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© 2023 International Council of Nurses and International Health Terminology Standards Development Organisation.  All rights reserved.  SNOMED CT® was originally created by the College of American Pathologists.

This document forms part of the ICNP SNOMED CT® Nursing Practice Refset Production package distributed by International Health Terminology Standards Development Organisation, trading as SNOMED International, on behalf of ICN and is subject to the SNOMED CT® Affiliate License, details of which may be found at

No part of this document may be reproduced or transmitted in any form or by any means, or stored in any kind of retrieval system, except by an Affiliate of SNOMED International in accordance with the SNOMED CT® Affiliate License. Any modification of this document (including without limitation the removal or modification of this notice) is prohibited without the express written permission of SNOMED International.

Any copy of this document that is not obtained directly from SNOMED International [or a Member of SNOMED International] is not controlled by SNOMED International, and may have been modified and may be out of date. Any recipient of this document who has received it by other means is encouraged to obtain a copy directly from SNOMED International [or a Member of SNOMED International. Details of the Members of SNOMED International may be found at].

Access within SNOMED International member countries is provided by the Member National Release Centre in each country, via the relevant Member webpage.  Affiliates of SNOMED International in non-member countries can access the table through their MLDS (Member Licensing & Distribution Service) account.  

A human readable version of the refset is available from ICN along wih the equivalence table - both are available for download from the ICN website:

Users of the refset must comply with the licensing agreements of either ICN or SNOMED International, or both - according to the users' individual requirements. 


Page At A Glance

1. Introduction

The International Classification of Nursing Practice (ICNP) Reference Set is a product agreed as part of a collaboration agreement between the International Council of Nurses (ICN) and the International Health Terminology Standards Organisation (IHTSDO), trading as SNOMED International. ICNP content has been incorporated into SNOMED CT and is being released as a reference set by SNOMED International on behalf of ICN. This production release is based on ICNP 2019 as was the release in October 2021.


ICN and SNOMED International have worked together since 2006 to advance terminology harmonisation and foster interoperability in health information systems. This work resulted in the release of an equivalence table between the International Classification for Nursing Practice (ICNP®) and SNOMED Clinical Terms (SNOMED CT®) for nursing diagnoses and an equivalence table between ICNP and SNOMED CT for nursing interventions which were released 6 monthly until 2018. It also resulted in the SNOMED CT Nursing Activities Reference Set and SNOMED CT Nursing Health Issues Reference Set which were released until October 2021. No further releases of these reference sets are planned. 

ICN initiated a review of its role in health informatics globally, enabling them to develop a strategy for supporting nursing globally. It is this review which lead to the new agreement between ICN and SNOMED International, with the following key components:

  • ICNP 2019 incorporated into SNOMED CT
  • SNOMED International to maintain and distribute ICNP as a SNOMED reference set on behalf of ICN
  • ICN to retain ownership of ICNP – SNOMED International to retain ownership of SNOMED CT
  • ICN to continue to lead on ICNP clinical development over time and its quality assurance through ICN governance processes
  • Free for use in SNOMED International member countries and licensed by ICN in non-member countries

ICN has established the ICNP Editorial Board through which decisions on the content of ICNP are made. The ICNP Editorial Board has put in place a mechanism for requesting changes and additions to ICNP reference set - for more information please contact

2. Motivation

The key drivers for this approach are:

  • To ensure that nursing remains connected to the wider health information landscape globally
  • To ensure that SNOMED CT continues to adequately reflect global nursing practice
  • To ensure that information collected using ICNP can link to SNOMED CT encoded records and be shared with other healthcare professionals to support the care of individuals
  • To capture nursing care in a standardised way thus avoiding local mapping which will lead to inconsistency
  • To facilitate the sharing of ICNP-based information in a standardised way to support delivery of patient care, usage for research purposes and participation in health policy making

The ICNP, and therefore this reference set, is a terminology that enables nurses to describe and report their practice in a systematic way. The resulting information is used to support care and effective decision-making, and to inform nursing education and health policy. 

As ICNP is intended for use by and for nurses, ICN has been able to focus attention on the development of ICNP specifically for nursing practice. This has resulted in a rich and comprehensive resource that nurses can use to describe and report in detail the things that they assess (diagnoses e.g. nausea) and the things that they do (interventions e.g. counselling). The potential benefits of a consistent approach to capturing nursing data are far-reaching. However, nurses do not practice in isolation, they practice alongside many other disciplines. One of the potential risks of a specific nursing-focus is that nursing will be somehow disconnected from a larger health information landscape, hence the integration of ICNP into SNOMED CT. 

3. Future releases

The SNOMED ICNP reference set is released October 2022 as planned. It has been agreed with ICN that the next release of the SNOMED ICNP reference set will be April 2024 and then annually in April. This supports changes to the release cycles of derivatives at SNOMED International and will also allow ICN a further period to collect and agree additions to ICNP which are being proposed by users through the ICNP Editorial Board. This heralds the start of an annual update cycle by ICN, ensuring that the ICNP refset remains current and in line with global nursing practice.

It should be noted that the content of the ICNP refset (October 2022) will be included in the free for use Global Patient Set which will be issued in October 2022 by SNOMED International, replacing the Nursing Health Issues and Nursing Activities reference sets.

4. Design

The decisions about additions and changes to SNOMED CT as a result of the incorporation of ICNP 2019 into SNOMED CT has been directed by the advice given by subject matter experts from both organisations and also members of ICNP Editorial Board at ICN. To ensure fit with international requirements and other sources of terminology, the SNOMED International Nursing Clinical Reference Group has also provided advise and expertise.

This work provided an opportunity for ICN to review and make decisions about the content of ICNP 2019. 

5. Versions

The version of ICNP used in this reference set is the May 2019 release.  

The version of SNOMED CT used is the July 2022 International Release.

6. Content

The 2022 International Classification of Nursing Practice (ICNP) Reference Set is comprised of 1958 active concepts from the SNOMED CT Clinical Finding, Procedure and Situation with Explicit Context hierarchies. Changes to the membership of the reference set for the 2022 release include replacements for inactivated concepts plus new content to represent some of ICNP terms that did not have an equivalence in the 2021 reference set release. The table below details the changes. 

1231385002 |Demonstrates knowledge of complementary therapy (finding)|New member
1141699006 |Demonstrates knowledge of traditional therapy (finding)|Concept inactivated - no longer an active reference set member
1231386001 |Deficient knowledge of complementary therapy (finding)|New member
704491001 |Deficient knowledge of traditional therapy (finding)|Concept inactivated - no longer an active reference set member
1231388000 |Assessment of knowledge of complementary therapy (procedure)|New member
710861001 |Assessment of knowledge of traditional therapy (procedure)|Concept inactivated - no longer an active reference set member
1231383009 |Support for use of complementary therapy (regime/therapy)|New member
710866006 |Support for use of traditional therapy (regime/therapy)|Concept inactivated - no longer an active reference set member
1231389008 |Assessment of use of complementary therapy (procedure)|New member
711010004 |Assessment of use of traditional therapy (procedure)|Concept inactivated - no longer an active reference set member
1163215007 |Pressure injury (disorder)|New member
399912005 |Pressure ulcer (disorder)|Concept inactivated - no longer an active reference set member
1217332007 |Persistent sadness (finding)|New member
1217127002 |Effective continuity of care (finding)|New member
224965009 |Grief finding (finding)|New member
1230052008 |Impaired ability to manage medication regime (finding)|New member
1217330004 |Impairment of integrity of oral mucous membrane (finding)|New member
417163006 |Traumatic or non-traumatic injury (disorder)|New member
1217126006 |Deficient knowledge of fluid regimen (finding)|New member
1236741000 |Parenting stress (finding)|New member
284778005 |Difficulty performing personal care activity (finding)|New member
1217125005 |Assessment of nausea (procedure)|New member
1230050000 |Assisting with dressing activity (procedure)|New member
1217461009 |Facilitation of ability to communicate about dying process (procedure)|New member
1217334008 |Management of respiratory device (procedure)|New member
1172582009 |Preparation of family for childbirth (situation)|New member
395076009 |Bereavement support (regime/therapy)|New member
1172619003 |Support of victim of child abuse (regime/therapy)|New member
1172620009 |Support of victim of elder abuse (regime/therapy)|New member
1172621008 |Support of victim of incest (regime/therapy)|New member
1172623006 |Support of victim of intimate partner violence (regime/therapy)|New member
225423004 |Complementary therapy (regime/therapy)|New member

Obtaining the reference set

This reference set covers content of ICNP 2019 and is published as a Production release in October 2022. It should be noted that SNOMED International is not providing an equivalence table as part of the 2022 release. For further information regarding a human readable version of the current equivalence table please contact

Access within SNOMED international member countries is provided by the Member National Release Centre in each country, via the relevant Member page. Users of ICNP in non-member countries need to gain a licence from ICN in the first instance, unless they are also SNOMED CT Affiliates in which case they will be able to access the files using their MLDS accounts. Please contact and for more information if required. 

7. Feedback

Feedback should be sent jointly to and Feedback should include any issues relating to implementation, suggestions for future content inclusion or general comments regarding the subset.

8. Technical Notes

8.1. RF2 package format

The RF2 package convention dictates that it contains all relevant files, regardless of whether or not there is content to be included in each particular release.  Therefore, the package contains a mixture of files which contain both header rows and content data, and also files that are intentionally left blank (including only a header record).  The reason that these files are not removed from the package is to draw a clear distinction between:

  1. ...files that have been deprecated (and therefore removed from the package completely), due to the content no longer being relevant to RF2 in this or future releases, and 
  2. ...files that just happen to contain no data in this particular release (and are therefore included in the package but left blank, with only a header record), but are still relevant to RF2, and could therefore potentially contain data in future releases.

This allows users to easily distinguish between files that have purposefully been removed or not, as otherwise if files in option 2 above were left out of the package it could be interpreted as an error, rather than an intentional lack of content in that release.

8.2. RF2 Delta files removed from the package

Delta files have been removed from both International and Managed Service release packages, and are now being removed from all Derivative products in line with this new Standard.

The Delta files have therefore been removed from this 2022 ICNP Nursing Practice Release package.  Please contact if you have any questions about these improvements.


Final Version






Jane Millar




Cathy Richardson 


Download .pdf here:

Draft Amendment History







Andrew AtkinsonInitial Version
0.2 20220928Cathy Richardson Revised minor edits
1.020221021Andrew AtkinsonNew technical updates included

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