Experiences of Nursing Students With NANDA‐I Documentation at a Public University in Nigeria

ABSTRACT

Aim

The study explored the lived experiences in the utilisation of NANDA International Inc. (NANDA‐I) classification in the documentation of nursing care among nursing students in a selected Public University.

Design

A qualitative phenomenological approach was adopted, guided by a constructivist paradigm and Benner's Novice to Expert theory.

Methods

Qualitative approach was explored in this study. The second to fifth year nursing students, of similar age groups, and ward postings were included in the study. Those on part‐time and first year nursing students were excluded. This was done in one phase with the use of a focus group discussion guide (FGDs). Participants were engaged in FGDs. Ethical approval was obtained from the ethical review committee, and informed consent was taken from the participants. Data were collected for 2 months and analysed using themes with independent coding by multiple researchers to ensure inter‐coder reliability. The Consolidated criteria for reporting qualitative research “COREQ” was used.

Results

The study involved 20 participants, 15 of whom were female, with a mean age of 23 years (±2.0). Two (2) themes with various subthemes were extracted showing participants' lived experiences. These include (i) personal reflections, subthemes (Universality, Completeness, Uniformity, Decision making, and accurate documentation). (ii) Difficulty domain, subthemes (Comprehending terminologies and concepts, prioritising diagnoses, keeping up with updates and revisions of NANDA‐I, and selecting appropriate ‘related factor’).

Patient or Public Contribution

Nursing students and nurses increase usage of the NANDA‐I diagnoses, improve coordinated patient care, and should result in better quality of care.

1. Introduction

By accurately documenting nursing care, nurses not only provide high‐quality nursing care but also play a key role in inter‐professional team communication (Rinenggantyas et al. 2020). To provide patients with high‐quality care, nursing documentation is an essential source of information on their needs and nursing interventions (De Groot et al. 2022). Several standardised nursing terminologies are available to support standardised documentation, such as NANDA International Inc. (NANDA‐I) classification, Nursing Outcome Classification (NOC), and Nursing Intervention Classification (NIC) (Nantschev and Ammenwerth 2021). Recent literature reviews support the positive impact that nursing terminologies can have on describing patient outcomes (Bertocchi et al. 2023). Using Standardised Nursing Languages (SNLs) in clinical practice can improve communication and enhance the delivery of high quality of care (Fennelly et al. 2021). Other authors note that the use of nursing diagnoses can predict patient and organisational outcomes, and that nursing care plans based on nursing diagnoses can improve some outcomes (Sanson et al. 2017; Bertocchi et al. 2023).

Some nurses find it difficult to implement the NANDA‐I nursing diagnosis guidelines, which results in a knowledge gap that influences the process of making decisions about patient care outcomes, interventions, and diagnoses. This difficulty is exacerbated by differences in educational backgrounds and levels of understanding of nurses and nursing students. The NANDA‐I has worked to improve the quality of nursing diagnosis documentation (Rinenggantyas et al. 2020). SNL is essential in contemporary nursing practice and education for planning, implementing, and evaluating the quality of care. It also facilitates communication with patients and other healthcare providers regarding the significance of professional nursing (Ojo et al. 2020). SNLs have applications across specialties and circumstances (Mantovani et al. 2020).

Nursing diagnoses are categorised and arranged according to clinical categories using the NANDA‐I taxonomy (Sánchez‐Almagro et al. 2022). Although nurses acknowledge the existence of the Nursing Process and standardised nursing languages in clinical settings, they are not used very often. A 2020 study by Mutasha et al. (Mutshatshi et al. 2020) identified several issues that hinder this usage, including knowledge gaps. A lack of knowledge regarding the use of SNLs in patient care hinders clinical nurses' utilisation of the nursing process and SNLs (Mutshatshi et al. 2020). It is advantageous for nursing personnel to provide patient care by using standardised nursing terminology, especially NANDA‐I. Better patient care, higher‐quality interventions, enhanced data collecting for outcome evaluation, adherence to care standards, and simpler assessment of nursing competence are some of these advantages (Somanpio et al. 2021). There is a dearth of research on the actual experiences of second to fifth‐year nursing students with NANDA‐I in documentation.

According to some research, there are major obstacles. About half of the participants in Ardahan et al. (Ardahan et al. 2019) descriptive study of third‐ and fourth‐year nursing students demonstrated the need to formulate diagnoses. The students determined that the primary causes of these difficulties were a lack of experience and inadequate education (Ardahan et al. 2019). According to Ata and Çobanoğlu (Ata and Çobanoğlu 2022), most participants cared for patients for roughly 4 days a week; however, only a small percentage could identify five nursing diagnoses for their patients. ‘Risk of infection’ was the most used diagnosis. In contrast, Akay and Dalcalı (2023) found that diagnoses pertaining to difficulty, inventiveness, and clarity received the lowest marks. Ojo et al. (2022) identified challenges in Southwest Nigeria related to NANDA‐I biannual revisions and limited knowledge about using nursing diagnoses.

Numerous research studies have examined nursing students' experiences utilising NANDA‐I nursing diagnoses (Ata and Çobanoğlu 2022; Akay and Dalcalı 2023; Ojo et al. 2022; Özkan et al. 2020). After implementing group case studies, Özkan et al. (2020) found that 70.9% of students were able to identify diagnoses, compared to 92.7% following the study. According to Ardahan et al., in 2019, 51.0% of students did not apply NANDA‐I diagnoses successfully, compared to 49.0% who did. According to Ata and Çobanoğlu (2022), 92.6% of students wanted to incorporate nursing diagnoses into future practice, and 98.1% of students thought they had a favourable impact on the quality of care. Students at South Marmara concurred that safer and better organised care was made possible by NANDA‐I diagnosis (Akay and Dalcalı 2023).

In Southwest Nigeria, 94.2% of respondents thought case study presentation may improve the creation of precise diagnostic labels (Ojo et al. 2022). According to earlier research, the nursing process and documentation benefit greatly from the use of NANDA‐I nursing diagnoses, which also enhance interprofessional communication and patient care outcomes (Donizetti‐Trevisan et al. 2020). A World Health Organisation survey indicates that one of the main causes of medical errors is inadequate communication among medical staff. Research has shown gaps in the global documentation practices of nurses (Tasew et al. 2019), indicating a high frequency of errors and low‐quality records (Nigussie et al. 2023), and connecting inadequate documentation to patient mortality (Nigussie et al. 2023). Correct nursing diagnostics can shorten a patient's time in the hospital by quickly determining their problems and improving outcomes through nursing intervention.

Given the crucial role of accurate nursing documentation in patient care and safety, understanding nursing students' experiences and challenges with NANDA‐I is essential for improving education and practice. This study explored the students' lived experiences using NANDA‐I to document nursing care. It also explored the difficulties and coping strategies.

Aim of study: This study aims to explore students' lived experiences using NANDA‐I to document nursing care. We also explore the difficulties and adaptive approach involved in using NANDA‐I.

2. Methods

This study was an exploratory research design that adopted the qualitative tradition of inquiry. Due to the shared experiences and interpretive nature of NANDA‐I use, focused group discussions (FGDs) were deployed to explore the lived experiences of nursing students at a selected university using NANDA‐I to document nursing care.

The study was conducted in the Department of Nursing, University of Ibadan that was established in 1948. The University offers a B.N.Sc programme initiated in 1995, which now trains 252 undergraduate students with a lecturer‐to‐student ratio of 1:11. The programme focuses on clinical nursing, emphasising the use of standardised nursing languages such as NANDA International Inc. (NANDA‐I) classification, Nursing Outcome Classification (NOC), and Nursing Intervention Classification (NIC).

During the academic year 2022–2023, 252 undergraduate nursing students made up the target population. These second‐ through fifth‐year students receive training in the use of SNLs while documenting patient care. Because of their relationship to improving positive patient outcomes, NANDA‐I Nursing Diagnosis, Nursing Outcome Classification, and Nursing Intervention Classification are given special attention. These nursing languages are taught to the students in the Nursing Process course, which spans their second through fifth year of university education as student nurses as opposed to first‐year nursing students who are still enrolled in general science courses. Until they can reach their second year in the university, this group of students is simply a potential nursing student. Inclusion criteria were nursing students in the second to fifth years, of similar ward posting who were willing to participate. Exclusion criteria included part‐time students, non‐consenting students, and first‐year students.

2.1. Data Collection

Data were collected using a structured FGD guide, designed to address study objectives. At the time of this study, the investigators of this study were Professors of Nursing, PhD Nursing Science, and Sociologist. The Professors and PhD of Nursing served as the moderators of the session and the Sociologist observed the data collection process. These researchers are experienced in qualitative research and have published studies in this area. The researchers were of male and female gender. A pilot FGD was conducted to refine the guide based on feedback, ensuring clarity and relevance for students in another public tertiary institution. In this present study, four FGDs were implemented. One group each was constituted across higher academic years (second, third, fourth and fifth). There were five participants per group, totalling 20 participants. This approach ensures saturation and comprehensive data collection. The study employed consecutive sampling through continuous recruitment, selecting participants based on their consent and willingness to participate. Everyone was offered the opportunity to participate, and once the necessary number of participants was established, the rest were discarded. In addition to the academic year, other variables that were taken into consideration were the wards that the nursing students had been posted to during their clinical postings. The researchers who participated in the focus discussion did not in any way or at any point teach the students as their lecturers or preceptors. Therefore, there was no possible influence on the participants' discourse. FGDs were recorded with consent, and notes were taken to capture non‐verbal cues during the FGD. It was a face‐to‐face approach for the FGD session which was held in a designated hall within the study setting. The seating arrangements were carried out in such a way that there was no interference among the participants involved in each session. The data collection process spanned 2 months, with each FGD lasting less than an hour. The researchers recorded the session using an audio tape recorder and note‐taking. Saturation of information was reached. Data were collected in 2 months (January–February 2024). None of the participants dropped out of the study.

2.2. Data Analysis

Thematic/content analysis was employed to analyse the qualitative data from the FGDs. NVivo 12 software was used to facilitate data organisation, coding, and analysis. Two researchers independently coded the data, with a third researcher reviewing discrepancies. Inter‐coder reliability was established through discussion and consensus‐building when disagreements arose. Transcriptions were validated by the participants. To enhance the trustworthiness of the findings, several strategies were employed, including Investigator triangulation: Data were independently coded by two researchers and interpretations were compared and reconciled. Member checking: Preliminary findings were shared with a subset of participants to verify accuracy and resonance with their experiences. Peer debriefing: Regular discussions among the research team to challenge assumptions and explore alternative interpretations. Reflexivity: Researchers maintained reflexive journals to acknowledge and mitigate potential biases throughout the research process.

2.3. Methodological Rigour

To ensure methodological rigour, the following criteria for establishing trustworthiness in qualitative research were employed: Credibility was addressed through prolonged engagement with the data, member checking, and investigator triangulation. Transferability was enhanced through detailed descriptions of the research context and participant characteristics. Dependability was established by maintaining an audit trail of all methodological decisions and analytical processes. Confirmability was supported through reflexive practices and regular research team discussions to ensure findings were grounded in participants' accounts rather than researchers' biases or motivations.

2.4. Ethical Considerations

Ethical approval was obtained from the ethical review committee with the approval number REDACTED. The study adhered to ethical guidelines, ensuring privacy, confidentiality, and respect for participants. Participants provided informed consent and could withdraw at any time without consequences. The study involved no invasive procedures, requiring only participants' time.

3. Results

3.1. Socio Demographic Information of the Participants

There were N = 20 research participants, and most n = 9 were between the ages of 21 and 23 years. More than half n = 13 of the participants were Christians; there were no Hausa participants. There was an equal number n = 5 of participants across years of study and most n = 15 of the participants were females, as shown in Table 1.

TABLE 1.

Socio‐demographic information.

Characteristics	Categories	Frequency
Age Mean Age 23 ± 2.0 years	18–20 years 21–23 years 24–26 years 27–29 years	3 9 7 1
Religion	Christianity Islam Others	13 5 2
Ethnic group	Yoruba Hausa Igbo Others	14 0 3 3
Years of Study	Second year Third year Fourth year Fifth year	5 5 5 5
Gender	Male Female	5 15

3.2. Summary of Themes

The transcripts presented two themes (Lived experiences; Domains of NANDA‐I difficulties) and sub‐themes as shown in Table 2.

TABLE 2.

Summary of themes.

Themes	Sub‐themes	Findings
Theme 1: Lived experiences	Experiences of NANDA‐I –Familiar experience –Limited experience –Practical experience	Limited and familiar experiences is conveyed in terms of the participants sighting, actual use, or observing a third‐party's use of the NANDA‐I nursing diagnosis Practical experience in clinical settings and advancement through academic levels positively influence students understanding and utilisation of NANDA‐I, indicating the importance of practical experience in reinforcing theoretical knowledge The use of NANDA‐I nursing diagnosis facilitates efficient documentation of nursing care, enabling students to create care plans quickly and accurately
	Personal reflections on NANDA‐I –Universality –Completeness –Automation –Treatment –Uniformity –Decision making –Accurate documentation	NANDA‐I is described as a universal guide with significant value for diagnosis completeness, automation of care, uniformity of treatment approach, decision making and accurate documentation Participants feel NANDA‐I nursing diagnosis is a tool for monitoring patient treatment processes, that influences decision‐making and documentation Participants recognise the role of NANDA‐I nursing diagnosis in reducing documentation errors
Theme 2: Domains of NANDA‐I difficulties	Difficulty domains –Comprehending terminologies and concepts –Prioritising diagnoses –Keeping up with updates and revisions of NANDA‐I –Selecting appropriate ‘related factor’	Areas of NANDA‐I difficulties include comprehending terminologies and concepts, prioritising diagnoses, keeping up with updates and revisions of NANDA‐I, selecting appropriate ‘related factor’ is a challenge
	Coping strategies –Experienced nurses and lecturers' guidance –Interactive learning methods –Assistance from peers	Strategies to overcome the challenges faced when utilising NANDA‐I nursing diagnosis include seeking guidance from experienced nurses and lecturers, engaging in interactive learning methods, and utilising assistance from peers or online resources, continuous learning, open‐mindedness, and collaborative decision‐making Other strategies include selecting related factors that were most similar or applicable to the patient's condition, even if not explicitly stated in the NANDA‐I textbook

All quotes are indented with description of level of study of participants and the date of focused group discussion. The following are the themes and sub‐themes generated.

3.3. Experiences in the Use of NANDA‐I Nursing Diagnosis in Nursing Care Documentation

The participants have varying experience in the use of NANDA‐I in nursing care documentation. Some were familiar with the use of NANDA‐I nursing diagnosis in the documentation of nursing care, while others have limited experience.

The limited user experience of NANDA I relates to the year of study. The level of nursing training was observed to account for the limited experience. An example from a newer student noted thus—

There was a time in the ward when a patient had Anaemia and the nurse on duty asked us to state a nursing diagnosis related to the disease condition. That was because she was not aware that we were 200level students, she thought we were foreign trained nursing students. We didn't say the right diagnosis, so she used the NANDA‐I booklet to explain how to go about it. We came up with Ineffective tissue perfusion (Second year Nursing student: 18/04/2024)

Among more advanced students in year three and more, the level of familiarity with NANDA I was observably different. In FGD 2, the participants' response when asked to discuss specific experiences in the use of NANDA‐I in nursing care documentation was more detailed. The response implies that the participants have better experience compared to participants from FGD 1.

A participant said:

The specific experience I will be discussing is the one I had on the ward, where I was assigned to care for a baby with an ear infection. While going through the patient's nursing care plan, I noticed some nursing diagnosis that I personally felt were not appropriate for the patient and were not listed in order of priority. I had to use the NANDA‐I textbook to crosscheck the nursing diagnosis and their defining characteristics. It was a good experience for me (Third year Nursing student: 18/04/2024)

Another participant buttressed what the first speaker said while emphasising that the experience with the use of NANDA‐I diagnosis in clinical scenarios has added to his knowledge on nursing diagnosis. The participant was able to demonstrate that prior classroom experience with the use of NANDA I was valuable residual knowledge to bring into the clinical experience with the tool. The participant said:

My experience with the use of NANDA‐I nursing diagnosis in documentation of nursing care was on orthopaedic ward where my course mates and I were assigned to care for a patient with Fracture. We were able to write nursing diagnosis in order of priority for the patient using NANDA‐I nursing diagnosis textbook. This experience was on my first posting, prior to that time we have been taught NANDA‐I in class. It added to my knowledge of NANDA‐I nursing diagnosis (Third year Nursing student: 18/04/2024)

3.4. Personal Reflections on the Use of NANDA‐I

In FGD 1, it was revealed that the participants feel that the of NANDA‐I nursing diagnosis is universal, which enhances complete and automatic nursing care, and it serves as a guide in the accurate documentation of nursing care.

A participant said

I feel it helps a lot in planning patient care because when you have the guideline of what you're supposed to do, it will help plan patient care and the care rendered will be complete and automatic. It is better to use NANDA‐I in the documentation of nursing care. NANDA‐I serve as a guide in nursing care (Second year Nursing student: 18/04/2024)

To further support what the first participant said, another participant added:

I feel NANDA‐I nursing diagnosis is like a guide that every nurse and nursing students use in the documentation of patient care, and that is really good. It is universal, irrespective of the environment or location, the set of nursing diagnosis used in patient care documentation is the same. It brings uniformity to the nursing profession (Second year Nursing student: 18/04/2024)

Another participant said:

I feel the use of NANDA‐I influence decision making in terms of care, intervention and documentation (Third year nursing student: 18/04/2024)

More precisely, FGD 3 revealed that the student feels the use of NANDA‐I nursing diagnosis in the documentation of nursing care helps avoid documentation errors.

For example, a participant said:

To me, I feel the use of NANDA‐I nursing diagnosis is very effective and it cuts down a lot of possible errors. It helps you know what you want to do in clinical situations. For example, when choosing a nursing diagnosis for a patient, the related factors can serve as pointers to the appropriate intervention the patient needs (Fourth year nursing student: 15/03/2024)

3.5. Difficulties of Using NANDA‐I

The participants expressed various difficulties they encounter when utilising NANDA‐I nursing diagnosis in nursing care documentation, ranging from difficult understanding the concept of NANDA‐I nursing diagnosis to understanding the patient disease condition. The following challenges were encountered: comprehending terminologies and concepts, prioritising diagnoses, keeping up with updates and revisions of NANDA‐I, and selecting appropriate ‘related factor’.

3.5.1. Comprehending Terminologies and Concepts

The participants were able to express their experience in the use of NANDA‐I, which is one of the standardised nursing languages. Below is the excerpt:

In FGD 1, one of the participants stated that.

I think I'm not yet very conversant with the use of NANDA‐I. I have issues with understanding the ‘related to’ and ‘evidence by’ and this makes it difficult for me to formulate nursing diagnosis for patients on the ward (2nd year Nursing student: 18/04/2024)

In FGD 2, the participants' response when asked to discuss specific experiences in the use of NANDA‐I in nursing care documentation was more detailed. The response implies that the participants have better experience compared to participants from FGD 1.

A participant said:

The specific experience I will be discussing is the one I had on the ward, where I was assigned to care for a baby with an ear infection. While going through the patient's nursing care plan, I noticed some nursing diagnosis that I personally felt were not appropriate for the patient and they were not listed in order of priority. I had to use the NANDA‐I textbook to crosscheck the nursing diagnosis and their defining characteristics. It was a good experience for me (Third year Nursing student: 18/04/2024)

Another participant buttressed while emphasising that the experience with the use of NANDA‐I diagnosis in clinical scenarios has added to his knowledge of nursing diagnosis. The participants said:

My experience with the use of NANDA‐I nursing diagnosis in documentation of nursing care was on orthopaedic ward where my course mates and I were assigned to care for a patient with Fracture. We were able to write nursing diagnosis in order of priority for the patient using NANDA‐I nursing diagnosis textbook. This experience was on my first posting, prior to that time we were taught NANDA‐I in class. It added to my knowledge of NANDA‐I nursing diagnosis (Third year Nursing student: 18/04/2024)

3.6. Prioritising Diagnosis

The nursing students express that prioritising diagnosis is important when NANDA‐I is being used.

A participant said:

I have many experiences with the use of NANDA‐I. In most cases, assessment of the patient gives me intuition on the NANDA‐I nursing diagnosis that will best suit the patient. A patient that is not breathing well will have a diagnosis of ‘Ineffective Breathing Pattern’ related to the physical sign I can see (Fourth year nursing student: 15/03/2024)

Another participant described a specific scenario where she used NANDA‐I nursing diagnosis to document nursing care. She said:

There was a time I was posted to Burns unit where I cared for a critically ill patient that couldn't move from the bed. I carefully used the NANDA‐I textbook to select nursing diagnosis that specifically suited the patient's condition. I came up with a perfect one ‘disability associated with urinary incontinence’. NANDA‐I Nursing diagnosis helped me document the care I provided (Fourth year nursing student: 15/03/2024)

3.7. Keeping Up With Updates and Revisions

To keep abreast of the update and revision in the NANDA‐I diagnoses where concerns were raised by the participants.

In FGD 3, the participants expressed different difficulties they encounter when using NANDA‐I nursing diagnosis.

For example, one participant said:

The main difficulty I face with using NANDA‐I nursing diagnosis is how difficult it is to keep up with them because the diagnosis gets updated every three years. Sometimes I get so accustomed to the previous diagnosis that I might still use them unconsciously even when they have been updated (Fourth year nursing student: 15/03/2024)

Another participant said:

The difficulty I face using NANDA‐I nursing diagnosis is that even when I write the correct diagnosis some nurses on the ward may think it is wrong because they are not conversant with the new diagnosis. NANDA‐I nursing diagnosis gets reviewed every two years. Deciding on the right nursing diagnosis to use causes controversy (Fifth year nursing student: 24/03/2024)

3.8. Selecting Appropriate Related Factors

Selecting appropriate “related factors” was one of the concerns raised by the nursing student in the utilisation of NANDA‐I.

In FGD 4, a participant said:

In the use of NANDA‐I nursing diagnosis in documentation of nursing care the major difficulty I encounter is getting the appropriate ‘related factor’ because most times the signs and symptoms the patient present with does not fit the ‘related factors’ in NANDA‐I textbook. Most times I just write what I know (5th year nursing student: 24/03/2024)

Another participant said:

I picked the related factor that is most similar or applicable to what the patient is experiencing (Fifth year nursing student: 15/03/2024)

In FGD4, a participant said:

I pick the ‘related factor’ from my head instead of using the one in the NANDA‐I nursing diagnosis textbook, they do not relate to the patient condition. Sometimes I search for possible related factors on the Internet (Fifth year nursing student: 24/03/2024)

3.9. Adaptation to NANDA‐I Challenges

There are several ways through which participants adapt to the challenges associated with using NANDA I. They either ask nurses who are currently practising or check back with the lecturer.

In FDG 1, one of the participants stated that:

The nurse in the wards was helpful, she understood that we're beginners in using NANDA‐I and she carefully explained how to go about it using real life scenarios. I understood all she explained (Second year Nursing student: 18/04/2024)

Another participant said:

In a particular class on nursing process I asked the lecturer the difference between related to and evidence by and she explained elaborately (Second year Nursing student: 18/04/2024)

While another participant said:

When there is controversy on the appropriate nursing diagnosis to use for patient. We come together to discuss and pick the best (Fifth year nursing student: 24/03/2024)

4. Discussion

4.1. Socio‐Demographic Characteristics

The socio‐demographic findings above show that the majority of the respondents are within the age range of 21–23 years. The students are evenly distributed into different academic levels that are found suitable for the purpose of this study. Similar studies (Ardahan et al. 2019; Özkan et al. 2020) from the empirical review also reported similar socio‐demographic findings. The findings from this study show that the Nigeria policy on entry level, which is 18 years, could have accounted for the age range seen among the study participants.

4.2. Lived Experiences of Nursing Students on the Use of NANDA‐I in the Documentation of Nursing Care

The data shows that nursing students exhibit varying experiences with the use of NANDA‐I nursing diagnosis in the documentation of nursing care, with some displaying familiarity with NANDA‐I while others have limited exposure. One of the reasons for this discrepancy is that progression through academic levels and practical experience in clinical settings positively correlates with an increased lived experience in using NANDA‐I nursing diagnosis in the documentation of nursing care, indicating the importance of practical experience in reinforcing theoretical knowledge. This finding is consistent with previous literature that has shown that 3rd and 4th year nursing students are unable to determine nursing diagnoses appropriate to the patients due to being unable to receive sufficient education about diagnoses and a lack of experience (Ardahan et al. 2019). In addition, this study also found that the feelings evoked by using NANDA‐I varied among participants. While some perceived it as a universal guide facilitating complete and automatic nursing care, others initially found it daunting but later realised its practical utility in clinical practice. This variation in perception could be due to factors such as individual learning styles, prior exposure to nursing diagnosis concepts, and the level of support and guidance received during their education. Overall, the consensus suggests that NANDA‐I serves as a valuable tool in nursing education, promoting standardised care and minimising documentation errors. Similarly, according to a study conducted by Ata and Çobanoğlu (Ata and Çobanoğlu 2022) nursing students reported that their engagement with nursing diagnoses positively impacted the quality of care, and the majority of the participants indicated a preference for incorporating nursing diagnoses into their future professional practice. Özkan et al. (Özkan et al. 2020) identified that nursing students' use of nursing diagnosis is required. Similarly, a study by Husna et al. (Husna et al. 2019) revealed that the reason why fourth grade students perceived nursing diagnoses more positively than other classes could be the result of having more experience in using nursing diagnoses during their nursing education. These findings underscore the importance of integrating NANDA‐I into nursing curricula and clinical practice to enhance students' competency and confidence in providing quality patient care. Furthermore, these findings highlight the need for ongoing support and resources to ensure effective utilisation of NANDA‐I in diverse healthcare settings.

4.3. Difficulties Faced by Nursing Students in Using NANDA‐I Nursing Diagnosis in Documentation of Nursing Care

The findings from the focused group discussion among nursing students provided valuable insights into the several difficulties that the students encounter in the use of NANDA‐I nursing diagnosis in the documentation of nursing care. The difficulties they encounter include understanding NANDA‐I terminology and concepts like “related to”, comprehending disease conditions, and prioritising diagnoses. This study result is consistent with previous literature that found that nursing students experience difficulty in the utilisation of NANDA‐I nursing diagnosis (Ata and Çobanoğlu 2022; Kurt et al. 2024). This study also revealed that the majority of the participants find it difficult to prioritise nursing diagnosis. This finding is consistent with that of a study conducted by Ardahan et al. (Ardahan et al. 2019) that confirmed that out of the 241 students that participated in the study, 36.1% experienced difficulties during identification of the nursing diagnosis and 32.8% frequently during the phase of putting into order of priority. This implies there is complexity associated with using NANDA‐I nursing diagnosis. One reason for these challenges could be the complexity associated with applying theoretical knowledge to practical situations, particularly for students who may not have had extensive clinical exposure.

Results also revealed that the majority of the participants expressed that keeping up with updates and revisions of NANDA‐I nursing diagnosis is a major challenge they encounter. This finding is in alignment with a previous study in Southwest Nigeria, which revealed that one of the difficulties experienced in the use of NANDA‐I is keeping up with biennial changes of NANDA‐I (78.3%) and insufficient information on the use of nursing diagnoses (Ojo et al. 2022).

The findings from this study also revealed that the strategies the student used to overcome the challenges faced when utilising NANDA‐I nursing diagnosis include seeking guidance from experienced nurses and lecturers, engaging in interactive learning methods, and utilising assistance from peers or online resources. Continuous learning, open‐mindedness, and collaborative decision‐making are key factors in effectively overcoming difficulties related to the use of NANDA‐I in nursing care documentation. This highlights the importance of support, critical thinking, and collaboration in overcoming the associated challenges among nursing students.

Another major challenge students encounter when using NANDA‐I nursing diagnosis in the documentation of nursing care is selecting appropriate ‘related factors’. To overcome this difficulty, some participants mentioned selecting related factors that were most similar or applicable to the patient's condition, even if not explicitly stated in the NANDA‐I textbook. This indicates the need for further refinement in teaching methodologies to enhance students' ability to apply theoretical knowledge to clinical practice. A study by Enebeli et al. (2023) in Calabar, Nigeria, found that nurses encounter some problems in formulating correct nursing diagnoses (Enebeli et al. 2023). However, another study conducted by Özkan et al. (2020) identified that prior to the group case study, 35.9% of the students had difficulty in finding a diagnostic label and 29.9% of them had difficulty writing PES (Problem, Aetiology, Symptom), and after the group case study, only 2.5% of the students had difficulty in writing the diagnostic label, and 47.9% had trouble writing the PES (Problem, Aetiology, Symptom) section of the care plan (Özkan et al. 2020). This underscores the impact of structured learning experiences on students' ability to formulate accurate nursing diagnoses.

4.4. Limitation of the Study

The limitations of the study are that the study was conducted with a small sample size and a specific group of nursing students who are undergraduates. This may limit the generalisability of the findings to other nursing student populations in other public universities in the country. Despite this limitation, enough spectrum of experiences was captured regarding the perspectives of utilisation of NANDA‐I nursing diagnosis among nursing students.

5. Conclusion

The findings of this study highlight the lived experiences of nursing students utilising NANDA‐I nursing diagnosis in the documentation of nursing care. It is evident that participants exhibit varying levels of experience in utilising NANDA‐I, with practical experience in clinical settings and academic progression positively influencing their understanding and utilisation of this framework. Despite encountering challenges such as understanding NANDA‐I terminology, keeping up with updates, and selecting appropriate related factors, the participants of this study recognise the importance of NANDA‐I in facilitating efficient documentation, monitoring patient treatment processes, and reducing documentation errors.

5.1. Implication of the Study

5.1.1. Nursing Practice

Nursing students while on clinical posting can leverage the knowledge gained from this study. It is evident that the growth in knowledge, skills, and implementations across the spectrum of years 2–5 on Nursing diagnoses varies. In addition, students and practising nurses can benefit from continuous education and training on NANDA‐I terminology and concepts to stay updated in utilising this framework in their daily practice. Institutions and healthcare organisations can offer workshops, seminars, and online resources to support nurses in this endeavour. This will optimise the utilisation of NANDA‐I nursing diagnosis and enhance the delivery of high‐quality patient care.

5.1.2. Nursing Research

The findings provide insight into the lived experiences of nursing students in the utilisation of NANDA‐I among nursing students in patient diagnoses. This study will serve as an important addition to current literature; researchers can build upon these findings to conduct more robust studies that contribute to the advancement of nursing knowledge and practice.

5.1.3. Nursing Education

Nursing educators can use the study findings to inform curriculum development and teaching strategies aimed at enhancing students' understanding and utilisation of NANDA‐I nursing diagnosis. Incorporating practical experiences, interactive learning methods, and peer support mechanisms can better prepare students for clinical practice. For instance, in year 2 they learn the terminology of NANDA‐I while in years 3–5 in clinical practice the students can begin a NANDA‐I plan with diagnosis, related to, as evidenced by, and implementations. It will also inform educators and clinical preceptors about the effectiveness of current educational methods and enable targeted interventions to enhance student competence in using NANDA‐I for accurate and comprehensive nursing documentation.

5.1.4. Nursing Policy

The challenges faced by students and inconsistencies regarding NANDA‐I use in documentation could inform policy changes to promote standardised and efficient documentation practices. This study may uncover a need for a faculty development programme to ensure educators are well‐versed in NANDA‐I and can effectively guide students.

5.2. Recommendation

Based on the findings of this study, the following recommendations were made:

• Nursing education programmes should incorporate more practical experiences in clinical settings to reinforce theoretical knowledge and enhance utilising NANDA‐I nursing diagnosis.

• Students should be encouraged to seek guidance from experienced nurses, lecturers, and utilise online resources to overcome challenges associated with understanding and selecting appropriate NANDA‐I diagnoses.

• There is a pressing need to digitalise NANDA‐I nursing diagnoses in Nigeria by integrating them into electronic health records (EHRs). This would address the challenges associated with manual searching and enable quicker access to relevant diagnoses, ultimately enhancing efficiency in nursing care documentation. In the need for updating with changes as they occur biannually.

5.3. Suggestion for Future Studies

Conducting a comparative analysis of nursing students' lived experiences with NANDA‐I utilisation across different institutions. By comparing the experiences of students at the study setting with those from other nursing institutions in the country or internationally, researchers can gain insights into how curriculum differences and institutional factors impact the utilisation of NANDA‐I nursing diagnosis. This comparative analysis can inform best practices in nursing education and curriculum development, fostering greater consistency and effectiveness in nursing care documentation practices.

Author Contributions

Study design: I.O.O., F.T.M. and I.A.A. Data collection: I.O.O., F.T.M. and O.O.O. Data analysis: F.T.M., I.A.A.and O.O.O. Study supervision: E.K.A., A.A.O. and P.O.A. Manuscript writing: I.O.O., F.T.M. and I.A.A. Critical revisions for important intellectual content: I.O.O., I.A.A. and O.O.O.

Disclosure

Artificial Intelligence: The authors did not use artificial intelligence tools to write any part of this manuscript.

Conflicts of Interest

The authors declare no conflicts of interest.

Ojo, I. O. , Mohammed F. T., Adedeji I. A., et al. 2026. “Experiences of Nursing Students With NANDA‐I Documentation at a Public University in Nigeria.” Nursing Open 13, no. 1: e70324. 10.1002/nop2.70324.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.