International Journal of Nursing Knowledge

Pediatric nurse practitioners (PNPs) need an integrated, comprehensive classification that includes nursing, disease, and developmental diagnoses to effectively describe their practice. No such classification exists. Further, methodologic studies to help evaluate the content validity of any nursing taxonomy are unavailable. A conceptual framework was derived. Then 178 diagnoses from the North American Nursing Diagnosis Association (NANDA) 1986 list, selected diagnoses from the International Classification of Diseases, the Diagnostic and Statistical Manual, Third Revision, and others were selected. This framework identified and listed, with definitions, three domains of diagnoses: Developmental Problems, Diseases, and Daily Living Problems. The diagnoses were ranked using a 4-point scale (4=highly related to l=not related) and were placed into the three domains. The rating scale was assigned by a panel of eight expert pediatric nurses. Diagnoses that were assigned to the Daily Living Problems domain were then sorted into the 11 Functional Health patterns described by Gordon (1987). Reliability was measured using proportions of agreement and Kappas. Content validity of the groups created was measured using indices of content validity and average congruency percentages.

The experts used a new method to sort the diagnoses in a new way that decreased overlaps among the domains. The Developmental and Disease domains were judged reliable and valid. The Daily Living domain of nursing diagnoses showed marginally acceptable validity with acceptable reliability. Six Functional Health Patterns were judged reliable and valid, mixed results were determined for four categories, and the Coping/Stress Tolerance category was judged reliable but not valid using either test. There were considerable differences between the panel's, Gordon's (1987), and NANDA's clustering of NANDA diagnoses. This study defines the diagnostic practice of nurses from a holistic, patient-centered perspective. It is the first study to use quantitative methods to test a diagnostic classification system for nursing. The classification model could also be adapted for other nurse specialties.

Despite the interest and research in nursing diagnosis, few studies have examined the incidence and quality of the diagnoses. Specifically, a lack of knowledge exists regarding what nursing diagnoses are formulated on a patient's admission to the hospital Data from the charts of 33 adult orthopedic patients were evaluated for the type, frequency, and quality of admission nursing diagnoses. Of the 106 nursing diagnoses written, approximately two-thirds were on the accepted list of the North American Nursing Diagnosis Association (NANDA) at the time of the study (1988). Alteration in comfort was the most prevalent diagnostic label. The quality of the diagnoses was evaluated using Ziegler's (1984) tool Only one diagnosis, potential alteration in skin integrity related to bedrest. met all 12 criteria. Nurses showed more difficulty in correctly identifying the etiology component than the response component of the diagnostic statement. Factors that affect the quality of nursing diagnoses and the need for tool refinement are discussed, and research recommendations are made.