A review of nursing diagnoses prevalence in different populations and healthcare settings

D’Agostino, Fabio; Tuinman, Astrid; Lopes, Camila Takáo; Leoni-Scheiber, Claudia; Widmann, Marika; Barrientos-Trigo, Sergio; Batista-Santos, Vinicius; Zeffiro, Valentina

doi:10.37689/acta-ape/2024AR0011733

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Review Article • Acta Paul Enferm 37 • 2024 • https://doi.org/10.37689/acta-ape/2024AR0011733 copy

A review of nursing diagnoses prevalence in different populations and healthcare settings

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To provide an overview of the prevalence of nursing diagnoses in different patient populations and healthcare settings, and on the methods identifying nursing diagnoses.

Methods

A descriptive review with a systematic method was applied according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All studies, in Medline and CINAHL databases from January 2007 to January 2020, reporting nursing diagnoses prevalence were included regardless of population and setting retrieving 1839 articles.

Results

After the screening, 328 articles were included for the analysis. Twenty different patient populations with their respective nursing diagnoses prevalence were identified. Most studies were conducted in inpatient settings (e.g., intensive, and surgical units). NANDA International was a widespread standard nursing language used, and risk for infection was the most frequently identified nursing diagnosis. Several gaps were identified regarding the methods used in the articles analyzed.

Conclusion

The most prevalent nursing diagnoses in different patient populations were identified. Moreover, the nursing diagnoses in the five standard nursing languages recognized by the American Nurses Association were summarized. Advances, gaps, and a call to action were identified.

Nursing diagnosis; Prevalence; Standardized nursing terminology

Variables	n(%)
Country
Brazil	252(76.8)
Spain	22(6.7)
USA	12(3.7)
Turkey	11(3.4)
Italy	9(2.7)
Portugal	6(1.8)
Finland	2(0.6)
Korea	2(0.6)
Switzerland	2(0.6)
Colombia	1(0.3)
Denmark	1(0.3)
Iceland	1(0.3)
Iran	1(0.3)
Netherlands	1(0.3)
Nigeria	1(0.3)
Norway	1(0.3)
South Korea	1(0.3)
Sweden	1(0.3)
Taiwan	1(0.3)
Year of publication
2007	15(4.6)
2008	14(4.3)
2009	19(5.8)
2010	30(9.1)
2011	32(9.8)
2012	19(5.8)
2013	30(9.1)
2014	18(5.5)
2015	34(10.4)
2016	34(10.4)
2017	31(9.4)
2018	21(6.4)
2019	28(8.5)
2020	3(0.9)
Design
Observational/cross-sectional	310(94.5)
Observational/longitudinal	9(2.7)
Retrospective	6(1.8)
Quasi-experimental	3(0.9)
Standardized nursing language
NANDA-I Classification of Nursing Diagnoses	298(90.8)
International Classification for Nursing Practice	16(4.9)
OMAHA System	11(3.3)
Clinical Care Classification System	2(0.6)
Perioperative Nursing Data Set	1(0.3)
Age groups
Adult	123(37.5)
Adult and elderly	99(30.2)
Elderly	54(16.5)
Children	22(6.7)
Not available	10(3.0)
Adolescent	8(2.4)
Newborn	6(1.8)
Child and adolescent	3(0.9)
Child and adult and elderly	3(0.9)
Macro setting
Inpatient	230(70.1)
Outpatient	73(22.2)
Home care	15(4.6)
School	7(2.1)
Prison	3(0.9)
Micro setting
Ambulatory care clinics	36(11.0)
Intensive care unit	36(11.0)
Surgical unit	29(8.8)
District health unit	28(8.6)
Medical unit	27(8.2)
Home	20(6.1)
Hemodialysis unit	15(4.6)
Emergency department	14(4.3)
Pediatric unit	13(4.0)
Oncology unit	11(3.4)
Cardiology unit	10(3.1)
Medical and surgical unit	10(3.1)
Long-term care institution	9(2.7)
Obstetric unit	9(2.7)
Psychiatric unit	9(2.7)
Rehabilitation unit	9(2.7)
Infectious disease unit	8(2.4)
Neurological unit	7(2.1)
School	7(2.1)
Different inpatient units (at least three different inpatient units)	4(1.2)
Post-anesthetic recovery room	4(1.2)
Operating room	3(0.9)
Prison	3(0.9)
Not available	2(0.6)
Human milk bank	1(0.3)
Nurse-managed wellness center	1(0.3)
Nursing home and rehabilitation unit	1(0.3)
Nursing-led unit	1(0.3)
Palliative care unit	1(0.3)
Patient population
Cardiovascular disease	35(10.7)
Critical care	24(7.3)
Chronicity	19(5.8)
Kidney disease	18(5.5)
Medical (non-specific)	16(4.9)
Obstetric	16(4.9)
Surgical	15(4.6)
Cancer	13(4.0)
Psychiatric disorders	13(4.0)
Respiratory disorders	13(4.0)
Diabetes	12(3.7)
HIV/AIDS	11(3.4)
Medical/surgical	10(3.1)
Healthy	9(2.7)
Cerebrovascular disease	8(2.4)
Neurological problems	8(2.4)
Caregiver	7(2.1)
Transplant	7(2.1)
Orthopedic disorders	5(1.5)
Pressure injury risk	5(1.5)
Wounds	5(1.5)
Hypertension and diabetes	4(1.2)
Infectious diseases	4(1.2)
Not available	4(1.2)
Obesity	4(1.2)
Palliative	4(1.2)
Ostomy	3(0.9)
Prisoner	3(0.9)
Prostatectomy	3(0.9)
Vulnerability	3(0.9)
Alcoholism	2(0.6)
Homeless	2(0.6)
Malnutrition	2(0.6)
Prematurity	2(0.6)
Social isolation	2(0.6)
Alveolar bone graft	1(0.3)
Appendectomy	1(0.3)
Bed falls	1(0.3)
Bedridden	1(0.3)
Cochlear implantation	1(0.3)
Cognitive impairment (rehabilitation problems)	1(0.3)
Esophageal surgery	1(0.3)
Insufficient physical activity	1(0.3)
Mastectomy	1(0.3)
Nasoenteral tube placement	1(0.3)
Nosocomial infection	1(0.3)
Postural instability	1(0.3)
Psychological distress	1(0.3)
Radiological interventions	1(0.3)
Special health care needs	1(0.3)
Thoracic surgery	1(0.3)
Urological surgery	1(0.3)
Sample size calculation
Yes	84(25.6)
No	243(74.1)
Not needed	1(0.3)
Sampling
Convenience	162(49.4)
Consecutive	136(41.5)
Random	23(7.0)
Systematic	4(1.2)
Census (complete enumeration)	1(0.3)
Cluster and systematic	1(0.3)
Multistage	1(0.3)
Criteria used to identify nursing diagnoses
Not available	65(19.8)
Instrument	57(17.4)
Instrument and interview and physical examination	31(9.4)
Instrument and agreement	25(7.6)
Mapping	24(7.3)
Instrument and interview	23(7.1)
Instrument and physical examination	18(5.5)
Instrument and interview and physical examination and agreement	17(5.2)
Instrument and physical examination and agreement	11(3.4)
Interview and physical examination	11(3.4)
Interview and physical examination and agreement	10(3.1)
Interview	9(2.7)
Physical examination	6(1.8)
Instrument and interview and agreement	5(1.5)
Interview and agreement	4(1.2)
Agreement	2(0.6)
Instrument and interview and physical examination and clinical decision-making support	2(0.6)
Instrument and mapping	2(0.6)
Physical examination and agreement	2(0.6)
Clinical decision-making support	1(0.3)
Instrument and interview and accuracy	1(0.3)
Instrument and physical examination and mapping	1(0.3)
Physical examination and mapping	1(0.3)
Time of identification of ND
During the length of stay	120(36.6)
During outpatient visit	82(25)
On admission	66(20.1)
After surgical intervention	33(10.1)
Post-partum	6(1.8)
During hemodialysis treatment	5(1.5)
On discharge	5(1.5)
Before surgical intervention	4(1.2)
During breast-feeding	3(0.9)
After procedure	1(0.3)
Before labour	1(0.3)
During radiation treatment	1(0.3)
During surgical treatment	1(0.3)
Studies that considered all the NDs available in that SNL
yes	173(52.7)
Variables	Min	Max
Median sample size
73	8	582,171
Mean/median of the NDs identified per patient
8.5/6.6	1.3	44.3

Nursing diagnosis	Number of studies having the diagnosis	Prevalence range
Nursing diagnosis	Number of studies having the diagnosis	Max	Min
NANDA-I Classification of Nursing Diagnoses
Risk for infection	160	100.0	0.4
Acute pain	131	100.0	1.1
Anxiety	112	100.0	0.9
Impaired skin integrity	111	100.0	0.2
Impaired physical mobility	102	100.0	0.1
Imbalanced nutrition: less than body requirements	92	93.9	0.1
Risk for falls	91	100.0	1.2
Bathing self-care deficit	85	100.0	0.04
Ineffective breathing pattern	78	100.0	0.5
Risk for impaired skin integrity	78	100.0	0.1
Deficient knowledge	71	100.0	1.8
Disturbed sleep pattern	66	100.0	0.6
Constipation	62	96.1	0.1
Activity intolerance	59	100.0	0.0001
Ineffective health management	58	100.0	0.5
Impaired tissue integrity	56	100.0	1.0
Ineffective airway clearance	54	100.0	0.2
Ineffective peripheral tissue perfusion	54	100.0	0.01
Impaired urinary elimination	53	100.0	0.01
Decreased cardiac output	51	100.0	3.4
Impaired verbal communication	51	100.0	0.2
Excess fluid volume	50	100.0	0.7
Impaired gas exchange	50	100.0	0.5
Fatigue	49	91.1	0.2
Ineffective protection	49	100.0	0.9
Chronic pain	48	80.0	0.2
Fear	48	100.0	1.3
Impaired walking	48	100.0	2.8
Risk for constipation	48	100.0	1.0
Risk for aspiration	45	100.0	0.1
Risk for unstable blood glucose level	44	100.0	2.0
Imbalanced Nutrition: More Than Body Requirements	43	77.8	0.5
Dressing self-care deficit	42	100.0	0.1
Feeding self-care deficit	41	100.0	0.4
Impaired dentition	40	100.0	1.9
Acute confusion	39	80.0	0.3
Impaired memory	39	100.0	0.1
Nausea	38	94.7	0.04
Sedentary lifestyle	33	88.9	4.0
Situational low self-esteem	33	100.0	0.1
Deficient fluid volume	32	65.1	0.03
Hyperthermia	32	61.9	0.2
Impaired social interaction	32	100.0	0.2
Insomnia	32	83.3	0.04
Impaired bed mobility	31	100.0	0.04
Toileting self-care deficit	31	100.0	0.1
Sexual dysfunction	30	66.6	1.0
Impaired comfort	29	100.0	5.4
Impaired swallowing	29	100.0	0.7
Diarrhea	28	33.8	0.1
Risk for bleeding	28	100.0	1.0
Impaired spontaneous ventilation	27	100.0	1.6
Ineffective health maintenance	27	100.0	0.8
Functional urinary incontinence	26	53.2	0.004
Hopelessness	26	100.0	1.0
Impaired oral mucous membrane integrity	26	84.2	0.02
Risk for injury	26	100.0	1.7
Readiness for enhanced health management	25	100.0	3.1
Risk for imbalanced fluid volume	25	100.0	0.9
Self-care deficit	25	100.0	1.0
Ineffective coping	24	79.0	0.6
Interrupted family processes	24	93.0	0.9
Risk for deficient fluid volume	24	100.0	0.1
Risk for loneliness	22	98.03	2.0
Disturbed body image	21	75.0	0.9
Noncompliance	21	69.0	0.3
Chronic confusion	20	90.0	0.1
Risk-prone health behavior	20	94.4	5.0
Risk for activity intolerance	19	100.0	0.2
Risk for ineffective thermoregulation	19	100.0	3.0
Social isolation	19	96.1	1.3
Disturbed thought processes	18	85.0	1.1
Ineffective sexuality pattern	18	100	3.0
Impaired transfer ability	17	94.0	0.6
Hypothermia	16	70.0	0.002
Risk for electrolyte imbalance	16	100	0.1
Bowel incontinence	15	55.7	0.004
Dysfunctional family processes	15	96.7	0.04
Risk for peripheral neurovascular dysfunction	14	100.0	0.7
Sleep deprivation	14	100.0	0.4
Caregiver role strain	13	100.0	0.1
Chronic sorrow	13	44.0	0.8
Impaired home maintenance	13	77.0	0.1
Risk for ineffective renal perfusion	13	100.0	5.6
International Classification for Nursing Practice
Impaired walking	6	82.1	0.7
Risk for infection	6	72.3	1.2
Alcohol abuse	5	46.9	2.4
Impaired sleep	5	47.5	10.8
Tobacco abuse	5	63.3	5.4
Anxiety	4	61.2	5.3
Impaired ability to bath	4	86.1	8.0
Risk for fall	4	84.9	5.5
Constipation	3	28.0	13.6
Depressed mood	3	46.9	1.2
Hypertension	3	40.6	25.0
Non adherence to therapeutic regime	3	69.4	2.4
Bowel incontinence	2	43.5	5.3
Drug abuse	2	31.6	24.5
Dyspnea	2	32.3	23.8
Edema	2	33.3	20.8
Impaired ability to dress	2	77.2	7.6
Impaired family process	2	22.6	8.1
Impaired food intake	2	52.4	10.5
Impaired self-toileting	2	68.3	8.5
Impaired skin integrity	2	15.9	5.3
Impaired vision	2	49.1	26.5
Insomnia	2	31.6	28.3
Lack of knowledge of medication regime	2	10.8	5.3
Musculoskeletal pain	2	20.8	1.2
Nonadherence to exercise regime	2	10.0	8.3
Overweight	2	28.8	21.0
Risk for pressure ulcer	2	28.0	24.4
Self-care deficit	2	69.6	1.2
Sleep deprivation	2	60.7	22.6
Urinary incontinence	2	72.2	1.2
Omaha System
Circulation	11	89.0	1.6
Nutrition	10	88.0	0.7
Health care supervision	8	100.0	0.8
Income	8	44.0	7.7
Neuromusculoskeletal function	8	89.0	2.0
Pain	8	67.0	2.0
Residence	8	67.5	2.8
Caretaking/Parenting	7	65.0	6.8
Medication regimen	7	78.0	2.9
Mental health	6	100.0	0.3
Respiration	6	78.0	0.3
Communication with community resources	5	44.9	4.4
Growth and development	5	64.3	4.6
Skin	5	33.0	3.0
Cognition	4	71.1	0.2
Digestion-hydration	4	78.0	1.0
Urinary function	4	33.0	2.8
Clinical Care Classification System
Activity intolerance	2	6.2	1.7
Bathing/hygiene deficit	2	68.7	0.7
Diversional activity deficit	2	2.1	2.3
Sleep pattern disturbance	2	10.4	3.0
Perioperative Nursing Data Set
Dryness of mouth	1	28.0	10.0
Hemorrhage	1	37.0	36.0
Impaired physical mobility	1	14.0	12.0
Impaired urinary elimination	1	23.0	21.0
Ineffective breathing patterns	1	26.0	18.0
Pain	1	69.0	50.0
Risk for fluid volume imbalance	1	48.0	27.0

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[1] Corresponding author: Fabio D’Agostino E-mail: fabio.dagostino@unicamillus.org