Validation of Nursing Management Diagnoses

Val i da t i o n of N u rs i ng Management Diagnoses Ruby Shaw Morrison

Nursing management diagnosis based on nursing and management science, merges ”n urs ing diagn 0s is ” a nd “organ iza t iona I diagnosis ”. Nursing management diagnosis is a judgment about nursing organizational problems. The diagnoses provide a basis for nurse manager interventions to achieve outcomes for which a nurse manager is accountable. A nursing organizational problem is a discrepancy between what should be happening and what is actually happening that prevents the goals of nursing from being accomplished. The purpose of this study was to validate 73 nursing management diagnoses identified previously in 7 992: 71 of the 72 diagnoses were considered valid by at least 70% of 136 participants. Diagnoses considered to have high priority for future research and development were identified by summing the mean scores for perceived frequency of occurrence and level of disruption. Further development of nursing management diagnoses and testing of their effectiveness in enhancing decision making is recommended.

[Keywords: nursing management; diagnoses]

*

iagnosing the problems of organizational units is essential to effective management decision making, just as diagnosing actual or potential health problems is essential for planning effective nursing care. During the past 20 years, there have been a

number of efforts to standardize the language used to diagnose the problems that are addressed in clinical practice and to clarify nursing interventions. Some of those efforts include the work of the North American Nursing Diagnosis Association (NANDA) to inductively identify nursing diagnoses and lay the foundation for knowledge development in clinical decision making (North American Nursing Diagnosis Association, 1992). Another is the Iowa Intervention Project that classifies direct care nursing interventions (Bulechek & McCloskey, 1992). In relation to nursing management, Barrett (1991) identified 14 role components for nurse managers in a Delphi study. There has, however, been little work in the field of nursing service administration to standardize or classify the problems that are the focus of nurse managers’ work.

Identifying a list of nursing management diagnoses is an initial step in development of the diagnoses and, subsequently, developing interventions. “Nursing management diagnosis” is defined as a judgment about nursing organizational problems that provides a basis for nurse manager interventions to achieve outcomes for which a nurse manager is accountable. A nursing organizational problem is a discrepancy between what should be happening and what is actually happening that prevents the goals of nursing from being accomplished in the organization. The goals of nursing include providing of cost effective, holistic,

Volume 27, Number 4, Winter 1995 -

* *

quality care in settings accessible to clients (Redman, 1994). In a previous study, 72 nursing management diagnoses were

identified from problems described by practicing nurse managers (Morrison, 1992). The purpose of the present study was to validate those diagnoses using the definition of “nursing management diagnosis,” to identify the perceived frequency of occurrence and level of disruption caused by the organizational problems, and to determine the correlation between perceived frequency and level of disruption.

Conceptual Framework and Review of Literature

Nurses have borrowed concepts and theories from other disciplines and developed them into a science that is uniquely nursing. The nursing process has been developed as a problem- solving activity for nurses in providing care for individuals and groups and has been used widely in nursing practice and

Ruby Shaw Morrison, RN, DSN, Epsilon Omega, is an Assistant Professor at Capstone College of Nursing, The University of Alabama, Tuscaloosa. The author wishes to acknowledge that the Capstone College of Nursing for Summer Research Award funded this study. Correspondence to Dr. Morrison, Capstone College of Nursing, The University of Alabama, Box 870358, Tuscaloosa, AL 35487-0358.

Accepted for publication October 25, 1994.

Image: Journal of Nursing Scholarship, 1995; 27(4), 267-271. 01995, Sigma Theta Tau International.

267

Validation of Nursing Management Diagnoses

education (Tappen, 1989). Marquis and Huston (1992) asserted that “although the [nursing] process was designed for nursing practice with regard to client care and nursing accountability, it can easily be adapted as a theoretical model for solving leadership and management problems” (p. 24).

Management science incorporates concepts and theories from a variety of behavioral sciences to help accomplish organizational goals by working with and through individuals and groups (Hersey & Blanchard, 1977). Critical responsibilities of managers include diagnosing organizational problems and making decisions to solve those problems. The process of decision making, from the management science perspective, includes identification of disequilibrium, diagnosis and definition of a problem situation, determination of alternative methods of solving a problem, and implementing chosen solutions (Simon, 1957). Critical to effective decision making is diagnosis and definition of the problem (Elbing, 1970; Joiner & Corkrean, 1986; Marquis & Huston, 1992; Yates, 1990). A working diagnosis must be stated explicitly to assess new information related to a problem and to develop plans to solve the problem. Because problems and solutions are domain-specific, diagnoses of problems must be defined in the language of a discipline.

This study is based on a theoretical framework that combines theories and concepts from nursing and management. The nursing theory that served as a foundation for the study was King’s Interacting Systems Framework. This framework provides support for diagnosing organizational problems by nurse managers (Elberson, 1989). The following proposition developed from King’s framework supports identification and validation of nursing management diagnoses: “The perceptions of nurses in their roles as nurse managers influence decision making in the social system of hospitals” (Momson, 1992, p. 5). King’s theory was applied to this validation study by using the expertise of practicing nurse managers who described their perceptions of nursing management diagnoses and reported the perceived frequency and level of disruption of each diagnostic problem.

Many disciplines use the concept of diagnosis to refer to the process of analyzing data and labelling a problem by clusters of signs and symptoms. In clinical nursing practice, the term nursing diagnosis refers to the analytical activity that results in labelling problems based on diagnostic cues and clusters of signs and symptoms. Nursing diagnosis is defined by the North American Nursing Diagnosis Association (NANDA) as “a clinical judgment about individual, family, or community responses to actual and potential health problems/life processes. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable” (North American Nursing Diagnosis Association, 1992, p. 5).

Nursing diagnoses were first identified inductively at invitational conferences. A majority vote of conference participants was used to accept diagnoses. In 1986, NANDA accepted a taxonomic structure based on theorists’ patterns of unitary man with four levels of abstraction. The label “Patterns of Unitary Man” was subsequently changed to “Human Response Patterns.” NANDA reported that the diagnoses and taxonomic development “provides a beginning classification scheme” that has been approved by the NANDA membership for development

and testing (NANDA, 1992, p. 2). Although some researchers have identified “wellness” nursing diagnoses, typically nursing diagnosis represents a problem-centered approach to planning care to individuals, families, and communities (Kim & Camilleri, 1994).

Just as individuals and groups, the clients of nurses, suffer actual or potential health problems (NANDA, 1992), “organizations, too, suffer insult and injury from their environments” (Levinson, 1972, p. 5). Levinson (1972) stated that diagnoses should be used equally well in multiple disciplines to facilitate goal achievement desired by the organization. Diagnosis can be an instrument that helps an organization’s members by:

1. Enhancing their capacity to assess and change the culture of the organization

2. Providing an opportunity for organizational members to acquire new insights into the dysfunctional aspects of their culture and patterns of behavior as a basis for developing a more effective organization

3. Ensuring that the organization remains engaged in a process of continuous improvement (Beer & Spector, 1993, p. 642).

~

268 IMAGE: Journal of Nursing Scholarship

Background

Seventy-two nursing management diagnoses were identified by the author’s 1992 study using both qualitative and quantitative methodologies. In Phase I of the study, four focus-group

Hain and Tubbs (1974) defined organizational diagnosis as “getting a valid and reliable indication of what the organization is like, what its problems are, and how they may be related” (p. 4). They suggested a causal-model approach to diagnosis that includes identification of external causal variables, internal causal variables, intervening variables, and end-result variables. External causal variables included market/economic factors, as well as legal-political and socio-cultural influences. Internal causal variables included factors related to leadership, organizational structure, technology, and organizational climate. Intervening variables included communication, coordination, and motivational/decision-making factors. End-result variables included measures of satisfaction and productivity.

Sturner (1 990) suggested that organizational diagnoses should include individual self assessment; assessment of strengths, weaknesses, and styles of colleagues; and evaluation of the organizational culture. Organizational diagnosis needs to be consistent with the type of organization (Vardaman & Halterman, 1968).

The concept of organizational diagnosis has been used by management science to describe analysis of discrepancies or problems and potential for change. Organizational diagnosis is “identifying ‘gaps’ between ‘what is’ and ‘what ought to be’ as supported by the data” (Weisbord, 1978, p. 4). The definition of nursing management diagnosis used in this study was derived by integrating definitions proposed by NANDA and management science. Both nursing diagnosis and organizational diagnosis relate to problem identification based on assessment and are used to facilitate change in people or organizational units.


incentives were given to participants. Questionnaires were mailed bulk rate and included self-addressed, business reply envelopes for return. Randomly selected names and addresses (in the form of address labels) were purchased from AONE. The cover letter and questionnaire for the study were sent to AONE for approval. AONE required that the statement “Participation of AONE members does not indicate AONE review or endorsement of the study” be made on the cover letter to participants and in reports of the research. In addition, the agreement to purchase mailing labels specified that the labels not be photocopied or reproduced in any way. This stipulation made it impossible to send reminder follow-up notices.

interviews were conducted, each with 7 to 10 nurse managers in four Southeastern states. The purpose of this phase was to identify organizational problems and diagnoses made by nurse managers when managing nursing units. In Phase 11, a three- round Delphi survey was conducted with a randomly selected sample of 400 nurse manager affiliates of the American Organization of Nurse Executives (AONE). The purpose of round-1 was to validate problems and judgments identified in Phase I. The purpose of round-2 was to generate diagnoses from the validated problems and judgments. The purpose of round-3 was to validate the diagnoses identified in round-2. A total of 38 participants completed all three rounds of the study and identified 72 nursing management diagnoses. A total of 66 of those diagnoses were validated at a 70% agreement level. It was recognized in that study that a follow-up study should be conducted to further validate the 72 nursing management diagnoses with a larger sample size, the primary purpose of the study being reported here.

Methodology

To further validate the 72 nursing management diagnoses, the researcher mailed questionnaires to 700 randomly selected nurse- manager affiliate members of AONE. The questionnaire included a theoretical definition of the concept nursing management diagnosis as well as demographic data section and the 72 nursing management diagnoses with three questions about each of the diagnoses. The three questions were: (a) Does the diagnosis fit the definition of nursing management diagnosis? (b) If yes, how often do nursing organizational problems associated with the nursing management diagnosis occur in practice? and (c) How disruptive are the nursing organizational problems associated with the diagnosis in meeting nursing’s goals? The definition of nursing management diagnosis was: a judgment about nursing organizational problems that provides a basis for nurse manager interventions to achieve outcomes for which the nurse manager is accountable.

The questionnaire was pilot-tested by 25 nurse managers in one acute care hospital located in the southeastern United States. Revisions in the format and instructions were made as indicated.

To validate the nursing management diagnoses, participants were asked whether the diagnosis fit the definition of nursing management diagnosis provided by the researcher. The researcher specified that the diagnoses accepted by at least 70% of the respondents would be considered valid. The second and third questions regarding frequency and level of disruption had 5-point Likert scales for responses with 1 = low, 5 = high, and 2, 3, and 4 undefined. Priority scores were calculated by adding the mean scores for frequency and level of disruption for each diagnosis. Pearson’s correlation coefficients were computed to determine the correlations between frequency of occurrence and level of disruption for each nursing management diagnosis.

Approval from the Institutional Review Board was obtained before conducting the study. Participation in the study was voluntary and questionnaires were returned without identifying information, thereby maintaining anonymity. No payment or

Volume 27, Number 4, Winter 1995 __

Resu I ts

Of the 700 questionnaires mailed, 136 (19.4%) usable questionnaires were returned. Thirty-six states were represented by the participants 94.9% of whom were female. The mean age was 41 years, the mean scores for length of time in nursing and in nursing management were 19 years and 9 years, respectively. Four (2.9%) participants were educated in a practical nursing program, 18 (13.2%) in an associate-degree nursing program, 52 (38.2%) in a diploma program, and 61 (44.9%) in a baccalaureate nursing program. In response to a question about the highest degree earned, two (1.5%) participants reported associate degrees, 10 (7.4 %) reported diplomas, 38 (27.9%) reported baccalaureate degrees in nursing, 10 (7.4%) reported baccalaureate degrees in non-nursing majors, 50 (36.8%) reported master’s degrees in nursing, and 26 (19.1%) reported master’s degrees in other disciplines. Participants gave 3 1 different job titles with almost half holding the title “nurse manager” (n = 66, 48.5%). A total of 64 (47.1%) were first-line managers, 63 (46.3%) were middle-level managers, and 9 were (6.6%) top-level managers.

Seventy-one of the 72 nursing management diagnoses were validated by the percentage of “yes” responses being greater than or equal to 70%. Only one diagnosis “ineffective employment assistance programs” was validated by fewer than 70% of the respondents. The highest levels of agreement of fit between diagnosis and definition were for the diagnoses “ineffective change management” (97.8%), “ineffective evaluation methods” (96.3%), “ineffective communication” (95.6%), “ineffective systems management” (95.6%), and “inadequate budgeting skills” (94.9%). Percentage for validation, mean frequencies, mean levels of disruption, priority scores, and correlation coefficients are in Table 1.

The most frequently occurring diagnoses were excessive paperwork ( M = 4.24, SD = 1.03), unpredictable workload ( M = 4.05, SD = 1.06), excessive stress level ( M = 4.02, SD = 0.99), lack of empowerment ( M = 3.65, SD = 1.04), and inadequate ancillary staff ( M = 3.64, SD = 0.98).

The most disruptive diagnoses were ineffective change management (M = 4.24, SD = 1.02), ineffective communication (M = 4.17. SD = 1.02), lack of administrative support (M = 4.16, SD = 0.97), inadequate leadership skills (M = 4.15, SD = 0.98), and ineffective leadership ( M = 4.12, SD = 1.02). It was interesting to note that none of the five diagnoses identified as occurring most

269


~~ ~

Table 1 : Nursing Management Diagnoses-Validation, Fnqucnc'm, Level of Disruption, Priority Scores, and cornliltion coefficients,

Mca (50)

3.600 I1 .O)

3.425U.1) 3.552 (1.0) 3.602 I1 .O) 3.3%11.0) 3.176 (1.1 1

3.165 11.1) 3241 (0.91 3.17811.0) 3.030 I1 .O) 3.053 (1.0) 3.504 112) 3.097 (1 .2 ) 329811.1) 3.466 11.0) 3.183 (1.0) 3273 11.0) 3.076 11.0) 3244 11.2) 3.370t1.0) 2.765 (1.1) 3224 (1.1) 3.385 (1.2) 2.821 (1.1) 2.940 11.1)

3.389 11.1) 3.233 11.1) 3.037 (1.0) 3.085(1.1)

3.13011.11

2.88611.1) 3.642 (1.0) 3.271 (1.1) 3.252 11.1) 3.64911.0) 4.016 (1.01 3.000 (1.1) 3.030 (1.11 3.293 10.9) 3.237 I1 .O) 3.231 (1.2) 3.465 (1.2) 2.687 (1.0) 2.%1 (1.01 2.%9 (1 2) 3.885 (1 .l ) 3.205 (121 2.773 (1.0) 2.679 (1 2) 2.369 11.11

4237 (1.0) 3.552 (1.1) 4.172 (1.1) 3.752 (1.1) 4.082 (12) 3.846(1.1) 3.744 (1.01 3.827 (1.0) 3.711 (1.1) 3.704 (1.0) 3.523 (1.1) 3.607 11.2) 3.552 (1.1) 3.672 (1.1) 3.955 (1.0) 3.939 ( I .O) 4.152 0.0) 3.977 (1.1) 3.63411.1) 3.627(1.1) 4.015(1.1) 3.873 ri.1) 4.089 (1.1) 3.590 (1 2) 3.629 (1.1)

3.473 (1.2) 3.773 11.1) 3.800 (1.2) 3.654 (1.1)

3.366 11.21

3.258(1.2) 3.948 (1.0) 3.707 (1.2) 4.122 (1.0) 3.769 (1.0) 4.223 11.0) 3.539 (1.1) 3.803 (1.01 4.159 (1.0) 4.084 (1.0) 3.4Kll1.2) 3.6900.1) 3.130(1.11 3.688 (1.1) 3.605 (1.2) 4.092 11.1) 3.053 (1.2) 3.250 (1.1) 3.435 (1.31

7.837 6.978 7.724 7.353 7.478 7.031 6.910 7.068 6.889 6.733 6.576 7.111 6.649 6.969 7.421 7.122 7.424 7.069 6.870 6.993 6.780 7.097 7.474 6.410 6.868

6.863 7.008 6.837 6.738

6.4%

6.144 7.590 6.977 7.374 7.418 8.248 6.531 6.833 7.462 7.321 6.63 I 7.1 55 5.81 7 6.648 6.574 7.977 6.258 6.023 6.115

3.7W(1.33) 6.176

.58 3.3 .61 .56 .60 .58 .54 .49 .45 .41 .67 .58 .46 .65 .60 .53 .43 .41 .65 .52 .33 .64 .61 .57 .57

.56

.55

.54

.52

.a

.46

.69

.69

.4 1

.61

.59

.53

.48

.51

.39

.65

.62

.55

.51

.46

.69

.55 5.1 .48 .39 Q d d y o n ~ 89.0

_~ -. 270

Table 1 con't.

hdC55lOMl &w(opmenl. InddeqUdtP 8881

P o l q d e w l o p m e n t I ~ 882 h b a l e , lack d M.2 Worklad. unpredtcuble 883 Input trom nurriw lack d 802 lob kriptm, idequate 87 5 M ~ M ~ w I ~ , indieawe 868 ~ , ~ n i z a t m a l methodr idfectrw 86.0 Lt'ork e m i r o n m Miclency 85 3 SuKxulturdl d m t y , i m l l v l t y 85 3 L a b relations methods. I& 85 3 CopinRskills ineffective 85 3 P d p r n k ehcwive 846 Pmdddnlb rkc-edsed 8 4 6 Hiring policy. ind(eaive 83 8 0rRdnizatioo.d climate. negative 82 4 Nit) indfective 81 6 krrti\enerc, lwkd 80.9

R c y m t . lack of 78 7 Finance inadequate 77 9

Ethics. ConflKtlng perSpCItveS 80 9

Employee assistame program, iw4tective 64.7

3.069(1.1) 2.76002) 3.323 (1 .I 1 4.053 (7.1,' 3.137(12) 2.598 11.41 3.047 ( 1 1 3.118 (1.0) 3.039 (1 1) 2.679 11.2) 2.831 112) 2.915 (1.M 4.238 (1.0) 2.875 11.11 2.414 (1.0) 3 m 3 (1.0 2.05902) 2.877 (1 .O)

3.078ri.i) 2.858 (1 .l) 3.531 (1.31

1.331 (1.2) 3.047 (13) 4.169 (1.0)

4.115 (10) 3.901 (1.1) 2.848 (1.3) 3.992 (1.1) 3.622 11.1) 3.409111) 3.115(121 3.392 (1.3) 3.374 (1.1) 3.992 11.1) 3.51 6 (1.2) 3.133 (1.3) 4.039(1.1) 3.266 11.3) 3.162 (1.1) 3359(1d) 3.504 (1 3 3.775 (13)

6.400 P 5m 63 7.492 .% at69 " L I i A6 I r n .41 5.447 .6 7.039 .a 5.714 .bZ 6.449'. ',9&l 5.794 .a 6 U 3 M

8.231 .U 6392 . be 5.547 .n 7.132 .40

.6.125 65 6.038 .Y 6.423- k 6 3 w . 5 9 7.313 .63

km 55

2.419(1.1) 2.768L12) .5.169 3 9

frequently were included in the five diagnoses perceived as being most disruptive.

The five diagnoses with the highest priority using summed means were excessive stress level ( M = 8.25, SD = 1.72), excessive paperwork ( M = 8.23, SD = 1.91), unpredictable workload (M = 8.17, SD = 1.80), excessive workload (M = 7.98, SD = 1.94), and ineffective change management (M = 7.84, SD = 1.85).

The highest correlations between frequency of Occurrence and level of disruption were for the diagnoses inadequate finances (r = .83), work environment deficiency ( r = .70), inadequate ancillary support (Y = .69), ineffective group process ( r = .69), and excessive workload (Y = .69). All 72 correlations presented in Table 1 were statistically significant at p < .01.

Limitations

Several limitations became apparent during conduct of the study. The concept of nursing management diagnosis is relatively new and the author found no published research on this topic. Data were collected in the summer when many nurse managers may have been vacationing and attending to other priorities. Also, the questionnaires were mailed bulk rate so that undeliverable questionnaires were not returned.

The response rate of 19.4% was disappointing but no follow- up of nonresponders was possible. In order to examine the possibility of bias because of differences between responders and nonresponders, demographic characteristics of responders were compared with characteristics of participants from a previous

IMAGE: Journal of Nursing Scholarship

study of AONE members. In the AONE national study, with 280 nurse manager participants, 98.9% of the 280 participants were female, 84.7% were between 30 and 49 years of age, 41.1% had less than a baccalaureate degree, and 40.5% had been in the nurse manger role between 5 and 10 years (Barrett, 1991). Of the 136 participants in this study, 94.9% were female, 89.7% were between 30 and 49 years of age, 55.1% had earned less than a baccalaureate degree, and 5 1.3% had been in the nurse manager role between 5 and 10 years. Results of this comparison suggest that the demographic characteristics of responders were similar the characteristics of the responders in the AONE study.

Discussion and Recommendations

Results of the study support the validity of 71 of the 72 nursing management diagnoses identified in the researcher’s previous study (Momson, 1992). The additional validation strengthens the foundation for further development and testing of nursing management diagnoses. The high number of validated nursing management diagnoses illustrates the broad scope of practice of nurse managers.

Even at the beginning developmental stage of nursing management diagnoses, a list of validated diagnoses serves as a resource for nurse managers to identify problems in managing nursing units. Nurse managers can use the diagnoses as a basis for discussions regarding situations that occur in an organizational unit in order to identify the problems and the changes needed. Once problems are identified, nurse managers can proceed to plan change to resolve the problems. Generating and testing of interventions for the diagnoses will further enhance nurse manager decision-making.

Because decision-making is a vital component of management, education programs that prepare nurses for roles as managers must teach decision-making skills. Students should learn how to assess organizational units and plan for organizational change relative to each of the validated nursing management diagnoses. Application of the entire nursing process, including the use of nursing management diagnosis in managing nursing units, can provide an excellent framework for nurse manager decision- making.

An even greater responsibility for teaching the concepts and processes for decision-making exists for graduate programs in nursing administration. Graduate education in nursing should explore problems associated with the identified nursing management diagnoses. Development and testing of interventions for each diagnosis should be emphasized in research activities of nursing administration majors. Further, integration of knowledge between nursing science and management science, including nursing management diagnoses and organizational diagnoses, should be discussed as graduate programs in nursing administration evolve.

Einstein and Infield (1938) stated that identification of problems of concern to the discipline is central to developing knowledge. By validating nursing management diagnoses, this study establishes a foundation for knowledge development for the role of nurse manager. Much research is needed to define the diagnoses, identify defining characteristics of signs and

-

Volume 27, Number 4, Winter 1995 I, I


symptoms, identify etiologies, and develop and test interventions. Further research is also needed to test the effectiveness of using nursing management diagnoses for decision-making in management practice.

Three recommendations for future research are as follows. First, developmental studies are needed for each of the validated nursing management diagnoses including concept definitions, defining characteristics, and etiologies. Priority scores resulting from this study suggest the order with which to proceed with further development. Second, studies for development and testing of nursing interventions are required. Third, effectiveness of using nursing management diagnoses to enhance decision making of nurse managers should be explored.

References Barrett, S. (1991). American organization of nurse executives 1990 national nurse manager study. Chicago: American Organization of Nurse Executives.

Beer, M., & Spector, B. (1993). Organizational diagnosis: Its role in organizational learning. Journal of Counselling and Development, 71,642- 650.

Bulechek, G. M., & McCloskey, J. C. (1992). Defining and validating nursing interventions. Nursing Clinics of North America, 27(2), 289-299.

Einstein, A., & Infield, L. (1938). The evolution of physics. New York: Simon and Schuster.

Elberson, K. (1989). Applying King’s model to nursing administration. In B. Henry, C. Amdt, M. DiVincenti, & A. Marriner-Tomey (Eds.), Dimensions of nursing administration: Theory, research, education, practice (47-53). Boston: Blackwell Scientific Publications.

Elbing, A.O. (1970). Behavioral decisions in organizations. Glenview, IL: Scott, Foresman.

Hain, T., & ’Ihbbs, S.L. (1974). Organizational development: The role of communication in diagnosis, change, and evaluation. Paper presented at the Annual Meeting of the International Communication Association, New Orleans, LA.

Hersey, P., & Blanchard, K.H. (1977). Management of organizational behavior: Utilizing human resources (3rd ed.). Englewood Cliffs, NJ: Prentice-Hall.

Joiner, C., & Corkrean, M. (1986). Critical incidents in nursing management. Nonvalk, C T Appleton-Century-Crofts.

Kim, MJ., & Camilleri, D. (1994). Nursing diagnosis: Is it essential for the nursing profession? In O.L. Strickland & D.J. Fishman (Eds.), Nursing issues in the 1990s (2 11-23 1). Albany, N Y Delmar.

Levinson, H. (1972). Organizational diagnosis. Cambridge, MA: Harvard University Press.

Marquis, B.L., & Huston, CJ. (1992). Leadership roles and management functions in nursing. Philadelphia: J.B. Lippincott.

Morrison, R.S. (1992). Identification of nursing management diagnoses. Unpublished doctoral dissertation, University of Alabama at Birmingham.

North American Nursing Diagnosis Association. (1992). NANDA nursing diagnoses: Definitions and classification 1992-1993. Philadelphia: Author.

Redman, B.K. (1994). Nursing’s agenda for health care reform: The profession’s ability to create a health care system congruent with its philosophy. In O.L. Strickland & D.J. Fishman, Nursing issues in the 1990’s (81-95). Albany, N Y Delmar.

Simon, H.A. (1957). Administrative behavior: A study of decision making processes in administrative organization. New York: MacMillian.

Sturner, W.F. (1990). Maximizing success by work setting diagnosis. Journal of creative behavior, 24, 132-139.

Tappen, R.M. (1989). Nursing leadership and management: Concepts and practice. Philadelphia: F.A. Davis.

Vardaman, G.T., & Halterman, C.C. (1968). Managerial control through communication: Systems for organizational diagnosis and design. New York John Wiley & Sons.

Weisbord, M.R. (1978). Organizational diagnosis: A workbook of theory and practice. Reading, MA: Addison-Wesley.

Yates, J.F. (1990). Judgment and decision making. Englewood Cliffs, NJ: Prentice-Hall.

77 1

Documents

Validation of Nursing Management Diagnoses