NANDA International Nursing Diagnoses: Definitions and Classification 2021-2023

Book Preface

The International Year of the Nurse and Midwife began with a battle with COVID-19. I cannot thank healthcare professionals enough who are caring for patients despite, at times, the lack of protective equipment. I am writing this as the impact of COVID-19 is continuing around the world. I hope that by the time you read this text, effective treatments and preventive measures have been developed and are available to everyone.

A while back, a nurse fighting on the frontline asked me, “Which nursing diagnosis should I use for COVID-19 patients?” This question reminded me of the need to repeatedly emphasize the meaning of nursing diagnosis. Most importantly, patients with the same medical diagnosis do not necessarily have the same human responses (nursing diagnoses). Likewise, patients with the same genotype of coronavirus infection do not necessarily have the same human responses. That is why, prior to providing proper care for each patient, nurses must conduct a nursing assessment and identify his/her unique responses (nursing diagnoses). Even at times like those we are facing today, nurses need to identify what we independently diagnose and treat related to patients and their families, which are different from medical diagnoses. If nurses have properly documented the nursing diagnoses of patients with COVID-19 and their families, then in the near future, we will be able to identify commonalities and differences in their human responses, from an international perspective.

In this 2021–2023 version, the Twelfth Edition, the classification provides 267 diagnoses, with the addition of new diagnoses. Each nursing diagnosis has been the product of one or more of our many NANDA International (NANDA-I) volunteers, and most have a defined evidence base. Each new diagnosis has been reviewed and refined by our Diagnosis Development Committee (DDC) members assigned as primary reviewers, and by content experts, prior to receiving DDC approval. This DDC approval does not mean the diagnosis is “completed” or “ready to be used” across all countries or practice areas. We all know that practice and regulation of nursing varies from region to region. It is our hope that publication of these new diagnoses will facilitate further validation studies in different parts of the world, to achieve a higher level of evidence.

We always welcome submissions for new nursing diagnoses. At the same time, we have a serious need for revision of existing diagnoses to reflect the most recent evidence. In the eleventh edition, we identified approximatel 90 diagnoses without an assigned level of evidence (LOE), or which required major updates. Thanks to the cooperation of many volunteers, most of whom were published in the focus area of the diagnosis, the majority of these diagnoses are now revised and have met requirements for our LOE criteria. However, we were not able to complete all revisions, so 32 diagnoses remain without an identified LOE. The intention is to revise or retire these remaining diagnoses by the next edition. I want to strongly encourage all students and researchers to submit their nursing diagnosis-related research results to NANDA-I, to improve the evidence base of the terminology.

The NANDA-I terminology is translated into more than 20 distinct languages. Translating abstract English terms into other languages can often be frustrating. During this cycle, a decision was made to incorporate standardized terms from the United States National Library of Medicine, the Medical Subject Headings (MeSH), to facilitate translation. Identifying the MeSH terms, where appropriate, that are found within our diagnostic indicators provides standardized definitions for terms, which we believe will support translators in their work.

The years since the past edition have also been the first in what we hope will be a lasting partnership with our academic partner, Boston College (BC) and the Connell School of Nursing. Under the direction of Dr. Dorothy Jones,the Marjory Gordon Program for Knowledge Development and Clinical Reasoning has been established. We held our first conference at BC in 2018, and had planned our second conference for 2020, which unfortunately was cancelled due to the impact of COVID-19. However, work on an online educational module has been completed as a joint venture between BC and NANDA-I, several postdoctoral scholars have been welcomed into the program from around the world (Brazil, Italy, Spain, Nigeria), and our collaboration continues. We look forward to additional conferences, educational opportunities, postdoctoral scholarships, and future opportunities that this partnership with BC will bring. I wish to extend my sincere gratitude to Dr. Jones, Dean Susan Gennaro, and Associate Dean Christopher Grillo for their collaboration, collegiality, and dedication to making this partnership a reality.

I want to acknowledge the work of all NANDA-I volunteers, committee members, chairpersons, and members of the Board of Directors for their time, commitment, devotion, and ongoing support. I would also like to thank the various content experts who, although not members of NANDA International, contributed countless hours to reviewing and revising diagnoses in their area of expertise. The NANDA-I staff, led by our Chief Executive Officer, Dr. T. Heather Herdman, is to be commended for its efforts and support. My special thanks to the members of the DDC and the Expert Clinical Advisory Panel for their outstanding and timely efforts to review and edit the terminology represented within this book, and especially for the leadership of our new DDC Chair, Dr. Camila Takáo Lopes, who began her term in 2019.

This remarkable committee, with representation from North and South America and Europe, is the true “powerhouse” of the NANDA-I knowledge content. I am deeply impressed and pleased by the astonishing, comprehensive work of these volunteers during this cycle, and I am confident that you will be, as well.

It has been my honor and privilege to serve as President of this dedicated association of international nurses, and I look forward to where the future will continue to take our work.
Shigemi Kamitsuru, PhD, RN, FNI
President, NANDA International, Inc.