Integration of NANDA International Nursing Diagnoses Into Italian Operational Procedures During the Digital Transition: A Narrative Review (2015-2024) (Preprint)

BACKGROUND he digital transformation of the Italian National Health Service (NHS), accelerated by the National Recovery and Resilience Plan, requires the adoption of standardized terminology to ensure semantic interoperability and the measurability of care. NANDA International (NANDA-I) nursing diagnoses represent a critical standardized taxonomy for improving care quality and enabling digital health integration. OBJECTIVE This narrative review analyzes the state of integration of NANDA International (NANDA-I) nursing diagnoses into hospital and community operational procedures in Italy from 2015 to 2024, identifying implementation patterns, barriers, and opportunities for advancement in the context of digital transformation. METHODS A narrative review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) guidelines. A systematic search on PubMed, CINAHL, and Scopus yielded 54 selected sources, including legislative acts and peer-reviewed studies. Methodological quality was rigorously appraised using the Mixed Methods Appraisal Tool (MMAT), applying a strict inclusion threshold of ≥60% to ensure robustness of the evidence. Thematic analysis was conducted using NVivo 14 (Lumivero, Burlington, MA, USA) to identify recurring implementation patterns. RESULTS The analysis reveals a heterogeneous implementation landscape across Italy. Northern regions (e.g., Emilia-Romagna, Tuscany) have successfully embedded NANDA-I into Electronic Health Records (EHRs) through regional mandates, whereas Southern regions face significant infrastructural and organizational challenges. Evidence confirms that standardized taxonomies improve diagnostic accuracy, patient safety outcomes (specifically fall prevention and heart failure management), and care continuity across settings. CONCLUSIONS The integration of NANDA-I represents a strategic asset for the digital evolution of the Italian NHS. To achieve full interoperability and measurability of care, future efforts must focus on mandatory nursing education, establishment of national interoperability standards (SNOMED-CT mapping), and bridging the digital divide between northern and southern regions. Implementation of standardized nursing terminology is essential for realizing the full potential of digital health transformation in Italian healthcare.