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NANDA International BlogImagine your mom has been admitted to the emergency room for shortness of breath and chest pain. She has her tests done, is assessed by her nurse and her doctor, and they come in to tell both of you what they think is happening. You tell them both you and your mom are nurses, thinking that will help them to explain things more completely.

The doctor says to you, “well, your mom has an alteration in cardiac rhythm” and the nurse says, “we also have assessed that you are suffering from altered anxiety management." Would you have any idea what they were saying? Or you might wonder, “What kind of alteration in cardiac rhythm? What do you mean by altered anxiety management???”

Sound ridiculous? Possibly….but isn’t that exactly what happens when we decide it is okay to create labels for nursing diagnoses/patient problems for ourselves – with no literature support, no basis in research, no consensus around the terms? If one nurse calls a patient’s problem “Pain," the second nurse NANDA International Blogstipulates “Acute Pain” and the third nurse chooses “Chronic Pain” – do we really have any idea what the patient is experiencing, or why the nurse chose to use the label that she did?

How frustrated would we be as patients or nurses if each doctor who saw a patient changed the medical diagnosis – how would we know what was going on with the patient? How would we know how to intervene or to set appropriate outcomes? And yet, we are often content to do just that with nursing diagnoses.

The primary problem with this is patient safety – if we do not have nursing diagnoses with clear definitions, and with diagnostic indicators (assessment data – the things NANDA-I calls defining characteristics, related factors or risk factors), then how do we know that we are making the correct diagnosis in the first place? And how do we know the interventions we choose are going to be effective? Chronic pain and acute pain, for example, require very different interventions and have different underlying etiologies. If we do not know how the diagnosis was made (by referring to the indicators used to make the diagnosis), and we do not have a clear definition, then we do not have a way to ensure that we are providing the best care to our patients.

Nursing is so much more than following doctor’s orders, isn’t it? Then don’t we need to have one terminology that allows us to identify and communicate our knowledge about our clinical judgment – to one another, our health care partners, and our patients?

NANDA International BlogIs the terminology within NANDA-I perfect? Absolutely not! Does it need clarification, revision, expansion? Most definitely! But if we do not have it, we either have to go back to the days that we wrote paragraphs in our patient charts – which meant very little of what we knew (our judgments) about our patients was ever seen by other care givers – or we will be relegated to showing the things we do (the tasks of nursing) in an electronic record, which could lead administrators / financial leadership to determine that “we don’t need nurses because non-licensed personnel can be taught to do these tasks."

Is that really in the best interest of our patients?

Dr. T. Heather Herdman, PhD, RN
Executive Director
NANDA International, Inc.
Cori Scott
This is a great article! I will be using it to explain to my students why I ask them to be systematic in their development of their nursing diagnoses. I will say however, the inconsistency in the EMR records with the use or non -use of NANDA-I diagnoses is confusing to them. I am also concerned that as a profession we are NOT at the table of the EMR development and thus missing a HUGE opportunity to effect how they are designed and to ensure they are designed to included standardized nursing diagnoses. I do need your clarification on one thing. As a nurse with 15 years experience, I have witnessed many changes to the profession, and in particular the tyoes of diagnoses included in your Taxonmomy. We need to know WHY some diagnoses are retired and why some are not available. For instance Infectioin (Actual, Risk for) used to be available NoW ONLY Risk for Infection is available. Similarly Ineffective Tissue Perfusion has been changed to Ineffective Peripheral Tissue Perfusion and RISK for every OTHER type of decreased or compromised tissue perfusion. Why is that? From what I understand those former diagnoses were retired or redefined because it was thougth that an ACTUAL INFECTION diagnoses was not within the scope of a Nursing diagnoses. But I dont know why I cant determine -Ineffective Cardiac tissue perfusion...only Risk for Ineffective Tissue Perfusion. Signed, A Professor in support of NANDA-I with questions that need answering. Thank you in advance for your clarification and assistance.
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