Nursing CRG_ Able with difficulty topic

Clinical Reference Groups Nursing CRG
1

A request submission has been received concerning the concept 371157007 |Able with difficulty (qualifier value)|, querying if it should be classified as a subtype of 371150009 |Able (qualifier value)| since it denotes a form of ability.

To help determine the appropriate hierarchy placement, we are gathering feedback on how nursing professionals interpret the term “able,” and whether there is an expectation that “able with difficulty” concepts would seen as subtypes of “able” concepts.

Existing Hierarchy & Terminology

1. Qualifier Value Hierarchy

The subhierarchy under Qualifier value used to represent the Has interpretation value for finding ability concepts is 371148001 |Ability interpretation value (qualifier value)|. Its subtypes include:

  • 371150009 |Able (qualifier value)|

    • 371155004 |Able to and does (qualifier value)|

  • 371157007 |Able with difficulty (qualifier value)|

  • 371151008 |Unable (qualifier value)|

At present, |Able (qualifier value)| and |Able with difficulty (qualifier value)| are positioned as sibling concepts.

2. Clinical Finding Hierarchy

Concepts representing ability findings are located under << 118228005 |Functional finding (finding)|:

  • Five concepts currently outside this hierarchy will be reviewed separately.

  • Concepts addressing performance and dependency (e.g., does , does not , dependent for , independent for ) fall outside the scope of this topic.

Concept Counts

  • Able to (finding): 924 concepts

  • Able to with assistance (finding): 4 concepts

  • Able to without assistance (finding): 5 concepts

  • Difficulty (finding): 734 concepts

  • Difficulty without assistance (finding): 2 concepts

  • Unable to (finding): 736 concepts

Example Hierarchy Structure

In 365189008 |Finding related to ability to dry self (finding)|, the concepts Able to (finding) and Difficulty (finding) are siblings.

Open World View Perspective

SNOMED CT operates on an open world view. Under this framework, 371150009 |Able (qualifier value)| indicates the basic capacity to carry out an activity, regardless of the effort or difficulty involved. For example, a person remains capable of walking even if their movement is limited by reduced pace, short distance, or impaired gait. The same logic applies to the use of assistive devices or assistance. For example, an individual who uses a walking stick to move around is still classified as ‘able to walk’.

The Question

In noting this, would there be the same expectation clinically? Would nurses expect to see a concept representing able with difficulty to perform as a subtype of able to perform ? Using the above example, this would make 284832007 |Difficulty drying self (finding)| a subtype of 284828001 |Able to dry self (finding)|.

Thank you for your input.

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Nursing CRG call 8 September 2026 - summary of discussion

|Able with difficulty (qualifier value)| should be a subtype of |Able (qualifier value)|

Regarding the need for finding concepts representing ability with or without assistance - only add if asked.

There are ‘able to’ finding concepts where the ‘unable to’ finding concept isn’t present (see numbers above). Both are needed for recording. Noted post call, this would also apply to Difficulty finding concepts.

Thank you to the group for this feedback.

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I’m not sure if I’ve fully understood everything, since I’m not (yet) an expert on SNOMED CT. I had a thought on this that I wasn’t able to articulate very well the day before yesterday.

I don’t know if it’s helpful, but I’d like to share my thoughts.

First, a question: How can it be represented if someone is able with an assistive device, such as a walking stick (which SNOMED CT concept)?

My thoughts on the discussion: In my opinion, if someone is able to walk with an assistive device, he or she is “able” and does not need help from a nurse. Because in this case, he or she compensates the difficulties with the assistive device and is therefore independent. But if the person does not have an assistive device, i would say she is able to walk with difficulties and she may need help from a nurse. Therefore i would plan interventions to assist with walking.

So I agree with this: “For example, an individual who uses a walking stick to move around is still classified as “able to walk.”” - I wouldn’t plan interventions to assist with walking; rather, I might just observe them and focus on other fall prevention interventions.

If i would classify a person: “able” or “able with assistive device” would mean that someone does not need assistance from nurses. “Able without assistance” would be the same as “able” to me.

“Able with difficulty” as a qualifier value would mean to me that someone needs assistance from nurses. This would be the same as “able with assistance”. Therfore i would plan assistive interventions.

I hope I was able to explain my thoughts in a way that makes sense.

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