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What’s up with Axes in the NANDA-I Taxonomy?

December 8, 2023

Today we’re providing some clarity around the axes in NANDA-I taxonomy. You may have heard that we have recently undergone a major revision of our axes terms. This was driven by two major needs: 

(1) First, we had too many terms that were synonyms of one another, which therefore led to confusion. 

(2) Second, we wanted to ensure we were synchronized with the ISO Norm 18104 model for nursing diagnosis.

Do Nurses in Clinical Practice Need to be Intimately Familiar with the NANDA-I Axes?

The short answer: No, this is not required to use the diagnoses when caring for patients. 

Other clinical fields, such as psychology, have restructured their documentation systems to remove multiaxial diagnosis and documentation because it was felt to not be clinically useful (American Psychiatric Association, 2013).  

At NANDA-I, it is our belief that the axes, and the ISO norm 18104, are most useful to nurses in informatics, using standardized terminology systems within electronic health records, in Apps, and for development of clinical support tools (International Standards Organization, 2014). 

However, even a manual use of the axes can support clinical decision-making, especially when dealing with responses that you don’t frequently see in practice. 

Sneak Peek: Eight Axes Now Included in NANDA-I

Axis 1: the focus of the diagnosis

  • Primary focus - the broad conceptual focus of the diagnosis (behavior, development, respiratory function, thermoregulatory function, etc.); the area of attention (International Standards Organization, 2014).
  • Secondary focus  - a more granular context / symptom focus (allergy, communication, decision-making, health management, lactation, parenting, etc.)

Axis 2: subject of information (individual, family, community)

Axis 3: judgment(delayed, excessive, ineffective, maladaptive, etc.)

Axis 4: anatomical site (cardiopulmonary system, genitourinary system, sensory nervous system, etc.)

Axis 5: age  (not represented by terms, which overlap, but demarcated by upper and lower age limits, notated in days or years)

  • age lower limit  (1d, 1y, 120d, etc.)
  • age upper limit (28d, 365d, 60y, etc.)

Axis 6: clinical course (acute, chronic, intermittent)

Axis 7: status of the diagnosis(problem-focused, potential to improve, potential to deteriorate)

Axis 8: situational constraint (occupational setting, perioperative period)

We will provide more information in the coming weeks and months regarding these changes. 


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  2. International Standards Organization (ISO). Second edition. (2014). ISO 18104:2014(en): Health informatics — Categorial structures for representation of nursing diagnoses and nursing actions in terminological systems. Licensed to NANDA International. ISO Store Order: OP-626322 / Downloaded: 2022-08-26.

Categorized in: General, Informatics, NANDA-I Education

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