WHY THIS BOOK?
When the first edition of this book was published, all the
authors were faculty members at the same school of nursing.
We had become frustrated with the books that were available
for teaching nursing diagnosis and found that the students
were also expressing some of the same frustration.
The students felt they needed to bring several books to
the clinical area because the books for nursing diagnosis had
limited information on pathophysiology and psychosocial or
developmental factors that had an impact on individualized
care planning. The students were also confused regarding
the different definitions, defining characteristics, and related
factors each of the authors used. They were having difficulty
writing individualized nursing actions for their patients
because the various authors appeared to focus on specifics
related to the etiology or signs and symptoms of the nursing
diagnosis rather than on the concept represented by the nursing
diagnosis that had been emphasized to our students. The
authors were also concerned about the number of books our
students had to buy, because most books focused on just one
clinical area, such as adult health or pediatrics. Thus, as the
students progressed through the school, they had to buy different
books for different clinical areas even though each of
the books had the common theme of the use of nursing diagnosis.
Another concern we, as faculty, had was the lack of
information in the various books regarding the final phase of
the nursing process—evaluation. This most vital phase was
mentioned only briefly, and very little guidance was given
on how to proceed through this phase.
The final concern that led to the writing of the book
was our desire to focus on nursing actions and nursing care,
not medical care and medical diagnosis. We strongly believe
and support the vital role of nurses in the provision of health
care for our nation, and so we have focused strictly on nursing
in this book. After all, the majority of health-care
providers are nurses, and statistics consistently show the
general public has high respect for them.1 In a 2004 poll
conducted by USA Today,2 the public considered nursing
the most honest profession and trusted the information
that nurses give them. This increases the importance of
utilizing a standard nursing language to provide the foundation
for quality nursing care and continued development of
evidence-based practice.
For these reasons, we have written this book particularly
geared to student use. Specifically, we wrote the first
book to assist students in learning how to apply nursing
diagnosis in the clinical area. By using the framework of the
nursing process and the materials generated by the North
American Nursing Diagnosis Association International
(NANDA),3 we believe this book makes it easier for you, the
student, to learn and use nursing diagnosis in planning care
for your patients. (Nursing diagnoses were developed by
and used with permission of North American Nursing
Diagnosis Association.3)
Since the writing of that first book, NANDA has
grown to become an international organization with nursingcontributions from many countries and an alliance between
NANDA International, the Nursing Interventions Classification
(NIC),4 and Nursing Outcomes Classification (NOC),5
which resulted in the creation of the NANDA, NIC, and
NOC (NNN) Taxonomy of Nursing Practice. This taxonomy
was based on a modified framework of Gordon’s6 functional
health patterns with “the final taxonomic structure less like
Gordon’s original, but with reduced misclassification errors
and redundancies to near zero.”3 Taxonomy II has been recognized
as an international nursing language. Designed to be
multiaxial in form, it provides greater flexibility of nomenclature
and allows for easy additions and modifications, thus
providing a more clinically useful tool that better supports
nursing practice. In spite of these revisions, some in nursing
service organizations continue to view Nursing Diagnosis as
an academic exercise, good for students to learn, but highly
impractical in the fast-paced world of nursing operations.
When service settings utilize nursing diagnosis, it is most
often in electronic documentation systems. The care plans in
these systems are most often standardized and demonstrate
little adaptation to the individual or their health status. A
review of the documentation shows that once a diagnosis is
chosen the care plan is not updated during the contact with
the patient. Care planning, involving telling the computer
that the nurse saw the patient during that shift and looked at
the care plan to determine whether it was still pertinent, simply
becomes a “task” the nurse must perform. The multiaxial
format of Taxonomy II can provide the clinician with the
tools necessary to better format his or her clinical documentation,
showing the “whole picture” of diagnosis, treatment,
evaluation, re-evaluation, and nursing outcomes.
It is however, important that this tool be used correctly.
“Using a multiaxial structure allows many diagnoses
to be constructed that have no defining characteristics and
may even be nonsense.”3 For this reason the authors of this
book felt that it was important to continue to provide
NANDA, NIC and NOC, and the NNN Taxonomy of nursing
practice in this fifth edition. This inclusion will hopefully
better clarify the work and give not only the academic
setting, but also the clinical setting a guide that will provide
the individual student and practitioner a resource that leads
to better understanding and operational use of nursing diagnoses
and, ultimately, better patient outcomes. To facilitate
this integration we have provided charts in each chapter that
provide basic links between the taxonomies.