NANDA’s Nursing Diagnoses:
Definitions and Classification
Ineffective Health Maintenance (00099) (1982)
Domain 1: Health Promotion
Class 2: Health Management
Definition: Inability to identify, manage, and/or seek out help to maintain health
Defining Characteristics: Demonstrated lack of adaptive behaviors to environmental changes,
Demonstrated lack of knowledge about basic health practices, Lack of expressed interest in
improving health behaviors, History of lack of health-seeking behavior, Inability to take responsi-
bility for meeting basic health practices, Impairment of personal support systems
Related Factors: Cognitive impairment, Complicated grieving, Deficient communication skills,
Diminished fine motor skills, Diminished gross motor skills, Inability to make appropriate judg-
ments, Ineffective family coping, Ineffective individual coping, Insufficient resources (e.g., equip-
ment, finances), Lack of fine motor skills, Lack of gross motor skills, Perceptual impairment,
Spiritual distress, Unachieved developmental tasks
Ineffective Self Health Management (00078) (1994, 2008, LOE 2.1)
Domain 1: Health Promotion
Class 2: Health Management
Definition: Pattern of regulating and integrating into daily living a therapeutic regime for treatment
of illness and its sequelae that is unsatisfactory for meeting specific health goals
Defining Characteristics: Failure to include treatment regimens in daily living, Failure to take
action to reduce risk factors, Makes choices in daily living ineffective for meeting health goals,
Verbalizes desire to manage the illness, Verbalizes difficulty with prescribed regimens
Related Factors: Complexity of healthcare system, Complexity of therapeutic regimen, Deci-
sional conflicts, Economic difficulties, Excessive demands made (e.g., individual, family), Family
conflict, Family patterns of healthcare, Inadequate number of cues to action, Knowledge deficit,
Regimen, Perceived barriers, Powerlessness, Perceived seriousness, Perceived susceptibility, Per-
ceived benefits, Social support deficit
References
Banister N.A., Jastrow, S.T., Hodges, V., Loop, R., & Gillham, M.B. (2004). Diabetes self-management
training program in a community clinic improves patient outcomes at modest cost. J Am Dietetic Assoc
104: 807–10.
Benavides-Vaello S., Garcia, A.A., Brown, S.A., et al (2004). Using focus group to plan and evaluate diabetes
self-management interventions for Mexican Americans. Diabetes Educ 30: 238–56.
Bodenheimer, T., Lorig, K., Holman, H., et al (2002). Patient self-management of chronic disease in primary
care. JAMA 288: 2469.
Brown, C.M. & Segal, R. (1996). Ethnic differences in temporal orientation and its implications for hyperten-
sion management. J Health Soc Behav 37: 350.
Bythe, F.M., March, L.M., Nicholas, M.K., & Counsins, M.J. (2005). Self-management of chronic pain: a
population-based study. Pain 113: 285–92.
Chinn, M.H. et al (2000). Developing a conceptual framework for understanding illness and attitudes in
older, urban African Americans with diabetes. Diabetes Educ 26: 439.
, NANDA’S NURSING DIAGNOSES: DEFINITIONS AND CLASSIFICATION
Cousins, S.O. (2000). My heart can’t take it: older women’s beliefs about exercise benefits and risks. J
Gerontol B Psychol Sci Soc Sci 55B: 283.
Curtin, R.B., Sitter, D.C.B., Schatell, D., et al (2004). Self-management, knowledge, and functioning and
well being of patients on hemodialysis, Neph Nurs J 31: 378–86.
Deakin, T., McShane, C.E., Cade, J.E., & Willams, R.D. (2005). Group-based training for self management
strategies in people with type 2 diabetes mellitus. Cochrane Database Sys Rev 18(2): CD003417.
DeWalt, D.A., Pignone, M., Malone, R., et al (2004). Development and pilot testing of a disease management
program for low literacy patients with heart failure. Patient Educ Couns 55: 78–86.
DiLorio, C., Shafer, P.O., Letz, R., Henry, T.R., Schomer, D.I., & Yeager, K. (2004). Project EASE: a study
to test a psychosocial model of epilepsy medication management. Epilepsy Behav 5: 926–36.
Funnell, M.M. & Anderson, R.M. (2004). Empowerment and self-management of diabetes. Clin Diabetes
22: 123–7.
Gallant, M.H., Beaulieu, M.C., & Carnevale, F.A. (2002). Partnership: an analysis of the concept within the
nurse-client relationship. J Adv Nurs 40(2): 149.
Georges, C.A., Bolton, L.B., & Bennett, C. (2004). Functional health literacy: an issue in African-American
and other ethnic and racial communities, J Natl Black Nurses Assoc 15(1): 1–4.
Goldberg, H.I., Lessier, D.S., Mertens, K., Eytan, T.A., & Cheadle, A.D. (2004). Self management support
in a web-based medical record: A pilot randomized controlled trial. J Comm J Qual Saf 30: 629–35, 589.
Goodwin, J.S., Black, S.A., & Satish, S. (1999). Aging versus disease: the opinions of older black, Hispanic,
and non-Hispanic white Americans about the causes and treatment of common medical conditions. J Am
Geriatr Soc 47: 973.
Gray, J.A. (2004). Self-management in chronic illness. Lancet 364: 1467–8.
Grey, M., Knafl, K., & McCorkle R. (2006). A framework for the study of self- and family management
of chronic conditions. Nurs Outlook 54: 278–86.
Griffiths, R., Johnson, M., Piper, M., et al (2004). A nursing intervention for the quality use of medicines
by elderly community clients. Int J Nurs Pract 10: 166.
Haidet, P., Kroll, T., & Sharf, B. (2006). The complexity of patient participation: lessons learned from
patients’ illness narratives. Patient Educ Couns., 62(3): 323–9. Epub 2006 Aug 2. Last accessed June 23,
2008.
Harmon, M., Castro, F., & Coe, K. (1996). Acculturation and cervical cancer: Knowledge, beliefs, and
behaviors of Hispanic women. Women’s Health, 24(3): 37.
Harvey, I.S. (2006). Self management of a chronic illness: an exploratory study on the role of spirituality
among older African American women. J Women Aging 18(3): 75–88.
Hibbard, J.H. (2004). Moving toward a more patient-centered health care delivery system. Health Affairs
(Millwood), Suppl Web Exclusives: CAR 133–5. Last accessed June 24, 2008.
Huang, C.L., Wu, S.C., Jeng, C.Y., et al (2004). The efficacy of a home-based nursing program in diabetic
control of elderly people with diabetes mellitus living alone. Publ Health Nurse 21(1): 49.
Kastermans, M.C. & Bakker, R.H. (1999). Managing the impact of health problems on daily living. In: Ranz,
M.J. & Lemone, P. (ed.), Classification of nursing diagnoses: Proceedings of the thirteenth conference.
Glendale. CA: CINAHL Information Systems.
Kennedy, M.S. (2005). Education benefits women with IBS: nurses teach self management techniques. Am
J Nurs 105(1): 22.
Kennedy, A.P., Nelson, E., Reeves, D., et al (2004). A randomized controlled trial to assess the effectiveness
and cost of a patient oriented self-management approach to chronic inflammatory bowel disease. Gut, 53:
1639–45.
Koch, T., Jenkin, P., & Kralik, D. (2004). Chronic illness self-management: locating the ‘‘self’’. J Adv Nurs.,
48(5): 484–92.
Krein, S., Heisler, M., Piette, J., Makki, F., & Kerr, E. (2005). The effect of chronic pain on diabetes patients’
self-management. Diabetes Care, 28(1): 65–70.
,NANDA’S NURSING DIAGNOSES: DEFINITIONS AND CLASSIFICATION
McMurray, S.D., Johnson, G., Davis, S., et al (2002). Diabetes education and care management significantly
improve patient outcomes in a dialysis unit. Am J Kidney Dis 40: 566.
Marabini, A., Brugnami, G., Curradi, F., et al (2002). Short term effectiveness of an asthma educational
program: results of a randomized controlled trial. Respir Med 96: 933.
Midwest Bioethics Center (2001). Healthcare narratives from diverse communities -a self-assessment tool
for health-care providers. Bio-ethics Forum 17(3–4): SS1.
Millard, L., Hallett, C., & Luker, K. (2006). Nurse-patient interaction and decision making in care: patient
involvement in community nursing. J Adv Nurs 55: 142–50.
Mohammadi, E., Abedi, H.A., Gofranipour, F., et al (2002). Partnership caring: a theory of high blood
pressure control in Iranian hypertensives, Int J Nurs Pract 8: 324.
Munir, F., Leka, S. & Griffiths, A. (2005). Dealing with self-management of chronic illness at work: predictors
for self-disclosure. Soc Sci Med 60: 1397–407.
Neafsey, P.J., Strickler, Z., Shellman, J., et al (2002). An interactive technology approach to educate older
adults about drug interactions arising from over-the-counter self medication practices. Public Health Nurs
19: 255.
Newman, S., Steed, L., & Mulligan, K. (2004). Self management interventions for chronic illness. Lancet
364: 1523–37.
Nguyen, H.Q., Carrieri-Kohlman, V., Rankin, S.H., Slaughter, R., & Stulberg, M. (2005). Is Internet-based
support for dyspnea self-management in patients with chronic obstructive pulmonary disease possible?
Results of a pilot study. Heart Lung 34(1): 51–62.
Opler, L.A., Ramirez, P.M., Dominguez, L.M., et al (2004). Rethinking medication prescribing practices in
an inner-city Hispanic mental health clinic. J Psychiatr Pract 10: 134–40.
Ogedegbe, G., Mancuso, C.A., & Allegrante, J.P. (2004). Expectations of blood pressure management in
hypertensive African-American patients: a qualitative study. J Natl Med Assoc 96: 442–9.
Patterson, B.L., Russell, C., & Thorne, S. (2003). Critical analysis of everyday self care decision making
in chronic illness. J Adv Nurs 35: 335–41.
Pearson, J., Mensing, C., & Anderson, R. (2004). Medicare reimbursement and diabetes self-management
training: national survey results. Diabetes Educ 30: 914, 916, 918.
Robbins, B., Rausch, K.J., Garcia, R.I., et al (2004). Multicultural medication adherence: a comparative
study. J Gerontol Nurs 30(7): 25–32.
Rogers, A., Kennedy, A., Nelson, E., et al (2005). Uncovering the limits of patient centeredness: implementing
a self management trail for chronic illness, Qual Health Res 15: 224–39.
Stevens, S. & Sin, J. (2005). Implementing a self-management model of relapse prevention for psychosis
into routine clinical practice. J Psych Ment Health Nurs 12: 495.
Thackeray, R., Merrill, R.M., & Neiger, B.L. (2004). Disparities in diabetes management practice between
racial and ethnic groups in the United States. Diabetes Educ 30: 665–75.
Thorne, S.E. & Paterson, B.L. (2000). Two decades of insider research: what we know and don’t know
about chronic illness experience. Annu Rev Nurs Res 18: 3.
Warsi, A., Wang, P.S., LaValley, M.P., et al (2004). Self management education programs in chronic disease.
Arch Intern Med 164: 1641–9.
Watts, T., Merrell, J., Murphy, F., et al (2004). Breast health information needs of women from minority
ethnic groups. J Adv Nurs 47: 526–35.
Wen, L.K., Shepard, M.D., & Parchman, M.L. (2004). Family support, diet, and exercise among older
Mexican Americans with type 2 diabetes. Diabetes Educ 30: 980–93.
Whittemore, R., Melkus, G.D., & Grey, M. (2005). Metabolic control, self management and psychosocial
adjustment in women with type 2 diabetes. J Clin Nurs 14: 195–204.
Impaired Home Maintenance (00098) (1980)
Domain 1: Health Promotion
Class 2: Health Management
, NANDA’S NURSING DIAGNOSES: DEFINITIONS AND CLASSIFICATION
Definition: Inability to independently maintain a safe growth-promoting immediate environment
Defining Characteristics
Objective: Disorderly surroundings, Inappropriate household temperature, Insufficient clothes,
Insufficient linen, Lack of clothes, Lack of linen, Lack of necessary equipment, Offensive odors,
Overtaxed family members, Presence of vermin, Repeated unhygienic disorders, Repeated unhy-
gienic infections, Unavailable cooking equipment, Unclean surroundings
Subjective: Household members describe financial crises, Household members describe outstand-
ing debts, Household members express difficulty in maintaining their home in a comfortable
fashion, Household members request assistance with home maintenance
Related Factors: Deficient knowledge, Disease, Inadequate support systems, Injury, Impaired
functioning, Insufficient family organization, Insufficient family planning, Insufficient finances,
Lack of role modeling, Unfamiliarity with neighborhood resources
Readiness for Enhanced Immunization Status (00186) (2006, LOE
2.1)
Domain 1: Health Promotion
Class 2: Health Management
Domain 11: Safety/Protection
Class 1: Infection
Class 5: Defensive Processes
Definition: A pattern of conforming to local, national, and/or international standards of immunization
to prevent infectious disease(s) that is sufficient to protect a person, family, or community and can
be strengthened
Defining Characteristics: Expresses desire to enhance behavior to prevent infectious disease,
Expresses desire to enhance identification of possible problems associated with immunizations,
Expresses desire to enhance identification of providers of immunizations, Expresses desire to
enhance immunization status, Expresses desire to enhance knowledge of immunization standards,
Expresses desire to enhance record-keeping of immunizations
References
Bundt, T.S. & Hu, H.M. (2004). National examination of compliance predictors and the immunization status
of children: Precursor to a developmental model for health systems. Military Medicine 169: 740–5.
Centers for Disease Control (1997). Recommended childhood immunization schedule. United States 1997.
Mortality and Morbidity Weekly Report 46(2): 35–40.
Centers for Disease Control. (2002). Recommended adult immunization schedule: United States, 2002–2003.
Mortality and Morbidity Weekly Report 51: 904–8.
Das, J. & Das, S. (2003). Trust, learning and vaccination: A case study of a North Indian village. Social
Science & Medicine 57(1), 97–112.
Davis, T.C., Frederickson, D.D., Kennen, E.M., et al. (2004). Childhood vaccine risk/ benefit communication
among public health clinics: A time motion study. Public Health Nursing 21: 228–36.
Hull, S., Hagdrup, N., Hart, B., et al. (2002). Boosting uptake of influenza immunization: A randomised
controlled trial of telephone appointing in general practice. British Journal of General Practice 52: 712.
Lambert, J. (1995). Every child by two. A program of the American Nurses Foundation. American Nurse
27(8): 12.
