NOC Nursing Outcomes Classification: Complete Guide

The Nursing Outcomes Classification (NOC) is the standardized language for measuring and evaluating the results of nursing care. Developed at the University of Iowa College of Nursing by a research team led by Sue Moorhead and Marion Johnson, NOC provides a systematic way to define patient outcomes, select measurable indicators, and track progress over time. It completes the NNN triad alongside NANDA-I (diagnoses) and NIC (interventions), giving nurses a complete evidence-based framework for the entire care planning process.

What Is NOC?

NOC is a comprehensive classification of patient, caregiver, family, and community outcomes that are sensitive to nursing interventions. The phrase “nursing-sensitive outcomes” is critical — these are outcomes that nursing care can influence, as distinct from outcomes that depend primarily on medical treatment or other disciplines.

The current edition contains over 540 outcomes, each consisting of:

• Label — the standardized name (e.g., “Pain Level,” “Mobility,” “Knowledge: Disease Process”)
• Definition — a concise statement of what the outcome measures
• Indicators — specific, observable patient states or behaviors used to evaluate the outcome (typically 5-20 per outcome)
• Measurement scale — a 5-point Likert scale used to rate each indicator
• Unique code — a four-digit identifier for EHR integration and research

History and Development

The need for NOC arose from a fundamental gap in nursing documentation. Nurses could describe what they did (interventions) and why (diagnoses), but had no standardized way to measure whether their care was effective. Quality improvement was difficult because there was no consistent language for patient outcomes across nurses, units, or institutions.

Development began in 1991 at the University of Iowa. The first edition was published in 1997 with 190 outcomes. Through six editions, the classification has grown to over 540 outcomes, with each edition adding new outcomes, refining indicators and scales, and strengthening the linkages to NANDA-I diagnoses. NOC is recognized by the ANA, included in the UMLS and SNOMED CT, and translated into multiple languages.

How NOC Is Organized

NOC uses a three-level hierarchical structure parallel to NIC: domains, classes, and outcomes.

The 7 NOC Domains

Domain I: Functional Health

Outcomes that describe the capacity for and performance of basic tasks of living. Includes classes for energy maintenance, growth and development, mobility, and self-care.

Example outcomes:

• Mobility (0208) — Ability to move purposefully in own environment independently with or without assistive device
• Self-Care: Activities of Daily Living (ADL) (0300) — Personal care activities performed independently or with assistive device
• Activity Tolerance (0005) — Physiologic response to energy-consuming movements with daily activities
• Endurance (0001) — Capacity to sustain activity
• Transfer Performance (0210) — Ability to change body location independently with or without assistive device

Domain II: Physiologic Health

Outcomes that describe organic functioning. This is the largest domain, covering cardiac function, elimination, fluid and electrolytes, immune response, metabolic regulation, neurocognitive function, nutrition, respiratory function, sensory function, therapeutic response, and tissue integrity.

Example outcomes:

• Respiratory Status: Airway Patency (0410) — Open, clear tracheobronchial passages for air exchange
• Cardiac Pump Effectiveness (0400) — Adequacy of blood volume ejected from the left ventricle to support systemic perfusion pressure
• Tissue Integrity: Skin & Mucous Membranes (1101) — Structural intactness and normal physiological function of skin and mucous membranes
• Blood Glucose Level (2300) — Extent to which glucose levels in plasma and urine are maintained in expected range
• Fluid Balance (0601) — Water balance in the intracellular and extracellular compartments of the body
• Nutritional Status (1004) — Extent to which nutrients are ingested and absorbed to meet metabolic needs

Domain III: Psychosocial Health

Outcomes that describe psychological and social functioning. Includes classes for psychological well-being, psychosocial adaptation, and self-control.

Example outcomes:

• Anxiety Level (1211) — Severity of manifested apprehension, tension, or uneasiness arising from an unidentifiable source
• Coping (1302) — Personal actions to manage stressors that tax an individual’s resources
• Body Image (1200) — Perception of own appearance and body functions
• Hope (1201) — Optimism that is personally satisfying and life-supporting
• Self-Esteem (1205) — Personal judgment of self-worth

Domain IV: Health Knowledge & Behavior

Outcomes that describe attitudes, comprehension, and actions with respect to health and illness. Includes classes for health behavior, health beliefs, health knowledge, risk control, safety, and health management.

Example outcomes:

• Knowledge: Disease Process (1803) — Extent of understanding conveyed about a specific disease process and prevention of complications
• Knowledge: Medication (1808) — Extent of understanding conveyed about the safe use of medication
• Adherence Behavior (1600) — Self-initiated actions to promote optimal wellness, recovery, and rehabilitation
• Risk Control (1902) — Personal actions to understand, prevent, eliminate, or reduce modifiable health threats
• Health-Promoting Behavior (1602) — Personal actions to sustain or increase wellness

Domain V: Perceived Health

Outcomes that describe impressions of an individual’s health and health care. Includes satisfaction with care and symptom status.

Example outcomes:

• Pain Level (2102) — Severity of observed or reported pain
• Comfort Status (2008) — Overall physical, psychospiritual, sociocultural, and environmental ease and safety of an individual
• Nausea & Vomiting Severity (2107) — Severity of observed or reported nausea, retching, and vomiting
• Client Satisfaction: Nursing Care (3003) — Extent of positive perception of nursing staff’s concern for the client

Domain VI: Family Health

Outcomes that describe health status, behavior, or functioning of the family as a whole or of an individual as a family member.

Example outcomes:

• Family Coping (2600) — Capacity of the family to manage stressors that tax family resources
• Caregiver Performance: Direct Care (2205) — Provision by family care provider of appropriate personal and health care for a family member
• Family Functioning (2602) — Capacity of a family to meet the needs of its members during developmental transitions
• Parenting Performance (2211) — Parental actions to provide a child with a nurturing and constructive physical, emotional, and social environment

Domain VII: Community Health

Outcomes that describe the health, well-being, and functioning of a community or population.

Example outcomes:

• Community Competence (2700) — Capacity of a community to collectively problem-solve to achieve community goals
• Community Health Status (2701) — General health status and social functioning of a community or population
• Community Risk Control: Communicable Disease (2800) — Community actions to eliminate or reduce the spread of infectious agents

The NOC Measurement Scale

Every NOC outcome uses a 5-point Likert scale to rate each indicator. The scale anchors vary depending on the type of outcome being measured. The most common scale types are:

Extent Scale

Used for outcomes measuring degree of impairment or compromise:

1. Severely compromised
2. Substantially compromised
3. Moderately compromised
4. Mildly compromised
5. Not compromised

Frequency Scale

Used for outcomes measuring how often a behavior or symptom occurs:

1. Never demonstrated
2. Rarely demonstrated
3. Sometimes demonstrated
4. Often demonstrated
5. Consistently demonstrated

Severity Scale

Used for outcomes measuring symptom severity:

1. Severe
2. Substantial
3. Moderate
4. Mild
5. None

Knowledge Scale

Used for outcomes measuring understanding:

1. No knowledge
2. Limited knowledge
3. Moderate knowledge
4. Substantial knowledge
5. Extensive knowledge

The measurement process works as follows: (1) rate each indicator at baseline using the 5-point scale; (2) set a target score to achieve within a specified timeframe; (3) re-rate the indicator at the evaluation interval; (4) compare the new score to the target to determine whether the outcome was met, partially met, or not met.

Setting Realistic NOC Targets

Setting appropriate target scores is a clinical judgment skill that improves with experience. Targets that are too ambitious lead to frustration and falsely indicate intervention failure; targets that are too conservative do not challenge patients to achieve their potential.

Factors to Consider

• Baseline score — A patient starting at 1 (severely compromised) is unlikely to reach 5 (not compromised) in a single shift. A realistic target might be 3 (moderately compromised) within 72 hours.
• Acuity and prognosis — Acute, reversible conditions (postoperative pain) may improve rapidly. Chronic conditions (COPD, heart failure) may have more modest improvement targets.
• Patient capacity — Age, cognitive status, motivation, support systems, and comorbidities all affect the achievable rate of improvement.
• Intervention intensity — Higher-intensity interventions (continuous monitoring, aggressive physical therapy) may support faster improvement than lower-intensity approaches.
• Length of stay — Inpatient targets must be achievable within the expected hospitalization period. Outcomes requiring longer timelines should be communicated to the next care setting through discharge planning.
• Evidence base — Published research on typical recovery trajectories for specific conditions can inform realistic target-setting.

General Guidelines

• An improvement of 1-2 points on the Likert scale is typical for most acute care encounters
• Long-term care outcomes may target maintenance (preventing decline) rather than improvement for progressive conditions
• Short-term targets (end of shift, 24 hours) should represent incremental progress toward longer-term goals (72 hours, discharge)
• Always include a timeframe — “Pain Level will improve from 2 to 4” is incomplete; “Pain Level will improve from 2 to 4 within 48 hours” is actionable

NOC in the NNN Framework

NOC outcomes are most powerful when used within the complete NNN framework:

• NANDA-I identifies the nursing diagnosis — the patient problem or risk
• NIC specifies the interventions — what the nurse does to address the problem
• NOC measures the result — whether the interventions were effective

Published linkage research maps which NOC outcomes are expected to improve for each NANDA-I diagnosis when appropriate NIC interventions are implemented. For example, for the diagnosis “Ineffective Airway Clearance,” linked NOC outcomes include “Respiratory Status: Airway Patency” and “Respiratory Status: Ventilation,” which should improve when NIC interventions like “Airway Management” and “Cough Enhancement” are implemented.

This triad ensures that care planning is evidence-based from start to finish — the diagnosis drives the intervention selection, and the outcomes measure whether those interventions achieved the intended effect.

Using NOC in Care Plans

When incorporating NOC into nursing care plans, document the following for each nursing diagnosis:

• NOC outcome label and code — the standardized outcome being measured
• Selected indicators — the specific indicators most relevant to this patient (you do not need to use all indicators for a given outcome)
• Baseline rating — the current score for each indicator based on your assessment
• Target rating — the score you expect the patient to achieve
• Target timeframe — when the target should be achieved
• Evaluation rating — the score at the evaluation interval, with a determination of met/partially met/not met

CarePlanHQ generates NOC outcomes with appropriate indicators, baseline scores, and target scores based on your patient assessment data. Each outcome is linked to the corresponding NANDA-I diagnosis and NIC interventions, providing a complete NNN care plan ready for clinical review.

Common NOC Outcomes by Specialty

Medical-Surgical

• Pain Level (2102)
• Wound Healing: Primary Intention (1102)
• Mobility (0208)
• Knowledge: Disease Process (1803)
• Infection Severity (0703)

Critical Care

• Respiratory Status: Airway Patency (0410)
• Cardiac Pump Effectiveness (0400)
• Tissue Perfusion: Peripheral (0407)
• Neurological Status (0909)
• Fluid Balance (0601)

Geriatrics/Long-Term Care

• Fall Prevention Behavior (1909)
• Tissue Integrity: Skin & Mucous Membranes (1101)
• Self-Care: ADL (0300)
• Nutritional Status (1004)
• Cognition (0900)

Psychiatric/Mental Health

• Anxiety Level (1211)
• Coping (1302)
• Self-Esteem (1205)
• Depression Level (1208)
• Suicide Self-Restraint (1408)

Why Standardized Outcomes Matter

Before NOC, nursing outcomes were documented in unstandardized language that made it impossible to aggregate data, compare results, or demonstrate the value of nursing care. Standardized outcomes enable:

• Evidence-based practice — Researchers can study which interventions produce the best outcomes for specific diagnoses
• Quality improvement — Facilities can track outcome trends and identify areas for practice improvement
• Staffing decisions — Outcome data can demonstrate the relationship between nurse staffing levels and patient outcomes
• Reimbursement — Measurable outcomes support the case for nursing services in value-based payment models
• Professional visibility — Standardized outcomes make nursing’s contribution to patient care measurable and visible to other disciplines and administrators

For a complete walkthrough of incorporating NOC outcomes into a care plan alongside NANDA-I diagnoses and NIC interventions, see our guide on how to write a nursing care plan.

Frequently Asked Questions

What is NOC in nursing?

NOC (Nursing Outcomes Classification) is a standardized classification of patient outcomes that are sensitive to nursing interventions. Developed at the University of Iowa, NOC contains over 540 outcomes organized into 7 domains and 34 classes. Each outcome includes a definition, a set of indicators, and a 5-point Likert measurement scale. NOC provides a consistent way to measure the effectiveness of nursing care and track patient progress over time.

How are NOC outcomes measured?

NOC outcomes are measured using 5-point Likert scales. The nurse rates each indicator at baseline and at defined evaluation intervals. The scale labels vary by outcome type but typically range from 1 (most negative) to 5 (most positive). Progress is measured by comparing scores over time.

What is the difference between NOC outcomes and nursing goals?

NOC outcomes are standardized, measurable patient states with defined indicators and rating scales. Nursing goals are individualized targets that specify what NOC score the patient should achieve and by when. NOC provides the measurement framework; the goal defines the target on that framework.

How does NOC relate to NANDA-I and NIC?

NOC is part of the NNN framework (NANDA-NIC-NOC). NANDA-I identifies what the problem is (nursing diagnosis), NIC specifies what the nurse will do about it (interventions), and NOC measures whether it worked (outcomes). Published linkage research maps validated NOC outcomes to each NANDA-I diagnosis, and these outcomes are expected to improve when the corresponding NIC interventions are implemented effectively.