Introduction
NANDA International (NANDA-I) regularly updates its nursing diagnosis list to reflect current healthcare practices, emerging health concerns, and new research. This document provides an overview of the key changes introduced in the 2018-2020, 2021-2023, and 2024-2026 editions compared to their predecessor editions. The overview includes new diagnoses, retired diagnoses, and revisions made to existing classifications. NANDA-I emphasizes that nursing diagnoses should be used within a holistic context, avoiding mere listing of terms to ensure patient safety.
Definition of Nursing Diagnosis
NANDA International defines a nursing diagnosis as a clinical judgment concerning a human response to health conditions or life processes, or the vulnerability to such responses, in individuals, families, groups, or communities.
Key Changes by Edition
- 2018-2020 Edition
- New Nursing Diagnoses (17):
o Readiness for enhanced health literacy
o Ineffective adolescent eating dynamics
o Ineffective child eating dynamics
o Ineffective infant eating dynamics
o Risk for metabolic imbalance syndrome
o Imbalanced energy field
o Risk for unstable blood pressure
o Risk for complicated immigration transition
o Neonatal abstinence syndrome
o Acute substance withdrawal syndrome
o Risk for acute substance withdrawal syndrome
o Risk for surgical site infection
o Risk for dry mouth
o Risk for venous thromboembolism
o Risk for female genital mutilation
o Risk for occupational injury
o Risk for ineffective thermoregulation - Retired Nursing Diagnoses (8):
o Risk for disproportionate growth
o Noncompliance
o Readiness for enhanced fluid balance
o Readiness for enhanced urinary elimination
o Risk for impaired cardiovascular function
o Risk for ineffective gastrointestinal perfusion
o Risk for ineffective renal perfusion
o Risk for imbalanced body temperature - Revised Nursing Diagnoses: 72 diagnoses were revised. Refer to NANDA-I publications for a complete list.
- 2021-2023 Edition
- New Nursing Diagnoses (5):
o Anxiety related to being in a new or unfamiliar environment
o Overwhelming sensory input
o Readiness for enhanced self-care
o Readiness for enhanced self-care behavior
o Risk for falls - Retired Nursing Diagnoses (3):
o Anxiety related to uncertainty about prognosis (merged into Anxiety related to a specific health concern)
o Disturbed thought process related to a mental health disorder (merged into Disturbance in thought processes)
o Deficient diversional activity (merged into Risk for Imbalanced Sleep Pattern) - Revised Nursing Diagnoses (Examples):
o Disturbance in thought processes: Revised to include more specific examples of thought disturbances.
o Disturbance in thought content: Now includes examples of delusional thinking and hallucinations.
o Impaired thought processes: Reworded to emphasize its relationship with other diagnoses and interventions.
o Readiness for enhanced self-care: Emphasizes patient motivation.
o Insomnia: Updated to include different subtypes.
- 2024-2026 Edition
- Problem-focused diagnosis: A clinical judgment concerning an undesirable human response to a health condition / life process that exists in an individual, family, or community.
- Risk diagnosis: A clinical judgment concerning the susceptibility of an individual, family, or community for developing an undesirable human response to health conditions/life processes (representing a potential to deteriorate).
- Health promotion diagnosis: A clinical judgment concerning motivation and desire to increase well-being and to actualize health potential (representing a potential to improve). These responses are expressed by a readiness to enhance specific health behaviors, and can be used in any health state. In cases where individuals are unable to express their own readiness to enhance health behaviors, the nurse may determine that a condition for health promotion exists and then act on the client’s behalf.
Domain 1: Health Promotion - Class 1. Health Awareness
o Decreased Diversional Activity engagement
o Risk for Decreased Diversional Activity engagement
o Excessive sedentary behaviours
o Risk for Excessive sedentary behaviours
o Imbalanced energy field - Class 2: Health Management
o Ineffective health self-Management
o Risk for Ineffective health self-Management
o Readiness for enhanced self-health Management
o Ineffective family health Management
o Risk for Ineffective family health Management
o Ineffective community health management
o Risk for ineffective community health management
o Risk for ineffective blood glucose pattern self-management.
o Ineffective dry eye self-management.
o Ineffective dry mouth self-management
o Risk for ineffective dry mouth self-management
o Ineffective fatigue self-management
o Ineffective lymphedema self-management
o Risk for ineffective lymphedema self-management.
o Ineffective nausea self-management
o Ineffective pain self-management
o Risk for ineffective overweight self-management
o Ineffective underweight self-management
o Risk for ineffective underweight self-management
o Ineffective health maintenance behaviours
o Risk for ineffective health maintenance behaviours
o Ineffective home maintenance behaviours
o Risk for ineffective home maintenance behaviours
o Readiness for enhanced home maintenance behaviours
o Readiness for enhanced exercise engagement
o Inadequate health literacy
o Risk for inadequate health literacy
o Readiness for enhanced health literacy
o Readiness for enhanced healthy aging
o Elder frailty syndrome
o Risk for elder frailty syndrome
Domain 2: Nutrition - Class 1: Ingestion
o Inadequate nutritional intake
o Risk for inadequate nutritional intake
o Readiness for enhanced nutritional intake
o Inadequate protein energy nutritional intake
o Risk for inadequate protein energy nutritional intake
o Ineffective chest feeding
o Risk for ineffective chest feeding
o Disrupted exclusive chest feeding
o Risk for disrupted exclusive chest feeding
o Readiness for enhanced chest feeding
o Inadequate human milk production
o Risk for inadequate human milk production
o Ineffective infant feeding dynamics
o Ineffective child eating dynamics
o Ineffective adolescent eating dynamics
o Impaired swallowing - Class 2. Digestion
o This class does not currently contain any diagnoses - Class 3. Absorption
o This class does not currently contain any diagnoses - Class 4. Metabolism
o Neonatal hyperbilirubinemia
o Risk for neonatal hyperbilirubinemia - Class 5. Hydration
o Risk for impaired water-electrolyte balance
o Risk for impaired fluid volume balance
o Excessive fluid volume
o Risk for excessive fluid volume
o Inadequate fluid volume
o Risk for inadequate fluid volume
Domain 3. Elimination and exchange - Class 1. Urinary function
o Impaired urinary elimination
o Risk for urinary retention
o Disability-associated urinary incontinence
o Mixed urinary incontinence
o Stress urinary incontinence
o Urge urinary incontinence
o Risk for urge urinary incontinence - Class 2. Gastrointestinal function
o Impaired gastrointestinal motility
o Risk for impaired gastrointestinal motility
o Impaired intestinal elimination
o Risk for impaired intestinal elimination
o Chronic functional constipation
o Risk for chronic functional constipation
o Impaired fecal continence
o Risk for impaired fecal continence - Class 3. Integumentary function
o This class does not currently contain any diagnoses - Class 4. Respiratory function
o Impaired gas exchange
Domain 4. Activity / rest - Class 1. Sleep / rest
o Ineffective sleep pattern
o Risk for ineffective sleep pattern
o Readiness for enhanced sleep pattern
o Ineffective sleep hygiene behaviours
o Risk for ineffective sleep hygiene behaviours - Class 2. Activity / exercise
o Impaired physical mobility
o Risk for impaired physical mobility
o Impaired bed mobility
o Impaired wheelchair mobility
o Impaired sitting ability
o Impaired standing ability
o Impaired transferring ability
o Impaired walking ability - Class 3. Energy balance
o Decreased activity tolerance
o Risk for decreased activity tolerance
o Excessive fatigue burden
o Impaired surgical recovery
o Risk for impaired surgical recovery - Class 4. Cardiovascular / pulmonary responses
o Risk for impaired cardiovascular function
o Risk for imbalanced blood pressure
o Risk for decreased cardiac output
o Risk for ineffective cerebral tissue perfusion
o Ineffective peripheral tissue perfusion
o Risk for ineffective peripheral tissue perfusion
o Ineffective breathing pattern
o Impaired spontaneous ventilation
o Impaired child ventilatory weaning response
o Impaired adult ventilatory weaning response - Class 5. Self-care
o Decreased self-care ability syndrome
o Risk for decreased self-care ability syndrome
o Readiness for enhanced self-care abilities
o Decreased bathing abilities
o Decreased dressing abilities
o Decreased feeding abilities
o Decreased grooming abilities
o Decreased toileting abilities
o Ineffective oral hygiene behaviours
o Risk for ineffective oral hygiene behaviours
Domain 5. Perception / cognition - Class 1. Attention
o This class does not currently contain any diagnoses - Class 2. Orientation
o This class does not currently contain any diagnoses - Class 3. Sensation / perception
o This class does not currently contain any diagnoses - Class 4. Cognition
o Acute confusion
o Risk for acute confusion
o Chronic confusion
o Ineffective impulse control
o Disrupted thought processes
o Inadequate health knowledge
o Readiness for enhanced health knowledge
o Impaired memory
o Impaired decision-making
o Readiness for enhanced decision-making
o Impaired emancipated decision-making
o Risk for impaired emancipated decision-making
o Readiness for enhanced emancipated decision-making - Class 5. Communication
o Impaired verbal communication
o Risk for impaired verbal communication
o Readiness for enhanced verbal communication
Domain 6. Self-perception - Class 1. Self-concept
o Readiness for enhanced self-concept
o Disrupted personal identity
o Disrupted family identity syndrome
o Risk for disrupted family identity syndrome
o Risk for impaired human dignity
o Readiness for enhanced transgender social identity - Class 2. Self-esteem
o Chronic inadequate self-esteem
o Risk for chronic inadequate self-esteem
o Situational inadequate self-esteem
o Risk for situational inadequate self-esteem
o Inadequate health self-efficacy - Class 3. Body image
o Disrupted body image
Domain 7. Role relationship - Class 1. Caregiving roles
o Impaired parenting behaviours
o Risk for impaired parenting behaviours
o Readiness for enhanced parenting behaviours
o Excessive parental role conflict - Class 2. Family relationships
o Disrupted family interaction patterns
o Risk for disrupted family interaction patterns
o Impaired family processes
o Readiness for enhanced family processes
o Risk for disrupted attachment behaviours - Class 3. Role performance
o Ineffective role performance
o Ineffective intimate partner relationship
o Risk for ineffective intimate partner relationship
o Readiness for enhanced intimate partner relationship
o Impaired social interaction
o Ineffective childbearing process
o Risk for ineffective childbearing process
o Readiness for enhanced childbearing process
Domain 8. Sexuality - Class 1. Sexual identity
o This class does not currently contain any diagnoses - Class 2. Sexual function
o Impaired sexual function - Class 3. Reproduction
o Risk for impaired maternal-fetal dyad
Domain 9. Coping / stress tolerance - Class 1. Post-trauma responses
o Post-trauma syndrome
o Risk for post-trauma syndrome
o Risk for disrupted immigration transition - Class 2.
o Maladaptive coping
o Readiness for enhanced coping
o Maladaptive family coping
o Readiness for enhanced family coping
o Maladaptive community coping
o Readiness for enhanced community coping
o Excessive caregiving burden
o Risk for excessive caregiving burden
o Maladaptive grieving
o Risk for maladaptive grieving
o Readiness for enhanced grieving
o Impaired resilience
o Risk for impaired resilience
o Readiness for enhanced resilience
o Readiness for enhanced hope
o Inadequate self-compassion
o Excessive anxiety
o Excessive death anxiety
o Excessive fear- Class 3. Neurobehavioral responses
o Risk for autonomic dysreflexia
o Ineffective emotion regulation
o Impaired mood regulation
o Acute substance withdrawal syndrome
o Risk for acute substance withdrawal syndrome
Domain 10. Life principles - Class 1. Values
o This class does not currently contain any diagnoses - Class 2. Beliefs
o This class does not currently contain any diagnoses - Class 3. Value / belief / action congruence
o Moral distress
o Impaired spiritual well-being
o Risk for impaired spiritual well-being
o Readiness for enhanced spiritual well-being
o Impaired religiosity
o Risk for impaired religiosity
o Readiness for enhanced religiosity
Domain 11. Safety / protection - Class 1. Infection
o Impaired immune response
o Risk for infection
o Risk for surgical wound infection - Class 2. Physical injury
o Risk for physical injury
o Risk for burn injury
o Risk for cold injury
o Risk for corneal injury
o Risk for dry eye
o Risk for perioperative positioning injury
o Neonatal pressure injury
o Risk for neonatal pressure injury
o Child pressure injury
o Risk for child pressure injury
o Adult pressure injury
o Risk for adult pressure injury
o Risk for urinary tract injury
o Impaired tissue integrity
o Risk for impaired tissue integrity
o Impaired skin integrity
o Risk for impaired skin integrity
o Impaired nipple-areolar complex integrity
o Risk for impaired nipple-areolar complex integrity
o Impaired oral mucous membrane integrity
o Risk for impaired oral mucous membrane integrity
o Risk for child falls
o Risk for adult falls
o Risk for aspiration
o Ineffective airway clearance
o Risk for accidental suffocation
o Risk for excessive bleeding
o Risk for shock
o Risk for thrombosis
o Risk for impaired peripheral neurovascular function
o Risk for sudden infant death
o Risk for elopement attempt - Class 3. Violence
o Risk for other-directed violence
o Risk for female genital mutilation
o Risk for suicidal self-injurious behavior
o Non-suicidal self-injurious behavior
o Risk for non-suicidal self-injurious behavior - Class 4. Environmental hazards
o Contamination
o Risk for contamination
o Risk for accidental poisoning
o Risk for occupational illness
o Risk for occupational physical injury - Class 5. Defensive processes
o Risk for allergic reaction
o Risk for latex allergy reaction - Class 6. Thermoregulation
o Ineffective thermoregulation
o Risk for ineffective thermoregulation
o Decreased neonatal body temperature
o Risk for decreased neonatal body temperature
o Decreased body temperature
o Risk for decreased body temperature
o Risk for decreased perioperative body temperature
o Hyperthermia
o Risk for hyperthermia
Domain 12. Comfort - Class 1. Physical comfort
o Impaired physical comfort
o Readiness for enhanced physical comfort
o Impaired end-of-life comfort syndrome
o Acute pain
o Chronic pain syndrome
o Chronic pain
o Labor pain - Class 2. Environmental comfort
o This class does not currently contain any diagnoses - Class 3. Social comfort
o Readiness for enhanced social comfort
o Inadequate social connectedness
o Inadequate social support network
o Excessive loneliness
o Risk for excessive loneliness - Class 4. Psychological comfort
o Impaired psychological comfort
o Readiness for enhanced psychological comfort
Domain 13. Growth / development - Class 1. Growth
o Delayed child growth
o Risk for delayed child growth - Class 2. Development
o Delayed child development
o Risk for delayed child development
o Delayed infant motor development
o Risk for delayed infant motor development
o Impaired infant neurodevelopmental organization
o Risk for impaired infant neurodevelopmental organization
o Readiness for enhanced infant neurodevelopmental organization
o Ineffective infant suck-swallow response
Trends and Themes Across Editions - Focus on Contemporary Health Issues: Addressing emerging health concerns.
- Emphasis on Prevention: Inclusion of numerous “Risk for…” diagnoses.
- Refining Specificity and Relevance: Continuous effort to improve accuracy and clinical relevance.
- Patient-Centered Approach: Highlights patient motivation and engagement.
- Addressing Vulnerable Populations: Acknowledges unique needs.
Conclusion
The 2018-2020, 2021-2023, and 2024-2026 editions of the NANDA-I nursing diagnosis list reflect an ongoing evolution in nursing practice. These updates provide a more comprehensive and relevant framework for assessing and addressing patient care. Staying current with these changes is essential for providing safe, effective, and evidence-based nursing care
