Promise, The
Craft-Roseberg, Martha
NANDA International now has new leadership. I want to extend a hearty “Thank You” to past leaders for your commitment, expertise, and valuable time. The leadership of past president Mary Ann Lavin was marked by increasing partnerships and active participation in endeavors ensuring NANDA International representation in the electronic health record. Kay Avant left the board in March. Her influence was instrumental in the development of a new standing Informatics Committee, chaired by judy Warren. Sheila Sparks Ralph also left the board in March after serving as Treasurer. She will continue her contributions by once again editing the new edition of NANDAs nursing diagnosis book and by participating in initiatives of the NNN Alliance.
I am very pleased to begin my 2-year term in office during a period of fiscal stability and promise. T. Heather Herdman is the new President-Elect, Rona Levin continues as secretary, and Anne Perry has a new position as Treasurer. Continuing board members are Dickon Weir-Hughes and Barbara Krainovich-Miller. New board members include june Clark and Leann Scroggins.
You have a strong board with varied knowledge and experience. I urge you to use them to represent your views and help you in making our organization a visible and strong force in global standardized nursing terminologies.
NANDA International Significance
I hope you realize that NANDA International is an organization with a vision and mission of global significance. It is the only professional organization with an entire focus on the development of nursing concepts/terminology. The cover of our new brochure says it well, that our organization “develops terminology to describe the important judgments nurses make.” Our work is significant because these judgments are grounded on assessment data from individuals, families, and communities. The NANDA International language is the language that provides defining characteristics and related factors to facilitate assessment.
The work of NANDA International is the foundation of clinical decision making and the nursing process. Valid diagnoses lead to selection of valid outcomes and selection of interventions to meet these outcomes. For this reason, diagnosis statements frame nursing skills and resources needed for care. Our significance rests with assessment and diagnosis as the center for nursing outcomes and interventions (Craft-Rosenberg & Delaney, 1996).
NANDA International is well positioned. Because of past efforts of our members and leaders, NANDA terminology is positioned to be a player in the development of infrastructure needed for the electronic health record. Our language is compatible with the ISO terminology model, registered with HL7 (part of the UMLS), and integrated with SNOMED-CT®. The integration with SNOMED-CT® provides potential for use in CHI, CMS, DoD, NIH/NCI, and VHA. During 2003/2004, nine major publishers acquired print licenses for NANDA Nursing Diagnoses: Definitions and Classification, 2003-2004; 17 electronic/software licenses and eight translation licenses were issued. The book is currently available in 12 languages-Chinese, Danish, Dutch, English, French, German, Icelandic, Italian, Japanese, Norwegian, Portuguese, and Spanish. According to a CINAHL search, 252 articles included content on NANDA International diagnoses over the 20-year period from 1982 to 2002 (Lavin, 2004).
Importantly, NANDA International is enjoying a period of economic stability. We need to move forward with corporate partnerships and development of a consultation arm to ensure this stability continues and to broaden budgetary options so our committees have budget to function.
The Promise: Increasing Scope and Emphasizing Quality
The development and refinement of diagnosis concepts must increase in pace and scope. The board has asked the Diagnosis Review Committee (DRC) to take leadership by expanding their role to include development as well as diagnosis review. We will also reach out to help nurses who want to develop or refine nursing diagnosis by providing assistance through the NLINKS Web site on the nanda.org Web site.
The development of the NLINKS opportunity was the vision of Mary Ann Lavin, and it is supported by one of our board members, Dickon Weir-Hughes. This past year Mary Ann Lavin added an evidence-based matrix and filters to help with literature reviews. The processes and forms to assist with concept analysis for diagnosis development developed by the Nursing Diagnosis Extension and Classification (NDEC) team at the University of Iowa are included on the concept analysis portion of the site. I submitted a National Library of Medicine proposal for an online Terminology Development Training Center for nurses wishing to develop and refine language. It is an inclusive proposal for diagnosis, interventions, and outcomes development supported by the NANDA International organization, the Classification Center at the University of Iowa, Virginia Saba’s Home Healthcare Classification, and the International Classification of Nursing Practice (ICNP). The purpose of the proposal is to expand the existing NLINKS site, then to add one language in addition to English in the second year, and two languages (Japanese and Portuguese) the third year. The outcome will be a nursing diagnosis language with increasing cultural relevance and global application. The proposal will be resubmitted this summer.
Other strategies planned to increase global application of our nursing diagnoses include the use of “country coordinators” and DRC review of diagnosis developed in languages other than English. To begin, one country coordinator per country is needed. Pleaes let me know if you are interested. Country coordinators will identify nurses who want to work on diagnosis development or refinement in any country. Coordinators will assist nurses through collaboration with the DRC. In order to review diagnoses submitted in several languages, DRC needs volunteers with translation abilities. Please step forward and let me know if you are willing to help.
The long process of DRC review needs to be ongoing, so we are not waiting until 2 years pass without the newest possible diagnosis terms. DRC has been asked by the board to develop this process, posting new diagnoses on our Web site once final approval has been given.
The quality of our diagnosis rests with development, refinement, and review based on the “best” or strongest evidence available. The days of expert opinion and decisions about terms based on a small number of clinical cases are over. Nurses are expected to use evidence for their practice, and we must adhere to that expectation in our own terminology development.
Other methods for development of diagnosis terms are needed to increase our effectiveness and our efficiency. The effective use of large databases is one such method that needs to be explored. Large literature databases help us as we search literature for concept identification and analysis. Similarly, clinical databases should be explored. We need to examine them with data-mining techniques.
Our diagnosis classification is relatively small. The scope needs to be broadened, including diagnoses needed by nurses in every practice setting. Mary Ann Lavin has taken the first step to invite participation in diagnosis development from members of specialty nursing groups. Another step is the mapping of our terminology with other classifications, such as the ICNP and ICF. Negotiations are underway to facilitate this mapping.
The Promise: International Structure and Processes
Even though the name of our organization has become international, our governing structure has not yet followed. While you and I know that strong nursing diagnosis organizations exist around the world, they are not organizationally linked to NANDA International because our organization was a North American organization. Now that we are international, we need to rethink our structure.
Your board is working to explore options to make our structure and processes reflect our international name. At our fall board meeting we will develop a first draft of a proposal to alter our governing structure. Please share your thoughts with any member(s) of the board.
The Promise: Increasing Partnerships
NANDA International has several partnerships, including the NANDA, NIC, NOC: NNN Alliance. We also partner with Virginia Saba and the Home Health Care Classification (HHCC), and we are beginning a partnership with the ICNP. There are other international partnerships that may be available and desirable.
The Promise: Members
NANDA International is an organization of committed leadership and members. The creation of our terms is the meaning of nursing, and it is difficult but exciting work! Let us all work to recapture the excitement of our cause by inviting just ONE person to become a member. Then, help your recruits refine a diagnosis they do not like or develop a diagnosis they need for practice. Help is as close as the Web and e-mail. It is available across the globe.
Our membership committee is active and dynamic. The board is working to make sure our website is interactive and membership friendly. Ours is a grassroots organization small enough that we can know each other. Technology can make it happen.
We are a strong organization with a committed membership. We are positioned to move forward, and the time is now!
References
Craft-Rosenberg, M.J., & Delaney, C. (1996, April 13). Nursing Diagnosis Extension and Classification (NDEC) collaborative panel. Panel presentation at the North American Nursing Diagnosis Association, Pittsburgh, PA.
Lavin, M.A., Avant, K., Warren, J., Craft-Rosenberg, M.J., & Braden, J. (2003). The National Center Vital and Health Statistics (NCVHS). (2004, February 13). Patient medical record informatio (PMRI) terminology questionnaire: Responses of NANDA International. Unpublished report.
Martha Craft-Roseberg, PhD, RN, FAAN
Martha Craft-Rosenberg, PhD, RN, FAAN
President, NANDA International
Martha-craft-rosenberg@uiowa.edu
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