The underlying logic within the structure and content of ATIC results from the re-conceptualization of the nursing care process and outcomes, published by Dr. Juvé-Udina in 2012.

An interpretation that defines the nursing process as non-linear and iterative in which:

  • The initial ASSESSMENT of the person’s condition and circumstances,
  • Generates one or the conclusion of several JUDGMENTS (Diagnosis),
  • Leading to the PRESCRIPTION of care (Interventions_ Planning),
  • Whose IMPLEMENTATION ( Interventions_Execution),
  • Has to be EVALUATED in an ongoing ASSESSMENT of the status and progress of the person and their circumstances (OUTCOMES),
  • That may lead to new judgements, restarting the process again.

Nursing organizational context (work environment) and  clinical expertise of each nurse are factors that influence the process and its outcomes. The content of the ATIC diagnostic axis is developed considering the hypothesis that the level of clinical expertise of each registered nurse determines their diagnostic skills. The effect of clinical expertise of each nurse in the diagnostic formulation is illustrated in the introduction section of the book ATIC Diagnostic Axis (pp 29-33).

The doctoral thesis of Dr. Gonzalez-Samartino provides relevant results on the diagnostic accuracy nurse and clinical outcomes relationship.

The influences of both modulating variables, work environment and clinical expertise, are explored in Dr. Castellà-Creus’s doctoral thesis and several resulting scientific publications .

Process element ATIC conceptualization

Initial assessment

Systematic collection of objective and subjective data about the person (family, group, community or population), its context, history, circumstances and environment as well as the reason why they seek, request or require health care, leading to clinical judgment.

Focus assessment

Systematic set of data on a specific issues or concerns of the status, situation, circumstances and/or environment of the person (family, group, community or population).

Ongoing assessment and Outcomes

Identification of health outcomes is a by-product of the diagnostic judgment .

Outcomes are clinical judgments on the progress of the individual's health status (or their consequences) once nursing interventions have been executed.

Outcomes in ATIC are classified in: Evolutionary outcomes and End outcomes.

Likewise, they may be subclassified into: Healthy outcomes and Unhealthy outcomes and Adverse outcomes

Evolutionary and end outcomes are expressed within ATIC as ongoing assessment variables and/or new diagnoses.

Elements of initial, focused and ongoing assessment are expressed with variables (basic elements) and parameters (molecular and atomic elements) of the Assessment Axis.


Prescription of nursing care resulting from the diagnoses, that reflects the approach to their partial of final prevention, resolution or palliation.

ATIC interventions are not detailed descriptions of nursing procedures.They are concepts that includes the goals and the caring actions.

Interventions may be indicated by registered nurser, a physician, or other authorized healthcare professional. 

Their execution can be carried out by the patients, their caregivers, the registered nurse, the nurse and the physician or other professional,  or may be delegated to the nurse aids or technical staff.

Interventions are basic elements of the ATIC Intervention Axis.


Activities in ATIC are molecular and atomic elements of the Intervention Axis.

They are used to increase the level of specificity of the interventions, that allows recording of essential elements that characterize an intervention.

They inform about points to be highlighted or that must be detailed to assure patient safety, quality, continuity of care or, or following regulatory, policy, ethical, legal or cost-efficiency reasons. .


Clinical judgment or the conclusion of several judgments , resulting from the analysis and prioritization of the assessment data s about the health status of the person (family , group, community or population) and the actual or risk consequences and reactions, within the different dimensions of the beneficiary of care and their integrality, in the context of their environment and particular experience, within the nursing ​​professional scope of practice and accountability, which also includes co-responsibility with the care beneficiary, their caregivers and with other healthcare professionals.

The goal of the nursing diagnosis is to:

Identify problems or situations that require or can benefit from nursing interventions, In health, for its preservation, In relative health, to prevent diseases and promote the restoration of the previous status, In disease conditions, to prevent disabilities, complications and their progression, as well as to promote restoration or achievement of the best possible health status, and at the end of life, to prevent and palliate suffering.

Diagnostics in ATIC are basic elements of the Diagnostic Axis.