Evolution of the Nursing Diagnoses Classification T. Heather Herdman, PhD; RN Executive Director NANDA International

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

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

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

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 (

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 2NUTRITION Class 2Digestion Domain 1HEALTH PROMOTION Class 1Health Awareness DOMAIN 2NUTRITION Class 3Absorption 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 10LIFE PRINCIPLES Class 1Values Class 2Beliefs 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

Primary concern What does the nurse in practice need to explain what nurses know? This must be the major concern of all our efforts Must develop terms with language that is: “User friendly” Clear Concise Easily translated 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 NutritionElimination / 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 SexualityCoping / Stress Tolerance Life PrinciplesSafety / Protection ComfortGrowth / 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