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
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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
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)
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 Lacks Domain Completeness
• Domains refer to essential human qualities and
functions
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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
• Class 2
• Domain 1
• Class 1
NUTRITION
Digestion
HEALTH PROMOTION
Health Awareness
• DOMAIN 2 NUTRITION
• Class 3
Absorption
• These were prioritized for development by
members of the DDC, Taxonomy & Informatics
committees in September, 2007
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
• Class 2
Values
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?
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?
NANDA-I: Ontologically Consistent?
Domain and Classes in NANDA-I with Potential Ontological Disparity
Health
Promotion
Nutrition
Elimination /
Exchange
Activity /
Rest
Perception /
Cognition
Selfperception
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
•Cardiovascular
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
•Neurobehavioral stress
•Values
•Beliefs
•Value / belief
congruence
•Infection
•Physical injury
•Violence
•Environmental
hazards
•Defensive
processes
•Thermoregulation
•Physical comfort
•Environmental
comfort
•Social comfort
•Growth
•Development
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
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
Thank You
T. Heather Herdman, PhD; RN
Executive Director, NANDA International
execdir@nanda.org