Why are some current NANDA-I diagnosis labels considered symptoms rather than nursing diagnoses, and what examples are given?

Some NANDA-I labels are considered symptoms rather than nursing diagnoses because they do not fit the multiaxial structure: they name a symptom using only a focus term (axis 1), sometimes with a time qualifier (axis 6), but they lack an explicit judgment term from axis 3. Examples include constipation (00011), insomnia (00095), wandering (00154), hopelessness (00124), fear (00148), hyperthermia (00007), acute confusion (00128), chronic sorrow (00137), and acute pain (00132).

The NANDA-I classification uses a multiaxial system in which diagnosis labels should include both a focus (axis 1) and a judgment (axis 3) describing the nurse's appraisal of the human response. Some current labels, however, are constructed only with a focus term, or with a focus plus a time qualifier (axis 6), but no judgment term. These labels essentially name a symptom, such as constipation, insomnia, or acute pain, rather than a nursing diagnosis. Because the judgment is missing, it is unclear what exactly the nurse is assessing or concluding about the symptom, such as its presence, severity, or self-management. Additionally, terms like anxiety (00146) and fatigue (00093) are classified as diagnoses but also appear as defining characteristics of other nursing diagnoses, creating confusion about whether they should be diagnosed separately or treated as indicators of another condition. The text suggests these symptom labels may need to be reconceptualized, placed in a secondary classification, or removed from the nursing diagnosis classification.