Evolution of the Nursing Diagnoses Classification

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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 - PowerPoint PPT Presentation

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  • Evolution of the Nursing Diagnoses ClassificationT. Heather Herdman, PhD; RNExecutive DirectorNANDA International

  • 1970 - 1979Concept of Nursing diagnosis was first used in publication in 1970 by the American Nurses AssociationHeld first task force meeting to name and classify Nursing Diagnoses Established first Clearinghouse for Nursing Diagnoses ResourcePublished first conference proceedingsWork of the Nurse Theorist Group began

  • 1980 - 1989Established North American Nursing Diagnosis Association (NANDA) in 1982NANDA and American Nurses Association Developed Nursing Diagnosis Collaboration Model Published Taxonomy I (1987)Categories based on human response patterns within Martha Rogers theory, The Unitary ManFacilitated International Participation in NANDA

  • 1990 - 1999Published Nursing Diagnosis - The Official Journal of the North American Nursing Diagnosis AssociationHeld First Joint Meeting of NANDA, NIC, NOCJournal title changes to International Journal of Nursing Terminologies and ClassificationsCelebrated NANDAs 25th Anniversary!Defined evidence-based criteria for acceptance of a diagnosis into the NANDA-I taxonomy

  • 2000 - 2008Published Taxonomy II (2001)Hierarchical structure of 13 domains and 47 classesPublished NNN Taxonomy (2002)NANDA becomes NANDA International (2002), or NANDA-IReview/revision of diagnoses in taxonomy set as priority during 2006 2008Updated evidence-based criteria required for acceptance of a diagnosis into the NANDA-I taxonomyLarger number of new & revised diagnoses entered into taxonomy in 2006 & 2008 than ever beforeOnline System Launched for worldwide membership review/commentary on Nursing Diagnosis submissionsNew website launched for NANDA-I (www.nanda.org)

  • 2008 - CurrentFirst 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 organization2009 2011 Taxonomy21 new nursing diagnoses added (total of 206)9nursing diagnoses revised 6 nursing diagnoses retired Dr. Margaret Lunney publishes Critical Thinking to Achieve Positive Health Outcomes: Nursing Case Studies and AnalysesWork begins on first conference to be held outside of the USA (Madrid, Spain in May, 2010)

  • The NANDA-I TaxonomyTaxonomic structure is a work in progressNursing knowledge is constantly expandingKnowledge of taxonomic structure is improving within NANDA-I International use of NANDA-I Use of NANDA-I across a variety of patient settingsNurses with varied paradigms seeking to use NANDA-ISignificantly increased submission of revisions and new diagnoses that challenge current taxonomic structure

  • NANDA-I TaxonomyIdentification, definition and systematic ordering of phenomena of concern to nursing defining the knowledge of nursingForm the basis for activity by providing nurses with perspective and understanding regarding empirical phenomenaClassification schema must make sense for cliniciansMust have clear, concise definitionsMust have critical defining characteristics with standardized terms

  • Domain completenessCategories that cover the domain of nursing practice generating knowledge about all types of patient phenomena related to nursing practiceOntological homogeneityClassification groups phenomena sharing essential qualities into main groups/subgroups - enabling generalized knowledge about phenomena belonging to the same group/subgroup within the structureClinical functionalitySupports clinicians in attaining perspective on & understanding of empirical phenomena encountered in their daily work

    - Von Krogh, G. (2008)NANDA-I Taxonomy

  • DomainsPredominant levels dividing phenomena into main groupsNANDA-I currently has 13 domainsClassesIntermediate levels clustering phenomena with common characteristicsNANDA-I currently has 47 classesConceptsConcrete levels where each phenomenon is located named, defined and numberedNANDA-I currently has 206 diagnosesNANDA-I Taxonomy

  • NANDA-I Lacks Domain CompletenessDomains refer to essential human qualities and functionsGrowth/DevelopmentSexualityPerception/CognitionSelf-PerceptionRole RelationshipsDomains refer to human health experiencesComfortSafetyLife principles

  • Gaps in Nursing Diagnoses within Taxonomy IIDomain 2NUTRITIONClass 2DigestionDomain 1HEALTH PROMOTIONClass 1Health AwarenessDOMAIN 2NUTRITIONClass 3Absorption

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

  • BreastfeedingNutritional aspect versus role-relationship aspectCultural / spiritual adaptationCommunity diagnoses are lackingDOMAIN 10LIFE PRINCIPLESClass 1ValuesClass 2Beliefs

    Gaps in Nursing Diagnoses within Taxonomy II

  • Potential revision to Taxonomy IIIs 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

  • Primary concernWhat does the nurse in practice need to explain what nurses know?This must be the major concern of all our effortsMust develop terms with language that is:User friendlyClearConciseEasily translatedGaps 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 contentDo nursing theorists describe and conceptualize categories of patient phenomena in theories that represent different paradigms within nursing?

  • NANDA-I: Ontologically Consistent?

    Domain and Classes in NANDA-I with Potential Ontological DisparityHealth PromotionNutritionElimination / ExchangeActivity / RestPerception / CognitionSelf- perceptionRole relationshipHealth awarenessHealth managementIngestionDigestionAbsorptionMetabolismHydrationUrinary systemGI systemIntegumentary systemPulmonary systemSleep/restActivity / exerciseEnergy balanceCardio-vascular pulmonary responsesSelf-careAttentionOrientationSensation / perceptionCognitionCommunicationSelf-conceptSelf-esteemBody imageCaregiving rolesFamily relationshipsRole performanceSexualityCoping / Stress ToleranceLife PrinciplesSafety / ProtectionComfortGrowth / DevelopmentSexual identitySexual functionReproductionPosttrauma responsesCoping responsesNeurobeha-vioral stressValuesBeliefsValue / belief congruenceInfectionPhysical injuryViolenceEnvironmental hazardsDefensive processesThermoregu-lationPhysical comfortEnvironmental comfortSocial comfortGrowthDevelopment

  • Clinical Functionality of NANDA-I TaxonomyMake domain completeness of classification probableThe 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 orientationEase the task of orientation in classificationTo work as a cognitive map, must reduce the number of domains and classesValidate selected classified conceptsGeneralizing knowledge about phenomena within a hierarchical structure enables clinicians to quickly identify potential intervention choices

  • NANDA-I Taxonomy: Toward the futureAbstraction level of many domains is too lowDomain concepts have insufficient universal meaning and content to derive exhaustive classesNeed to increase the abstraction level of several of the current domainsSome domains should be reduced to classes within a hierarchical structureNeed 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 requiredNANDA-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; RNExecutive Director, NANDA Internationalexecdir@nanda.org

    *1973: Kristine Gebbie and Mary Ann Lavin call the First Task Force to Name and Classify Nursing Diagnoses. Members plan to meet biannually in St. Louis, MO. 1973: Dr. Marjory Gordon serves as chairperson of the Task Force of the National Conference Group on the Classification of Nursing Diagnoses. 1973: Clearinghouse for Nursing Diagnoses established at St. Louis University. Served as a depository for nursing diagnosis materials and National Conference Group on the classification of Nursing Diagnoses. The clearinghouse published a newsletter, maintained a speakers bureau, coordinated plans for national conferences and distributed bibliographies on each diagnostic category developed. 1974: First Conference Proceedings edited by Gebbie and Lavin were published. 1977: Work of nurse theorist group began, facilitated by Sister Callista Roy. The group presented papers at the 1978 and 1980 meetings. In 1982, prominent theorists (e.g. Dorothea Orem and Drs. Imogene King, Margaret Newman, Martha Rogers and Callista Roy) presented an organizing framework for nursing diagnoses called Patterns of Unitary Man (Humans), to NANDA and the Taxonomy Committee.*1982: North American Nursing Diagnosis Association (NANDA) established, incorporating National Task Force members from the United States and Canada. Dr. Marjory Gordon elected as first president of NANDA. Dr. Gordon was re-elected in 1986 and served until 1988. 1982: American Nurses Association (ANA) establishes a steering committee on the classification of Nursing Practice Phenomena. The president of NANDA was a committee member. 1986: ANA forwards NANDAs nursing language and classification to the World Health Organization, for possible inclusion as a chapter in the Int