Supporting and Hindering Factors in the Use of Nursing Diagnosis in Romanian Healthcare: A Multilevel Regression...

In an increasingly complex healthcare system, the use of nursing diagnosis is considered a gold standard of care and has become more integrated into clinical practice. Many countries have introduced policies to support the use of nursing diagnosis and align them with international nursing standards. In Romania, accreditation requirements have recently incorporated nursing diagnosis into clinical practice. However, although a legal framework exists, it remains unclear whether individual and organizational factors promote their use in daily practice.

This study aims to examine the associations between individual factors (nurses' education, attitudes, and self-directed learning) and organizational factors (department size and type) and the use of nursing diagnosis in clinical practice, while accounting for theoretically relevant confounders.

A cross-sectional survey was conducted among clinical and managerial nurses in Romanian hospitals. A total of 691 nurses participated, and the final sample included 589 participants. Data were collected using a multistage sampling strategy and analyzed using multilevel regression modeling.

Multilevel regression analysis showed that positive attitudes and formal education were significantly associated with nursing diagnosis use, while lack of formal education or reliance on self-training was associated with lower use. Greater time dedicated to self-directed learning was associated with increased use. Older age, male gender, and larger department size were negatively associated with nursing diagnosis use, while use was lower in emergency and intensive care units compared to medical departments.

Both individual and organizational factors are associated with the use of nursing diagnosis. Education, self-directed learning, and positive attitudes support their use, while department characteristics, older age, and male gender are associated with lower use. Targeted training and the promotion of self-directed learning may enhance the use in clinical practice.

Nurse leaders should promote nursing diagnosis-focused education and continuing professional development tailored to nurses' prior training, support opportunities for self-directed learning, and implement structural measures in larger departments and adapted protocols in high-acuity settings where lower use was observed.