Where is the NANDA-I diagnosis list?
I cannot tell you the number of times I receive this question, nor how it perplexes me as to why people want such a “list”! It takes me back quite a while to my days as a student nurse when nursing units had a list of nursing diagnoses pinned to bulletin boards near the charting areas in nursing stations. It was not at all uncommon to see a nurse, or a student, scanning the list for a diagnosis that “sounded like” what was going on with a patient.
Later, as a registered nurse, I again saw this in a neonatal intensive care unit in which I worked. It was here that I realized, while studying for my master’s degree, that many of us were using the diagnosis, Impaired parenting (00056), to try to reflect the fact that parents were not able to perform their parenting role in a normal manner because they couldn’t hold, feed, or care for their infants due to their fragility. I came to realize, however, that the definition and defining characteristics of that diagnosis in fact referred to an inability of the parent/caregiver to provide an environment to promote growth and development of a child. Defining characteristics include: hostile parenting behaviors, negative communication, decreased engagement in parent-child relations, inadequate responses to infant behavioral cues, etc. So, although our intention was to address the separation between parent and infant in a NICU setting, which occurred through no fault of the parents/guardians, we were in fact mislabeling – misdiagnosing – what was actually occurring. A far more appropriate diagnosis for the vast majority of families in NICU settings would be risk for impaired attachment (00058): a susceptibility to disruption of the interactive process between parent or significant other and child that fosters the development of a protective and nurturing reciprocal relationship. Risk factors for this diagnosis include an infant’s illness preventing effective initiation of parental contact, disorganized infant behavior, a parental illness preventing effective initiation of infant contact, physical barrier, etc.
What would we think of a physician who used the label, acute myocardial infarction, for anyone complaining of chest pain? Most likely, we would consider her to be a poor diagnostician and perhaps, even, incompetent. According to the criteria for acute myocardial infarction (types 1, 2 and 3MI) (Thygesen et al., 2018), this term should only be used when there is acute myocardial injury with clinical evidence of acute myocardial ischemia and with detection of a rise and/or fall of cTn values with at least 1 value above the 99the percentile URL and at least 1 o the following: syptoms of myocardial ischemia; new ischemic ECG changes; development of pathological Q waves; imaging evidence of new loss of viable myocardium or new regional wall motion abnormality in a pattern consistent with an ischemic etiology; identification of a coronary thrombus by angiography or autopsy (not for types 2 or 3 MIs).
Clearly our colleagues in medicine recognize the importance of diagnostic criteria – which they are constantly revising/updating as new evidence becomes available from research – so why is it that nurses so often miss this point? We learn, as nursing students, the criteria used by physicians for diagnosing medical diseases – why is it we do not learn the criteria for diagnosing those phenomena of concern to our own discipline? Further, the complete disregard of phenomena of concern to nurses – often veiled in the pressure to be “multidisciplinary”, should be of grave concern to us all. After all, patients come to hospitals – or we go to their homes, places of work, and community settings – because they need nursing care…not only medical care. We can only provide multidisciplinary care when we all bring the knowledge of our disciplines to the table. Standardized terms, with definitions and assessment criteria, provide the language for nurses to communicate within nursing and among all health care disciplines in a manner that brings our unique contributions to the table. The use in education or clinical practice of a list of nursing diagnoses is completely meaningless. Without definitions and, more importantly, without assessment criteria that are necessary for diagnosis, these labels (nursing diagnoses) lack validity and standardization. Let’s not forget that.
T. Heather Herdman, PhD, RN, FNI, FAAN
Chief Executive Officer
Herdman, T.H., Kamitsuru, S. & Takao Lopes, C. (2020). NANDA International nursing diagnoses: Definitions and classification, 2021-2023. New York: Thieme Publishers.
Thygesen K, Alpert JS, Jaffe AS, et al., on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. (2018). Journal of the American College of Cardiology, 72(18), 2231-2264.