关。这些分类是国际公认的，它们提供了医学教育的核心内容，它们领导医学研究以及资助医疗/保健费用的系统。没有这种国际公认的和金融相关的护理分类（目前）。

分类是基于概念的

分类由定义的、有效的和相关的概念组成，包括它们的表示（定义特征）和相关/致病因素。这些概念被编码并有意义地组织在一个描述科学、专业知识的分类结构中（Ingenerf & Giere, 1998 ; Müller Staub et al., 2017 ; Van der Bruggen, 2002）。代码允许在设置之间检索、评估、比较和共享有关概念的信息。它们的结构必须遵循允许互操作性的编码原则。互操作性是指计算机系统或软件交换和利用信息的能力：不同制造商制造的设备之间的互操作性（Merriam-Webster，2022；Müller Staub 等人，2017 年；Müller Staub & Rappold， 2017 年；Odenbreit 等人， 2012 年）。在这篇社论中，重点不是互操作性，因此没有进一步讨论。然而，编码概念是否有效是关键，因为通过可互操作的代码比较无效概念既没有意义也不合乎道德——这将导致有缺陷的研究。

概念是科学的基石。基于它们的表征原语，连同它们的从属类和属性或属性，被排序为属和种的类别，以及包括表征原语和实例之间的描述关系，基于概念的分类描述了知识。基于研究的概念提供分类的内容，并明确概念之间的关系和方式，以及它们之间的差异。换句话说，概念描述了护士的工作、他们为什么这样做以及他们取得了什么成就（Polit 和 Tatano Beck，2021；Sojer、Aronsky、Müller 和 Ruch，2011；L. Walker 和 Avant，2019）。

概念包含一个标题（术语），但标题只是概念标签，并且存在许多术语而不提供包括定义在内的完整概念。事实上，每个护理诊断的标题（术语/标签）都很重要，并且必须有文献支持。诊断标题/标签必须清晰，并附有 NANDA-I 要求的解释性定义（Herdman 等人，2021 年；Scroggins，2012 年））。因此，标题和定义是一体的——没有定义，标题就变得毫无意义，可以自由解释或误解。更重要的是：没有完整概念的标题无法教授、研究、比较。为了准确地陈述护理诊断，护士需要诊断的完整概念知识，包括定义特征和相关/风险因素和相关条件。这就是为什么 NANDA-I 需要基于证据的标题/标签和每个护理诊断的定义以及这些附加内容。概念本身的标题和定义在现实世界中是不可见的。因此，诊断概念包括定义特征和相关/风险因素。定义特征是经验的现实世界中可观察到的现象。2012；Müller Staub & Paans， 2020 年）。

分类法是分类的整体排序系统。“分类学”源于希腊语（táxis = order 和 nomos = law），意思是分类及其系统的科学理论。在一个系统化的过程中，对象根据一定的标准进行分类，即归类（也称为类群）。最初，狭义的分类学是指对所有生物进行分类的科学（Merriam-Webster，2022；Müller Staub 等人，2017 年；Müller Staub & Rappold，2017 年；Müller-Staub 等人，2017 年；Van der Bruggen , 2002）。研究和命名法描述了“分类”和“分类”这两个词经常被用作同义词，因为它们相互依赖：分类描述了构建和排序分类的科学（Merriam-Webster，2022；Müller Staub，2021）。分类被有意义地排序到分类中。分类法包含领域和类别（诊断），它们再次与有效的干预措施和相关结果有意义地相关联 e（Müller Staub，2021 年）。

NANDA-I、NIC 和 NOC 是唯一具有健全分类护理结构（包括分类所有级别的定义）的分类，并且诊断包含定义特征和相关/风险因素以及相关条件（Herdman 等，2021；Müller Staub & Rappold，2017 年；Müller-Staub 等人，2007 年）。NANDA-I、NIC 和 NOC 是分类，而不是术语：这三个都是基于概念的分类包括定义；在最具体（细化）的层面上，它们的描述符在经验世界中是可观察/可测量的，例如：护理诊断的定义特征/相关或风险因素、NIC 中干预概念的护理行动以及结果指标NOC 中的结果概念（Butcher 等人，2018 年；Moorhead 等人，2018 年）。

术语是描述标签/标题的标准化术语

术语描述商业、艺术、科学或特殊学科中使用的技术或特殊术语（Merriam-Webster，2022）。术语的目的是提供按字母顺序或根据语言轴排序的标准化术语（标题），和/或进行编码并用于互操作性。文献表明，术语并非旨在描述专业知识体系（Ingenerf & Giere, 1998 ; Ingenerf & Linder, 2009 ; Müller Staub, 2022 ; Müller Staub & Rappold, 2017 ; Van der Bruggen, 2002）。因此，术语并不代表教学或研究的内容知识。举个例子，ICNP 是一个术语，“它提供了一组商定的术语……它提供了一个共享护理数据和跨环境比较护理实践的框架”（ https://www.icn.ch/what-we -do/projects/ehealth-icnptm/about-icnp. ICNP 包含术语（仅标题），但不包含具有经过验证的相关/风险因素和定义特征的护理诊断概念，也不包含与护理干预相关的诊断术语。ICNP 也不包含结果概念。研究表明，这样的术语不适用于护理计划或教学，因为它缺少经过验证的概念和描述护理范围的分类专业结构。

因此，使用 ICNP 无法衡量诊断的准确性、干预措施的有效性以及相关的护理敏感患者结果（Müller Staub，2022；Müller Staub & Rappold，2017；Olsen，2001）。最好的术语可以成为分类的一部分：概念的标题是术语。由于这些原因，在撰写分类时使用“术语”一词是没有意义的。总之，术语与分类不同——尽管术语经常被“误用”——即使在文献中也是如此（Müller Staub，2022 年）。只有基于概念的分类旨在并且可以描述知识，术语（仅限术语/标签）不能！

结论和建议

根据科学分类文献，将 NANDA-I、NIC 和 NOC 命名为术语是不正确的，降低了它们的价值。这样做时，这些分类的证据就会被稀释。NANDA-I、NIC 和 NOC 分类不仅仅是术语。它们代表了护理知识体系，因为它们的概念在分类中被组织和联系起来。这种编码概念可以通过研究进行彻底比较，而术语缺乏明确的、可观察的内容和联系。更糟糕的是，如果没有联系，就不可能评估干预措施对护理诊断的影响并衡量结果。如果没有编码的、基于概念的分类，护理的效果就无法显现，健全的研究方法也无法衡量它。从学术角度来看，建议对发表在该期刊上的每篇文章进行修订，以免作者将分类命名为术语。希望将来所有作者在提及 NANDA-I、NIC 或 NOC 分类时都使用分类/分类这个词。

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