Investigating the
Diagnostic Language of
Nursing Practice
NANDA International
Nursing Diagnosis
 Nursing diagnosis is 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 (NANDA, 1997).
NANDA International
 Develops terminology (Nursing Diagnoses) to
describe the clinical judgments made by nurses as they
provide care for individuals, families, groups and
communities
 Nursing diagnoses are the basis for selection of
outcomes, & interventions needed to reach those
outcomes
Evidence Based Practice
 Problem solving approach to
Expertise
Best evidence
Patient
Values
Patient
Preferences
clinical practice that integrates
the conscientious use of best
evidence in combination with a
clinician’s expertise as well as
patient preferences and values to
make decisions about the type of
care that is provided
 Melnyk & Fineout-Overholt (2005)
Aims of Evidence Based Practice
 Standardize practice
 Reduce wide variations in individual clinician’s
practices
 Maximize good practices
 Eliminate worst practices
 Reduce costs
 Improve the quality of care
Questioning Clinical Practice
 Ask questions about your clinical practice
 What are the conditions nurses treat most frequently in
neonates?
 How does the parent of a child hospitalized in an intensive
care unit respond?
 What phenomena that you see are most often linked to
increased length of stay in your patient populations?
Questioning Clinical Practice
Adopt a reflective, inquiring approach
“Asking the right questions
takes as much skill
as giving the right answers!”
Robert Half
Questioning Clinical Practice
 Consider research taking place in other clinical practice settings
 Look to the Centers for Evidence-Based Practice that exist
around the world
 Germany, New Zealand, Australia, United Kingdom, United States,
Canada
 How does nursing (is nursing) get represented in those evidence-
based practice guidelines?
Practice Outcome Evaluation Points
 Improved patient outcomes
 Decreased length of stay
 Decreased readmissions
 Improved clinical outcomes measures
 Best practice medication usage
 Best practice self-care education
 Decreased practice variation
 Decreased cost
Developing EBP Guidelines
 Protocols or Guidelines provide:
 Comfort for practitioners that the practice changes
are based on evidence versus opinion or cost
factors
 The level of evidence available on the topic
 Guidance on how to implement the practice
change, and what parts of that change are based on
what level of evidence
Diagnoses – Outcomes - Interventions
 Link these three components
 Use standardized classification systems and
language
 Identify your problem / diagnosis
 Select appropriate outcome indicators
 Identify potential interventions and activities to
best reach target outcomes
Nursing Diagnosis: Research Based?
 Diagnoses in the NANDA-I taxonomy were developed
and/or revised using a variety of research methods
 Expert consensus
 Concept analysis
 Content, construct and criterion validation
“Ideally, the conceptual base of each diagnostic concept is
firmly grounded in studies of the phenomenon.”
(Gordon, 1998 )
Nursing Diagnosis Research
 Research on the validity and reliability of diagnostic
categories has increased, but remains insufficient
 Large scale funding for basic research is needed to
identify, develop, and validate diagnostic
 Leaders in nursing research have not always supported
the need for a language and classification system that
differs from medicine
 Informatics is an impetus for this work
Concept Analysis
 First step in developing a new diagnosis and refining current
diagnoses
 Identification and exploration of phenomena of concern to
nursing remains critical today in order to fill in the gaps in
our taxonomy
"I use the word nursing for want of a better... I believe...that the very
elements of nursing are all but unknown."
(Nightingale, 1860)
Concept Analysis
 Distinguish between the defining characteristics of a
concept & its irrelevant attributes
 Refine ambiguous concepts
 Examine published sources
 Compare literature to experience/practice
 Examine consistencies between literature and
experience/practice
Content Validation
 Refinement of current diagnoses
 Development of new diagnoses
 Studies involving patients who are experiencing the
diagnosis are needed
 Studies involving nurses caring for those patients
 Clinical validation studies
 Assess for defining characteristics as patients are
experiencing a particular nursing diagnosis
 Decrease the number of defining characteristics to
improve diagnostic accuracy
Construct & Criterion Related Validity
 Multiple study types are needed to establish validity
 Causal analysis
 Show the relation of diagnoses to theories and the importance of using
standardized nursing diagnoses to achieve high quality nursing care
 Epidemiologic
 Incidence/prevalence of diagnoses in different settings & populations
 Shows importance & co-occurrence of diagnoses
 Demonstrates relationships between NDx – Nursing Outcomes – Nursing
Interventions
Construct & Criterion Related Validity
 Generalizability studies
 Demonstrate importance of nursing diagnoses across setting,
patient type, institutions and/or medical diagnoses
 Outcome / Effectiveness studies
 Demonstrate prognoses of diagnoses
 Identifies which interventions best lead to desired outcomes
 Reliability
 Establish stability & coherence of diagnose
(Parker & Lunney, 1998)
Consensus Validation
 Used to establish connections between
NANDA, NOC, NIC and other standardized
nursing languages (OMAHA, HHC, etc.)
 Aids in developing standards of practice
 Assists in development of terminology to populate
the EHR
Studies of Diagnostic Accuracy
 Accuracy of nurses’ diagnoses varies
widely from low to high
o (Lunney, 2001)
 Foundation for appropriate outcomes and
interventions
Lack of Cultural Sensitivity
 Diagnoses have primarily been developed and
refined by North American nurses
 Nurses from Asia, Europe and South America are
now submitting diagnoses
 Also receiving revisions to current diagnoses to support
cultural sensitivity, but need more!
What do we need?
 Emphasis on development, testing and
validation of new diagnostic concepts
 Revision of current diagnoses that lack
sufficient evidence-based defining
characteristics, risk factors or related factors
The Future of Nursing Diagnoses
 NANDA-International’s aim is to link with
organizations across the world that have as
their purpose nursing language development
 Increase diagnosis submission
 Increase clinical testing of diagnoses
 Ensure cultural sensitivity of diagnoses