We can all probably agree that the most critical part of a diagnosis is the focus – the human response that is being identified.
In the past, we had a focus term that mirrored the diagnosis label for every diagnosis, meaning that we had 170 terms! This is not helpful when a nurse is trying to identify a pattern in patient data that is not familiar, nor is it helpful for machine-readable tools that provide decision support to nurses.
Revising this Axis was without a doubt the most difficult part of this work, and it took us understanding that the terms in the axis do not have to be identical to the terms in the diagnosis label. They need to represent the human response, but do not need to be identical to the label terms.
With this new understanding in mind, we opted on a two-part focus, with the first part being a broader term (required) and the second being more granular (optional-used if it provides more clarity to the focus). This enabled us to reduce the terms to 24 primary foci and 71 secondary foci.
For the primary focus, we suggest that this be thought of as the inference that “strikes you first” as you are considering the human response you are identifying in the patient. Let’s look at an example using the diagnosis, decreased activity tolerance (00298). The thought process might be:
Q: “What strikes me about the pattern I am seeing in this individual?”
A: “There is an issue with the patient’s energy level.”
Q: “What, specifically, is it about the energy level?”
A: “The patient’s endurance is diminished.”
Therefore, for this diagnosis we have a primary focus of energy level, and a secondary focus of endurance. It should be noted that neither of these axis terms appears in the diagnostic label, decreased activity tolerance. However, the definition of the diagnosis – “Insufficient endurance to complete required or desired daily activities” – is clearly related to energy level and, more specifically, to endurance.
The terms for all axes will be provided in the NANDA International nursing diagnoses: definitions and classification, 2024-2026. It will be an expectation that developers of diagnoses identify the axes that best represent their diagnoses – or recommend additions, if none of our current terms are applicable.
We will provide more information in the coming weeks and months regarding these changes.