The North American Nursing Diagnosis Association (NANDA) is recognized in this and other countries as the pioneer in diagnostic classification in nursing. It began as a Task Force that was created at the First National Conference on Classification of Nursing Diagnoses, 1973, and evolved into an incorporated Association in 1982 to assist nurses in the United States and Canada in classification (Gordon, 1998). Initiation of work on classification for the nursing profession can be attributed to the foresight of two faculty at St. Louis University, Kristine Gebbie and Mary Ann Lavin who called the first conference on classification. Their belief that all nurses should have the opportunity to participate in the development of classifications used in nursing practice has influenced many decisions about the process of identification and classification of nursing.

Diagnostic Concept Development

Diagnoses are concepts that are given a word-label. Gordon observed that a diagnosis is a conceptual model for interpreting a set of observations and therefore provides a way of understanding and thinking about the set. The conceptual basis of a diagnostic concept is summarized in four dimensions: the definition, defining characteristics, and related (contributing, etiological) factors. Ideally, the conceptual base of each diagnostic concept is firmly grounded in studies of the phenomenon (Gordon, 1990). In 1973 when the first classification conference was held, research was minimal and substantive literature on concepts of this type, negligible.

After specifying the purpose of a proposed system, the first step in classification is to identify the phenomena of concern to be classified. It was clear at the First Conference in 1973 that the purpose of classification was to develop a classification system of use to all nurses in their practice, education, and research. Since that time the use in practice, alone, has been considerable. Examples of applications are quality assurance (McCourt,1986; Gordon, 1980), staffing (Halloran, 1985), nursing minimum data set (Werley and Lang, 1987; Mehmert & Delaney, 1991) identifying trends (Rantz and Miller, 1987), and information systems (Warren, 1997; Warren, Delaney, and Ryan, 1997).

An inductive approach was used initially by NANDA to begin to identify classes/categories. This is in contrast to deduction of elements from a nursing theory. Theoretical pluralism prevails and the choice of one theory would negate the others. The 100 participants (staff nurses, clinical specialists, educators, researchers, administrators, theorists, and consultants) at the 1973 conference generated a set of nursing diagnoses, definitions, and defining characteristics from their nursing practice expertise stored in memory. These diagnoses represented 29 conceptual areas with approximately 100 terms which were later condensed. This can be compared to the current classification system that contains 71 conceptual areas and 143 terms (North American Nursing Diagnosis Association, In Press).