Evolution of the Nursing Diagnoses Classification

T. Heather Herdman, PhD; RN

Executive Director

NANDA International

1970 - 1979

• Concept of “Nursing diagnosis” was first used in publication in 1970 by the American Nurses’ Association

• Held first task force meeting to name and classify Nursing Diagnoses

• Established first Clearinghouse for Nursing Diagnoses Resource

• Published first conference proceedings• Work of the Nurse Theorist Group began

1980 - 1989

• Established North American Nursing Diagnosis Association (NANDA) in 1982

• NANDA and American Nurses Association Developed Nursing Diagnosis Collaboration Model

• Published Taxonomy I (1987)• Categories based on human response patterns within

Martha Roger’s theory, The Unitary Man

• Facilitated International Participation in NANDA

1990 - 1999

• Published Nursing Diagnosis - The Official Journal of the North American Nursing Diagnosis Association

• Held First Joint Meeting of NANDA, NIC, NOC• Journal title changes to International Journal of

Nursing Terminologies and Classifications• Celebrated NANDA’s 25th Anniversary!• Defined evidence-based criteria for acceptance

of a diagnosis into the NANDA-I taxonomy

2000 - 2008

• Published Taxonomy II (2001)• Hierarchical structure of 13 domains and 47 classes

• Published NNN Taxonomy (2002)• NANDA becomes NANDA International (2002), or NANDA-I• Review/revision of diagnoses in taxonomy set as priority during 2006

– 2008• Updated evidence-based criteria required for acceptance of a diagnosis

into the NANDA-I taxonomy

• Larger number of new & revised diagnoses entered into taxonomy in 2006 & 2008 than ever before

• Online System Launched for worldwide membership review/commentary on Nursing Diagnosis submissions

• New website launched for NANDA-I (www.nanda.org)

2008 - Current

• First NANDA-I conference with translation into second language (Spanish)

• Nearly 33% of attendees native Spanish speakers!

• First non-American president elected to lead NANDA-I; Bylaws changed to reflect international organization

• 2009 – 2011 Taxonomy• 21 new nursing diagnoses added (total of 206)

• 9 nursing diagnoses revised

• 6 nursing diagnoses retired

• Dr. Margaret Lunney publishes Critical Thinking to Achieve Positive Health Outcomes: Nursing Case Studies and Analyses

• Work begins on first conference to be held outside of the USA (Madrid, Spain in May, 2010)

The NANDA-I Taxonomy

• Taxonomic structure is a “work in progress”• Nursing knowledge is constantly expanding• Knowledge of taxonomic structure is improving within

NANDA-I • International use of NANDA-I • Use of NANDA-I across a variety of patient settings• Nurses with varied paradigms seeking to use NANDA-I• Significantly increased submission of revisions and new

diagnoses that challenge current taxonomic structure

NANDA-I Taxonomy

• Identification, definition and systematic ordering of phenomena of concern to nursing – “defining the knowledge of nursing”

• Form the basis for activity by providing nurses with perspective and understanding regarding empirical phenomena

• Classification schema must make sense for clinicians

• Must have clear, concise definitions• Must have critical defining characteristics with

standardized terms

• Domain completeness• Categories that cover the domain of nursing practice – generating

knowledge about all types of patient phenomena related to nursing practice

• Ontological homogeneity• Classification groups phenomena sharing essential qualities into main

groups/subgroups - enabling generalized knowledge about phenomena belonging to the same group/subgroup within the structure

• Clinical functionality• Supports clinicians in attaining perspective on & understanding of

empirical phenomena encountered in their daily work

- Von Krogh, G. (2008)

NANDA-I Taxonomy

• Domains• Predominant levels dividing phenomena into main groups• NANDA-I currently has 13 domains

• Classes• Intermediate levels clustering phenomena with common

characteristics• NANDA-I currently has 47 classes

• Concepts• Concrete levels where each phenomenon is located – named,

defined and numbered• NANDA-I currently has 206 diagnoses

NANDA-I Taxonomy

NANDA-I Lacks Domain Completeness

• Domains refer to essential human qualities and functions

• Growth/Development• Sexuality• Perception/Cognition• Self-Perception• Role Relationships

• Domains refer to human health experiences• Comfort• Safety• Life principles

Gaps in Nursing Diagnoses within Taxonomy II

• Domain 2 NUTRITION• Class 2 Digestion

• Domain 1 HEALTH PROMOTION• Class 1 Health Awareness

• DOMAIN 2 NUTRITION• Class 3 Absorption

• These were prioritized for development by members of the DDC, Taxonomy & Informatics committees in September, 2007

• Breastfeeding• Nutritional aspect versus role-relationship aspect

• Cultural / spiritual adaptation• Community diagnoses are lacking• DOMAIN 10 LIFE PRINCIPLES

• Class 1 Values• Class 2 Beliefs

Gaps in Nursing Diagnoses within Taxonomy II

• Potential revision to Taxonomy II• Is it all inclusive?• Are the Functional Health Patterns a better fit after all?• Is there another model that is more relevant today?

Gaps in Nursing Diagnoses within Taxonomy II

NANDA-I: Ontologically Consistent?

• Domains must be at a level of abstraction which provides that its content of meaning is universal and indicates no specific direction or content

• Do nursing theorists describe and conceptualize categories of patient phenomena in theories that represent different paradigms within nursing?

Domain and Classes in NANDA-I with Potential Ontological Disparity

Health Promotion

Nutrition Elimination / Exchange

Activity / Rest

Perception / Cognition

Self- perception

Role relationship

•Health awareness•Health management

•Ingestion•Digestion•Absorption•Metabolism•Hydration

•Urinary system•GI system•Integumentary system•Pulmonary system

•Sleep/rest•Activity / exercise•Energy balance•Cardio-vascular pulmonary responses•Self-care

•Attention•Orientation•Sensation / perception•Cognition•Communication

•Self-concept•Self-esteem•Body image

•Caregiving roles•Family relationships•Role performance

Sexuality Coping / Stress Tolerance

Life Principles Safety / Protection

Comfort Growth / Development

•Sexual identity•Sexual function•Reproduction

•Posttrauma responses•Coping responses•Neurobeha-vioral stress

•Values•Beliefs•Value / belief congruence

•Infection•Physical injury•Violence•Environmental hazards•Defensive processes•Thermoregu-lation

•Physical comfort•Environmental comfort•Social comfort

•Growth•Development

NANDA-I: Ontologically Consistent?

Clinical Functionality of NANDA-I Taxonomy

• Make domain completeness of classification probable• The current taxonomy is oriented primarily towards the theoretical

concepts of Human Needs and Adaptation theories – it needs to include all nursing paradigms, including the existential and phenomenological orientation

• Ease the task of orientation in classification• To work as a cognitive map, must reduce the number of domains

and classes

• Validate selected classified concepts• Generalizing knowledge about phenomena within a hierarchical

structure enables clinicians to quickly identify potential intervention choices

NANDA-I Taxonomy: Toward the future

• Abstraction level of many domains is too low• Domain concepts have insufficient universal

meaning and content to derive exhaustive classes

• Need to increase the abstraction level of several of the current domains

• Some domains should be reduced to classes within a hierarchical structure

• Need to ensure that multiple theoretical paradigms are represented within the taxonomy, particularly the existential and phenomenological

• Gunn von Krogh, Chair of Taxonomy, will be leading the team to undertake this review and revision, as required

• NANDA-I members will have the opportunity to provide input as this review and revision progresses

NANDA-I Taxonomy: Toward the future

Thank You

T. Heather Herdman, PhD; RN

Executive Director, NANDA International

execdir@nanda.org