The NANDA International

Taxonomy

Taxonomy of Nursing Diagnoses

Focus of Nursing“Health” of “human beings”

Health-related phenomena are complex because they involve human experiences

Nursing’s goal is to identify people’s experiences or responses in order to support them.

Significant overlap of cues to diagnoses Contextual factors such as culture can change the

perspective of “what is the diagnosis?” Many studies have verified that interpretations of clinical

cases have the potential to be less accurate than indicated by the data

(Lunney, 2007).

Nursing Diagnosis: NANDA-I DefinitionAdapted from a national, Delphi study by Dr. Joyce Shoemaker (1984)A clinical judgment about individual,

family, or community responses to actual or potential health problems/life processes. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable (1997).

The Diagnoses206 NANDA-approved nursing

diagnoses as of 2008Level of Evidence (LOE) Criteria

Established for All New and Revised DiagnosesEntry into the Taxonomy requires various levels of clinical evidence

TaxonomyOxford English Dictionary

American Nurses Association

/taksonnmi/   • noun chiefly

Biology 1 the branch of

science concerned with classification.

2 a scheme of classification.

ORIGIN from Greek taxis ‘arrangement’ + -nomia ‘distribution’

Classification according to presumed natural relationships among types and their subtypes

ANA, 1999

Definitions for Classification of Nursing Diagnoses

ClassificationSystematic arrangement of related

phenomena in groups or classes based on characteristics that objects have in common

NomenclatureA system of designations (terms)

elaborated according to pre-established rules

(ANA, 1999)

Definitions for Classification of Nursing Diagnoses

DomainA sphere of activity, concern, or function; a

field: the domain of historyClass

A set, collection, group, or configuration containing members regarded as having certain attributes or traits in common; a kind or category.

o (http://www.thefreedictionary.com/domain)

History of NANDA-I Taxonomy II1994 – First placement of Nursing Diagnoses into Taxonomy I revised

1996 – Q-sort identified 21 categories…too many to be useful or practical

1998 – Gordon’s Functional Health Patterns were adapted to create Taxonomy II

Definitions developed for domains and classes within the structure

Definition of each diagnosis compared to that of the class and domain into which it was placed

History of NANDA-I Taxonomy II

Revisions / modifications in diagnosis placements made to ensure maximum match among diagnosis, class & domain

2002 – all NANDA-I approved diagnoses are placed into Taxonomy II

2003 – Further refinements made to Taxonomy II

2004 – Taxonomy II compared axes to ISO Reference Terminology Model for Nursing Diagnosis

Structure of Taxonomy IIDoma

ins

Class

NDx NDx

Class

NDx NDx

Code StructureNANDA-I uses a 32-bit integer (or a 5-

digit code) to enable growth & development of the taxonomy without having to change codes repeatedly to accommodate those changes

Code structure is compliant with the National Library of Medicine’s (USA) Unified Medical Language System (UMLS) concerning healthcare terminology codes

Structure of Taxonomy IIRegistered with Health Level 7 (HL7)

Modeled into SNOMED-CTCompliant with ISO terminology model for a nursing diagnosis

Working collaboratively with ICNP

Multiaxial System7 axes within NANDA-I TaxonomyAxis

A dimension of the human response that is considered in the diagnostic process

Allows for flexibility of the nomenclature

Allows for easy additions and modifications

NANDA-I AxesAxis 1

The Diagnostic Concept

Axis 2Subject of the

Diagnosis(Individual, Family, Group, Community)

Axis 3Judgment

(Decreased, Effective, Impaired,

Situational, etc.)

Axis 4Location

(GI, Oral, Skin, etc.)

Axis 5Age

(Infant, Preschool Child, Adolescent,

Adult, etc.)

Axis 6Time

(Acute, Intermittent,

Chronic, Continuous)

Axis 7Status of the

diagnosis(Actual, Health

Promotion, Risk, Wellness)Required Optional

The NANDA-I Model of a Nursing Diagnosis

Diagnostic concept(Axis 1)

Judgment(Axis 3)

Location(Axis 4)

Subject of Diagnosis(Axis 2)

Time(Axis 6)

Status ofDiagnosis

(Axis 7)

Age(Axis 5)

A NANDA-I Nursing Diagnosis Model:

(Individual) Ineffective Coping

Coping(Axis 1)

Ineffective(Axis 3)

N/A(Axis 4)

[Individual](Axis 2)

N/A(Axis 6)[Actual]

(Axis 7)

N/A(Axis 5)

A NANDA-I Nursing Diagnosis Model:Compromised Family Coping

Coping(Axis I)

Compromised(Axis 3)

N/A(Axis 4)

Risk for(Axis 7)

N/A(Axis 6)

Family(Axis 2)

A NANDA-I Nursing Diagnosis Model: Readiness for Enhanced Family CopingCoping

(Axis 1)Enhanced

(Axis 3)

N/A(Axis 4)

Family(Axis 2)

N/A(Axis 6)Readiness for

(Axis 7)

N/A(Axis 5)

NANDA-I Taxonomy II: 2008

13 Domains

47 Classes

206Nursing

Diagnoses

1998 – Gordon’s Functional

Health Patterns were adapted

to create Taxonomy II

Taxonomy: OpportunitiesThe Diagnosis Development, Taxonomy, and

Informatics Committees have identified the following priorities for diagnosis developmentDomain 2:  Nutrition

Class 2:  Digestion Domain 1:  Health Promotion

Class 1:  Health Awareness Domain 2:  Nutrition

Class 3:  Absorption

Future DevelopmentClinicians can easily identify opportunities

for new diagnoses by reviewing the domains/classes with few – or no – diagnoses present

Construction of new diagnoses, along with submission to NANDA-I, enables the taxonomy to continue to be strengthened

NANDA-I’s Diagnosis Development Committee is eager to partner with you to develop new diagnoses, and revise current diagnoses