Recently, it has come to our attention that a letter has been sent to nursing leaders and organizations within some European countries which suggests, quite strongly, that NANDA-I should be linked only to the Nursing Intervention Classification (NIC), the Nursing Outcome Classification (NOC), or to one particular nurse author’s work.

We have received several questions as to whether or not this is the official position of NANDA International.

NANDA-I does not endorse or prioritize the work of one author above any other; we are firmly committed to our own work, and to improving the evidence-based nature of our work.

Recognized linkages with NANDA-I

There are several nursing classifications which have been successfully linked to NANDA-I over the years, in practice, education, research, or merely in theory. Those classifications use a variety of methods to develop and test their interventions and outcomes (as well as some of their own diagnoses); these include, in alphabetical order:

  1. Belgium’s Nursing Minimum Data Set (NMDS)
  2. European Nursing care Pathways (ENP)
  3. International Classification of Function (ICF)
  4. Leistung Erfassung des Pflegeaufwandes (LEP)
  5. Nursing Intervention Classification (NIC), University of Iowa
  6. Nursing Outcome Classification (NOC), University of Iowa
  7. Omaha System (Omaha)
  8. Sundheds-væsenets Klassifikations System (SKS), a Danish Nursing Intervention Classification.

Additionally, the International Classification of Nursing Practice (ICNP) incorporated NANDA-I diagnoses when it began its development, with permission of the NANDA-I Board of Directors, as did Virginia Saba’s Clinical Care Classification(CCC) System, and the Perioperative Nursing Data Set (PNDS).

The majority of research on standardized terminologies has been conducted on NANDA-I, NIC and NOC, and the linkages between NANDA-I, NOC and NIC. However, studies do exist showing linkages of NANDA-I to other terminologies, while others have been used in practice for multiple years. NANDA-I does not, currently, require a linkage of its nursing diagnosis to any particular intervention or outcome classification.

What NANDA-I Supports

Standardized nursing assessment, using an evidence-based assessment tool is critical to accuracy in nursing diagnosis, because nursing diagnoses result from clinical reasoning based on a complete nursing assessment. Assessment data should capture the whole person response and provide evidence to support the diagnostic judgment/reasoning, using clearly defined diagnoses with standardized labels and identified assessment criteriaInterventions should be aimed primarily at etiological/causative factors (related/risk factors) of a diagnosis, and secondarily at signs/symptoms (defining characteristics) for symptom management. Outcomes should reflect resolution or diminishment of a patient problem, causative factors, or improvements in signs/symptoms (symptom management).

What NANDA-I Does Not Support

Standardized care plans that are developed for medical diagnoses do not represent an appropriate use of nursing diagnoses, outcomes, or interventions. The use of nursing diagnosis labels alone, without reference to standardized definitions and clearly identified assessment criteria, is contrary to the purpose of a standardized language. Interventions that seek only to improve symptoms, without consideration of influencing etiological or risk factors, is strictly symptom management. Although this may be helpful, it should always be the goal to intervene on causative or risk factors to diminish the intensity of – or reverse – the diagnosis itself, not merely its symptoms. Interventions that are “preassigned” or pre-linked to a diagnosis label, without consideration of patient assessment data or individualization, is contrary to patient-centered care. Likewise, standardized outcomes that do not consider patient as a whole, and their values and priorities and do not meet the criteria for patient-centered care.

If you have any questions, please do not hesitate to contact me.

T. Heather Herdman, PhD, RN, FNI
Chief Executive Officer
NANDA International, Inc.
[email protected]