Recommendations when using diagnoses with limited or no related/risk factors
As the NANDA-I terminology has evolved over the years, so has our thinking. Educators and instructors have emphasized that to remove the underlying cause of the problem-focused nursing diagnosis, nursing intervention should be aimed at related (etiological) factors, or to prevent the risk nursing diagnosis, nursing interventions should be aimed at risk factors that increase the susceptibility. However, until the 2018 – 2020 edition, diagnoses included many related/risk factors that were not amenable to independent nursing intervention. This caused serious confusion among students, educators, and clinical nurses over the years.
After much review and discussion, it was determined that many of the factors categorized as related/risk factors were important for clinical reasoning (they help us diagnose accurately), but independent nursing interventions could not eliminate or change them. To be clinically useful, and to meet the goal of identifying etiological factors, this needed to change. Therefore, two new categories were created: at risk populations and associated conditions.
The lists of related/risk factors were reviewed, and only those factors that could be eliminated or improved by independent nursing interventions were retained. After separating out related/risk factors from the tenth edition of the terminology into the two new categories, there were many diagnoses with few or no related/risk factors. Thus, we are now facing another new challenge! Therefore, during the previous and the current cycle, we have been focusing on developing more clinically useful related/risk factors on which nurses could independently intervene. We appreciate your understanding and cooperation, and we encourage you to participate in this process by recommending evidence-based factors which are amenable to independent nursing intervention.
Finally, it is very important to understand that the NANDA-I terminology is not a completed or finished product, rather, it will always be evolving as our knowledge base increases. When users find the phrase “to be developed”, or when there is a very limited list of related factors or risk factors, we encourage you to think critically and logically. Practically, you need to consider appropriate related/risk factor(s) for your patient, based on theories, literature, supporting research, expert opinion, and your own clinical experience. Remember that those factors you choose to use must be things that a nurse can improve or remove through independent nursing intervention. At the same time, we ask you to submit these newly identified related/risk factors to NANDA-I for diagnosis revision, so that your work can help support clinical reasoning of others using our terminology.
It is, we believe, important to explain to students that nursing language is evolving as our concepts evolve – and we cannot always keep up! Refinement of nursing diagnoses continues as an ongoing process. This shows that our discipline is constantly evolving, and that they will need to commit to lifelong learning to maintain currency in our field of study.
