Methodological Considerations for Developing Linkages of Nursing Problems, Outcomes, and Interventions to Support Clinical Decisions and Documentation of Care by Nurses

PURPOSE: Use of the nursing process is foundational in nursing. As standardized nursing terminologies developed for problems, outcomes, and interventions, associating these concepts became important in nursing. Thus, the term linkage appeared and has been around for the last twenty-five years. As linkages has evolved, different steps in the formulation have developed. The purpose of this paper is to review similarities and differences of methods used by researchers worldwide. This paper provides a linkage development process, which enhances linkage work through a more standardized approach. METHODS: In-depth reviews were conducted on solicited papers presenting linkages focusing on selected nursing diagnoses or clinical conditions. In total, the third linkage book (2012) and eight papers were reviewed to articulate the steps used by authors in linkage development. FINDINGS: Methodologies were generally consistent. The similarities were selecting experts; conducting literature reviews; selecting nursing diagnoses, separating problem and risk focused diagnoses, selecting outcomes and interventions for appropriate diagnoses category, reviewing definitions of nursing diagnoses, outcomes, and interventions to ensure consistency among the linkage elements, and a final session to reach consensus on the linkages. While the similarities represented most of the steps in the development process, the variations were used to identify the nursing diagnoses. Some scholars conducted an extensive literature review and rated the relevance of specific classification components already identified through research that were significant in the nursing care of clinical condition. Others used models of nursing care as the framework for nursing diagnoses identification. CONCLUSION: Linkages demonstrate the relationships among the elements of the nursing process. With the continued evolving of standardized languages, it is crucial for terminology scholars and researchers to develop methods for the construction of linkages to ensure credible examples for use in practice, education, and research, to support nursing care.