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Importance of Nursing Importance of Nursing Diagnosis ResearchDiagnosis Research
Margaret Lunney, RN, PhDMargaret Lunney, RN, PhDChairperson, Research Committee Chairperson, Research Committee
NANDA InternationalNANDA International
Keynote address given at the Keynote address given at the AENTDE conference in Valladolid, AENTDE conference in Valladolid,
SpainSpain
October 25October 25thth & 26, & 26,th th 20072007
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Nursing diagnosis research is Nursing diagnosis research is critically needed for ongoing critically needed for ongoing
development of the nursing diagnosis development of the nursing diagnosis taxonomy for international use.taxonomy for international use.
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Classifications are needed whenever Classifications are needed whenever the communication of names for the communication of names for
phenomena are important.phenomena are important.
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To develop and maintain a To develop and maintain a classification, ongoing research is classification, ongoing research is
needed. Research processes are used needed. Research processes are used to establish evidence.to establish evidence.
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Knowledge of the research process Knowledge of the research process is available in books, articles, and is available in books, articles, and
workshops.workshops.
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The goal is to promote nursing The goal is to promote nursing research to support the nursing research to support the nursing
diagnosis classification.diagnosis classification.
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To adequately support an To adequately support an international classification, nursing international classification, nursing
diagnosis research is needed in diagnosis research is needed in every country for 3 reasons.every country for 3 reasons.
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1. The EHR is international and 1. The EHR is international and inevitable.inevitable.
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2. The usefulness of an international 2. The usefulness of an international classification depends on global classification depends on global
consensus.consensus.
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3. Changes in clinical practice are 3. Changes in clinical practice are continuous, so studies are needed to continuous, so studies are needed to identify, describe, explain, and predict identify, describe, explain, and predict
clinical practice patterns.clinical practice patterns.
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Research is a systematic, disciplined Research is a systematic, disciplined process to develop, refine, and process to develop, refine, and expand a body of knowledge.expand a body of knowledge.
TheoreticalFramework for
Nursing DiagnosisResearch
Types of NursingDiagnosis Research
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In many types of studies, the In many types of studies, the foundation of the research process is foundation of the research process is
the theoretical framework.the theoretical framework.
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TTheoretical Frameworkheoretical Framework: linguistic : linguistic theory provides useful explanations for theory provides useful explanations for the importance of developing scientific the importance of developing scientific
classifications.classifications.
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Words are
“maps” to the
territory
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The meanings of words are known The meanings of words are known through context. Context is known through context. Context is known
through experience.through experience.
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The meaningsThe meanings of words are of words are extensional extensional(physical world)(physical world)andand
IntensionalIntensional(ideas about the(ideas about thephysical world) physical world)
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We can’t think without names. The We can’t think without names. The names for things influence our names for things influence our
thinking. Thinking about things also thinking. Thinking about things also influences our naming.influences our naming.
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We experience only a small fraction We experience only a small fraction of phenomena, e.g., Bessie the cow.of phenomena, e.g., Bessie the cow.
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Human beings abstract from their Human beings abstract from their experiences and observations.experiences and observations.
8. 8. WealthWealth
7. Asset7. Asset6. Farm asset6. Farm asset
5. Livestock5. Livestock 4. Cow4. Cow
3. Bessie3. Bessie 2. Perception 2. Perception 1. Process___________________________1. Process___________________________Words are abstractions of similarities, Words are abstractions of similarities,
not differences (read from bottom up)not differences (read from bottom up)
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Nurses abstract from their Nurses abstract from their interactions with patients and interactions with patients and
families.families.
Energy levelIs adequate
Calm demeanor
Vital signsAre good
Wants helpfrom a nurse
No signsof distress
Self esteem?
Color isgood
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This is an example of an abstraction This is an example of an abstraction ladder applied to nursing diagnosis.ladder applied to nursing diagnosis.
8. Neuman Systems Model 7. Lines of Defense
6. Functional Health Patterns 5. Cognitive-Perceptual Pattern 4. Decision Making
3. Decisional Conflict re: feeding 2. Cheryl’s Breastfeeding
1. Breastfeeding experience____________ Words are abstractions of similarities, not differences Words are abstractions of similarities, not differences
(read from bottom up)(read from bottom up)
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SummarySummary:: A theory of nursing diagnosis is A theory of nursing diagnosis is that we name things to think about them, that we name things to think about them, interpret the meaning, and, with others, interpret the meaning, and, with others,
provide actions for quality care.provide actions for quality care.
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Use this theoretical framework to Use this theoretical framework to explain the importance of nursing explain the importance of nursing
diagnosis research.diagnosis research.
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Many types of nursing diagnosis Many types of nursing diagnosis research are needed.research are needed.
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Qualitative methods that can be used Qualitative methods that can be used are participant action research, are participant action research,
grounded theory, and phenomenology.grounded theory, and phenomenology.
Nurses fromHackettstown
RegionalMedicalCenter
working in participant
actionresearch
study
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Example: Participant Action Research.Example: Participant Action Research.An advantage is that you involve the An advantage is that you involve the
stakeholders, e.g., patients or nurses.stakeholders, e.g., patients or nurses.
problemproblem
Action
Research Plan
Action
Research Plan
DataData
ResultsResults
Action Research
problemproblem
Action
Research Plan
Action
Research Plan
DataData
ResultsResults
Action Research
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We used action research methods to conduct a We used action research methods to conduct a consensus validation study of the common consensus validation study of the common
diagnoses (NANDA), interventions (NIC) and diagnoses (NANDA), interventions (NIC) and outcomes (NOC) for 2 local populations.outcomes (NOC) for 2 local populations.
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The action research methods for The action research methods for consensus validation were developed by consensus validation were developed by
Dr. Judy Carlson of Honolulu, Hawaii.Dr. Judy Carlson of Honolulu, Hawaii.
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In this study, 100% consensus of In this study, 100% consensus of staff nurses was achieved on staff nurses was achieved on
relevant NANDA, NIC and NOC relevant NANDA, NIC and NOC terms for 2 populations.terms for 2 populations.
People with Diabetes Women in Labor &one hour after delivery
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The results were brought back for use at The results were brought back for use at the bedside.the bedside.
The nurses who produced the research product use the research findings.
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Quantitative designs for ndx research Quantitative designs for ndx research can be nonexperimental, quasi-can be nonexperimental, quasi-experimental, or experimental.experimental, or experimental.
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This is what This is what part of the toolpart of the tool we used we used for the respiratory study looked like.for the respiratory study looked like.
Defining Characteristics Defining Characteristics Present/ AbsentPresent/ Absent ABG from Baseline, AbnormalABG from Baseline, Abnormal ______/________ ______/________ ABG from Normal Values, AbnormalABG from Normal Values, Abnormal ______/________ ______/________
Values Values pHpH ______/________ ______/________
pCO2pCO2 ______/________ ______/________ HCO3HCO3 ______/______________/________
pO2pO2 ______/________ ______/________ O2 SatO2 Sat ______/______________/________
Adventitious Breath Sounds:Adventitious Breath Sounds: Crackles/Rales Crackles/Rales
FineFine _______/______________/_______CourseCourse _______/_______ _______/_______ Gurgles/RhonchiGurgles/Rhonchi _______/_______ _______/_______ WheezesWheezes _______/_______ _______/_______ StridorStridor _______/_______ _______/_______
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Guidelines can be found in books and Guidelines can be found in books and examples in journals can be followed. examples in journals can be followed.
Also, ask for help from a mentor.Also, ask for help from a mentor.
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Quantitative clinical validation studies Quantitative clinical validation studies are critically needed because we do are critically needed because we do not “know” unless we systematically not “know” unless we systematically
investigate.investigate.
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Guidelines for planning a quantitative Guidelines for planning a quantitative clinical study were described by clinical study were described by
Carlson & Lunney (1995).Carlson & Lunney (1995).
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The science of nursing needs a broad The science of nursing needs a broad base of research to support its base of research to support its
diagnostic languagediagnostic language. .
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Nurses worldwide need to work Nurses worldwide need to work together to design and conduct studies together to design and conduct studies
of new and existing diagnoses.of new and existing diagnoses.
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Will you help us to build a future for Will you help us to build a future for nursing science by conducting nursing science by conducting nursing diagnosis research?nursing diagnosis research?