Importance of Nursing Diagnosis Research Margaret Lunney, RN, PhD Chairperson, Research Committee NANDA International Keynote address given at the AENTDE conference in Valladolid, Spain October 25 th & 26, th 2007

Nursing diagnosis research is critically needed for ongoing development of the nursing diagnosis taxonomy for international use.

Classifications are needed whenever the communication of names for phenomena are important.

To develop and maintain a classification, ongoing research is needed. Research processes are used to establish evidence.

Knowledge of the research process is available in books, articles, and workshops.

The goal is to promote nursing research to support the nursing diagnosis classification.

To adequately support an international classification, nursing diagnosis research is needed in every country for 3 reasons.

1. The EHR is international and inevitable.

2. The usefulness of an international classification depends on global consensus.

3. Changes in clinical practice are continuous, so studies are needed to identify, describe, explain, and predict clinical practice patterns.

Research is a systematic, disciplined process to develop, refine, and expand a body of knowledge. Theoretical Framework for Nursing Diagnosis Research Types of Nursing Diagnosis Research

In many types of studies, the foundation of the research process is the theoretical framework.

Theoretical Framework: linguistic theory provides useful explanations for the importance of developing scientific classifications. Theoretical Framework: linguistic theory provides useful explanations for the importance of developing scientific classifications.

Words are “maps” to the territory

The meanings of words are known through context. Context is known through experience.

The meanings of words are extensional (physical world) and Intensional (ideas about the physical world)

We can’t think without names. The names for things influence our thinking. Thinking about things also influences our naming.

We experience only a small fraction of phenomena, e.g., Bessie the cow.

Human beings abstract from their experiences and observations. 8. Wealth 8. Wealth 7. Asset 6. Farm asset 5. Livestock 4. Cow 4. Cow 3. Bessie 3. Bessie 2. Perception 2. Perception 1. Process___________________________ Words are abstractions of similarities, not differences (read from bottom up)

Nurses abstract from their interactions with patients and families. Energy level Is adequate Calm demeanor Vital signs Are good Wants help from a nurse No signs of distress Self esteem? Color is good

This is an example of an abstraction ladder applied to nursing diagnosis. 8. Neuman Systems Model 7. Lines of Defense 6. Functional Health Patterns 5. Cognitive-Perceptual Pattern 4. Decision Making 3. Decisional Conflict re: feeding 2. Cheryl’s Breastfeeding 1. Breastfeeding experience____________ Words are abstractions of similarities, not differences Words are abstractions of similarities, not differences (read from bottom up)

Summary: A theory of nursing diagnosis is that we name things to think about them, interpret the meaning, and, with others, provide actions for quality care. Summary: A theory of nursing diagnosis is that we name things to think about them, interpret the meaning, and, with others, provide actions for quality care.

Use this theoretical framework to explain the importance of nursing diagnosis research.

Many types of nursing diagnosis research are needed.

Qualitative methods that can be used are participant action research, grounded theory, and phenomenology. Nurses from Hackettstown Regional Medical Center working in participant action research study

Example: Participant Action Research. An advantage is that you involve the stakeholders, e.g., patients or nurses.

We used action research methods to conduct a consensus validation study of the common diagnoses (NANDA), interventions (NIC) and outcomes (NOC) for 2 local populations.

The action research methods for consensus validation were developed by Dr. Judy Carlson of Honolulu, Hawaii.

In this study, 100% consensus of staff nurses was achieved on relevant NANDA, NIC and NOC terms for 2 populations. People with Diabetes Women in Labor & one hour after delivery

The results were brought back for use at the bedside. The nurses who produced the research product use the research findings.

Quantitative designs for ndx research can be nonexperimental, quasi- experimental, or experimental.

This is what part of the tool we used for the respiratory study looked like. Defining Characteristics Present/ Absent ABG from Baseline, Abnormal______/________ ABG from Normal Values, Abnormal______/________ Values Values pH______/________ pCO2______/________ HCO3______/________ HCO3______/________ pO2______/________ O2 Sat______/________ Adventitious Breath Sounds: Crackles/Rales Crackles/Rales Fine_______/_______ Course_______/_______ Gurgles/Rhonchi_______/_______ Wheezes_______/_______ Stridor_______/_______

Guidelines can be found in books and examples in journals can be followed. Also, ask for help from a mentor.

Quantitative clinical validation studies are critically needed because we do not “know” unless we systematically investigate.

Guidelines for planning a quantitative clinical study were described by Carlson & Lunney (1995).

The science of nursing needs a broad base of research to support its diagnostic language.

Nurses worldwide need to work together to design and conduct studies of new and existing diagnoses.

Will you help us to build a future for nursing science by conducting nursing diagnosis research?