title: The interplay between global standards and local practice in nursing.
abstract: OBJECTIVE
  The paper assesses the extent, form, and transformation of global nursing classifications (NANDA) in a nursing practice during a period of 5 years.
  
  
  METHODS
  A longitudinal case study was used to trace implementation, adoption and use of nursing classifications as an integral part of an electronic nursing module. A mixed method of data collection was used, including semi-structured interviews, observation and document analysis.
  
  
  RESULTS
  A surprisingly high proportion of nursing diagnoses was consistent with the global standard, in spite of a gradual increase of user-generated concepts. This is elaborated more thoroughly through a co-constructing perspective, emphasizing how the global standard and the practice mutually shaped each other over several years.
  
  
  CONCLUSIONS
  Standardization is an iterative process that is performed in close relationship with practice. The mutual interrelation between formal classifications (NANDA) and local practices are co-constructed in a dynamic interplay that evolves over time. In such a process, the use of local classifications and local strategies can be a means to bridge the gap between these two extreme points.
authors.affiliation: Telemedicine Research Group, Department of Clinical Medicine, University of Tromsø, Norway. Electronic address: torbjorg.meum@uit.no.
authors.forename: Torbjørg
authors.initials: T
authors.lastname: Meum
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ellingsen
authors.forename: Eric
authors.initials: E
authors.lastname: Monteiro
authors.forename: Gro
authors.initials: G
authors.lastname: Wangensteen
authors.forename: Harald
authors.initials: H
authors.lastname: Igesund
mesh_terms: D014943:Global Health / Q000592:standards; D006801:Humans; D008137:Longitudinal Studies; D016347:Medical Records Systems, Computerized; D009729:Nursing / Q000592:standards*; D010347:Patient Care Planning / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*
keywords: Co-construction; Interplay between local and global standards; Nursing care plans; Nursing classifications