Evolution of the Nursing Diagnoses Classification T. Heather Herdman, PhD; RN Executive Director NANDA International
Dec 25, 2015
Evolution of the Nursing Diagnoses Classification
T. Heather Herdman, PhD; RN
Executive Director
NANDA International
1970 - 1979
• Concept of “Nursing diagnosis” was first used in publication in 1970 by the American Nurses’ Association
• Held first task force meeting to name and classify Nursing Diagnoses
• Established first Clearinghouse for Nursing Diagnoses Resource
• Published first conference proceedings• Work of the Nurse Theorist Group began
1980 - 1989
• Established North American Nursing Diagnosis Association (NANDA) in 1982
• NANDA and American Nurses Association Developed Nursing Diagnosis Collaboration Model
• Published Taxonomy I (1987)• Categories based on human response patterns within
Martha Roger’s theory, The Unitary Man
• Facilitated International Participation in NANDA
1990 - 1999
• Published Nursing Diagnosis - The Official Journal of the North American Nursing Diagnosis Association
• Held First Joint Meeting of NANDA, NIC, NOC• Journal title changes to International Journal of
Nursing Terminologies and Classifications• Celebrated NANDA’s 25th Anniversary!• Defined evidence-based criteria for acceptance
of a diagnosis into the NANDA-I taxonomy
2000 - 2008
• Published Taxonomy II (2001)• Hierarchical structure of 13 domains and 47 classes
• Published NNN Taxonomy (2002)• NANDA becomes NANDA International (2002), or NANDA-I• Review/revision of diagnoses in taxonomy set as priority during 2006
– 2008• Updated evidence-based criteria required for acceptance of a diagnosis
into the NANDA-I taxonomy
• Larger number of new & revised diagnoses entered into taxonomy in 2006 & 2008 than ever before
• Online System Launched for worldwide membership review/commentary on Nursing Diagnosis submissions
• New website launched for NANDA-I (www.nanda.org)
2008 - Current
• First NANDA-I conference with translation into second language (Spanish)
• Nearly 33% of attendees native Spanish speakers!
• First non-American president elected to lead NANDA-I; Bylaws changed to reflect international organization
• 2009 – 2011 Taxonomy• 21 new nursing diagnoses added (total of 206)
• 9 nursing diagnoses revised
• 6 nursing diagnoses retired
• Dr. Margaret Lunney publishes Critical Thinking to Achieve Positive Health Outcomes: Nursing Case Studies and Analyses
• Work begins on first conference to be held outside of the USA (Madrid, Spain in May, 2010)
The NANDA-I Taxonomy
• Taxonomic structure is a “work in progress”• Nursing knowledge is constantly expanding• Knowledge of taxonomic structure is improving within
NANDA-I • International use of NANDA-I • Use of NANDA-I across a variety of patient settings• Nurses with varied paradigms seeking to use NANDA-I• Significantly increased submission of revisions and new
diagnoses that challenge current taxonomic structure
NANDA-I Taxonomy
• Identification, definition and systematic ordering of phenomena of concern to nursing – “defining the knowledge of nursing”
• Form the basis for activity by providing nurses with perspective and understanding regarding empirical phenomena
• Classification schema must make sense for clinicians
• Must have clear, concise definitions• Must have critical defining characteristics with
standardized terms
• Domain completeness• Categories that cover the domain of nursing practice – generating
knowledge about all types of patient phenomena related to nursing practice
• Ontological homogeneity• Classification groups phenomena sharing essential qualities into main
groups/subgroups - enabling generalized knowledge about phenomena belonging to the same group/subgroup within the structure
• Clinical functionality• Supports clinicians in attaining perspective on & understanding of
empirical phenomena encountered in their daily work
- Von Krogh, G. (2008)
NANDA-I Taxonomy
• Domains• Predominant levels dividing phenomena into main groups• NANDA-I currently has 13 domains
• Classes• Intermediate levels clustering phenomena with common
characteristics• NANDA-I currently has 47 classes
• Concepts• Concrete levels where each phenomenon is located – named,
defined and numbered• NANDA-I currently has 206 diagnoses
NANDA-I Taxonomy
NANDA-I Lacks Domain Completeness
• Domains refer to essential human qualities and functions
• Growth/Development• Sexuality• Perception/Cognition• Self-Perception• Role Relationships
• Domains refer to human health experiences• Comfort• Safety• Life principles
Gaps in Nursing Diagnoses within Taxonomy II
• Domain 2 NUTRITION• Class 2 Digestion
• Domain 1 HEALTH PROMOTION• Class 1 Health Awareness
• DOMAIN 2 NUTRITION• Class 3 Absorption
• These were prioritized for development by members of the DDC, Taxonomy & Informatics committees in September, 2007
• Breastfeeding• Nutritional aspect versus role-relationship aspect
• Cultural / spiritual adaptation• Community diagnoses are lacking• DOMAIN 10 LIFE PRINCIPLES
• Class 1 Values• Class 2 Beliefs
Gaps in Nursing Diagnoses within Taxonomy II
• Potential revision to Taxonomy II• Is it all inclusive?• Are the Functional Health Patterns a better fit after all?• Is there another model that is more relevant today?
Gaps in Nursing Diagnoses within Taxonomy II
NANDA-I: Ontologically Consistent?
• Domains must be at a level of abstraction which provides that its content of meaning is universal and indicates no specific direction or content
• Do nursing theorists describe and conceptualize categories of patient phenomena in theories that represent different paradigms within nursing?
Domain and Classes in NANDA-I with Potential Ontological Disparity
Health Promotion
Nutrition Elimination / Exchange
Activity / Rest
Perception / Cognition
Self- perception
Role relationship
•Health awareness•Health management
•Ingestion•Digestion•Absorption•Metabolism•Hydration
•Urinary system•GI system•Integumentary system•Pulmonary system
•Sleep/rest•Activity / exercise•Energy balance•Cardio-vascular pulmonary responses•Self-care
•Attention•Orientation•Sensation / perception•Cognition•Communication
•Self-concept•Self-esteem•Body image
•Caregiving roles•Family relationships•Role performance
Sexuality Coping / Stress Tolerance
Life Principles Safety / Protection
Comfort Growth / Development
•Sexual identity•Sexual function•Reproduction
•Posttrauma responses•Coping responses•Neurobeha-vioral stress
•Values•Beliefs•Value / belief congruence
•Infection•Physical injury•Violence•Environmental hazards•Defensive processes•Thermoregu-lation
•Physical comfort•Environmental comfort•Social comfort
•Growth•Development
NANDA-I: Ontologically Consistent?
Clinical Functionality of NANDA-I Taxonomy
• Make domain completeness of classification probable• The current taxonomy is oriented primarily towards the theoretical
concepts of Human Needs and Adaptation theories – it needs to include all nursing paradigms, including the existential and phenomenological orientation
• Ease the task of orientation in classification• To work as a cognitive map, must reduce the number of domains
and classes
• Validate selected classified concepts• Generalizing knowledge about phenomena within a hierarchical
structure enables clinicians to quickly identify potential intervention choices
NANDA-I Taxonomy: Toward the future
• Abstraction level of many domains is too low• Domain concepts have insufficient universal
meaning and content to derive exhaustive classes
• Need to increase the abstraction level of several of the current domains
• Some domains should be reduced to classes within a hierarchical structure
• Need to ensure that multiple theoretical paradigms are represented within the taxonomy, particularly the existential and phenomenological
• Gunn von Krogh, Chair of Taxonomy, will be leading the team to undertake this review and revision, as required
• NANDA-I members will have the opportunity to provide input as this review and revision progresses
NANDA-I Taxonomy: Toward the future
Thank You
T. Heather Herdman, PhD; RN
Executive Director, NANDA International