History of the Development of Taxonomy II
NANDA International

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.

Gordon, M. (1998). Manual of nursing diagnoses. St. Louis: Mosby.

Jenny, J. (1994). Advancing the science of nursing with nursing diagnosis. In:  Rantz, M.. & LeMone, P. (eds), Classification of nursing diagnoses: Proceedings of the eleventh conference. Glendale, CA: CINAHL, pp. 73-81.

Johnson, M. & Maas, M. (1997). Nursing Outcomes Classification (NOC). St. Louis: Mosby.

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