the nanda international contribution to standardised ... · gordon’s functional health patterns...

The Royal Marsden NHS Foundation Trust

ProfessorProfessor DickonDickon WeirWeir--Hughes, Hughes, Chief Nurse/Deputy Chief Executive,Chief Nurse/Deputy Chief Executive,

The RoyalThe Royal MarsdenMarsden NHS Foundation Trust, UKNHS Foundation Trust, UK& President Elect & President Elect

NANDA InternationalNANDA International

The NANDA International contribution to

Standardised nursing communication

The Annual Meeting of the BCS, Scotland 2006


Objectives for todayObjectives for todayExplore the concept of Nursing Explore the concept of Nursing

Diagnosis and their development and Diagnosis and their development and applicationapplicationA brief overview of NANDA InternationalA brief overview of NANDA InternationalNANDA International vision for the futureNANDA International vision for the futureTransTrans--cultural challengescultural challengesAnswer questionsAnswer questions


NANDA InternationalNANDA International

NANDA International was formed as the North NANDA International was formed as the North American Nursing Diagnosis Association in the American Nursing Diagnosis Association in the USA in the 1970USA in the 1970’’s. It became NANDAs. It became NANDA--I in 2002 I in 2002 to reflect a growing international interest in to reflect a growing international interest in nursing language development. NANDA was nursing language development. NANDA was developed by a group of leading nurse theorists developed by a group of leading nurse theorists at the first conference on classification of nursing at the first conference on classification of nursing in 1973.in 1973.NANDA has collaborative links with ACENDIO, NANDA has collaborative links with ACENDIO, AENTDE, AFIDI, JSND and other regional AENTDE, AFIDI, JSND and other regional groups.groups.


NANDANANDA--II

NANDANANDA--I is nurse member led and the I is nurse member led and the leadership are selected by election.leadership are selected by election.

NANDANANDA--I provides a number of products I provides a number of products but is best known for itsbut is best known for its’’ evidenceevidence--based based classification of Nursing Diagnoses for classification of Nursing Diagnoses for use in practice and to determine use in practice and to determine interventions and outcomes.interventions and outcomes.


NANDANANDA--I produces the NANDA I produces the NANDA classification every two years. This is an classification every two years. This is an evidenceevidence--based classification of nursing based classification of nursing terms and is translated into languages terms and is translated into languages

including:including:--

• Chinese• Danish• Dutch• English (British)• French• German• Icelandic

• Italian

• Japanese

• Norwegian

• Portugese

• Spanish


NANDANANDA––I is managed by a Board of I is managed by a Board of Directors and a number of committees Directors and a number of committees including a Diagnostic Review including a Diagnostic Review Committee, Informatics Committee and Committee, Informatics Committee and Taxonomy Committee.Taxonomy Committee.The way that NANDAThe way that NANDA--I is managed and I is managed and governed was under review in order to governed was under review in order to make the organisation more make the organisation more internationally accountable and internationally accountable and applicable. These new arrangements applicable. These new arrangements come into force in 2008come into force in 2008


There are three European Directors on the There are three European Directors on the NANDA Board. One from Norway, one from NANDA Board. One from Norway, one from Wales and the PresidentWales and the President--Elect from the UK.Elect from the UK.

Professor WeirProfessor Weir--Hughes was the first nonHughes was the first non--USA USA based elected Director and will be the first nonbased elected Director and will be the first non--USA based President from 2008 USA based President from 2008 –– 2010.2010.The values and beliefs of nurses and the The values and beliefs of nurses and the humanistic philosophy of nursing transcends humanistic philosophy of nursing transcends national and cultural boundaries. Whilst valuing national and cultural boundaries. Whilst valuing different cultures and cultural approaches to different cultures and cultural approaches to nursing it is now more important than ever that nursing it is now more important than ever that nurses work together worldwide and actively seek nurses work together worldwide and actively seek areas of common understanding. areas of common understanding.


Nursing DiagnosisNursing Diagnosis

Nursing Diagnosis is a clinical judgment Nursing Diagnosis is a clinical judgment about individual, family or community about individual, family or community responses to actual or potential health responses to actual or potential health problems / life processes. Nursing problems / life processes. Nursing Diagnoses provide the basis for the Diagnoses provide the basis for the selection of nursing interventions to selection of nursing interventions to achieve the outcomes for which the nurse achieve the outcomes for which the nurse is accountableis accountableShoemaker, J 1984 (NANDA Delphi Shoemaker, J 1984 (NANDA Delphi Study)Study)


Benefits of Using Nursing Benefits of Using Nursing DiagnosisDiagnosis

ConsistencyConsistency

VisibilityVisibility

EfficiencyEfficiency


WHY?WHY?

If you canIf you can’’t name it, you cant name it, you can’’t t control it, finance it, teach it, or put control it, finance it, teach it, or put it into public policy.it into public policy.

(Lang 1993:9)(Lang 1993:9)


WHY?WHY?

Risk ManagementRisk ManagementEvidence based careEvidence based careProvides research base for nursingProvides research base for nursingEfficiencyEfficiencyCommunicationCommunicationElectronic patient record facilitationElectronic patient record facilitationAudit and evaluationAudit and evaluation


How a Nursing Diagnosis is How a Nursing Diagnosis is StructuredStructured……

Label : Label : Acute painAcute painDefinition : Definition : An unpleasant sensory and emotional An unpleasant sensory and emotional experience associated with actual or potential tissue experience associated with actual or potential tissue damage; sudden or slow onset of any intensity from mild damage; sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a to severe with an anticipated or predictable end and a duration of less than six monthsduration of less than six monthsDefining characteristics Defining characteristics

–– The patient states they have pain: The patient states they have pain: –– Observed evidenceObserved evidence–– Protective behaviour Protective behaviour –– Sleep disturbance Sleep disturbance

Related Factors: Related Factors: –– Injury agents: biological chemical physical Injury agents: biological chemical physical

psychological psychological


Research and Nursing DiagnosisResearch and Nursing Diagnosis

The Diagnostic Review Committee are The Diagnostic Review Committee are rigorous about examining the source of each rigorous about examining the source of each proposed diagnosis. proposed diagnosis. The research methods used include: expert The research methods used include: expert

consensus, concept analysis and criterion consensus, concept analysis and criterion validation validation The level of research evidence is indicated by The level of research evidence is indicated by each diagnosis listed in the classification. each diagnosis listed in the classification. Our challenges include lack of large scale Our challenges include lack of large scale

funding, lack of expertise in concept analysis funding, lack of expertise in concept analysis and all of the challenges faced by all member and all of the challenges faced by all member led nursing groups.led nursing groups.


Common Criticisms of Common Criticisms of Nursing DiagnosisNursing Diagnosis

Language is not very user friendlyLanguage is not very user friendlyDistracts from Individualized Patient Distracts from Individualized Patient Care Care Closely Linked to the Medical ModelClosely Linked to the Medical ModelNot patient friendly reducing the Not patient friendly reducing the potential for patient participation in carepotential for patient participation in careIt is sometimes viewed as It is sometimes viewed as reductionistreductionist(but interestingly not by many experts in (but interestingly not by many experts in holistic nursing and holism generally)holistic nursing and holism generally)


As example of an assessment structure is Functional Health Patterns (Gordon, 1994)

Health Perception - Health ManagementActivity - ExerciseCognitive - Perceptual Coping - Stress toleranceEliminationNutrition - MetabolicRole - RelationshipSelf Perception - Self ConceptSexuality - ReproductionSleep - RestValue – Belief

Gordon’s Functional Health Patterns provide an excellent way of assessing in a structured manner. Gordon’s structure is not a nursing theory or model, so many nurse leaders and nurses find it useful as it does not confuse the issue of nursing theory with assessment.


America versus Europe!America versus Europe!

Patients are patients!Patients are patients!Nursing transcends numerous cultural Nursing transcends numerous cultural

boundaries, but it is recognised that boundaries, but it is recognised that there are key differencesthere are key differencesThe NANDA Classification was The NANDA Classification was

originally developed in the USA and we originally developed in the USA and we must thank those original developers. It must thank those original developers. It is now time for nurses world wide to is now time for nurses world wide to contribute and to engage, recognising contribute and to engage, recognising that standardised nursing language is that standardised nursing language is essential for informatics.essential for informatics.


TransTrans--cultural issues and NANDA cultural issues and NANDA International: Conceptual International: Conceptual

DifferencesDifferences• For example “Fatigue” (France)

• “Anticipatory Grieving” (Numerous countries)

• “Family Process” (Japan)

• “Religiosity” (USA)

• “Energy Field Disturbance” (UK)

Nursing challenges in a multicultural society, especially in large cities in the developed world


NANDA International is a NANDA International is a Membership Membership Organisation Organisation

• We welcome your contributions as members

• We especially welcome suggestions for new or revised Nursing Diagnoses. These can be submitted in any language and can be culturally or country specific. Submission details can be found at www.nanda.org

• Your contributions will help to make NANDA a more culturally sensitive organisation and the NANDA classification an internationally useable tool for improving nursing practice


The futureThe future……Nursing Diagnosis will become Nursing Diagnosis will become increasingly important worldwide, apart increasingly important worldwide, apart from anything else because it is from anything else because it is fundamental to electronic patient records.fundamental to electronic patient records.It is important that we (nurses) It is important that we (nurses) understand nursing science and that we understand nursing science and that we verbalise our phenomena of concern and verbalise our phenomena of concern and our understanding of our work in a our understanding of our work in a consistent and cohesive manner. Nursing consistent and cohesive manner. Nursing Diagnosis enables us.Diagnosis enables us.


The futureThe future……

Please join me in taking forward the Please join me in taking forward the science of nursing through the science of nursing through the study and use of Nursing Diagnosis study and use of Nursing Diagnosis for the benefit of patients present for the benefit of patients present and future!and future!


Questions and AnswersQuestions and Answers


Thank you for listeningThank you for listeningProf.Prof. DickonDickon WeirWeir--Hughes,Hughes,Chief Nurse/Deputy Chief Executive,Chief Nurse/Deputy Chief Executive,The RoyalThe Royal MarsdenMarsden Hospital,Hospital,Fulham Road,Fulham Road,LONDON SW3 6JJ, U.K.LONDON SW3 6JJ, U.K.Tel: + 44 20 7808 2121Tel: + 44 20 7808 2121Fax: + 44 20 7808 2206Fax: + 44 20 7808 2206ee--mail: mail: dickondickon.weir.weir--hugheshughes@@rmhrmh..nhsnhs..ukukwww.www.nandananda.org.org

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