Reflections on the Judgement Axis, ICNP beta. International Classification of Nursing Practice.

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.

Building an intercultural nursing terminology bank for the phenomenon, Violence, of the International Classification of Nursing Practice: a methodological perspective.

The aim of this article was to present the methodology and results of an investigation into the intercultural evolution of the nursing phenomenon--Violence--from the identification phase to the summative evaluation phase, in order to contribute to the evolution of the International Classification of Nursing Practice (ICNP). The organizing construct was concept analysis of a nursing phenomenon. The identification of a universal problem in psychiatric-mental health nursing by a team of 10 international leaders in the speciality led from the phase of concept analysis to development of a postgraduate educational module. The results of the original analysis of the concept and findings from clinical and evaluation data resulted in further analysis and consequent synthesis of the concept. Results will be disseminated to the International Council of Nursing (ICN) for the International Classification of Nursing Practice (ICNP) to further the evolution of the phenomenon from a focus on the individual to that of the aggregate (social violence). The methodology pointed to a lack of transfer in the phenomenon from a focus on the individual to that of aggregates in the ICNP. There was also a paucity of intercultural components. The phenomena of Abuse and Aggression appear to have been used synonymously with Violence, without an explanation. The data, and the methods used for its collection and submission, will enhance the ICNP.

Social violence: a case for classification as a sub-phenomenon of community in the ICNP.

The study is intended to illustrate that the nursing phenomenon, Violence, exists as a phenomenon of the aggregate and should thus be classified, under the higher level phenomenon, Community, in the International Classification for Nursing Practice (ICNP), published by the International Council of Nurses. This proposition was confirmed during a meeting of an international team of psychiatric nurses to plan reality-based postgraduate modules for the nine countries they represented. Substantiating data, based on the team's module, Violence, clinical investigation and a review of the literature, evolved from a classroom project in north-east Brazil. The Master's Degree nursing students conducted observations and interviews based on identified factors of the phenomenon on children in two municipal day-care centres in targeted neighbourhoods in João Pessoa, Paraíba, Brazil. Data were gleaned from observations and verbalizations regarding their individual drawings depicting sadness and happiness, from school records and observations of these children by their teachers. The data, evolving from the time-limited classroom project, are too sparse to be considered valid, but pave the road for further studies. Professional and lay-literature substantiates the occurrence of violence in the Brazilian society.

A model for analysis of the nurse-patient interactive process (MAIP).

A model for analysis of the nurse-patient interactive process (MAIP), based on the analysis of the content of that interaction, is proposed as a method for determining appropriate psychosocial nursing diagnoses for the patient. The model focuses on the qualitative aspects of the phenomenon of interaction. The MAIP permits a systematic analysis of the nurse-patient interaction, and in turn will provide guidance for the professional in their actions in the interactive process.

PERC: a nursing syndrome for AIDS.

Perc is an acronym and represents a proposed nursing syndrome for people with AIDS. It incorporates the NANDA human response patterns of perceiving, exchanging, relating and choosing. These patterns were identified through a review of literature on AIDS, especially that which addressed NANDA nursing diagnoses. The analysis showed that the most frequently used nursing diagnoses across various clinical areas were concentrated in the four human response patterns. Following an analysis of the concept, syndrome, PERC was seen as an appropriate way of consolidating those nursing diagnoses, signs and symptoms that the nurses will generally encounter in working with people with aids.

Diagnoses of the human response pattern, communicating: a proposal for revision.

The authors present an analysis of the concept of communication, and propose a revision of NANDA's taxonomic human response pattern communicating, and its nursing diagnosis, impaired verbal communication. The authors recommend that the definitions of the human response pattern and its diagnosis be modified to incorporate facets other than verbal emissions. The addition of new defining characteristics and related factors also should be considered. New defining characteristics could include modifications of criteria of the American Speech and Hearing Association, highlighting disturbances in speech, language, hearing, and vision in addition to some of the present NANDA defining characteristics. Proposed related factors are classified as alterations in human patterns (developmental, physiological, psychological, social, cultural and environmental).

Achieving linguistic clarity: a model to aid translations.

An international validation study of selected NANDA nursing diagnoses prompted the development of a linguistic model for standardizing and operationalizing the defining characteristics. The translation of NANDA-approved defining characteristics into Portuguese illuminated problems related to the way that sentences, phrases, and words are used. Defining characteristics were reduced into the simplest linguistic components--words. In Portuguese translation, all of the major NANDA-defining characteristics were classified into two alphabetized lists as single-word phenomena/states or qualifiers. Linguistic standardization permitted similar expressions of the defining characteristics in Portuguese and English.

An axial representation of community mental health nursing diagnoses of a country at war: El Salvador.

This paper explores the impact of a workshop on the formulation of community mental health diagnoses in El Salvador. The author taught the process of diagnosis from the NANDA framework and explored diagnostic decision making through Caplan's Crisis Model. An epidemiologic framework was also incorporated in the diagnostic process so that host, agent, and environment could be scrutinized. The workshop resulted in the formulation of three universal community mental health diagnoses for this (then) war-torn country: depression, aggression, and anxiety; the development of a proposal for the implementation of mental health services; and an invitation to explore implementation of community mental health care services in five rural communities in El Salvador. Although the politics of El Salvador have changed, this example is typical of many Third-World and war-torn countries.

An intercultural assessment of the type, intensity and number of crisis precipitating factors in three cultures: United States, Brazil and Taiwan.

The precipitating factors of crisis have cultural interpretations that make diagnostic criteria and intervention methods ethnologically different. The crisis precipitating factors of individuals seeking intervention in the Republic of China (Taiwan), Brazil and the United States (U.S.) were investigated toward the end of isolating correlates and discrepancies of ethnic-related precipitants of crisis. The primary objective of the study was to influence crisis intervention in the profession of nursing from the almost universally utilized Western Model, to one that takes cultural uniqueness into account. Stressors and stressor intensities which lead to help-seeking behavior of clients in selected crisis intervention facilities in the three countries were identified. A 60 question instrument ranked client responses according to Axis 4 of the Diagnostic and Statistical Manual-III of the American Psychiatric Association (APA, 1980; 1986). Each item also reflected one of four Human Response Patterns of the North American Nursing Diagnostic Association (NANDA) taxonomy, which was utilized as a clustering device in data analysis. Somatization versus psychologization of crisis precipitating factors was also measured through the NANDA categories. A convenience sample of 30 subjects were queried in each country by nurse interviewers. Data analysis through ANOVA showed cultural uniqueness and mutuality.

A unified nursing diagnostic model.

The diagnostic model proposed in this article seeks to connect the taxonomic systems of the North American Diagnosis Association (NANDA) and the American Nurses Association (ANA). Pictured as an actual tree, the NANDA taxonomic labels are the roots; the ANA psychiatricmental health taxa, the supporting branches; the fruit, the NANDA diagnostic labels. A patient case vignette illustrates how the paradigm may be used as a clinical and research tool to validate each taxonomy, with the goal of creating a unified classification system for nursing phenomena.

Diagnoses for child and adolescent psychiatric nursing. Combining NANDA and the DSM-III-R.

The classification system of the North American Nursing Diagnosis Association and a revised axial system, such as appears in the DSM-III, offer a solution to combining nursing and psychiatry in the practice of child and adolescent psychiatric nursing. A historical perspective of the major diagnostic systems in nursing and psychiatry help focus on alternatives toward developing a meaningful method of diagnostic-based intervention.

A semiquantitative method to assess role image in nursing through the application of semantics.

A semiquantitative method is described for linking professional role image to semantics. The number and type of words generated by three open-ended questions seem to demonstrate professional role image in a staff population of a psychiatric unit. These relationships are quantified as the Role Image Index (RII). The population of a pilot group was divided into three main categories: (1) Nursing Service, Professionals; (2) Nursing Service, Nonprofessionals; and (3) Other Professionals, consisting of psychiatrists and other psychotherapists. Each group was subsequently divided into subgroups. Of these, the Associate Degree Nurse was the only nursing subgroup which demonstrated role image strength consistent with other professionals. Statistical measures employed were regression analyses to assess unusual individual behavior and correlational studies between three proposed indicators of role image strength. While the population is too small to be statistically significant, data are presented to demonstrate the potential significance in the employment of psycholinguistics as a tool for role assessment and development. The tool is seen to have implications for both nursing education and service in the affirmation of nursing as a profession.