Translation and cross-cultural adaptation of the Clinical Care Classification system

Translation and cross-cultural adaptation of the Clinical Care Classification system



The Clinical Care Classification (CCC) system is one of the standard nursing terminologies recognized by the American Nurses Association, developed to describe nursing care through electronic documentation in different healthcare settings. The translation of the CCC system into languages other than English is useful to promote its widespread use in different countries and to provide the standard nursing data necessary for interoperable health information exchange. The aim of this study was to translate the CCC system from English to Italian and to test its clinical validity.


A translation with cross-cultural adaptation was performed in four phases: forward-translation, back-translation, review, and dissemination. Subsequently a pilot cross-mapping study between nursing activities in free-text nursing documentation and the CCC interventions was conducted.


All elements of the CCC system were translated into Italian. Semantic and conceptual equivalences were achieved. Altogether 77.8% of the nursing activities were mapped into CCC interventions.


The CCC system, and its integration into electronic health records, has the potential to support Italian nurses in describing and providing outcomes and costs of their care in different healthcare settings. Future studies are needed to strengthen the impact of the CCC system on clinical practice.


Clinical Care Classification system; Cross-cultural comparison; Standardized Nursing Terminology; Translation.

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