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Purpose To clinically validate indicators of the nursing outcomes "Breastfeeding establishment: Infant (1000)" and "Breastfeeding establishment: maternal (1001)", and their conceptual and operational definitions in infants admitted to a neonatal unit and their mothers. Method This study utilized several methods in a stepwise approach including an integrative review of the literature, content validation, and clinical validation. The content validity index was performed by eight experts, who evaluated revised content of the studied nursing outcomes. In the clinical validation, 61 mother-infant dyads were evaluated by two pairs of nurses: one pair used an instrument with developed definitions, whereas the other used an instrument without definitions. The evaluations were compared using Fleiss' kappa and weighted kappa. Results The agreement between all evaluators was considered excellent for almost all nursing outcome indicators related to the mothers. The pair of evaluators using the definitions had an agreement greater than 0.80 for most indicators. For the pair that did not use the definitions, agreement was poor. Conclusion There was an increase in uniformity and accuracy between the assessments when using the conceptual and operational definitions for the nursing outcome indicators related to Breastfeeding establishment. Implications for nursing practice This study contributed to the development of terms within the Nursing Outcomes Classification, and enriched the body of nursing knowledge.

Purpose This article explores the current structure of NANDA-I nursing diagnoses (ND) labels. Methods Critical analysis of the ND labels, as categorized in the NANDA-I terminology. Findings Most of the 244 ND labels are composed of terms from the focus and judgment axes. Conclusions The specificity of the human responses toward health and life transitions may not be totally represented in the two most common axes, as categorized within taxonomy II. Implications for nursing practice Improvements in NANDA-I diagnosis labels would contribute to an advanced terminology and to increased specificity and accuracy of the diagnostic process that is needed in clinical practice. Completeness of the ND labels would reflect clinical reasoning preciseness and help students and nurses in delivering more personalized, safe, and effective patient-centered care. Objetivo Este artigo explora os titulos dos diagnosticos de enfermagem da NANDA-I. METODOS: Analise critica dos titulos dos diagnosticos de enfermagem da NANDA-I. Resultados A maioria dos 244 diagnosticos de enfermagem classificados sao compostos essencialmente por termos referentes ao foco e ao julgamento. CONCLUSOES: A especificidade das respostas as transicoes de saude e vida pode nao estar totalmente representada nos dois eixos mais comuns, como apresentado na taxonomia II. IMPLICACOES PARA A PRATICA: Melhorias nos diagnosticos da NANDA-I em relacao ao seu aspeto multiaxial contribuiriam no desenvolvimento da sua terminologia e poderiam melhorar a especificidade e acuracia do processo diagnostico que e necessario a pratica clinica. Complementar os titulos dos diagnosticos de enfermagem poderia refletir a acuracia do raciocinio clinico e ajudar os estudantes e enfermeiros em prestarem cuidados centrados no paciente mais personalizados, seguros e eficazes.

PURPOSE To critically evaluate 2014 American Academy of Nursing (AAN) call-to-action plan for generating interoperable nursing data. DATA SOURCES Healthcare literature. DATA SYNTHESIS AAN's plan will not generate the nursing data needed to participate in big data science initiatives in the short term because Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine – Clinical Terms are not yet ripe for generating interoperable data. Well-tested viable alternatives exist. CONCLUSIONS Authors present recommendations for revisions to AAN's plan and an evidence-based alternative to generating interoperable nursing data in the near term. These revisions can ultimately lead to the proposed terminology goals of the AAN's plan in the long term.

The identification of clinical indicators with good predictive ability allows the nurse to minimize the existing variability in clinical situations presented by the patient and to accurately identify the nursing diagnosis, which represents the true clinical condition. The purpose of this study was to analyze the accuracy of NANDA-I clinical indicators of the nursing diagnosis ineffective airway clearance (IAC) in children with acute respiratory infection. This was a prospective cohort study conducted with a group of 136 children and followed for a period of time ranging from 6 to 10 consecutive days. For data analysis, the measures of accuracy were calculated for clinical indicators, which presented statistical significance in a generalized estimated equation model. IAC was present in 91.9% of children in the first assessment. Adventitious breath sounds presented the best measure of accuracy. Ineffective cough presented a high value of sensitivity. Changes in respiratory rate, wide-eyed, diminished breath sounds, and difficulty vocalizing presented high positive predictive values. In conclusion, adventitious breath sounds showed the best predictive ability to diagnose IAC in children with respiratory acute infection.

Purpose To identify the frequency of the nursing diagnoses, ineffective breathing pattern, impaired gas exchange and impaired spontaneous ventilation in newborns; and, to analyze the accuracy of diagnostic indicators identified for each of these diagnoses. Methods This was a cross-sectional study conducted with a nonprobability sample of 92 infants. Data collected were represented by demographic and clinical variables, clinical indicators of the three respiratory nursing diagnoses from NANDA International, and were analyzed according to frequency and agreement between pairs of expert nurses (Kappa). Findings Ineffective breathing pattern was identified in 74.5% of infants; impaired gas exchange was noted in 31.5%; impaired spontaneous ventilation was found in 16.8% of subjects. Use of accessory muscles to breathe showed the highest sensitivity for ineffective breathing pattern; abnormal blood gases had the best predictive value for impaired gas exchange. Use of accessory muscles to breathe had the highest sensitivity for impaired spontaneous ventilation. Conclusions Ineffective breathing pattern was the most frequently identified; use of accessory muscles, alteration in depth of breathing, abnormal breathing, and dyspnea were the most representative signs/symptoms. Implication for nursing practice Early recognition of respiratory conditions can support safe interventions to ensure appropriate outcomes.

Purpose To describe a predictive middle range theory (MRT) that provides a process for validation and incorporation of nursing diagnoses in clinical practice. Data Sources Literature review. Data Synthesis The MRT includes definitions, a pictorial scheme, propositions, causal relationships, and translation to nursing practice. Conclusions The MRT can be a useful alternative for education, research, and translation of this knowledge into practice. Implications for Nursing Practice This MRT can assist clinicians in understanding clinical reasoning, based on temporal logic and spectral interaction among elements of nursing classifications. In turn, this understanding will improve the use and accuracy of nursing diagnosis, which is a critical component of the nursing process that forms a basis for nursing practice standards worldwide.

Purpose To identify and summarize clinical data supporting selection of nursing diagnoses related to the respiratory system for pediatric and neonatal populations. Method A literature review conducted in indexed publications was used. Findings The final sample consisted of 13 studies conducted in children with cardiac disease, respiratory infection, and asthma with nursing diagnoses such as ineffective breathing pattern, impaired gas exchange, and ineffective airway clearance. Conclusion The higher frequency defining characteristics were dyspnea, abnormal breathing pattern, use of accessory muscle to breathe, change in frequency and respiratory rate, decreased SaO2, and agitation. Implication for Nursing Knowledge This literature review may provide a basis for consideration of important diagnostic criteria in the pediatric population; however, clinical validation in different stages of development is critical for ensuring diagnostic accuracy.

OBJECTIVE:To report the experience of an outpatient nursing education clinic caring for people with chronic heart failure.EXPERIENCE REPORT:In this service, qualified “listening,” recreational educational actions about the disease and its treatment are conducted, based on the interventions from the

PURPOSE: To critically evaluate 2014 American Academy of Nursing (AAN) call-to-action plan for generating interoperable nursing data. DATA SOURCES: Healthcare literature. DATA SYNTHESIS: AAN’s plan will not generate the nursing data needed to participate in big data science initiatives in the short term because Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine – Clinical Terms are not yet ripe for generating interoperable data. Well-tested viable alternatives exist. CONCLUSIONS: Authors present recommendations for revisions to AAN’s plan and an evidence-based alternative to generating interoperable nursing data in the near term. These revisions can ultimately lead to the proposed terminology goals of the AAN’s plan in the long term.

Purpose To develop and test the content validity of a nursing assessment tool for data collection (NATDC) based on NANDA-I for use in outpatients with chronic cardiovascular diseases. Methods Construction based on the literature, refinement with a pilot group of hypertensive outpatients and content validation by experts. Findings The NATDC questions were divided into demographic information of the patient and family, clinical data, physical examination, and interview according to NANDA-I domains. Conclusion The NATDC was constructed and validated. Implications for Nursing Practice This tool can be used in patients with chronic illnesses who experience a variety of human responses seeking nursing care in an outpatient setting because it is based in human responses within a structured framework for nursing assessment.

Purpose To construct and validate a data collection instrument (DCI), and a corresponding instructional guide, for assessment of the nursing diagnosis, risk for infection, in patients following cardiac surgery. Methods Construction of conceptual and operational definitions for risk factors based on literature, content validation by experts, and clinical validation by clinical nurses. Findings There were significant internal consistency and reproducibility in the content validation. In the clinical validation, agreement among nurses was higher than 70% for all risk factors. Conclusions The DCI was constructed and validated. Implications for Nursing Practice This DCI could be used for assessment of adult patients after cardiac surgeries worldwide because of its detailed cues for risk factors, which facilitate clinical reasoning and diagnostic judgment. Objetivo Construir e validar um instrumento de coleta de dados (ICD) e seu roteiro instrucional (RI) para avaliacao do diagnostico de enfermagem Risco de infeccao em pacientes pos-cirurgia cardiaca. Metodos Construcao de definicoes conceituais e operacionais dos fatores de risco baseada na literatura, validacao de conteudo por experts e validacao clinica por enfermeiras assistenciais. Resultados Consistencia interna e reprodutibilidade significativas na validacao de conteudo. Na validacao clinica, a concordância foi maior que 70% para todos os fatores de risco. Conclusoes O ICD foi construido e validado. Implicacoes Para Pratica De Enfermagem O ICD poderia ser utilizado para avaliacao de adultos pos-cirurgia cardiaca internacionalmente devido as suas pistas detalhadas sobre os fatores de risco, que facilitam o raciocinio clinico julgamento diagnostico.

Purpose To determine the accuracy of NANDA-I defining characteristics for the nursing diagnosis, ineffective breathing pattern, in children with acute respiratory infection. Methods This was a prospective cohort study in 136 children. Measures of accuracy were calculated for the defining characteristics. Findings Use of accessory muscles to breathe presented the best measure of accuracy. Alterations in depth of breathing presented a high value of sensitivity. Altered chest excursion and orthopnea presented high values of specificity. Conclusions Use of accessory muscles to breathe showed the best predictive capacity for ineffective breathing pattern. Implications for Nursing Practice Measures of accuracy can contribute to an accurate diagnostic inference process, improving patient assessment and facilitating rapid, accurate diagnosis. Objetivo Determinar a acuracia das caracteristicas definidoras para o diagnostico de enfermagem Padrao respiratorio ineficaz em criancas com infeccao respiratoria aguda. Metodos Este foi um estudo de coorte prospectiva aberta com um grupo de 136 criancas. Medidas de acuracia foram calculadas para as caracteristicas definidoras. Resultados Uso de musculatura acessoria para respirar apresentou a melhor medida de acuracia. Alteracao na profundidade respiratoria apresentou elevado valor de sensibilidade. Excursao toracica alterada e Ortopneia apresentaram altos valores de especificidade. Conclusao Uso de musculatura acessoria para respirar apresentou melhor capacidade preditiva para Padrao respiratorio ineficaz. Implicacoes Para A Pratica De Enfermagem Medidas de acuracia podem contribuir para um processo de inferencia diagnostica acurado. Educadores podem usar o conhecimento de caracteristicas definidoras criticas para ensinar aos alunos tecnicas de avaliacao adequadas, e os enfermeiros na pratica clinica podem estar mais atentos a essas caracteristicas, a fim de facilitar o diagnostico rapido e preciso. Pesquisa adicional deve procurar replicar esse trabalho em populacoes semelhantes e diferentes, e identificar as caracteristicas do diagnostico ao longo do tempo.

The aim of this study was to explore diagnostic indicators in the neonatal population for one nursing diagnosis approved by NANDA International, Inc., hypothermia, and for a proposed diagnosis, risk for hypothermia. In this integrative review, 23 articles were reviewed from the Cinahl, PubMed, and LILACS databases during the period of January through April, 2013. Data were drawn from the articles and synthesized to develop a list of potential related and/or risk factors, and defining characteristics. Potential newborn-related defining characteristics and related factors were identified for clinical testing in hypothermia, (23 and 17, respectively). Twenty-three risk factors were identified for risk for hypothermia. Diagnostic indicators for nursing diagnoses that place newborns at risk of morbidity and mortality will enable risk screening and more adequate assessments. These newly identified diagnostic indicators require research to validate their clinical usefulness.

To identify and summarize clinical data supporting selection of nursing diagnoses related to the respiratory system for pediatric and neonatal populations.A literature review conducted in indexed publications was used.The final sample consisted of 13 studies conducted in children with cardiac disease, respiratory infection, and asthma with nursing diagnoses such as ineffective breathing pattern, impaired gas exchange, and ineffective airway clearance.The higher frequency defining characteristics were dyspnea, abnormal breathing pattern, use of accessory muscle to breathe, change in frequency and respiratory rate, decreased SaOThis literature review may provide a basis for consideration of important diagnostic criteria in the pediatric population; however, clinical validation in different stages of development is critical for ensuring diagnostic accuracy.

PURPOSE: Sedated patients in induced comas may experience ineffective eyelid closure, presenting higher risk for corneal ulcer. The objective was to identify evidence-based practice for corneal ulcer prevention within the intensive care unit. METHODS: A systematic literature review of nine articles was performed. CONCLUSIONS: Questions remain about which care practice is most effective, although most studies consider a humidity chamber with polyethylene film to be the best practice. IMPLICATIONS FOR NURSING PRACTICE: A proposed NANDA-I nursing diagnosis, risk for corneal injury, reflects this human response that demands nursing assessment and intervention. This study provides evidence toward developing nursing interventions and practice guidelines for the care of these patients.

PURPOSE. To identify the most frequent defining characteristics (DCs) for the diagnoses fear and anxiety in Brazilian patients in the immediate preoperative period following elective cardiac surgery; to develop conceptual and operational definitions for the DCs; to develop consensual validation. METHODS. Clinical and observational, descriptive study developed in two phases. FINDINGS. Forty DCs were identified for fear and 19 for anxiety. One expert judged it necessary to include “altered bowel motility” as a DC for fear. There was 100% agreement among the five experts in relation to the DCs. CONCLUSIONS. To add “altered bowel motility” to the DCs for the nursing diagnosis fear. IMPLICATIONS FOR PRACTICE. To enable nurses to more accurately assess patients for these diagnoses. OBJETIVOS. Selecionar as caracteristicas definidoras mais frequentes dos diagnosticos de enfermagem de medo e ansiedade em pacientes brasileiros no pre-operatorio imediato submetidos a cirurgia cardiaca eletiva; formular definicoes conceituais e operacionais para as caracteristicas definidoras; realizar a validacao consensual. METODOS. Estudo clinico e observacional desenvolvido em duas fases. RESULTADOS. Foram identificadas 14 caracteristicas definidoras para medo e 19 para ansiedade. Inicialmente, um especialista julgou necessaria a inclusao de “mobilidade intestinal alterada” para medo. Posteriormente, foram atingidos 100% de concordância entre os cinco especialistas em relacao as caracteristicas definidoras. CONCLUSAO. Acrescentar “mobilidade intestinal alterada” para o diagnostico de enfermagem de medo. IMPLICACOES PARA A PRATICA. Fornecer subsidios para uma melhor avaliacao dos pacientes com tais diagnosticos.

To describe a predictive middle range theory (MRT) that provides a process for validation and incorporation of nursing diagnoses in clinical practice.Literature review.The MRT includes definitions, a pictorial scheme, propositions, causal relationships, and translation to nursing practice.The MRT can be a useful alternative for education, research, and translation of this knowledge into practice.This MRT can assist clinicians in understanding clinical reasoning, based on temporal logic and spectral interaction among elements of nursing classifications. In turn, this understanding will improve the use and accuracy of nursing diagnosis, which is a critical component of the nursing process that forms a basis for nursing practice standards worldwide.

To report the experience of an outpatient nursing education clinic caring for people with chronic heart failure.In this service, qualified "listening," recreational educational actions about the disease and its treatment are conducted, based on the interventions from the Nursing Interventions Classification (NIC), as well as the evaluation of self-care behaviors with the outcomes from the Nursing Outcomes Classification (NOC). This article describes the practice of health education activities and the use of NANDA-I-NIC-NOC in a nursing clinic.The outpatient clinic supports client learning about the treatment of disease and stimulates self-control of health behaviors.This experience report will guide nurses in the establishment of outpatient nursing education clinics for different populations of patients with chronic health conditions.

Objetivo: descrever o julgamento clínico de enfermagem para identificar diagnósticos NANDA e desenvolver um plano de tratamento NIC para uma criança em pós-operatório de cirurgia cardíaca em terapia intensiva. Método: estudo de caso com coleta de dados retrospectiva no prontuário. Resultados: três enfermeiras identificaram diagnósticos NANDA e intervenções NIC. Criança de 6 meses, submetida a cirurgia cardíaca, necessitou oxigenação extracorpórea por membrana no pós-operatório. Foram identificados quatro principais diagnósticos, aos quais foram direcionadas dez intervenções. A proposta de intervenções para responder às necessidades humanas prioritárias da criança foi otimizada pelo uso das terminologias padronizadas. Todos os diagnósticos foram sustentados por indicadores diagnósticos; todas as intervenções foram cientificamente sustentadas. Conclusão: espera-se que os enfermeiros abordem não somente as respostas fisiológicas, mas também aquelas dos domínios psicossociais.

PURPOSE To examine the historical, legal/organizational, informatics, clinical, economic, and policy contexts underlying economic consequences of nursing diagnoses on patient outcomes. DATA SOURCES Published literature, online material. DATA SYNTHESIS Nursing diagnoses influence diagnostic-specific patient outcomes and other outcome variables such as length of hospital stay, morbidity, and mortality. CONCLUSIONS Examination of the economic ramifications of nursing diagnosis on patient outcomes can be facilitated using standardized language and databases containing nursing-sensitive measures.

To develop and test the content validity of a nursing assessment tool for data collection (NATDC) based on NANDA-I for use in outpatients with chronic cardiovascular diseases.Construction based on the literature, refinement with a pilot group of hypertensive outpatients and content validation by experts.The NATDC questions were divided into demographic information of the patient and family, clinical data, physical examination, and interview according to NANDA-I domains.The NATDC was constructed and validated.This tool can be used in patients with chronic illnesses who experience a variety of human responses seeking nursing care in an outpatient setting because it is based in human responses within a structured framework for nursing assessment.

To construct and validate a data collection instrument (DCI), and a corresponding instructional guide, for assessment of the nursing diagnosis, risk for infection, in patients following cardiac surgery.Construction of conceptual and operational definitions for risk factors based on literature, content validation by experts, and clinical validation by clinical nurses.There were significant internal consistency and reproducibility in the content validation. In the clinical validation, agreement among nurses was higher than 70% for all risk factors.The DCI was constructed and validated.This DCI could be used for assessment of adult patients after cardiac surgeries worldwide because of its detailed cues for risk factors, which facilitate clinical reasoning and diagnostic judgment.

Os sistemas de linguagens padronizadas são instrumentos importantes para lidar com a crescente complexidade do cuidado de enfermagem. Neste artigo os autores apresentam os principais benefícios que o uso desses sistemas oferece para o raciocínio clínico requerido no cuidado de enfermagem, para a construção e organização do conhecimento da disciplina e para a prática clínica de enfermagem. As potenciais contribuições dos sistemas de linguagens padronizadas nesses campos derivam do fato de tais sistemas oferecerem estrutura formal para apoiar o raciocínio clínico, organizar o conhecimento e a experiência de enfermagem. The standardized language systems are important tools for dealing with the increasing complexity of nursing care. In this article the authors present the main benefits that the use of these systems provide for the required clinical reasoning in nursing care, the construction and organization of knowledge of the discipline, and for the clinical practice of nursing. The potential contributions of the standardized language systems in these fields stem from the fact that these systems provide a formal structure for supporting clinical reasoning, organizing knowledge and nursing experience. Los sistemas de lenguajes estandarizados son herramientas importantes para hacer frente a la creciente complejidad de los cuidados de enfermería. En este artículo los autores presentan los principales beneficios que el uso de estos sistemas ofrece para el razonamiento clínico requerido en los cuidados de enfermería, para la construcción y organización del conocimiento de la disciplina, y para la práctica clínica de la enfermería. Las posibles contribuciones de los sistemas de lenguajes estandarizados en estos ámbitos se derivan del hecho de que estos sistemas proporcionan una estructura formal para apoyar el raciocinio clínico, organizar la experiencia y los conocimientos de enfermería.

The standardized language systems are important tools for dealing with the increasing complexity of nursing care. In this article the authors present the main benefits that the use of these systems provide for the required clinical reasoning in nursing care, the construction and organization of knowledge of the discipline, and for the clinical practice of nursing. The potential contributions of the standardized language systems in these fields stem from the fact that these systems provide a formal structure for supporting clinical reasoning, organizing knowledge and nursing experience.

To determine the accuracy of NANDA-I defining characteristics for the nursing diagnosis, ineffective breathing pattern, in children with acute respiratory infection.This was a prospective cohort study in 136 children. Measures of accuracy were calculated for the defining characteristics.Use of accessory muscles to breathe presented the best measure of accuracy. Alterations in depth of breathing presented a high value of sensitivity. Altered chest excursion and orthopnea presented high values of specificity.Use of accessory muscles to breathe showed the best predictive capacity for ineffective breathing pattern.Measures of accuracy can contribute to an accurate diagnostic inference process, improving patient assessment and facilitating rapid, accurate diagnosis.

To analyze the human response of delayed surgical recovery, approved by NANDA-I, and to validate its defining characteristics (DCs) and related factors (RFs).This was a two-part study using a concept analysis based on the method of Walker and Avant, and diagnostic content validation based on Fehring's model.Three of the original DCs, and three proposed DCs identified from the concept analysis, were validated in this study; five of the original RFs and four proposed RFs were validated.A revision of the concept studied is suggested, incorporating the validation of some of the DCs and RFs presented by NANDA-I, and the insertion of new, validated DCs and RFs.This study may enable the extension of the use of this diagnosis and contribute to quality surgical care of clients.

Aline Helena Appoloni, MSN, RN, is a Doctoral student, Graduate Program in Fundamental Nursing, Universidade do SaoPaulo—Ribeirao Preto, College of Nursing, Ribeirao Preto, Sao Paulo, Brazil; T. Heather Herdman, PhD, RN, FNI, is theCEO/Executive Director at NANDA International, Inc., Kaukauna, Wisconsin; Anamaria Alves Napoleao, PhD, RN, is anAdjunct Professor in the Department of Nursing, Universidade Federal de Sao Carlos (UFSCar), Sao Carlos, Sao Paulo,Brazil; Emilia Campos de Carvalho, PhD, RN, is a Professor in the School of Nursing of Ribeirao Preto, University of SaoPaulo, Ribeirao Preto, Sao Paulo, Brazil; and Priscilla Hortense, PhD, RN, is an Adjunct Professor in the Department ofNursing, UFSCar, Sao Carlos, Sao Paulo, Brazil.

Sedated patients in induced comas may experience ineffective eyelid closure, presenting higher risk for corneal ulcer. The objective was to identify evidence-based practice for corneal ulcer prevention within the intensive care unit.A systematic literature review of nine articles was performed.Questions remain about which care practice is most effective, although most studies consider a humidity chamber with polyethylene film to be the best practice.A proposed NANDA-I nursing diagnosis, risk for corneal injury, reflects this human response that demands nursing assessment and intervention. This study provides evidence toward developing nursing interventions and practice guidelines for the care of these patients.

This column describes the work of the Nursing Diagnosis Extension and Classification (NDEC) research team, which works in a collaborative agreement with NANDA to refine and extend the diagnosis classification.

PURPOSE. The Diagnosis Development Committee (DDC) of NANDA International frequently receives proposed “physiologic” and “surveillance diagnosis” submissions that may not meet the current definition of nursing diagnosis (NANDA, 2007, p. 332). There has been a request for a vote on newly proposed definitions of nursing diagnosis, risk diagnosis, and syndromes. The purpose of this article is to provide information which enables members and interested nurses to continue the dialogue and to share their thoughts and also to consider the thoughts and information generated by the participants in the NANDA-I interest survey on the definition of nursing diagnoses. DATA SOURCES. An electronic survey of the current NANDA-I definitions, and potential changes to those definitions, was distributed via the NANDA-I Web site. This article summarizes the overall findings of that survey and provides an overview of commentary received from the 269 participants. CONCLUSIONS. It is necessary to continue the dialogue on this important decision and to provide a mechanism for input from members and interested nurses before reaching any conclusions on this subject. NURSING IMPLICATIONS. NANDA-I has been recognized as the leader in the development and implementation of nursing diagnoses and must act responsibly in assessing the changing and emerging trends in nursing practice and in responding to these trends.

To examine the historical, legal/ organizational, informatics, clinical, economic, and policy contexts underlying economic consequences of nursing diagnoses on patient outcomes.Published literature, online material.Nursing diagnoses influence diagnostic-specific patient outcomes and other outcome variables such as length of hospital stay, morbidity, and mortality.Examination of the economic ramifications of nursing diagnosis on patient outcomes can be facilitated using standardized language and databases containing nursing-sensitive measures.

This column describes the work of the Nursing Diagnosis Extension and Classification (NDEC) research team, which works in a collaborative agreement with NANDA to refine and extend the nursing diagnosis classification. Information in this column is for feedback and dialog only, and does not indicate NANDA acceptance of the content. NDEC contributions and recommendations will be processed by NANDA through its DRC Committee. Postscript. A joint meeting of members from NANDA and NDEC occurred in Boston after this column was submitted. Present were: Dr. Dorothy Jones (President, NANDA), Drs. Marjory Gordon and T. Heather Herdman (Co-chairs, DRC Committee), and Dr. Martha Craft-Rosenberg (Co-principal investigator, NDEC). The purpose of the meeting was to clarify and strengthen the collaborative relationship between NANDA and NDEC. NDEC's guidelines for development and evaluation of diagnoses vary somewhat from NANDA criteria for staging nursing diagnoses. For example, NDEC guidelines state that a nursing diagnosis label is a noun phrase, whereas NANDA's definition of a diagnosis label is “a concise term or phrase that represents a pattern of related cues” (NANDA, 1999, pp. 149–150). The people at the recent meeting determined that guideline development would occur jointly, along with a periodic review of those guidelines. The next issue of tills column will be devoted to highlighting the ongoing collaborative relationship between NANDA and NDEC. It is our hope that this format will stimulate dialogue among the readership.