PubMed · 8223192
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B Meyer. 1993. [What is a nursing problem?].. https://pubmed.ncbi.nlm.nih.gov/8223192/
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This article presents questions, reflections and proposed resolutions regarding the Judgement Axis of the International Classification of Nursing Practice, Beta Version (ICNP beta). The Judgement Axis, in its present format, consists of an alphabetical listing of terms that are meant to reflect the clinical opinion of a nurse relating to the state of a nursing phenomenon appearing in Axis A of the ICNP beta. A review of literature indicates that judgement can be more extensive. Not considered in the development of the Axis is the fact that judgement can be clinical and actuarial. Actuarial judgement is predictive and based on statistics. Clinical judgement is patient-centred, creative and intuitive. Both are essential in defining nursing judgement. The list presents 49 modifiers in nominal form. Each of these is subordinated, in alphanumeric descending order, by qualifiers that do not conform to the concept of lexical hierarchy. We propose that the 49 terms which appear in the present listing as unique ordinates should be clustered into major categories with synonyms listed as subordinates of the major cluster headings. The qualifiers of degree, which are presently identified as subordinates in Axis B, might be presented in matrix format, providing a scale of degree of the modifier for the nurse.
Interpretations of patient data are complex and diverse, contributing to a risk of low accuracy nursing diagnoses. This risk is confirmed in research findings that accuracy of nurses' diagnoses varied widely from high to low. Highly accurate diagnoses are essential, however, to guide nursing interventions for the achievement of positive health outcomes. Development of critical thinking abilities is likely to improve accuracy of nurses' diagnoses. Newer views of critical thinking serve as a basis for critical thinking in nursing. Seven cognitive skills and ten habits of mind are identified as dimensions of critical thinking for use in the diagnostic process.
We evaluated the utility of the CEN Categorical Structure for Nursing Diagnoses as a terminology model for integrating nursing diagnosis concepts into SNOMED. First, we dissected nursing diagnosis term phrases from two source terminologies (North American Nursing Diagnosis Association (NANDA) Taxonomy 1 and Omaha System) into the semantic categories of the CEN categorical structure. Second, we critically analyzed the similarities between the semantic links in the CEN model and the semantic links used to formally define diagnostic concepts in SNOMED RT and SNOMED CT. Our findings demonstrated that focus, bearer, and judgment were present in 100% of the NANDA and Omaha term phrases. The Omaha term phrases contained no additional descriptors beyond those considered mandatory in the CEN model. In contrast, at least 3% of NANDA diagnoses included a term in each semantic category of the categorical structure. The comparison among the semantic links showed that neither SNOMED RT and SNOMED CT currently contain all the semantic links needed to model the two source terminologies for integration. In conclusion, our findings support the potential utility of the CEN categorical structure as a terminology model for dissecting nursing diagnostic concepts for integration into SNOMED RT and SNOMED CT. However, in order to accomplish this task, appropriate semantic links must be added to SNOMED RT and SNOMED CT.