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Should the structure of Taxonomy II be used as a nursing assessment framework?

The purpose of the taxonomy is to provide organization to the terms (diagnoses) within NANDA-I. It was never intended to serve as an assessment framework. Please see our Position Statement on the use of the NANDA-I taxonomy as a nursing assessment framework, on p. 459.

Can nursing diagnosis be used safely other than in an inpatient unit, such as in the operating room and outpatient clinics?

Absolutely! Nursing diagnoses are used in operating rooms, ambulatory clinics, psychiatric facilities, home health, and hospice organizations, as well as in public health, school nursing, occupational health – and, of course, in hospitals. As diverse as nursing practice is, there are core diagnoses that seem to cross them all – acute pain (00132), anxiety (00146), deficient knowledge (00126), readiness for enhanced health management (00162), for example, can probably be found anywhere a nurse might practice. That said, we know that there is a need for the development of diagnoses to further expand the terms we use to describe nursing knowledge across all of these areas of nursing. Work is underway in some areas, such as pediatrics and mental health, and across a great number of countries, and we are eagerly awaiting the results!

Should nurses in a critical care unit use nursing diagnosis? We are busy taking care of medical conditions.

What an interesting question! Should nurses practice nursing? Yes, of course! There is no question that critical care nurses have a high focus on interventions as a result of medical conditions, and often intervene with patients using “standing protocols” (standing medical orders) that require critical thinking to implement correctly. But let’s be honest: nurses in critical care units need to practice nursing. Patients in critical condition are at risk for many complications that can be prevented by nurses: ventilator-related pneumonias (risk for infection, 00004), pressure ulcers (risk for pressure ulcer, 00249), corneal injury (risk for corneal injury, 00245). They are often scared (fear, 00148), and families are stressed but need to know how to care for their loved one when he comes home: deficient knowledge (00126), stress overload (00177), risk for caregiver role strain (00162). If nurses only attend to the obvious medical condition, then, as the old adage says, they may win the battle, but still lose the war. These patients may develop sequelae that could have been avoided, length of stay may be prolonged, or discharge home could result in untoward events and increased readmission rates. Attend to the medical conditions? Certainly! And focus on the human responses? Absolutely!

What are the types of nursing diagnoses in the NANDA-I classification?

NANDA-I identifies three categories of nursing diagnosis: problem-focused, health promotion, and risk diagnoses. Within these categories, you can also find the use of syndromes. Definitions for each of these categories, and syndromes, can be found in the Glossary of Terms, on p. 464.

What are nursing diagnoses, and why should I use them?

A nursing diagnosis is a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community. It requires a nursing assessment to diagnose your patient correctly – you cannot safely standardize nursing diagnoses by using a medical diagnosis. Although it is true that there are common nursing diagnoses that frequently occur in patients with various medical diagnoses, the fact is that you will not know if the nursing diagnosis is accurate unless you assess for defining characteristics and establish that key related factors exist.

A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability. This means that nursing diagnoses are used to determine the appropriate plan of care for the patient, driving patient outcomes and interventions. You cannot standardize a nursing diagnosis, but it is possible to standardize nursing interventions, once you have selected the appropriate outcome for the nursing diagnosis, as interventions should be evidence-based whenever possible.

Nursing diagnoses also provide a standard language for use in the Electronic Health Record, enabling clear communication among care team members and the collection of data for continuous improvement in patient care.

What is the difference between a medical diagnosis and a nursing diagnosis?

A medical diagnosis deals with a disease, illness or injury. A nursing diagnosis deals with actual or potential human responses to health problems and life processes. For example, a medical diagnosis of cerebrovascular attack (CVA or stroke) provides information about the patient’s pathology. The nursing diagnoses of impaired verbal communication, risk for falls, interrupted family processes, chronic pain, and powerlessness provide a more holistic understanding of the impact of that stroke on this particular patient and his/her family – they also direct nursing interventions to obtain patient-specific outcomes. If nurses only focus on the stroke, they might miss the chronic pain the patient suffers, his sense of powerlessness, and even the interrupted family processes. All of these issues will have an impact on his potential discharge home, his ability to manage his new therapeutic regimen, and his overall quality of life. It is also important to remember that, while a medical diagnosis belongs only to the patient, nursing treats the patient and his family, so diagnoses regarding the family are critical because they have the potential to influence – positively or negatively – the outcomes you are trying to achieve with the patient.

What are the component parts of a diagnosis, and what do they mean for nurses in practice?

There are several parts of a nursing diagnosis: the diagnostic label, definition, and the assessment criteria used to diagnose, the defining characteristics and related factors or risk factors. As we noted in Chapter 4, NANDA-I has strong concerns about the safety of using terms (diagnosis labels) that have no standardized meaning, and/or no assessment criteria. Picking a diagnosis from a list, or making up a term at a patient’s bedside, is a dangerous practice for a couple of very important reasons. First, communication between healthcare team members must be clear, concise, and consistent. If every person defines a “diagnosis” in a different way, there is no clarity. Secondly, how can we assess the validity of a diagnosis, or the diagnostic ability of a nurse, if we have no data to support the diagnosis?

Let’s look at the example of Myra Johansen. This case study shows the problem with “picking” a diagnosis from a list of terms, without knowledge of the definition or the assessment data needed to diagnose the response.