Brazil - NANDA

Strengthening Diagnosis-centered Standardized Nursing Language Through Digital Implementation

The International Nursing Knowledge Association (INKA), formerly NANDA® International, supports international research collaborations focused on the implementation, validation, and ongoing development of diagnosis-centered standardized nursing language.

In Brazil, implementation work is underway to integrate INKA’s diagnosis-centered standardized nursing language into the electronic health record (EHR) nursing module of a regional public health system.

As nursing documentation becomes increasingly structured and data-driven, collaborations that support diagnosis-centered implementation are essential for ensuring that nursing knowledge remains visible, clinically meaningful, and scientifically robust across diverse healthcare systems.

Progress in INKA Standardized Nursing Language Integration

Recent updates from nursing leaders in Brazil indicate that progress has been made in integrating INKA’s diagnosis-centered standardized nursing language into the EHR nursing module of a regional public health system.

This represents an important step in advancing standardized nursing documentation and strengthening the clinical infrastructure needed for consistent diagnostic reasoning.

Structured nursing diagnoses within EHR systems support:

Clear nursing clinical judgment at the point of care
Improved interdisciplinary communication
Comparable nursing data across populations and settings
A foundation for nursing-sensitive outcomes research

Embedding diagnosis-centered standardized nursing language into digital workflows is increasingly recognized as a critical requirement for modern professional nursing practice.

Identified Challenge: Nursing Actions and Patient Goals / Outcomes Infrastructure

A key issue has also been identified in the continuation of full nursing process implementation within EHR environments.

While nursing diagnoses have been structured successfully, there is not yet an authorized standardized database of patient goals / outcomes and nursing actions linked by evidence to the nursing diagnoses available for use in the current implementation context.

This gap affects the ability to fully support the care planning and prescription stage of the nursing process digitally.

As noted in recent updates from our partners in Brazil:

Diagnoses are present and structured
Patient goals / outcomes and nursing actions linked to nursing diagnoses in an evidence-based manner remain a critical missing component
Standardization and governance are required for the next phase of implementation

This reflects a broader challenge seen internationally: diagnosis-centered standardized nursing language is foundational, but full digital nursing process integration requires aligned infrastructure across diagnoses, patient goals / outcomes, and nursing actions.

futuristic image of nurse touching patient data screen

Connection to the Future: NANDA 360 and Expanded Classification Development

This identified need underscores the importance of INKA’s ongoing development of NANDA 360.

NANDA 360 is an expanded and unified set of classifications with a digital (web-based) clinical reasoning framework, designed to strengthen linkages between:

Nursing assessment
Nursing diagnoses
Patient-centered goals and outcomes
Nursing actions

Brazilian implementation experiences suggest that greater robustness in the patient goals/ outcomes and nursing actions stages will be essential for fully supporting nursing practice within EHR systems.

NANDA 360 is intended to provide a future-oriented structure for this type of integrated clinical reasoning environment, while continuing to keep nursing diagnosis central.

Research Collaboration Development in Brazil

INKA’s engagement in Brazil reflects growing interest in strengthening diagnosis-centered standardized nursing language within digital care environments and generating real-world evidence to support classification refinement.

INKA (formerly NANDA International) entered into a formal contract with the Public Health Secretary of Rio Grande do Norte (Brazil) – Secretaria de Saúde Pública do Rio Grande do Norte, Brasil (SESAP/RN) in 2025.

As part of this agreement, SESAP/RN agrees to provide INKA (formerly known as NANDA-I) with a limited data set (LDS) as requested, based on research approved by an approved Institutional Review Board (IRB), within two months of the request. The IRB must be identified by SESAP/RN or INKA and included in the request for data. This provides an opportunity for researchers interested in the NANDA nursing diagnosis classification to access patient data for research studies.

Additionally, INKA will receive records to identify usage patterns of the diagnoses and their component phrases annually, in April (to reflect the previous year). These data are to be provided to the INKA CEO by April 30 of each year of the contracted period, to enable an understanding of the most frequently used nursing diagnoses and which diagnostic indicator components (phrases) are most selected by the nurses using them.

Research projects may be jointly conducted between INKA and this regional public health system, or by INKA independently, in accordance with the terms of the agreement.

The Role of Implementation Collaborations in Nursing Knowledge Advancement

Implementation-based research collaborations contribute to the scientific and clinical future of diagnosis-centered standardized nursing language by supporting:

Validation of diagnostic indicators in real practice contexts
Improved alignment between documentation and nursing reasoning
Stronger digital representation of nursing knowledge
High-quality nursing data for research and outcomes evaluation

As healthcare systems continue to evolve, ensuring that nursing diagnoses are accurately represented in clinical technologies is essential for nursing visibility, accountability, and professional impact.

INKA’s international collaborations support this work by connecting classification development directly to practice-based evidence.

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To learn more about INKA’s international collaboration and ongoing work to strengthen nursing knowledge through research and implementation, explore:

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