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Investigating the

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
Nursing diagnoses are the basis for
selection of outcomes, & interventions
needed to reach those outcomes

Problem solving approach to

Expertise Based Practice
Best evidence



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


Standardize practice
Reduce wide variations in individual

clinicians practices

Maximize good practices

Eliminate worst practices

Reduce costs
Improve the quality of care

Questioning Clinical

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

Questioning Clinical
Adopt a reflective, inquiring

Asking the right questions
takes as much skill
as giving the right answers!
Robert Half

Questioning Clinical
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
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

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
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 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
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

Incidence/prevalence of diagnoses in different settings &

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
Outcome / Effectiveness studies
Demonstrate prognoses of diagnoses
Identifies which interventions best lead to desired

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 of nurses

diagnoses varies widely from

low to high
o (Lunney, 2001)

Foundation for appropriate

outcomes and interventions

Lack of Cultural
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

Revision of current diagnoses that
lack sufficient evidence-based
defining characteristics, risk factors
or related factors

The Future of Nursing

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