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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

Problem solving approach to

Evidence
Expertise Based Practice
Best evidence

Patient
Values

Patient
Preferences

clinical practice that


integrates the conscientious
use of best evidence in
combination with a
clinicians 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

clinicians 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:
Diagnoses in the
Research
Based?
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-Internationals 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