NANDA_NursingDiagnoses_21-23

NANDA_NursingDiagnoses_21-23_Sample

Contents Contents Part 1 The NANDA International Terminology: General Information 1 1.1 1.2 1.3 1.4 1.5 1.6 2 What’s New in the NANDA-I 2021–2023 Edition Overview on Changes and Revisions in the NANDA-I 2021–2023 Edition New Nursing Diagnoses Revised Nursing Diagnoses Changes to Nursing Diagnosis Labels Retired Nursing Diagnoses NANDA-I Nursing Diagnoses: Indicator Term Standardization International Considerations on the Use of the NANDA-I Nursing Diagnoses Part 2 Recommendations for Research to Improve the Terminology 3 3.1 3.2 3.3 4 4.1 4.2 4.3 4.4 Future Improvement of the NANDA-I Terminology Research Priorities Refinement and Diagnoses to be Developed References Revised Level of Evidence Criteria for Diagnosis Submission Introduction Relationship Between Clinical Evidence and Validity Theory Evidence Levels of Validity for NANDA-I Diagnoses References Part 3 The Use of NANDA International Nursing Diagnoses Nursing Diagnosis Basics Principles of Nursing Diagnosis: Introduction Principles of Nursing Diagnosis: Diagnosing Principles of Nursing Diagnosis: Knowledge of Nursing Concepts Assessing Diagnosing 5 5.1 5.2 5.3 5.4 5.5 12 24 24 24 30 37 37 41 45 50 50 51 55 57 57 58 59 74 78 78 81 82 82 84

Contents 5.6 5.7 5.8 5.9 5.10 5.11 Planning/Implementing Kamitsuru’s Tripartite Model of Nursing Practice Evaluating Principles of Nursing Diagnosis: Clinical Application Brief Chapter Summary References 6 6.1 6.2 6.3 6.4 6.5 6.6 6.7 7 7.1 7.2 7.3 7.4 8 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 9 9.1 9.2 9.3 9.4 9.5 Nursing Diagnosis: An International Terminology Nursing Commonalities Around the Globe Nursing Education and Practice Professional Associations and Nursing Classifications International Implementation Summary Acknowledgment of Contributors to This Chapter References Clinical Reasoning: From Assessment to Diagnosis Clinical Reasoning: Introduction Clinical Reasoning within the Nursing Process The Nursing Process References Clinical Application: Data Analysis to Determine Appropriate Nursing Diagnosis Clustering of Information/Seeing a Pattern Identifying Potential Nursing Diagnoses (Diagnostic Hypotheses) Refining the Diagnosis Confirming/Refuting Potential Nursing Diagnoses Eliminating Possible Diagnoses Potential New Diagnoses Diﬀerentiating Similar Diagnoses Diagnosing/Prioritizing Summary References Introduction to the NANDA International Taxonomy of Nursing Diagnoses Introduction to Taxonomy Organizing Nursing Knowledge Using NANDA-I Taxonomy The NANDA-I Nursing Diagnosis Taxonomy II: A Short History References 87 88 90 90 91 92 93 93 93 95 96 104 105 106 109 109 109 113 123 126 126 126 129 131 132 134 134 135 136 137 138 138 143 145 150 163 13

Contents 10 10.1 10.2 10.3 10.4 10.5 10.6 Specifications and Definitions Within the NANDA International Taxonomy of Nursing Diagnoses Structure of Taxonomy II NANDA-I Taxonomy II: A Multiaxial System Definitions of the Axes Developing and Submitting a Nursing Diagnosis Further Development: Using Axes References 11 Glossary of Terms 11.1 11.2 11.3 11.4 11.5 11.6 Nursing Diagnosis Diagnostic Axes Components of a Nursing Diagnosis Definitions for Terms Associated with Nursing Diagnoses Definitions for Classification of Nursing Diagnoses References Part 4 The NANDA International Nursing Diagnoses Domain 1. Health promotion Class 1. Health awareness Decreased diversional activity engagement Readiness for enhanced health literacy Sedentary lifestyle Class 2. Health management Risk for elopement attempt Frail elderly syndrome Risk for frail elderly syndrome Readiness for enhanced exercise engagement Deficient community health Risk-prone health behavior Ineﬀective health maintenance behaviors Ineﬀective health self-management Readiness for enhanced health self-management Ineﬀective family health self-management Ineﬀective home maintenance behaviors Risk for ineﬀective home maintenance behaviors Readiness for enhanced home maintenance behaviors Ineﬀective protection 164 164 165 166 174 175 176 177 177 178 180 182 182 183 187 188 189 190 192 193 195 196 197 198 199 201 203 204 206 207 208 209 14

Domain 2. Nutrition Class 1. Ingestion Imbalanced nutrition: less than body requirements Readiness for enhanced nutrition Insuﬃcient breast milk production Ineﬀective breastfeeding Interrupted breastfeeding Readiness for enhanced breastfeeding Ineﬀective adolescent eating dynamics Ineﬀective child eating dynamics Ineﬀective infant feeding dynamics Obesity Overweight Risk for overweight Ineﬀective infant suck-swallow response Impaired swallowing Class 2. Digestion This class does not currently contain any diagnoses Class 3. Absorption This class does not currently contain any diagnoses Class 4. Metabolism Risk for unstable blood glucose level Neonatal hyperbilirubinemia Risk for neonatal hyperbilirubinemia Risk for impaired liver function Risk for metabolic syndrome Class 5. Hydration Risk for electrolyte imbalance Risk for imbalanced fluid volume Deficient fluid volume Risk for deficient fluid volume Excess fluid volume Domain 3. Elimination and exchange Class 1. Urinary function Disability-associated urinary incontinence Impaired urinary elimination Mixed urinary incontinence Stress urinary incontinence Urge urinary incontinence Risk for urge urinary incontinence Urinary retention Risk for urinary retention Contents 211 213 215 216 217 219 220 221 222 224 226 228 230 232 234 236 238 239 240 241 242 243 244 245 246 247 249 250 251 252 253 254 255 256 15

Contents Class 2. Gastrointestinal function Constipation Risk for constipation Perceived constipation Chronic functional constipation Risk for chronic functional constipation Impaired bowel continence Diarrhea Dysfunctional gastrointestinal motility Risk for dysfunctional gastrointestinal motility Class 3. Integumentary function This class does not currently contain any diagnoses Class 4. Respiratory function Impaired gas exchange Domain 4. Activity/rest Class 1. Sleep/rest Insomnia Sleep deprivation Readiness for enhanced sleep Disturbed sleep pattern Class 2. Activity/exercise Decreased activity tolerance Risk for decreased activity tolerance Risk for disuse syndrome Impaired bed mobility Impaired physical mobility Impaired wheelchair mobility Impaired sitting Impaired standing Impaired transfer ability Impaired walking Class 3. Energy balance Imbalanced energy field Fatigue Wandering Class 4. Cardiovascular/pulmonary responses Ineﬀective breathing pattern Decreased cardiac output Risk for decreased cardiac output Risk for impaired cardiovascular function Ineﬀective lymphedema self-management Risk for ineﬀective lymphedema self-management 16 257 259 260 261 263 265 267 268 269 270 271 274 276 278 279 280 281 282 283 284 285 287 288 289 290 291 292 294 295 297 299 300 301 303

Impaired spontaneous ventilation Risk for unstable blood pressure Risk for thrombosis Risk for decreased cardiac tissue perfusion Risk for ineﬀective cerebral tissue perfusion Ineﬀective peripheral tissue perfusion Risk for ineﬀective peripheral tissue perfusion Dysfunctional ventilatory weaning response Dysfunctional adult ventilatory weaning response Class 5. Self-care Bathing self-care deficit Dressing self-care deficit Feeding self-care deficit Toileting self-care deficit Readiness for enhanced self-care Self-neglect Domain 5. Perception/cognition Class 1. Attention Unilateral neglect Class 2. Orientation This class does not currently contain any diagnoses Class 3. Sensation/perception This class does not currently contain any diagnoses Class 4. Cognition Acute confusion Risk for acute confusion Chronic confusion Labile emotional control Ineﬀective impulse control Deficient knowledge Readiness for enhanced knowledge Impaired memory Disturbed thought process Class 5. Communication Readiness for enhanced communication Impaired verbal communication Contents 305 306 307 308 309 310 311 312 314 316 317 318 319 320 321 323 325 326 327 328 329 330 331 332 333 334 335 336 17

Contents Domain 6. Self-perception Class 1. Self-concept Hopelessness Readiness for enhanced hope Risk for compromised human dignity Disturbed personal identity Risk for disturbed personal identity Readiness for enhanced self-concept Class 2. Self-esteem Chronic low self-esteem Risk for chronic low self-esteem Situational low self-esteem Risk for situational low self-esteem Class 3. Body image Disturbed body image Domain 7. Role relationship Class 1. Caregiving roles Impaired parenting Risk for impaired parenting Readiness for enhanced parenting Caregiver role strain Risk for caregiver role strain Class 2. Family relationships Risk for impaired attachment Disturbed family identity syndrome Risk for disturbed family identity syndrome Dysfunctional family processes Interrupted family processes Readiness for enhanced family processes Class 3. Role performance Ineﬀective relationship Risk for ineﬀective relationship Readiness for enhanced relationship Parental role conflict Ineﬀective role performance Impaired social interaction 18 339 341 343 344 345 346 347 348 350 351 353 355 357 359 361 363 364 367 369 370 372 373 376 377 378 379 380 381 382 384

Domain 8. Sexuality Class 1. Sexual identity This class does not currently contain any diagnoses Class 2. Sexual function Sexual dysfunction Ineﬀective sexuality pattern Class 3. Reproduction Ineﬀective childbearing process Risk for ineﬀective childbearing process Readiness for enhanced childbearing process Risk for disturbed maternal-fetal dyad Domain 9. Coping/stress tolerance Class 1. Post-trauma responses Risk for complicated immigration transition Post-trauma syndrome Risk for post-trauma syndrome Rape-trauma syndrome Relocation stress syndrome Risk for relocation stress syndrome Class 2. Coping responses Ineﬀective activity planning Risk for ineﬀective activity planning Anxiety Defensive coping Ineﬀective coping Readiness for enhanced coping Ineﬀective community coping Readiness for enhanced community coping Compromised family coping Disabled family coping Readiness for enhanced family coping Death anxiety Ineﬀective denial Fear Maladaptive grieving Risk for maladaptive grieving Readiness for enhanced grieving Impaired mood regulation Powerlessness Risk for powerlessness Readiness for enhanced power Impaired resilience Contents 385 386 387 388 390 391 392 393 395 396 398 399 400 402 403 404 405 407 408 409 410 411 412 414 415 416 418 419 421 423 424 425 426 428 429 430 19

Contents Risk for impaired resilience Readiness for enhanced resilience Chronic sorrow Stress overload Class 3. Neurobehavioral stress Acute substance withdrawal syndrome Risk for acute substance withdrawal syndrome Autonomic dysreflexia Risk for autonomic dysreflexia Neonatal abstinence syndrome Disorganized infant behavior Risk for disorganized infant behavior Readiness for enhanced organized infant behavior Domain 10. Life principles Class 1. Values This class does not currently contain any diagnoses Class 2. Beliefs Readiness for enhanced spiritual well-being Class 3. Value/belief/action congruence Readiness for enhanced decision-making Decisional conflict Impaired emancipated decision-making Risk for impaired emancipated decision-making Readiness for enhanced emancipated decision-making Moral distress Impaired religiosity Risk for impaired religiosity Readiness for enhanced religiosity Spiritual distress Risk for spiritual distress Domain 11. Safety/protection Class 1. Infection Risk for infection Risk for surgical site infection Class 2. Physical injury Ineﬀective airway clearance Risk for aspiration Risk for bleeding Impaired dentition Risk for dry eye 20 432 433 434 435 436 437 438 440 442 443 445 446 447 449 451 452 453 454 455 456 457 458 459 460 462 463 466 467 468 469 470 471 472

Ineﬀective dry eye self-management Risk for dry mouth Risk for adult falls Risk for child falls Risk for injury Risk for corneal injury Nipple-areolar complex injury Risk for nipple-areolar complex injury Risk for urinary tract injury Risk for perioperative positioning injury Risk for thermal injury Impaired oral mucous membrane integrity Risk for impaired oral mucous membrane integrity Risk for peripheral neurovascular dysfunction Risk for physical trauma Risk for vascular trauma Adult pressure injury Risk for adult pressure injury Child pressure injury Risk for child pressure injury Neonatal pressure injury Risk for neonatal pressure injury Risk for shock Impaired skin integrity Risk for impaired skin integrity Risk for sudden infant death Risk for suﬀocation Delayed surgical recovery Risk for delayed surgical recovery Impaired tissue integrity Risk for impaired tissue integrity Class 3. Violence Risk for female genital mutilation Risk for other-directed violence Risk for self-directed violence Self-mutilation Risk for self-mutilation Risk for suicidal behavior Class 4. Environmental hazards Contamination Risk for contamination Risk for occupational injury Risk for poisoning Class 5. Defensive processes Risk for adverse reaction to iodinated contrast media Risk for allergy reaction Risk for latex allergy reaction Contents 473 475 476 478 480 481 482 484 485 486 487 488 490 491 492 494 495 497 499 501 503 505 507 508 510 512 513 514 516 517 519 521 522 523 524 526 528 530 532 534 535 536 537 538 21

Contents Class 6. Thermoregulation Hyperthermia Hypothermia Risk for hypothermia Neonatal hypothermia Risk for neonatal hypothermia Risk for perioperative hypothermia Ineﬀective thermoregulation Risk for ineﬀective thermoregulation Domain 12. Comfort Class 1. Physical comfort Impaired comfort Readiness for enhanced comfort Nausea Acute pain Chronic pain Chronic pain syndrome Labor pain Class 2. Environmental comfort Impaired comfort Readiness for enhanced comfort Class 3. Social comfort Impaired comfort Readiness for enhanced comfort Risk for loneliness Social isolation Domain 13. Growth/development Class 1. Growth This class does not currently contain any diagnoses Class 2. Development Delayed child development Risk for delayed child development Delayed infant motor development Risk for delayed infant motor development Index Foci 22 539 540 541 542 544 545 546 547 549 551 552 553 554 555 557 558 560 561 562 563 564 565 567 568 570 571 573 575 Inside back cover

1 The NANDA International Terminology: General Information 1 What’s New in the NANDA-I 2021–2023 Edition T. Heather Herdman, Shigemi Kamitsuru, Camila Takáo Lopes 1.1 Overview on Changes and Revisions in the NANDA-I 2021–2023 Edition Part 1 presents an overview of major changes to this edition: new and revised diagnoses, retired diagnoses, continued revision to standardize diagnostic indicator terms, new level of evidence criteria for diagnosis submission, a pro- posed refinement to the terminology, and introductory recommendations on nursing diagnoses that require development. It is our hope that the organization of this 12th edition will make it eﬃ- cient and eﬀective to use. We welcome your feedback. If you have suggestions, please send them by email to: admin@nanda.org. Changes have been made in this edition based on feedback from users, to address both the needs of students, clinicians, and researchers, as well as to provide additional support to educators. New information has been added to assessment. Many diagnoses were revised by international collaborators of the Diagnosis Development Committee Task Force, in order to strengthen their level of evidence. The diagnostic indicators of each diagnosis were revised to decrease ambiguity and improve clarity. Editors referred to the Medical Sub- ject Headings (MeSH, https://www.ncbi.nlm.nih.gov/mesh) whenever possi- ble, to provide standardized definitions, which are available to translators to ensure consistency across languages. Revised level of evidence criteria are pre- sented to ensure that all future diagnoses submitted for inclusion in the classi- fication are at an appropriate level of evidence to represent the current strength of nursing knowledge. Users who are familiar with previous editions of this text may note that the diagnostic focus is no longer highlighted in the diagnosis label. Instead, the diagnostic focus will be found below the label for each diagnosis in the classification. This was done to facilitate ease of identification of diagnostic foci across languages. 1.2 New Nursing Diagnoses A significant body of work representing new and revised nursing diagnoses was submitted to the NANDA-I Diagnosis Development Committee. The edi- tors would like to take this opportunity to congratulate those submitters who 24

1.2 New Nursing Diagnoses successfully met the level of evidence criteria with their submissions and/or revisions. Forty-six new diagnoses were approved by the Diagnosis Develop- ment Committee and were presented to the NANDA-I Board of Directors (▶ Table 1.1), and are now included here for members and users of the termi- nology. The submitters of each diagnosis are presented following the table. Submitters of nursing diagnoses. Included here are those contributors who submitted new diagnoses or completed reviews of diagnoses including both label and definition change, or significant content change. Individuals who Table 1.1 New NANDA-I Nursing Diagnoses, 2021–2023* Domain Diagnosis 1. Health Promotion Risk for elopement attempt (00290) Readiness for enhanced exercise engagement (00307) Ineffective health maintenance behaviors (00292)* Ineffective health self-management (00276)* Readiness for enhanced health self-management (00293)* Ineffective family health self-management (00294)* Ineffective home maintenance behaviors (00300)* Risk for ineffective home maintenance behaviors (00308) Readiness for enhanced home maintenance behaviors (00309) 2. Nutrition Ineffective infant suck-swallow response (00295)* 3. Elimination and Exchange Risk for metabolic syndrome (00296)* Disability-associated urinary incontinence (00297)* Mixed urinary incontinence (00310) Risk for urinary retention (00322) Impaired bowel continence (00319)* 4. Activity/rest Decreased activity tolerance (00298)* Risk for decreased activity tolerance (00299)* Risk for impaired cardiovascular function (00311) Ineffective lymphedema self-management (00278) Risk for ineffective lymphedema self-management (00281) Risk for thrombosis (00291) Dysfunctional adult ventilatory weaning response (00318) 5. Perception/cognition Disturbed thought process (00279) 7. Role relationship Disturbed family identity syndrome (00283) Risk for disturbed family identity syndrome (00284) 9. Coping/stress tolerance Maladaptive grieving (00301)* Risk for maladaptive grieving (00302)* Readiness for enhanced grieving (00285) 25

1 The NANDA International Terminology: General Information Table 1.1 (Continued) Domain Diagnosis 11. Safety/protection Ineffective dry eye self-management (00277) Risk for adult falls (00303)* Risk for child falls (00306) Nipple-areolar complex injury (00320) Risk for nipple-areolar complex injury (00321) Adult pressure injury (00312) Risk for adult pressure injury (00304)* Child pressure injury (00313) Risk for child pressure injury (00286) Neonatal pressure injury (00287) Risk for neonatal pressure injury (00288) Risk for suicidal behavior (00289)* Neonatal hypothermia (00280) Risk for neonatal hypothermia (00282) Delayed child development (00314) Risk for delayed child development (00305)* Delayed infant motor development (00315) Risk for delayed infant motor development (00316) 13. Growth/ development *For taxonomic purposes, when a diagnosis label and definition are revised, the original code is retired and a new code is assigned worked as a group are listed together; in cases where more than one individual or group submitted content, they are listed separately. Countries of submitters: 1. Brazil, 2. Germany, 3. Iran, 4. Mexico, 5. Spain, 6. Turkey, 7. USA Domain 1. Health promotion – Risk for elopement attempt – Amália F. Lucena, Ester M. Borba, Betina Franco, Gláucia S. Policarpo, Deborah B. Melo, Simone Pasin, Luciana R. Pinto, Michele Schmid1 – Readiness for enhanced exercise engagement – Raúl Fernando G. Castañeda4 – Ineﬀective health maintenance behaviors – Rafaela S. Pedrosa, Andressa T. Nunciaroni1 – Camila T. Lopes1 – Ineﬀective health self-management – Camila S. Carneiro, Agueda Maria R. Z. Cavalcante, Gisele S. Bispo, Viviane M. Silva, Alba Lucia B.L. Barros1 26

1.2 New Nursing Diagnoses – Maria G.M.N. Paiva, Jéssica D.S. Tinôco, Fernanda Beatriz B.L. Silva, Juliane R. Dantas, Maria Isabel C.D. Fernandes, Isadora L.A. Nogueira, Ana B.A. Medeiros Marcos Venícios O. Lopes, Ana L.B.C. Lira1 – Richardson Augusto R. Silva, Wenysson N. Santos, Francisca M.L.C. Souza, Rebecca Stefany C. Santos, Izaque C. Oliveira, Hallyson L.L. Silva, Dhyanine M. Lima1 – Camila T. Lopes1 – Readiness for enhanced health self-management – DDC – Ineﬀective family health self-management – Andressa T. Nunciaroni, Rafaela S. Pedrosa1 – Camila T. Lopes1 – Ineﬀective home maintenance behaviors, Risk for ineﬀective home mainte- nance behaviors, Readiness for enhanced home maintenance behaviors – Ángel Martín-García5 – Diagnosis Development Committee (DDC) Domain 2. Nutrition – Ineﬀective infant suck-swallow response – T. Heather Herdman7 – Risk for metabolic syndrome – DDC Domain 3. Elimination and exchange – Disability-associated urinary incontinence, Mixed urinary incontinence – Juliana N. Costa, Maria Helena B.M. Lopes, Marcos Venícios O. Lopes1 – Risk for urinary retention – Aline S. Meira, Gabriella S. Lima, Luana B. Storti, Maria Angélica A. Diniz, Renato M. Ribeiro, Samantha S. Cruz, Luciana Kusumota2 – Juliana N. Costa, Micnéias L. Botelho, Erika C.M. Duran, Elenice V. Carmona, Ana Railka S. Oliveira-Kumakura, Maria Helena B.M. Lopes2 – Impaired bowel continence – DDC – Barbara G. Anderson7 Domain 4. Activity/rest – Decreased activity tolerance, Risk for decreased activity tolerance – Jana Kolb, Steve Strupeit2 27

1 The NANDA International Terminology: General Information – Risk for impaired cardiovascular function – María B.S. Gómez5, Gonzalo D. Clíments5, Tibelle F. Mauricio1, Rafaela P. Moreira1, Edmara C. Costa1 – Gabrielle P. da Silva, Francisca Márcia P. Linhares, Suzana O. Man- gueira, Marcos Venícius O. Lopes, Jaqueline G.A. Perrelli, Tatiane G. Guedes1 – Ineﬀective lymphedema self-management, Ineﬀective lymphedema risk self-management – Gülengün Türk, Elem K. Güler, İzmir Demokrasi6 – DDC – Risk for thrombosis – Eneida R.R. Silva, Thamires S. Hilário, Graziela B. Aliti, Vanessa M. Mantovani, Amália F. Lucena1 – DDC – Dysfunctional adult ventilatory weaning response – Ludmila Christiane R. Silva, Tânia C.M. Chianca1 Domain 5. Perception/cognition – Disturbed thought process – Paula Escalada-Hernández, Blanca Marín-Fernández5 Domain 7. Role relationship – Disturbed family identity syndrome, Risk for disturbed family identity syndrome – Mitra Zandi, Eesa Mohammadi3 – DDC Domain 9. Coping/stress tolerance – Maladaptive grieving, Risk for maladaptive grieving, Readiness for enhanced grieving – Martín Rodríguez-Álvaro, Alfonso M. García-Hernández, Ruymán Brito-Brito5 – DDC Domain 11. Safety/protection – Ineﬀective dry eye self-management – Elem K. Güler, İsmet Eşer6Diego D. Araujo, Andreza Werli-Alvarenga, Tânia C.M. Chianca1 28

1.2 New Nursing Diagnoses – Jéssica N. M. Araújo, Allyne F. Vitor1 – DDC – Risk for adult falls – Flávia O.M. Maia1 – Danielle Garbuio, Emilia C. Carvalho1 – Dolores E. Hernández1 – Camila T. Lopes1 – Silvana B. Pena, Heloísa C.Q.C.P. Guimarães, Lidia S. Guandalini, Môn- ica Taminato, Dulce A. Barbosa, Juliana L. Lopes, Alba Lucia B.L. Barros1 – Risk for child falls – Camila T. Lopes, Ana Paula D.F. Guareschi1 – Neonatal hypothermia, Risk for neonatal hypothermia – T. Heather Herdman7 – Nipple-areolar complex injury, Risk for nipple-areolar complex injury – Flaviana Vely Mendonca Vieira1 – Agueda Maria Ruiz Zimmer Cavalcante1 – Janaina Valadares Guimarães1 – Adult pressure injury, Risk for adult pressure injury – Amália F. Lucena, Cássia T. Santos, Taline Bavaresco, Miriam A. Almeida1 – T. Heather Herdman7 – Child pressure injury, Risk for child pressure injury, Neonatal pressure injury, Risk for neonatal pressure injury – T. Heather Herdman7 – Amália F. Lucena, Cássia T. Santos, Taline Bavaresco, Miriam A. Almeida1 – Risk for suicidal behavior – Girliani S. Sousa, Jaqueline G.A. Perrelli, Suzana O. Mangueira, Marcos Venícios O. Lopes, Everton B. Sougey1 Domain 13. Growth/development – Delayed child development – Juliana M. Souza, Maria L.O.R. Veríssimo1 – T. Heather Herdman7 – Risk for delayed child development, Delayed infant motor development, Risk for delayed infant motor development – T. Heather Herdman7 29

2 International Considerations on the Use of the NANDA-I Nursing Diagnoses 2 International Considerations on the Use of the NANDA-I Nursing Diagnoses T. Heather Herdman As we noted earlier, NANDA International, Inc. initially began as a North American organization and, therefore, the earliest nursing diagnoses were pri- marily developed by nurses from the United States and Canada. However, over the past 20 to 30 years, there has been an increasing involvement by nurses from around the world, and membership in NANDA International, Inc. now includes nurses from nearly 40 countries, with nearly two-thirds of its members coming from countries outside North America. Work is occur- ring across all continents using NANDA-I nursing diagnoses in curricula, clinical practice, research, and informatics applications. Development and refinement of diagnoses is ongoing across multiple countries, and the majority of research related to the NANDA-I nursing diagnoses is occurring outside North America. As a reflection of this increased international activity, contribution, and utilization, the North American Nursing Diagnosis Association changed its scope to an international organization in 2002, changing its name to NANDA International, Inc. So, please, we ask that you do not refer to the organiza- tion as the North American Nursing Diagnosis Association (or as the North American Nursing Diagnosis Association International), unless referring to something that happened prior to 2002 – it simply does not reflect our inter- national scope, and it is not the legal name of the organization. We retained “NANDA” within our name because of its status in the nursing profession, so think of it more as a trademark or brand name than as an acronym, since it no longer “stands for” the original name of the association. As NANDA-I experiences increased worldwide adoption, issues related to diﬀerences in the scope of nursing practice, diversity of nurse practice models, divergent laws and regulations, nurse competency, and educational diﬀerences must be addressed. In 2009, NANDA-I held an International Think Tank Meeting, which included 86 individuals representing 16 countries. During that meeting, significant discussions occurred as to how best to handle these and other issues. Nurses in some countries are not able to utilize nursing diagnoses of a more physiologic nature because they are in conflict with their current scope of nursing practice. Nurses in other nations are facing regulations aimed to ensure that everything done within nursing practice can be demonstrated 45

1 The NANDA International Terminology: General Information to be evidence-based, and therefore face diﬃculties with some of the older nursing diagnoses and/or those linked interventions that are not supported by a strong level of research literature. Discussions were therefore held with international leaders in nursing diagnosis use and research, looking for direc- tion that would meet the needs of the worldwide community. These discussions resulted in a unanimous decision to maintain the taxon- omy as an intact body of knowledge in all languages, in order to enable nurses around the world to view, discuss, and consider diagnostic concepts being used by nurses within and outside of their countries, and to engage in discus- sions, research, and debate regarding the appropriateness of all of the diag- noses. A critical statement agreed upon in that Summit is noted here prior to introducing the nursing diagnoses themselves: Not every nursing diagnosis within the NANDA-I taxonomy is appropriate for every nurse in practice – nor has it ever been. Some of the diagnoses are specialty-specific, and would not necessarily be used by all nurses in clinical practice . . . There are diagnoses within the taxonomy that may be outside the scope or standards of nursing practice governing a particular geographic area in which a nurse practices. Those diagnoses and/or related/risk factors would, in these instances, not be appropriate for practice, and should not be used if they lie outside the scope or standards of nursing practice for a particular geographic region. However, it is appropriate for these diagnoses to remain visible in the classification, because the classification represents clinical judgments made by nurses around the world, not just those made in one region or country. Every nurse should be aware of, and work within, the standards and scope of practice and any laws or regulations within which he/she is licensed to practice. However, it is also important for all nurses to be aware of the areas of nursing practice that exist globally, as this informs discussion and may over time support the broadening of nursing practice across other countries. Conversely, these indi- viduals may be able to provide evidence that would support the removal of diagnoses from the current classification, which, if they were not shown in their translations, would be unlikely to occur. That said, it is important that you are not avoiding the use of a diagnosis because, in the opinion of one local expert or published textbook, it is not appropriate. I have met nurse authors who indicate that operating room nurses “cannot diagnose because they don’t assess”, or that intensive care unit nurses “have to practice under strict physician protocol that doesn’t include 46

2 International Considerations on the Use of the NANDA-I Nursing Diagnoses nursing diagnosis”. Neither of these statements is factual, but rather represents the personal opinions of those nurses. It is, therefore, important to truly edu- cate oneself on regulation, law, and professional standards of practice in one’s own country and area of practice, rather than relying on the word of one per- son, or group of people, who may be inaccurately defining or describing nurs- ing diagnosis. Ultimately, nurses must identify those diagnoses that are appropriate for their area of practice, that fit within their scope of practice or legal regulations, and for which they have competency. Nurse educators, clinical experts, and nurse administrators are critical to ensuring that nurses are aware of diagnoses that are truly outside the scope of nursing practice in a certain geographic region. Multiple textbooks in many languages are available that include the entire NANDA-I terminology, so for the NANDA-I text to remove diagnoses from country to country would no doubt lead to a great level of confusion worldwide. Publication of the classification in no way requires that a nurse utilize every diagnosis within it, nor does it justify practicing outside the scope of an individual’s nursing license or regulations to practice. 47