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Patients' education and behaviour change are the first step in a patient's recovery, and patient education and behaviour change are factors that affect the results of the execution of the nursing diagnosis of this study. Patient education and behaviour change require nurses' time and other resources, and this represents a limiting factor in the application of the instrument to perform the assessment of the care relationship in the observation of this NANDA nursing diagnosis.
Another important factor is the need for hospital and specialised community resources, because none of the nurses had received training on the instrument for use in nursing care planning. This was confirmed by results in the literature.[@R21] [@R35] [@R38] [@R42] Likewise, the NANDA diagnoses are not adequate for use in clinical practice.
However, nurses should be trained so that they can apply NANDA diagnoses in nursing clinical practice, which can make an important contribution to improving patients' health, preventing complications and morbidity, and reducing costs and resources.[@R43] Thus, NANDA offers the opportunity for nurses to apply NANDA principles as a means for analysing their daily practice and providing leadership in quality of care.[@R44]
Therefore, appropriate training for nurses is a fundamental component for the application of this instrument in nursing.
When the NANDA-I was applied, some nurses suggested changes in the instrument. These changes would improve the instrument, but it was not possible in the present study because only one version of the NANDA-I was validated for the Portuguese language. The validation of the NANDA-I should include a revision process of each nursing language, because there 0b46394aab