Development of Nursing Diagnosis
After reading the chapter, the following questions should be answered:
What are the benefits of a uniform language in nursing?
What is nursing diagnosis?
What is NANDA International?
What is NANDA-I taxonomy?
How are nursing diagnoses approved for clinical use?
What Are the Benefits of a Uniform Language in Nursing?
Before the development of a classification or list of nursing diagnoses, nurses used whatever word they wanted to describe client problems. For example, nurses might have described an individual recovering from surgery as “the appendectomy,” another individual as “the diabetic,” and another individual as “difficult.” Clearly, knowing that a person has diabetes brings to mind blood sugar problems and risk for infection, so the focus is on common problems or risk factors derived from medical diagnoses. If the individual with diabetes or surgery had another problem that needed nursing attention, this problem would have gone undiagnosed. Before 1972, not only did nurses lack the terms to describe problems (except medical diagnoses), but they also did not have assessment questions to uncover such problems.
The need for a common, consistent language for medicine was identified more than 200 years ago. If physicians chose to use random words to describe their clinical situations, then
How could they communicate with one another? With nurses?
How could they organize research?
How could they educate new physicians?
How could they improve quality if they could not retrieve data systematically to determine which interventions improved the individual’s condition?
For example, before the formal labeling of AIDS, defining or studying the disease was difficult, if not impossible. Often, medical records of affected individuals would show various diagnoses or causes of death, such as sepsis, cerebral hemorrhage, or pneumonia, because the AIDS diagnosis did not exist. Every physician in the world uses the same terminology for medical diagnoses. As new diagnoses are discovered, all medical clinicians can access the research using the same words.
By definition, diagnosis is the careful, critical study of something to determine its nature. The question is not whether nurses can diagnose, but what nurses can diagnose.
What Is Nursing Diagnosis?
In 1953, Fry introduced the term nursing diagnosis to describe a step necessary in developing a nursing care plan. Over the next 20 years, references to nursing diagnosis appeared sporadically in the literature.
In 1973, the American Nurses Association (ANA) published its Standards of Practice; in 1980, it followed with its Social Policy Statement, which defined nursing as “the diagnosis and treatment of human response to actual or potential health problems.” Most state nurse practice acts describe nursing in accordance with the ANA definition.
In March 1990, at the Ninth Conference of the North American Nursing Diagnosis Association (NANDA), the General Assembly approved an official definition of nursing diagnosis (NANDA, 1990):
Nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.
This definition was revised from “the nurse is accountable” to “the nurse has accountability” at the National Conference of NANDA International in Miami (November 2009).
It is important to also emphasize that the responses called nursing diagnoses can be to illness and life events. Previously, nurses focused more on responses to medical conditions or treatments. Nurses now diagnose and treat responses to life events such as parenting, aging parents, and school failure.