Center for Nursing Classification and

Clinical Effectiveness (CNC)

Center for Nursing Classification and Clinical Effectiveness _CNC_ _1_.png

Fall/Winter 2021 Newsletter

Welcome to the fall/winter 2021 newsletter from the CNC! For many reasons, last year was a year like no other. Despite the challenges, we made progress in multiple areas such as developing a strategic plan and making contributions to the COVID-19 pandemic. We are excited for you to read about the recognition and achievements of the CNC this past year as well as the many recent publications. We are proud to share those highlights below and introduce the members of our team. 

Advancing our Strategic Directions

We started 2020 planning future strategic directions. With thoughtful reflection and boundless enthusiasm, we took part in a two-day Strategic Planning Retreat led by Laurie Schulte of the Clarion Group in late February. The retreat was attended by 21 leaders, including Dean Julie Zerwic and associate deans from the University of Iowa College of Nursing, University professors as well as national and international nurse leaders with expertise in the value of standardized nursing terminologies.

Attendees discussed the CNC’s strengths, areas for improvement, critical issues and anticipated central challenges in the next three to five years. After several large and small group sessions, the group coalesced on a restatement of the CNC’s overarching purpose:

To expand adoption of Nursing Interventions Classification and Nursing Outcomes Classifications to advance nursing science, practice and person-centered care.

This purpose will be carried out through five objectives:

  1. Develop and enhance relevant, easy to use products.
  2. Create opportunities for synergy among research education and practice.
  3. Expand context for use of the terminologies.
  4. Influence policy makers and regulatory bodies to promote the use of terminologies.
  5. Secure sufficient sustainable resources.

Each objective is linked to a set of three to five specific objectives with measurable milestones to be carried out throughout the next five years. All of us at the CNC are so appreciative that we were able to undertake the strategic planning meeting before the COVID-19 pandemic changed the way we all work and live. Although the pandemic slowed down some of our ambitious plans, we have made progress in all three areas.

Response to COVID-19 Pandemic

In summer 2020, Drs. Moorhead, Swanson, Wagner, Dunn Lopez, Maciera, Breitenstein, Ms. Abe, and Ms. Mantovani proposed NANDA-I, Nursing Interventions Classifications (NIC), and Nursing Outcomes Classification (NOC) linkages in an effort to guide nursing care and clinical documentation. What began as plans for one article, quickly became three as the team dove into the important and vast role nurses have in the COVID-19 pandemic.

The peer reviewed publications (Links to free publication available at focus on the role of nurses in providing care to individuals, families, and communities. In our future work, we will validate these proposed linkages for individuals using electronic health record data. This work lays an important foundation for the team’s ongoing research to determine the role of nursing care on COVID-19 related outcomes for individual patients, families, and communities.

  1. Moorhead, S., Macieira, T. G. R., Dunn Lopez, K., Monteiro Mantovani, V., Swanson, E., Wagner, C., & Abe, N. (2021). NANDA‐I, NOC, and NIC Linkages to SARS‐Cov‐2 (Covid‐19): Part 1. Community Response. International Journal of Nursing Knowledge. 32(1), 59-67. 
  2. Swanson, E., Monteiro Mantovani, V., Wagner, C., Moorhead, S., Dunn Lopez, K., Macieira, T. G. R., & Abe, N. (2021). NANDA‐I, NOC, and NIC linkages to SARS‐CoV‐2 (COVID‐19): Part 2. Individual response. International journal of nursing knowledge. 32(1), 68-83. 
  3. Wagner, C. M., Swanson, E. A., Moorhead, S., Monteiro Mantovani, V., Dunn-Lopez, K., Macieira, T. G. R., Abe, N., & Breitenstein, S. (2021). NANDA‐I, NOC, and NIC linkages to SARS‐CoV‐2 (COVID‐19): Part 3. Family response. International Journal of Nursing Knowledge. Advance online publication.

Faculty and Staff Updates


After 28 years at the University of Iowa, Dr. Sue Moorhead retired from her faculty role and as the director of the Center for Nursing Classification and Clinical Effectiveness at the end of 2020. Sue’s work in the CNC began when she was a PhD student. Since then, she has worked tirelessly on terminology development. Sue provided outstanding leadership to the CNC since 2004 and is a prolific writer, having published 74 manuscripts, 27 book chapters, and 12 books. She also has been the primary advisor to 15 national and international PhD students.

Dr. Moorhead is continually sought out by colleagues nationally and internationally to provide knowledge, advice, and direction to advance their careers. Although she will be stepping down, Sue will continue in an emeritus role and remain involved in the CNC as both the lead editor of NOC and Co-Editor of NOC books for the next addition.

Dr. Sue Moorhead

New Director

After a year of serving as the director of research for the Center for Nursing Classification and Clinical Effectiveness, Dr. Karen Dunn Lopez assumed the role of CNC director in July 2020. Karen completed her PhD at University of Iowa College of Nursing in 2008. She spent about a decade at the University of Illinois at Chicago (UIC), first as an NIH funded post-doctoral fellow and then as an assistant professor. At UIC, she led and collaborated on unique multidisciplinary research teams to improve the ability of novel technologies to strengthen nursing care, enhance health, and reduce health disparities. Many of the technologies included in her program of research were grounded in the use of NANDA-I, NIC, and NOC. Her research experiences were ideally suited to the CNC’s new strategic plan of broader focus that includes expanding engagement in research using NIC and NOC.


Dr. Karen Dunn Lopez

In addition to Dr. Dunn Lopez’s research using NANDA-I, NIC, and NOC, she is also a recognized leader in nursing informatics at a national level. She currently serves at the chair of the Nursing Informatics Work Group of the American Medical Informatics Association (AMIA), is a member of the Editorial Board of the Journal of the American Medical Informatics Association- Open and served on the Scientific Program Committee for the 2021 Annual AMIA Symposia.

“I am honored that Dean Zerwic, the College’s associate dean,s and Dr. Sue Moorhead have the confidence in my ability to lead the CNC. I look forward to the challenge ahead and am excited for the many new opportunities at the Center for Nursing Classification and Clinical Effectiveness.”

Lead NIC Editor

Dr. Cheryl Wagner has been a member of the NIC team since beginning work on the fifth edition in 2004 and an editor since 2011. A graduate from the University of Iowa’s College of Nursing PhD, Master of Science in Nursing, and Master of Business Administration programs, Cheryl’s engagement with the Center for Nursing Classification and Clinical Effectiveness dates back to her graduate studies when she became a member of the Physiologic NOC group, creating and updating physiologic NOCs in the 1990s. After more than a decade of experience, Cheryl will assume the role of lead editor, beginning with eighth NIC edition.


Dr. Cheryl Wagner

Cheryl enjoys participating in the ongoing work of the NIC group and seeing the contributions of both national and international experts to each edition. She also enjoys guiding clinical experts and students who are new to NIC as they share their talent and expertise.

Dr. Howard Butcher

New Opportunities

Dr. Howard Butcher became faculty of the Christine E. Lynn College of Nursing at Florida Atlantic University in August 2019, where he is a professor and director of the PhD Program in Nursing. A central theme of Howard’s research has been the development and testing of nursing interventions. Howard joined Drs. Bulechek and McCloskey Dochterman as co-editor of NIC with the fifth edition. Although no longer at the University of Iowa, Howard remains an active co-editor of the NIC book.


We are delighted to announce the following faculty, collaborators, and trainees, have joined the leadership of the Center for Nursing Classification and Clinical Effectiveness in the past year.

  • Dr. Ann Marie McCarthy: Member -Strategic planning committee
  • Dr. Maria Lindell Josephs: Member- Strategic planning committee and executive committee
  • Dr. Sena Chae: Associate faculty member, NOC team member
  • Dr. Natany Da Costa Ferreira Oberfrank: Post-doctoral fellow, NOC team member
  • Dr. Erin Cullen: College of Nursing DNP alumna, NIC team member

Drs. McCarthy and Josephs are joined by Dr. Dunn Lopez, Dr. Moorhead, Dr. Wagner, and Dr. Swanson on the executive and strategic planning committee.

In September, Elspeth Adriana McMullan Moreno (Adriana) joined as the CNC’s administrator and research specialist. She received her Bachelor of Arts in Sociology at the University of Iowa. She earned her Master of Public Health in Community and Behavioral Health from the University of Iowa College of Public Health, is a Certified Health Education Specialist (CHES), and is Certified in Infection Control (CIC). She has more than 10-years’ experience in health care and health education practices.

Adriana is excited to be a part of the CNC team advancing the center’s strategic initiatives. In her role, she will collaborate with faculty, organizations, and stakeholders to promote research and implementation of the classifications. Adriana will assist with the CNC’s communication plan to build relationships by utilizing social media, the CNC website and newsletters, to reach a broader audience and encourage use of the standardized languages.

Dr. Ann Marie McCarthy


Dr. Maria Lindell Josephs


Dr. Sena Chae


Dr. Natany Da Costa Ferreira Oberfrank


Dr. Erin Cullen


Dr. Elizabeth (Liz) Swanson


Elspeth Adriana McMullan Moreno


Noriko Abe

Steady Presence

Although known to some of you, we also wish to recognize, Noriko Abe who has worked with the CNC since 2015. Currently serving as the CNC program coordinator, Noriko provides operational and administrative support to the NIC and NOC editors, supports work with our many collaborators, and provides financial and information management for the CNC as a whole. She has been a steady presence during this time of change at the CNC.



First year postdoctoral fellow Dr. Natany da Costa Ferreira Oberfrank was recently awarded funding from the Class of 1969 Postdoctoral Scholarship for her research project “Improving heart failure symptom response behaviors using nursing terminologies: a vignette study.”

Dr. da Costa Ferreira Oberfrank, along with her research team comprised of Dr. Karen Dunn Lopez, Dr. Harleah Buck, and Dr. Andrea Achenbach, are working to design and estimate the validity and reliability of clinical vignettes to measure patient knowledge on heart failure symptom management. This project will provide Dr. da Costa Ferreira Oberfrank with a measure to be used in the development of nursing interventions tailored to patients’ knowledge needs on heart failure symptom management.

Dr. Karen Dunn Lopez received funding for her role as College of Nursing faculty liaison for the Iowa Health Data Resource: Building the Future of Health Informatics at the University of Iowa. This interdisciplinary team of researchers and staff led by Boyd Knosp, associate director for Biomedical Informatics Operations and associate dean for Information Technology at Carver College of Medicine was awarded $ 2.2million over three years. A transformative aspect of this grant will be the development of a novel multi-use nursing data set that includes nursing documentation data.

Career Awards

In spring 2020, Dr. Karen Dunn Lopez was awarded the Mid-Career Researcher Award by the Decision-Making Research Interest Group of the Midwest Nursing Research Society.

In October 2021, Karen Dunn Lopez will be inducted as a Fellow in the American Academy of Nursing. This honor recognizes her impact to date as well as her future contributions to the profession.


Dr. Natany da Costa Ferreira Oberfrank along with her scientific mentor Dr. Karen Dunn Lopez were selected to participate in the fourth cohort of the University of Utah Grant Writing Coaching Research Study funded by the National Institutes of Health (NIH) Common Fund. The study enrolls a national cohort of participants through a highlight competitive process and aims to have participants refine their proposal writing skills and increase their success in receiving NIH grants. Participants from 187 institutions developed 252 NIH grant proposals in the last three cohort cycle, and 93 awards were granted to date.

Dr. da Costa Ferreira Oberfrank and Dr. Dunn Lopez will engage in a five-month long, writing-intensive, small group, coaching experience led by a senior investigator in fall 2021. The coaching model used in this study has been developed over 10 years and expanded to national groups since 2014 through the National Research Mentoring Network (NRMN). Dr. da Costa Ferreira Oberfrank, an expert in self-management for patients with heart failure, is looking forward to submitting a K or R level- NIH proposal to the National Institute of Nursing Research (NINR) in 2022. Her proposal aims to advance heart failure symptom science developing and validating a novel measure of individuals’ motivation for symptom management.


Dr. Meridean Maas

Sad goodbyes

Dr. Meridean Maas passed away in November 2020. The last time I spoke with Meridean, she shared with me how eager she was to see NIC and NOC used to generate nursing knowledge. It is fitting that I heard the news of her passing during a very long meeting where, collaborating with the University of Iowa Hospitals and Clinics informatics nurse, we mapped NIC and NOC terms to the electronic health record flowsheets. I sensed her smiling down on us as we executed this foundational step to locating NIC and NOC data in electronic health records at UIHC.

Publications and Presentations

Related to NIC and NOC authored by CNC Faculty, collaborators and colleagues 2020-21


  1. Afonso, B. Q., Ferreira, N. C., & Butcher, R. C. G. S. (2020). Content validation of the symptom control outcome for heart failure patients in palliative care. Revista Gaúcha de Enfermagem, 41,
  2. Afonso, B. Q., Ferreira, N. C., & Butcher, R. C. G. S. (2020). Conceptual and operational definitions for the indicators of the nursing outcome classification: Symptom control in patients with heart failure in palliative care. Enfermeria Clínica.
  3. Burkhart, L., Coglianese, M., Kaelin, J., Moorhead, S., & Joyce, C. (2021). Communicating spiritual care in the electronic health record. CIN: Computers, Informatics, Nursing. Advance online publication.
  4. Chae, S., Oh, H., & Moorhead, S. (2020). Effectiveness of Nursing Interventions using Standardized Nursing Terminologies: An Integrative Review. Western journal of nursing research, 42(11), 963-973.
  5. Cavalcante, A. M. R. Z., Lopes, C. T., Swanson, E., Moorhead, S. A., Bachion, M. M., & de Barros, A. L. B. L. (2020). Validation of definitions of the indicators for Nursing Outcomes Classification outcomes: Self-management cardiac disease. Acta Paul Enferm, 33, e-APE20180265. https://doi:10.37689/acta-ape/2020ao0265
  6. Emidio, S. C. D., Moorhead, S., Oliveira, H. C., Herdman, T. H., Oliveira‐Kumakura, A. R. D. S., & Carmona, E. V. (2020). Validation of nursing outcomes related to breastfeeding establishment. International journal of nursing knowledge, 31(2), 134-144.
  7. Emidio, S. C. D., Dias, F. D. S. B., Moorhead, S., Deberg, J., Oliveira-Kumakura, A. R. D. S., & Carmona, E. V. (2020). Conceptual and operational definition of nursing outcomes regarding the breastfeeding establishment. Revista Latino-Americana de Enfermagem, 28.
  8.  Ferreira, N. C., Lopes, C. T., Moorhead, S. A., & Butcher, R. C. G. S. (2021). Content validation of the nursing outcome Knowledge Heart Failure Management: Brazilian nurses’ opinions. International Journal of Nursing Knowledge. 1-9.
  9. Ferreira, N. C., Moorhead, S. A., & Butcher, R. C. G. S. (2021). The Nurse­–Patient Outcome Content Validation Method. International Journal of Nursing Knowledge. 32(2), 88-95.
  10. Gençbaş, D., Bebiş, H., & Moorhead, S. (2020). Validation of the outcomes tools for urinary incontinence in Nursing Outcomes Classification system and their sensitivities on nursing interventions. Gulhane Medical Journal, 62, 21-27.
  11. Lucena, A. F., Argenta, C., Luzia, M. F., Almeida, M. A., Barreto, L. N. M., & Swanson, E. (2020). Multidimensional model of successful aging and nursing terminologies: similarities for use in the clinical practice. Revista Gaúcha de Enfermagem, 41(esp), e20190148.
  12. Macieira, T. G. R., Yao, Y., Smith, M., Bian, J., Wilkie, D. J., & Keenan, G. (2020). Nursing care for hospitalized older adults with and without cognitive impairment. Nursing Research. Symptom Science Series, 69(2), 116-126.
  13. Monteiro Mantovani, V., Moorhead, S., & Abe, N. (2020). NANDA‐I, NOC, and NIC linkages for nutritional problems. International Journal of Nursing Knowledge, 31(4), 246-252.
  14. Monteiro Mantovani, V., Moorhead, S., de Abreu Almeida, M., & Rabelo-Silva, E. R. (2020). Adverse Reactions to Medications: Concept Analysis and Development of a New Risk Nursing Diagnosis. International Journal of Nursing Knowledge, 31(2), 87-93.
  15. Oliveira, A. P.D., Cavalcante, A. M. R. Z, Carneiro, C. S., Santos, V. B., Moorhead, S., Lopes, J. L., Barros, A. L. B. L (2020). Health Education: The effectiveness of interventions in patients with heart failure. Revista Brasileira de Enfermagem, 73(2), e20180782.
  16. Reich, R., Rabelo-Silva, E. R., Swanson, E., Moorhead, S., Almeida, M. A. (2021). Development of a nursing outcome for a percutaneous procedure. International Journal of Nursing Knowledge. Advance online publication.

Doctoral Dissertations and DNP Projects 

  1.  Cullen, E. (2020). Development of nursing interventions related to palliative care. University of Iowa. 
  2. Emidio, S. C. D. (2020). Validação dos resultados de enfermagem propostos pela Nursing Outcomes Classification para o estabelecimento da amamentação. Universidade Estadual de Campinas. [Validation of breastfeeding establishment outcomes proposed for Nursing Outcomes Classification. University of Campinas].  *2020 CAPES Thesis Award - Prestigious award given to the 2 best nursing dissertation theses in Brazil.   
  3. Monteiro Mantovani, V. (2021). Validação clínica do diagnóstico de enfermagem Risco de Reações Adversas a Medicamentos. Universidade Federal do Rio Grande do Sul. [Clinical validation of the nursing diagnosis Risk for Adverse Reactions to Medications. Federal University of Rio Grande do Sul] 

NANDA-I 2021Conference Presentations 

  1. Dunn Lopez, K., Chae, S., Litwiller, D., Moorhead, S., Wagner, C., Monteiro Mantovani, V., Macieira, T., Abe, N., & Swanson, E. What is the role of nursing care on clinical outcomes for hospitalized patients with COVID-19? 
  2. Emidio, S. C. D., Moorhead, S., Oliveira-Kumakura, A. N., & Carmona, E. V. Content validation of nursing outcomes related to breastfeeding establishment. 
  3. Emidio, S. C. D., Olivera, H.C., Moorhead, S., Oliveira-Kumakura, A. N., & Carmona, E. V. Applying of nursing outcomes related to breastfeeding establishment in neonatal unit.  
  4. Ferreira, N. C., Lopes, C. T., Moorhead, S. A, & Butcher, R. C. G. S. Psychometric evaluation of the nursing outcome Knowledge: Heart Failure Management.  
  5. Ferreira, N. C., Moorhead, S. A, & Butcher, R. C. G. S. The Nurse-Patient Outcome Content Validation Method. 
  6. Wagner, C., Cummins, K., & Dean, M. Nurses & student nurses perceptions related to EHR patient care planning 

HIMSS in August 2021  

  1. Dunn Lopez, K., Chae, S., Litwiller, D., Moorhead, S., Wagner, C., Monteiro Mantovani, V., Macieira, T., Abe, N., & Swanson, E. Unearthing nursing documentation within electronic health record data to determine the impact of nursing care for hospitalized patients with COVID-19 

Did we miss any important publications?

If so, please send it to We will include the information in the next newsletter.

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University of Iowa College of Nursing Center for Nursing Classification & Clinical Effectiveness

Center for Nursing Classification and

Clinical Effectiveness (CNC)