nanda international investigating the diagnostic language of nursing practice
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NANDA International
Investigating the Diagnostic Language of Nursing Practice
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Nursing DiagnosisNursing 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).
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NANDA International
Develops terminology (Nursing Diagnoses) to describe the clinical judgments made by nurses as they provide care for individuals, families, groups and communities
Nursing diagnoses are the basis for selection of outcomes, & interventions needed to reach those outcomes
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Evidence Based Practice
Problem solving approach to clinical practice that integrates the conscientious use of best evidence in combination with a clinician’s expertise as well as patient preferences and values to make decisions about the type of care that is providedMelnyk & Fineout-Overholt (2005)
Best evidence
Expertise
Patient Preferences
Patient
Values
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Aims of Evidence Based PracticeStandardize practice
Reduce wide variations in individual clinician’s practices
Maximize good practicesEliminate worst practices
Reduce costsImprove the quality of care
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Questioning Clinical PracticeAsk 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 populations?
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Questioning Clinical Practice
Adopt a reflective, inquiring approach
“Asking the right questions takes as much skill
as giving the right answers!”Robert Half
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Questioning Clinical PracticeConsider research taking place in other
clinical practice settingsLook to the Centers for Evidence-Based
Practice that exist around the worldGermany, New Zealand, Australia, United
Kingdom, United States, CanadaHow does nursing (is nursing) get represented
in those evidence-based practice guidelines?
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Practice Outcome Evaluation PointsImproved patient outcomes
Decreased length of stayDecreased readmissionsImproved clinical outcomes measuresBest practice medication usageBest practice self-care education
Decreased practice variationDecreased cost
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Developing EBP GuidelinesProtocols 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 evidence
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Diagnoses – Outcomes - InterventionsLink these three components
Use standardized classification systems and languageIdentify your problem / diagnosisSelect appropriate outcome indicatorsIdentify potential interventions and activities to best reach target outcomes
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Nursing Diagnosis: Research Based?Diagnoses in the NANDA-I taxonomy
were developed and/or revised using a variety of research methodsExpert consensusConcept analysisContent, construct and criterion validation
“Ideally, the conceptual base of each diagnostic concept is
firmly grounded in studies of the phenomenon.” (Gordon, 1998 )
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Nursing Diagnosis ResearchResearch 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
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Concept AnalysisFirst step in developing a new diagnosis and
refining current diagnosesIdentification 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)
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Concept AnalysisDistinguish between the defining
characteristics of a concept & its irrelevant attributesRefine ambiguous concepts
Examine published sourcesCompare literature to experience/practiceExamine consistencies between literature
and experience/practice
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Content ValidationRefinement of current diagnosesDevelopment of new diagnoses
Studies involving patients who are experiencing the diagnosis are needed
Studies involving nurses caring for those patients
Clinical validation studiesAssess for defining characteristics as patients
are experiencing a particular nursing diagnosisDecrease the number of defining
characteristics to improve diagnostic accuracy
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Construct & Criterion Related ValidityMultiple study types are needed to establish validity
Causal analysisShow the relation of diagnoses to theories and the
importance of using standardized nursing diagnoses to achieve high quality nursing care
EpidemiologicIncidence/prevalence of diagnoses in different settings &
populationsShows importance & co-occurrence of diagnosesDemonstrates relationships between NDx – Nursing
Outcomes – Nursing Interventions
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Construct & Criterion Related Validity
Generalizability studiesDemonstrate importance of nursing diagnoses across
setting, patient type, institutions and/or medical diagnoses
Outcome / Effectiveness studiesDemonstrate prognoses of diagnosesIdentifies which interventions best lead to desired
outcomesReliability
Establish stability & coherence of diagnose (Parker & Lunney, 1998)
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Consensus ValidationUsed 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
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Studies of Diagnostic AccuracyAccuracy of nurses’ diagnoses varies widely from low to high
o(Lunney, 2001)
Foundation for appropriate outcomes and interventions
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Lack of Cultural SensitivityDiagnoses have primarily been developed
and refined by North American nursesNurses from Asia, Europe and South
America are now submitting diagnosesAlso receiving revisions to current diagnoses to
support cultural sensitivity, but need more!
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What do we need?Emphasis on development, testing and validation of new diagnostic concepts
Revision of current diagnoses that lack sufficient evidence-based defining characteristics, risk factors or related factors
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The Future of Nursing DiagnosesNANDA-International’s aim is to link with organizations across the world that have as their purpose nursing language developmentIncrease diagnosis submissionIncrease clinical testing of diagnosesEnsure cultural sensitivity of diagnoses