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Theoretical Explanations for the Importance of Using NANDA/NIC/NOC. Margaret Lunney, RN, PhD. Who Needs Theoretical Explanations? . Nurses and others who: value research-theory-practice relationship reject standardization reject the complexity of N/N/N

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Theoretical explanations for the importance of using nanda nic noc

Theoretical Explanations for the Importance of Using NANDA/NIC/NOC

Margaret Lunney, RN, PhD

Who needs theoretical explanations
Who Needs Theoretical Explanations? NANDA/NIC/NOC

Nurses and others who:

  • value research-theory-practice relationship

  • reject standardization

  • reject the complexity of N/N/N

  • feel the “power of nursing” without N/N/N

Explanations currently used
Explanations Currently Used NANDA/NIC/NOC

  • Need for documentation of nursing diagnoses, interventions, and outcomes

  • Visibility of nursing’s contribution

    Note: 1 & 2 are viewed by critics as self-serving

  • Improved quality & manageable costs

Problem pervasive criticisms
Problem: Pervasive Criticisms NANDA/NIC/NOC

  • Covert response (most common)

    • N/N/N are ignored & avoided

  • Overt responses:

    • Articles: Shamansky & Yanni (1983); Hagey & McDonough (1984); Leininger (1990); Mitchell (1991);

    • Negative comments on listservs; negative reviews of manuscripts & research

Effects of criticisms
Effects of Criticisms NANDA/NIC/NOC

  • N/N/N not included in education

  • N/N/N not required for documentation

  • N/N/N not in HIS/EHR

  • Research proposals & manuscripts not approved for funding/publication

Solution theoretical explanations
Solution: Theoretical Explanations NANDA/NIC/NOC

Theories to describe, explain and predict reasons to

use N/N/N:

  • Linguistic Theory

    Hayakawa (1990). Language in thought and action.

  • Critical thinking theory/concepts

    Scheffer & Rubenfeld (2000). Consensus statement

    on CT

  • Concept of Accuracy

    Lunney (2000). Critical thinking and nursing diagnosis

Linguistic theory
Linguistic Theory NANDA/NIC/NOC

Languages are:

  • fundamental mechanism of survival

  • most highly developed symbolic processes

  • tools for communication with self & others

  • sources of cooperative actions with others

  • tools to improve human experiences

Linguistic theory1
Linguistic Theory NANDA/NIC/NOC

  • Scientific names are needed because word usage varies

  • Naming is a “great” step forward; it makes discussion possible

  • There are no “right” names for anything

  • Definitions are statements of linguistic habits; not law

Linguistic theory2
Linguistic Theory NANDA/NIC/NOC

  • Naming is classifying

  • Classifications are developed for specific purposes

  • Classifications =pooled knowledge

  • Pooled knowledge helps us to deal with the physical world

  • Science seeks generally useful classifications, ones that produce results

  • Results in nursing = quality of nursing care

Maps to the territory
Maps to the Territory NANDA/NIC/NOC

  • Many maps needed to “know” a territory

  • No maps “fully” represent the territory

  • All maps do not “equal” the territory

  • Goal- Make “good maps” of the territory

  • NANDA, NIC and NOC are the “good maps”

Meaning context experience
Meaning, Context, Experience NANDA/NIC/NOC

  • Meanings known through context

  • Context gained through experience

  • Using N/N/N increases experience by:

    • depicting interrelationships

    • reducing complexity

    • available in one source

Extensional intensional meanings
Extensional/Intensional Meanings NANDA/NIC/NOC

  • Extensional

    • relates to the physical world

  • Intensional

    • relates to individual connotations

    • focus on intensional = Prejudice

  • N/N/N - extensional & intensional

How we know what we know
How We Know What We Know NANDA/NIC/NOC

  • We experience a small fraction of phenomena

  • We abstract the objects of our experiences

  • It makes no sense to distrust abstractions

  • We need to be AWARE of abstracting

  • Words always need to be connected with what they stand for.

    Avoid this:


    defining words

Abstraction ladder read from bottom
Abstraction Ladder NANDA/NIC/NOC(read from bottom)

8. Wealth

7. Asset

6. Farm asset

5. Livestock

4. Cow

3. Bessie

2. Perception

1. Process_______________________

Words are abstractions of

similarities, not differences (Hayakawa, 1990)

Abstraction ladder nursing
Abstraction Ladder: Nursing NANDA/NIC/NOC

8. Human-Environment Interaction

7. Nurse-Client Partnership

6. Functional Health Patterns

5. Cognitive-Perceptual Pattern

4. Decision Making

3. Decisional Conflict re: infant

feeding choice

2. Cheryl’s Breastfeeding

  • Experience of breastfeeding


    Gigliotti & Lunney, 1998

Application to n n n
Application to N/N/N NANDA/NIC/NOC

  • Explain relation of naming to knowing

  • Acknowledge reality of naming

  • Describe essential nature of abstraction & levels of abstraction

  • Demonstrate connections to the extensional world through case studies

Complexity of nnn and theory
Complexity of NNN and Theory NANDA/NIC/NOC

  • Indicators of Complexity:

    • ~1000 concepts with related information/knowledge

    • Ambiguous relationships among concepts

    • Extreme # of choices

  • Reducing complexity of N/N/N improves:

    • Efficiency and effectiveness of thinking

    • Accuracy of diagnoses

    • Discernment of best interventions and outcomes

What is critical thinking ct
What is Critical thinking (CT)? NANDA/NIC/NOC

Consensus of 57 Nurse Experts:

  • Cognitive Skills (7)

    • Analyzing

    • Applying Standards

    • Discriminating

    • Information Seeking

    • Logical Reasoning

    • Predicting

  • Habits of mind (10)

    Scheffer & Rubenfeld, 2000

    Lunney, 2001, Ch 1

Why critical thinking
Why Critical Thinking? NANDA/NIC/NOC

  • Thinking abilities of adults vary from low to high

  • The thinking processes needed for the nursing process are complex

  • Each clinical case requires specific types of thinking abilities

  • Thinking affects choices of diagnoses, interventions and outcomes

What is accuracy of ndx
What is Accuracy of NDx? NANDA/NIC/NOC

  • Definition

    “A rater’s judgment of the degree to which a diagnostic statement matches the cues in a client situation.” (Lunney, 1990)

  • Characteristics

    • Ranges from high to low

    • Relative to interactive elements

    • Simple to complex according to # of cues, types of cues, characteristics of cues

    • Includes supporting and conflicting cues

    • Relative to the whole situation

Why accuracy of ndx
Why Accuracy of NDx? NANDA/NIC/NOC

  • Accuracy is an outcome of CT

  • Client data lead to many possible dx choices, including etiologies

  • Research findings show that low accuracy is a reality

  • Diagnoses are the foundation of interventions and outcomes

Why discernment of outcomes interventions
Why discernment of outcomes/interventions? NANDA/NIC/NOC

  • Clinical situations differ based on contextual factors (e.g., culture, age, history)

  • Many outcomes and interventions are possible

  • The most appropriate outcomes and interventions need to be selected through CT

Using n n n improves ct for accuracy discernment
Using N/N/N Improves CT for Accuracy/Discernment NANDA/NIC/NOC

  • More efficient and effective:



    Information seeking

    Applying standards

    Logical reasoning


Effects on quality
Effects on Quality NANDA/NIC/NOC

Words & Critical Accuracy &

Phrases + Thinking + Discernment

Communication & Cooperation

Improved Actions

Improved Quality

Lunney, 1999, 2001

Using n n n

  • Mitigate criticisms, e.g.,

    • Be conscious that the labels of N/N/N/ are NOT nursing

  • Show connections of N/N/N to thinking & actions through case studies

  • Demonstrate through theories and

    research that using N/N/N improves quality