Importance of Nursing Importance of Nursing Diagnosis ResearchDiagnosis Research

Margaret Lunney, RN, PhDMargaret Lunney, RN, PhDChairperson, Research Committee Chairperson, Research Committee

NANDA InternationalNANDA International

Keynote address given at the Keynote address given at the AENTDE conference in Valladolid, AENTDE conference in Valladolid,

SpainSpain

October 25October 25thth & 26, & 26,th th 20072007

Nursing diagnosis research is Nursing diagnosis research is critically needed for ongoing critically needed for ongoing

development of the nursing diagnosis development of the nursing diagnosis taxonomy for international use.taxonomy for international use.

Classifications are needed whenever Classifications are needed whenever the communication of names for the communication of names for

phenomena are important.phenomena are important.

To develop and maintain a To develop and maintain a classification, ongoing research is classification, ongoing research is

needed. Research processes are used needed. Research processes are used to establish evidence.to establish evidence.

Knowledge of the research process Knowledge of the research process is available in books, articles, and is available in books, articles, and

workshops.workshops.

The goal is to promote nursing The goal is to promote nursing research to support the nursing research to support the nursing

diagnosis classification.diagnosis classification.

To adequately support an To adequately support an international classification, nursing international classification, nursing

diagnosis research is needed in diagnosis research is needed in every country for 3 reasons.every country for 3 reasons.

1. The EHR is international and 1. The EHR is international and inevitable.inevitable.

2. The usefulness of an international 2. The usefulness of an international classification depends on global classification depends on global

consensus.consensus.

3. Changes in clinical practice are 3. Changes in clinical practice are continuous, so studies are needed to continuous, so studies are needed to identify, describe, explain, and predict identify, describe, explain, and predict

clinical practice patterns.clinical practice patterns.

Research is a systematic, disciplined Research is a systematic, disciplined process to develop, refine, and process to develop, refine, and expand a body of knowledge.expand a body of knowledge.

TheoreticalFramework for

Nursing DiagnosisResearch

Types of NursingDiagnosis Research

In many types of studies, the In many types of studies, the foundation of the research process is foundation of the research process is

the theoretical framework.the theoretical framework.

TTheoretical Frameworkheoretical Framework: linguistic : linguistic theory provides useful explanations for theory provides useful explanations for the importance of developing scientific the importance of developing scientific

classifications.classifications.

Words are

“maps” to the

territory

The meanings of words are known The meanings of words are known through context. Context is known through context. Context is known

through experience.through experience.

The meaningsThe meanings of words are of words are extensional extensional(physical world)(physical world)andand

IntensionalIntensional(ideas about the(ideas about thephysical world) physical world)

We can’t think without names. The We can’t think without names. The names for things influence our names for things influence our

thinking. Thinking about things also thinking. Thinking about things also influences our naming.influences our naming.

We experience only a small fraction We experience only a small fraction of phenomena, e.g., Bessie the cow.of phenomena, e.g., Bessie the cow.

Human beings abstract from their Human beings abstract from their experiences and observations.experiences and observations.

8. 8. WealthWealth

7. Asset7. Asset6. Farm asset6. Farm asset

5. Livestock5. Livestock 4. Cow4. Cow

3. Bessie3. Bessie 2. Perception 2. Perception 1. Process___________________________1. Process___________________________Words are abstractions of similarities, Words are abstractions of similarities,

not differences (read from bottom up)not differences (read from bottom up)

Nurses abstract from their Nurses abstract from their interactions with patients and interactions with patients and

families.families.

Energy levelIs adequate

Calm demeanor

Vital signsAre good

Wants helpfrom a nurse

No signsof distress

Self esteem?

Color isgood

This is an example of an abstraction This is an example of an abstraction ladder applied to nursing diagnosis.ladder applied to nursing diagnosis.

8. Neuman Systems Model 7. Lines of Defense

6. Functional Health Patterns 5. Cognitive-Perceptual Pattern 4. Decision Making

3. Decisional Conflict re: feeding 2. Cheryl’s Breastfeeding

1. Breastfeeding experience____________ Words are abstractions of similarities, not differences Words are abstractions of similarities, not differences

(read from bottom up)(read from bottom up)

SummarySummary:: A theory of nursing diagnosis is A theory of nursing diagnosis is that we name things to think about them, that we name things to think about them, interpret the meaning, and, with others, interpret the meaning, and, with others,

provide actions for quality care.provide actions for quality care.

Use this theoretical framework to Use this theoretical framework to explain the importance of nursing explain the importance of nursing

diagnosis research.diagnosis research.

Many types of nursing diagnosis Many types of nursing diagnosis research are needed.research are needed.

Qualitative methods that can be used Qualitative methods that can be used are participant action research, are participant action research,

grounded theory, and phenomenology.grounded theory, and phenomenology.

Nurses fromHackettstown

RegionalMedicalCenter

working in participant

actionresearch

study

Example: Participant Action Research.Example: Participant Action Research.An advantage is that you involve the An advantage is that you involve the

stakeholders, e.g., patients or nurses.stakeholders, e.g., patients or nurses.

problemproblem

Action

Research Plan

Action

Research Plan

DataData

ResultsResults

Action Research

problemproblem

Action

Research Plan

Action

Research Plan

DataData

ResultsResults

Action Research

We used action research methods to conduct a We used action research methods to conduct a consensus validation study of the common consensus validation study of the common

diagnoses (NANDA), interventions (NIC) and diagnoses (NANDA), interventions (NIC) and outcomes (NOC) for 2 local populations.outcomes (NOC) for 2 local populations.

The action research methods for The action research methods for consensus validation were developed by consensus validation were developed by

Dr. Judy Carlson of Honolulu, Hawaii.Dr. Judy Carlson of Honolulu, Hawaii.

In this study, 100% consensus of In this study, 100% consensus of staff nurses was achieved on staff nurses was achieved on

relevant NANDA, NIC and NOC relevant NANDA, NIC and NOC terms for 2 populations.terms for 2 populations.

People with Diabetes Women in Labor &one hour after delivery

The results were brought back for use at The results were brought back for use at the bedside.the bedside.

The nurses who produced the research product use the research findings.

Quantitative designs for ndx research Quantitative designs for ndx research can be nonexperimental, quasi-can be nonexperimental, quasi-experimental, or experimental.experimental, or experimental.

This is what This is what part of the toolpart of the tool we used we used for the respiratory study looked like.for the respiratory study looked like.

Defining Characteristics Defining Characteristics Present/ AbsentPresent/ Absent ABG from Baseline, AbnormalABG from Baseline, Abnormal ______/________ ______/________ ABG from Normal Values, AbnormalABG from Normal Values, Abnormal ______/________ ______/________

Values Values pHpH ______/________ ______/________

pCO2pCO2 ______/________ ______/________ HCO3HCO3 ______/______________/________

pO2pO2 ______/________ ______/________ O2 SatO2 Sat ______/______________/________

Adventitious Breath Sounds:Adventitious Breath Sounds: Crackles/Rales Crackles/Rales

FineFine _______/______________/_______CourseCourse _______/_______ _______/_______ Gurgles/RhonchiGurgles/Rhonchi _______/_______ _______/_______ WheezesWheezes _______/_______ _______/_______ StridorStridor _______/_______ _______/_______

Guidelines can be found in books and Guidelines can be found in books and examples in journals can be followed. examples in journals can be followed.

Also, ask for help from a mentor.Also, ask for help from a mentor.

Quantitative clinical validation studies Quantitative clinical validation studies are critically needed because we do are critically needed because we do not “know” unless we systematically not “know” unless we systematically

investigate.investigate.

Guidelines for planning a quantitative Guidelines for planning a quantitative clinical study were described by clinical study were described by

Carlson & Lunney (1995).Carlson & Lunney (1995).

The science of nursing needs a broad The science of nursing needs a broad base of research to support its base of research to support its

diagnostic languagediagnostic language. .

Nurses worldwide need to work Nurses worldwide need to work together to design and conduct studies together to design and conduct studies

of new and existing diagnoses.of new and existing diagnoses.

Will you help us to build a future for Will you help us to build a future for nursing science by conducting nursing science by conducting nursing diagnosis research?nursing diagnosis research?