Taxonomy of Nursing Diagnoses

The NANDA International Taxonomy

Focus of Nursing
Health of human beings
Health-related phenomena are complex because they involve human

experiences Nursings goal is to identify peoples experiences or responses in order to support them.

Significant overlap of cues to diagnoses

Contextual factors such as culture can change the

perspective of what is the diagnosis? Many studies have verified that interpretations of clinical cases have the potential to be less accurate than indicated by the data

Nursing Diagnosis: NANDA-I Definition

Adapted from a national, Delphi study by

Dr. Joyce Shoemaker (1984)

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 (1997).

The Diagnoses
206 NANDA-approved nursing diagnoses as

of 2008 Level of Evidence (LOE) Criteria Established for All New and Revised Diagnoses Entry into the Taxonomy requires various levels of clinical evidence

Taxonomy Oxford English Dictionary

/taksonnmi/

American Nurses Association

Classification according

noun chiefly Biology

1 the branch of science

concerned with classification. 2 a scheme of classification.

ORIGIN from Greek

to presumed natural relationships among types and their subtypes

ANA, 1999

taxis

Definitions for Classification of Nursing Diagnoses

Classification Systematic arrangement of related phenomena

in groups or classes based on characteristics that objects have in common Nomenclature A system of designations (terms) elaborated according to pre-established rules
(ANA, 1999)

Definitions for Classification of Nursing Diagnoses

Domain A sphere of activity, concern, or function; a field:

the domain of history Class A set, collection, group, or configuration containing members regarded as having certain attributes or traits in common; a kind or category.
o (http://www.thefreedictionary.com/domain)

History of NANDA-I Taxonomy II

1994 First placement of Nursing Diagnoses into Taxonomy I revised

1996 Q-sort identified 21 categoriestoo many to be useful or practical

1998 Gordons Functional Health Patterns were adapted to create Taxonomy II Definitions developed for domains and classes within the structure Definition of each diagnosis compared to that of the class and domain into which it was placed

History of NANDA-I Taxonomy II

Revisions / modifications in diagnosis placements made to ensure maximum match among diagnosis, class & domain 2002 all NANDA-I approved diagnoses are placed into Taxonomy II

2003 Further refinements made to Taxonomy II

2004 Taxonomy II compared axes to ISO Reference Terminology Model for Nursing Diagnosis

Structure of Taxonomy II
Domains

Class

Class

NDx

NDx

NDx

NDx

Code Structure
NANDA-I uses a 32-bit integer (or a 5-digit

code) to enable growth & development of the taxonomy without having to change codes repeatedly to accommodate those changes Code structure is compliant with the National Library of Medicines (USA) Unified Medical Language System (UMLS) concerning healthcare terminology codes

Structure of Taxonomy II
Registered with Health Level 7

(HL7) Modeled into SNOMED-CT Compliant with ISO terminology model for a nursing diagnosis

Multiaxial System
7 axes within NANDA-I Taxonomy

Axis
A dimension of the human response

that is considered in the diagnostic process Allows for flexibility of the nomenclature

NANDA-I Axes
Axis 1 The Diagnostic Concept Axis 2 Subject of the Diagnosis (Individual, Family, Group, Community) Axis 5 Age (Infant, Preschool Child, Adolescent, Adult, etc.) Axis 7 Status of the diagnosis (Actual, Health Promotion, Risk, Wellness) Axis 3 Judgment (Decreased, Effective, Impaired, Situational, etc.)

Axis 4 Location (GI, Oral, Skin, etc.)

Axis 6 Time (Acute, Intermittent, Chronic, Continuous)

Required

Optional

The NANDA-I Model of a Nursing Diagnosis

Diagnostic concept (Axis 1)
Judgment (Axis 3) Status of Diagnosis (Axis 7) Time (Axis 6)

Location (Axis 4)

Subject of Diagnosis (Axis 2)

Age (Axis 5)

A NANDA-I Nursing Diagnosis Model: (Individual) Ineffective Ineffective Coping Coping (Axis 3)
(Axis 1) [Actual] (Axis 7) N/A (Axis 4) [Individual] (Axis 2)
N/A (Axis 5)

N/A (Axis 6)

A NANDA-I Nursing Diagnosis Model: Compromised Family Coping

Coping (Axis I)
Compromised (Axis 3) Risk for (Axis 7) N/A (Axis 4) Family (Axis 2) N/A (Axis 6)

A NANDA-I Nursing Diagnosis Model: Readiness for Enhanced Enhanced Coping Family Coping (Axis 3) (Axis 1)
Readiness for (Axis 7) N/A (Axis 6)

N/A (Axis 4)
Family (Axis 2) N/A (Axis 5)

NANDA-I Taxonomy II: 2008

Taxonomy: Opportunities
The Diagnosis Development, Taxonomy, and

Informatics Committees have identified the following priorities for diagnosis development Domain 2: Nutrition
Class 2: Digestion

Domain 1: Health Promotion Class 1: Health Awareness Domain 2: Nutrition Class 3: Absorption

Future Development
Clinicians can easily identify opportunities for

new diagnoses by reviewing the domains/classes with few or no diagnoses present Construction of new diagnoses, along with submission to NANDA-I, enables the taxonomy to continue to be strengthened NANDA-Is Diagnosis Development Committee is eager to partner with you to develop new