Question

what is the basis of Nanada taxonomy

Answer 1

The idea of bringing up the Nursing Classifications theme to this event came from the basic assumptions of the Nursing science state of art manifested in such classifications construction, and the need to have them in a globalized world, where people's health has been treated by multi-professional teams, in environments ranging from the most sophisticated, with the highest technology, to those where care is provided directly in a family's house or in the communities, many times, poor communities, which are part of the Brazilian reality, and need the Sistema Único de Saúde (SUS - Healthcare System).

No matter where care is provided, analyzing its efficacy, effectiveness and efficiency will facilitate the local, national, and international decision making processes, concerning the population's health and their quality of life.

Nursing, through its professionals, provides care based on a methodological reference denominated nursing process, which is supported by the scientific model.

Such tool-method assists nurses systematizing their actions through steps that are slowly operationalized, most of the times, along with the step, which gives it a flexible character.

Organizing and systematizing actions is something inherent to the human beings so that goals/outcomes may be reached.

Such method, if lacking of theoretical references, does not enable the verification of phenomena observed by the nurses during their daily practice (diagnosis), and of results (outcomes) of their actions (interventions).

The Nursing science evolution happened, initially, with the development of countless theoretical models and theories, transposed to the diagnosis, interventions, and outcomes classifications

DIAGNOSIS AND NURSING INTERVENTION CLASSIFICATIONS

The Nursing Process (NP) first generation is defined by the clinical reasoning that will take place to try and identify problems that must be solved based on theoretical references that will allow its identification and support the nursing actions in order to solve them.

The NP second generation is linked to the Diagnosis Classification usage, where clinical reasoning takes place through diagnosis hypothesis formulations that will be confirmed or refused in case the goals/objective stated are reached or not. The Intervention Classification usage may be or may be not adopted in this generation.

In the NP third generation, the three classifications will necessarily be used: Diagnosis, Outcomes, and Interventions. The clinical reasoning is based on the assessment of an initial result, derived from the outcome indicators established for the diagnosis supposedly identified and its progress, or absence of progress, is judged after the interventions take place.

Therefore, knowing the classifications, using, researching and spreading them is a must in the globalized world, where scientific evidence dictate conducts to healthcare professionals.

Diagnosis, Intervention, and Outcome Classifications have been built in different countries since the seventies, and have been changed and improved through research.

The first north American conference for the nursing diagnosis discussion took place in 1973, at St. Louis University. The conferences continued to occur, when in 1980 the diagnosis terms were generated, refined, and classified. Due to this process, in 1982, the North American Nursing Diagnosis Association (NANDA) was created. NANDA, until 2000, used to classify the nursing diagnosis according to Taxonomy I, which was structured by nine categories, as of the conceptual model of the Human Response Standards (to exchange, to communicate, to relate, to value, to choose, to move, to perceive, to know, to feel)

Following the biennial conference in April 1994, the Taxonomy Committee met to place newly submitted diagnoses into the Taxonomy I revised structure. The committee had considerable difficulty, however, categorizing some of these diagnoses. Given this difficulty and the expanding number of submissions at level 1.4 and higher, the committee felt that a new taxonomic structure was necessary. The possibility gave rise to considerable discussion as to how this might be accomplished.

To start, the committee agreed to determine whether there were categories that naturally arose from the data, i.e., from accepted diagnoses. Round 1 of a naturalistic Q-sort was completed at the eleventh biennial conference in 1994 in Nashville, TN (USA). Round 2 was completed and the analysis presented at the twelfth biennial conference in 1996 in Pittsburgh, Pennsylvania (USA). That Q-sort yielded 21 categories – far too many to be useful or practical.

In 1998, the Taxonomy Committee sent four Q-sorts using four different frameworks to the NANDA Board of Directors. Framework 1, reported in 1996, was in the naturalistic style. Framework 2 used Jenny’s (1994) ideas. Framework 3 used the Nursing Outcomes Classification’s (NOC) (Johnson & Maas, 1997), and Framework 4 used Gordon’s (1998) Functional Health Patterns. None of these frameworks was entirely satisfactory, although Gordon’s was the best fit. With Gordon’s permission, the Taxonomy Committee modified this framework to create Framework 5, which was presented to the membership in April 1998 at the thirteenth biennial conference in St. Louis, Missouri (USA). At that conference, the Taxonomy Committee invited the members to sort the diagnoses according to the domains that had been selected. By the end of the conference, 40 usable sets of data were available for analysis. During the data collection phase at the conference, members of the Taxonomy Committee took careful notes of the questions asked, the confusion expressed by members, and the suggestions for improvement.

Based on the analysis of the data and the field notes, additional modifications were made to the framework. One domain of the original framework was divided into two to reduce the number of classes and diagnoses falling within it. A separate domain was added for growth and development because the original framework did not contain that domain. Several other domains were renamed to better reflect the content of the diagnoses within them. The final taxonomic structure is much less like Gordon’s original, but has reduced misclassification errors and redundancies to near zero, which is a much-desired state in a taxonomic structure.

Finally, definitions were developed for all the domains and classes within the structure. The definition of each diagnosis was then compared with that of the class and the domain in which it was placed. Revisions and modifications in the diagnosis placements were made to ensure maximum match among domain, class, and diagnosis.

In 2002, following the NANDA, NIC and NOC (NNN) Conference in Chicago, the approved nursing diagnoses were placed in Taxonomy II. These included 11 health promotion nursing diagnoses as well as the revised and newly approved nursing diagnoses, In the future years, as new nursing diagnoses were developed and approved, they were added to the taxonomic structure in the appropriate locations. In January 2003, the Taxonomy Committee met in Chicago (USA) and made further refinements to the terminology in Taxonomy II. Following the 2004 NNN Conference in Chicago, the Taxonomy Committee placed the newly approved diagnoses in their appropriate categories. The Taxonomy Committee, to foster its international focus, reviewed the axes in Taxonomy II and compared them with the International Standards Organization (ISO) Reference Terminology Model for a Nursing Diagnosis.

Taxonomy is the practice and science of categorization and classification.

The NANDA-I taxonomy currently includes 234 nursing diagnoses that are grouped (classified) within 13 domains (categories) of nursing practice: Health Promotion; Nutrition; Elimination and Exchange; Activity/Rest; Perception/Cognition; Self-Perception; Role Relationships; Sexuality; Coping/Stress Tolerance; Life Principles; Safety/Protection; Comfort; Growth/Development.