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Perceptions and Attitudes Toward NANDA-I Nursing Diagnoses: A Cross-Sectional Study of Jordanian Nursing Students Mona Abed El-Rahman, PhD, RN, Mahmoud T. Al Kalaldeh, PhD, RN, MSN, CNS, and Malakeh Z. Malak, PhD, RN Mona Abed El-Rahman, PhD, RN, Lecturer of Medical-Surgical Nursing, Port Said University, Port Said, Egypt, Mahmoud T. Al Kalaldeh, PhD, RN, MSN, CNS is an Assistant Professor at Faculty of Nursing, Zarqa University, Zarqa, Jordan, and Malakeh Z. Malak, PhD, RN is an Assistant Professor at Faculty of Nursing, Zarqa University, Zarqa, Jordan.

Search terms: Attitude, NANDA-I, nursing, perception, student Author contact: [email protected], with a copy to the Editor: [email protected] Author contributions: We confirm that all authors listed had a substantial role in the following steps: (a) the conception of the study, (b) designing the study and applying for ethical approvals, (c) data collection, (d) data analysis (carried out by Mahmoud Al Kalaldeh and reviewed by other authors), and (e) writing up of the manuscript.

PURPOSE: To assess the perceptions and attitudes of undergraduate nursing students toward NANDA-I nursing diagnosis. METHODS: A descriptive cross-sectional design was used. A convenient sample was recruited from nursing students at Zarqa University/Jordan. Perceptions toward NANDA-I Nursing Diagnosis scale and Positions on Nursing Diagnosis scale were used. FINDINGS: A total of 101 nursing students were included. A correct perception toward NANDA-I nursing diagnosis was evident. Attitudes toward NANDA appeared positive. However, insufficient distinction between nursing diagnosis and medical diagnosis and feeling less comfort while using NANDA-I were reported. CONCLUSIONS: Nursing students showed correct perceptions and positive attitudes toward the application of NANDA-I. PRACTICE IMPLICATIONS: Proper implementation of NANDA-I is a prerequisite to the better understanding of nursing language.

The NANDA is a nursing language used widely for communicating patient problems, potential risks, and readiness for health promotion by nursing professionals who provide bedside care (Herdman & Kamitsuru, 2014; Lunney, 2010; Rutherford, 2008). The rapid change in healthcare system in accordance to the development of electronic medical records has increased the opportunity to enhance visibility of the advancement of nursing practice toward better patient outcomes (Collins, 2013). Standardization within nursing terms is important for two main reasons. The first is to incorporate nursing descriptions of delivered care into healthcare records in a way that maintains uniqueness of care provided by nurses (Rutherford, 2008). The second is to differentiate nursing contributions from contributions of other health-care providers (Schwiran & Thede, 2011). When a standardized classification system is used, care can be communicated much easier between nurses and other care providers (Rutherford, 2008). With regard to human

© 2015 NANDA International, Inc. International Journal of Nursing Knowledge Volume ••, No. ••, •• 2015

responses, nurses need to embrace the complexity of the patients’ conditions in order to become competent diagnosticians (NANDA-I, 2012). It is a nursing responsibility to accurately identify the appropriate nursing diagnosis for each patient’s condition, in which a combination of physical, emotional, and developmental issues is well anticipated (Ahern, Ark, & Byers, 2008; Earvolino-Ramirez, 2007; Gillespie, Chaboyer, & Wallis, 2007; Pickett, Ianotti, Simon-Morton, & Dostaler, 2009). While nursing diagnosis is the basis for nursing care assessment, planning, and implementation (Aydin & Akansel, 2013; Gordon, 1994), students are required to grasp that level of competency to assess the patient’s needs and to estimate risks using their critical thinking (Odutayo, Olaogun, Oluwatosin, & Ogunfowokan, 2013; Ogunfowokan, Oluwatosin, Olajubu, Alao, & Faremi, 2013). Therefore, the intellectual capacity and thoroughness in technical skills along with interpersonal relationships are

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Perceptions and Attitudes Toward NANDA-I Nursing Diagnoses required to attain that level of competency. It is acknowledged that cognitive skills are essential to analyze and interpret the patient’s data appropriately (Bittencourt & Crossetti, 2013; Hasegawa, Ogasawara, & Katz, 2007; Lunney, 2010). In practice, it is viewed that to increase competency in nursing diagnosis, more clinical scenarios and case studies should be examined (Bittencourt & Crossetti, 2013; Lunney, 2009). In Jordan, NANDA-I is taught to nursing students in schools and colleges. Two levels of nursing profession are presented in Jordan; diploma (associate nursing) and baccalaureate levels (registered nursing). However, nurses who hold the diploma degree of nursing are entitled to enroll baccalaureate programs in universities as bridged students to become registered nurses. There is still no evidence of how NANDA-I is actually applied in clinical practice and whether its implementation is obligated throughout different healthcare systems in Jordan. Therefore, bridged students are uncertain to become role models for those regular students when engaged in the same academic program. Establishing positive attitudes toward NANDA nursing diagnosis among nursing students is the stepping-stone for improving adherence to NANDA in actual clinical practice (Guedes, Turrini, Sousa, Baltar, & Cruz, 2012). According to the Theory of Reasoned Action (Ajzen & Fishbein, 1980), a person’s intention to behave in a certain way is influenced by two factors: the attitude toward the behavior, and the personal norms and perceptions to perform or not perform that particular behavior. In this context, the nurses’ intention to document nursing diagnoses might be influenced by their attitudes toward nursing diagnosis as well as their perceptions of social pressures such as expectations by nursing administrators and colleagues. In general, the nurses’ attitudes toward nursing diagnoses were found positive (Junittila, Salantera, & Hupli, 2005). Older nurses with longer clinical experience and postbasic nursing education were most positive in their attitudes (Junittila et al., 2005; Lunney, 2009). However, little is known about nursing students’ attitudes toward nursing diagnosis (Jensen, Lopes, Silveira, & Ortega, 2012). In addition, there were ambivalences in the nurses’ attitudes toward nursing diagnosis as nurses who reported not using nursing diagnoses were found to have more positive attitudes NANDA and vice versa (Hasegawa et al., 2007). Further, negative attitudes toward NANDA were seen in the inability to clearly represent a patient’s situation, the use of strange wording of the diagnostic labels leading to difficulties in utilization, and difficulty to introduce complex patient situations such as aging and multiple comorbidities and chronic diseases (Halverson et al., 2011). In Jordan, few studies examined the nursing students’ perceptions and attitudes toward NANDA-I nursing diagnosis. For these reason, this study’s aim is to assess the perceptions and attitudes of Jordanian undergraduate nursing students toward NANDA-I nursing diagnosis. 2

M. Abed El-Rahman et al. Design

A descriptive cross-sectional design was used in this study. Setting The study was carried out in the School of Nursing at Zarqa University, Jordan. Sample A convenience sample from undergraduate nursing students was recruited in the period between April 2014 and May 2014. The inclusion criteria were predefined as follows: nursing students in the second, third, and fourth academic year, bridged or regular. Students in the first academic year were excluded because of their limited practice on NANDA-I nursing diagnosis. Of 160 eligible students initially invited to the study, 101 students consented and completed the study questionnaire. Instruments A self-administered questionnaire was used in this study and included the following parts: 1. Demographical data including information about the academic progress. 2. Perceptions toward NANDA-I Nursing Diagnosis scale. This is a component of a questionnaire developed in a previous study (Ogunfowokan et al., 2013) to assess the knowledge of using NANDA-I nursing diagnosis in the community nursing courses. The researchers in that study reviewed the literature on NANDA-I nursing diagnosis and retrieved questions from the concept of nursing diagnosis, which seemed congruent to the common misconception of nursing students. However, minor modifications on the phrases used in this scale were performed, making the tool suitable for general nursing students rather than community nursing students. The scale consists of 13 questions, which were scored using a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Five out of the 13 statements were negative statements. Cronbach’s alpha coefficient for the questionnaire was obtained from a previous study to show high internal consistency at 0.77 (Ogunfowokan et al., 2013). 3. Positions on Nursing Diagnosis (POND) scale, which was developed to measure the attitudes of nurses toward the idea of nursing diagnosis (Lunney & Krenz, 1994). The POND scale is a 20-item scale used in the semantic differential technique of the words to measure and encourage the expression of people’s attitudes toward NANDA nursing diagnosis. Each item is composed of a pair of opposing adjectives that represent opposing properties

M. Abed El-Rahman et al.

Perceptions and Attitudes Toward NANDA-I Nursing Diagnoses

of the diagnostic process. The order of the positive and negative descriptors is random to avoid acquiescence. In each item, two adjectives were joined by a line divided by 7 equidistant points. A score ranging from 1 to 7 is assigned to each of these points, so score 1 corresponds with the point closest to the unfavorable adjective and score 7 to the favorable adjective. It was estimated that the content validity index was 91.5, internal consistency reliability was 0.97, and test–retest reliability using the Pearson correlation was 0.91 (Lunney & Krenz, 1994).

Table 1. Participants’ Demographics Demographic

Categories

Number

Percent

p value

Age

20–25 26–30 31–35 >35 Total Male Female Total No experience 1–5 5–10 >10 Total First Second Third Fourth Total Regular Bridged Total

74 18 8 1 101 20 81 101 52 35 12 2 101 3 24 23 51 101 48 53 101

73.3 17.8 7.9 1.0 100 19.8 80.2 100 51.5 34.7 11.9 2.0 100 3.0 23.8 22.8 50.5 100 47.5 52.5 100

Perceptions and Attitudes Toward NANDA-I Nursing Diagnoses: A Cross-Sectional Study of Jordanian Nursing Students.

To assess the perceptions and attitudes of undergraduate nursing students toward NANDA-I nursing diagnosis...
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