Evolution of the Nursing Diagnoses Classification

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

2. 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

3. 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

4. 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

5. 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)

6. 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)

7. 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

8. 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

9. NANDA-I Taxonomy • 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)

10. 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

11. 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

12. 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

13. Gaps in Nursing Diagnoses within Taxonomy II • Breastfeeding • Nutritional aspect versus role-relationship aspect • Cultural / spiritual adaptation • Community diagnoses are lacking • DOMAIN 10 LIFE PRINCIPLES • Class 1 Values • Class 2 Beliefs

14. 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?

15. 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?

16. NANDA-I: Ontologically Consistent?

17. 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

18. 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

19. NANDA-I Taxonomy: Toward the future • 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

20. Thank You • T. Heather Herdman, PhD; RN • Executive Director, NANDA International • execdir@nanda.org