Source of Diagnoses. Now to further answer the question of how an idea becomes an accepted nursing diagnosis in the NANDA system. The NANDA is the only group in nursing classification that has a formal review process. Diagnoses for review and possible classification are accepted from any nurse or group of nurses. Submission and staging guidelines are published (North American Nursing Diagnosis Association, 1997, pp.89-94). Staging reflects multiple levels of development and research. For example, guidelines begin with a "received for development" category in order to offer consultation from the Diagnosis Review Committee to the submitter. Publication during the review of a submitted diagnosis in the Nursing Diagnosis journal offers opportunities for comments from other nurses.

The review of a submitted diagnosis is coordinated hy the NANDA Diagnosis Review Committee consisting of seven elected members. The reviewer uses

1. nurse-experts in the content of the diagnosis and
2. specialty organizations who wish to participate.

Participation of nursing specialty organizations is important. Some organizations have submitted high frequency diagnoses in their specialty that are not already classified (Association of Rehabilitation Nurses, the former ANA Council of Psychiatric-Mental Health Nurses, Holistic Nurses, Association of Operating Room Nurses, etc.). The Association of Rehabilitation Nurses submitted new diagnoses from a research study that involved a national, random sample of members. This Association also funded a study that resulted in publication of 21 rehabilitation nursing diagnoses-intervention-outcome linkages (Rehabilitation Nursing Foundation, 1995).

A recent, but major source of diagnostic submissions is the collaborative project between NANDA and project directors, Drs. Martha Craft-Rosenberg and Connie Delaney, at University of Iowa. The Nursing Diagnosis and Extension Classification (NDEC) Project is designed to refine current diagnoses, reference the source of defining characteristics, and extend the classification (Craft-Rosenberg and Delaney, 1997). Teams working on the project review the literature, do concept analysis of existing diagnoses, and generate new concepts when suggested by the literature. This work sets the stage for clinical validation and epidemiological studies.