Taxonomy of Nursing Diagnoses
The NANDA
International
Taxonomy
Focus of Nursing
 “Health” of “human beings”
 Health-related phenomena are complex because they involve human experiences
 Nursing’s goal is to identify people’s experiences or responses in order to support
them.
 Significant overlap of cues to diagnoses
 Contextual factors such as culture can change the perspective of
“what is the diagnosis?”
 Many studies have verified that interpretations of clinical cases
have the potential to be less accurate than indicated by the data
(Lunney, 2007).
Nursing Diagnosis: NANDA-I Definition
 Adapted from a national, Delphi study by Dr.
Joyce Shoemaker (1984)
 A clinical judgment about individual, family, or community
responses to actual or potential health problems/life
processes. Nursing diagnoses provide the basis for selection
of nursing interventions to achieve outcomes for which the
nurse is accountable (1997).
The Diagnoses
 206 NANDA-approved nursing diagnoses as of 2008
 Level of Evidence (LOE) Criteria Established for All
New and Revised Diagnoses
 Entry into the Taxonomy requires various levels of
clinical evidence
Taxonomy
Oxford English Dictionary
American Nurses Association
 /taksonnmi/
 Classification according to
 • noun chiefly Biology
 1 the branch of science
concerned with classification.
 2 a scheme of classification.
 ORIGIN from Greek
taxis
-nomia
‘arrangement’ +
‘distribution’
presumed natural
relationships among types and
their subtypes

ANA, 1999
Definitions for Classification of
Nursing Diagnoses
 Classification
 Systematic arrangement of related phenomena in groups or
classes based on characteristics that objects have in common
 Nomenclature
 A system of designations (terms) elaborated according to
pre-established rules
(ANA, 1999)
Definitions for Classification of
Nursing Diagnoses
 Domain
 A sphere of activity, concern, or function; a field: the domain
of history
 Class
 A set, collection, group, or configuration containing
members regarded as having certain attributes or traits in
common; a kind or category.
o (http://www.thefreedictionary.com/domain)
History of NANDA-I Taxonomy II
1994 – First placement of Nursing Diagnoses into
Taxonomy I revised
1996 – Q-sort identified 21 categories…too many
to be useful or practical
1998 – Gordon’s Functional Health Patterns were
adapted to create Taxonomy II
Definitions developed for domains and classes
within the structure
Definition of each diagnosis compared to that of
the class and domain into which it was placed
History of NANDA-I Taxonomy II
Revisions / modifications in diagnosis placements made to
ensure maximum match among diagnosis, class & domain
2002 – all NANDA-I approved diagnoses are placed into
Taxonomy II
2003 – Further refinements made to Taxonomy II
2004 – Taxonomy II compared axes to ISO Reference
Terminology Model for Nursing Diagnosis
Structure of Taxonomy II
Domains
Class
NDx
Class
NDx
NDx
NDx
Code Structure
 NANDA-I uses a 32-bit integer (or a 5-digit code) to
enable growth & development of the taxonomy
without having to change codes repeatedly to
accommodate those changes
 Code structure is compliant with the National Library
of Medicine’s (USA) Unified Medical Language System
(UMLS) concerning healthcare terminology codes
Structure of Taxonomy II
Registered with Health Level 7 (HL7)
Modeled into SNOMED-CT
Compliant with ISO terminology
model for a nursing diagnosis
Working collaboratively with ICNP
Multiaxial System
 7 axes within NANDA-I Taxonomy
 Axis
 A dimension of the human response that is
considered in the diagnostic process
 Allows for flexibility of the nomenclature
 Allows for easy additions and modifications
NANDA-I Axes
Axis 1
The Diagnostic Concept
Axis 2
Subject of the Diagnosis
(Individual, Family,
Group, Community)
Axis 3
Judgment
(Decreased, Effective,
Impaired, Situational,
etc.)
Axis 4
Location
(GI, Oral, Skin, etc.)
Axis 5
Age
(Infant, Preschool Child,
Adolescent, Adult, etc.)
Axis 6
Time
(Acute, Intermittent,
Chronic, Continuous)
Required
Axis 7
Status of the diagnosis
(Actual, Health
Promotion, Risk,
Wellness)
Optional
The NANDA-I Model of a Nursing
Diagnosis
Judgment
(Axis 3)
Diagnostic concept
(Axis 1)
Status of
Diagnosis
(Axis 7)
Location
(Axis 4)
Subject of Diagnosis
(Axis 2)
Age
(Axis 5)
Time
(Axis 6)
A NANDA-I Nursing Diagnosis Model:
(Individual) Ineffective Coping
Ineffective
(Axis 3)
Coping
(Axis 1)
[Actual]
(Axis 7)
N/A
(Axis 4)
[Individual]
(Axis 2)
N/A
(Axis 5)
N/A
(Axis 6)
A NANDA-I Nursing Diagnosis Model:
Compromised Family Coping
Coping
(Axis I)
Compromised
(Axis 3)
Risk for
(Axis 7)
N/A
(Axis 4)
Family
(Axis 2)
N/A
(Axis 6)
A NANDA-I Nursing Diagnosis Model:
Readiness for Enhanced Family Coping
Enhanced
(Axis 3)
Coping
(Axis 1)
Readiness for
(Axis 7)
N/A
(Axis 4)
Family
(Axis 2)
N/A
(Axis 5)
N/A
(Axis 6)
NANDA-I Taxonomy II: 2008
Taxonomy: Opportunities
 The Diagnosis Development, Taxonomy, and Informatics
Committees have identified the following priorities for
diagnosis development
 Domain 2: Nutrition
 Class 2: Digestion
 Domain 1: Health Promotion
 Class 1: Health Awareness
 Domain 2: Nutrition
 Class 3: Absorption
Future Development
 Clinicians can easily identify opportunities for new
diagnoses by reviewing the domains/classes with few – or
no – diagnoses present
 Construction of new diagnoses, along with submission to
NANDA-I, enables the taxonomy to continue to be
strengthened
 NANDA-I’s Diagnosis Development Committee is eager to
partner with you to develop new diagnoses, and revise
current diagnoses