Consensus on Language Translations: Some thoughts and lessons learned.

A meeting was held in June, in Kassel, Germany, to discuss and resolve issues related to the German translation of the NANDA-I book Nursing Diagnoses: Definitions and Classification 2012-2014.

I have had the opportunity to participate in translation consensus meetings for German-speaking countries for the last two editions of  This might seem quite strange, because unfortunately, I have no German-language skill. (Thankfully, my German-speaking colleagues have a much greater mastery of English than I have of German!) However, I have found that these meetings provide a very important and helpful opportunity that could impact all language versions of our book – including the original English version!

As with any translation, the first issue is that of conceptual versus literal “word-for-word” translation. Literal translation is fairly straightforward and it is possible quite quickly to get all to agree that the need for conceptual clarity is most important.

For example the nursing diagnosis Disorganized infant behavior (00116) does not mean that the infant is “disorganized” (e.g., messy, confused, cluttered), but rather that his physiological and neurobehavioral responses are not well integrated. Therefore the translation of the diagnostic label must represent that diagnostic concept (infant behavior) and the nursing judgment (disorganized); it should not merely translate the three individual words, “disorganized” + “infant” + “behavior”. It is also critical that translation reviewers are aware of the nursing literature, to ensure use of terms that are already established in the nursing literature rather than developing new terms.

It is also quickly realized that words that are quite obvious in meaning to a native English speaker, are not so obvious to those for whom English is a second language. Even those for whom English is a strong second language find difficulties in the vagaries of some of our common English words. Take a simple example: what is the meaning of the phrase “lack of?" Does this mean "nonexistent" or does it mean "insufficient?" Unfortunately, in English it can mean either of these things. However, I learned that in the German language, the phrase "lack of" cannot be translated in the same way for both of those concepts – so we really need to specify "absence of" when we mean “nonexistent," and "insufficient" when we mean “not enough." This not only helps with the German translation - it clarifies the English meaning as well! These lessons learned have helped to institute the beginning of a list of standards, which we can use to clarify terms used in all of our diagnoses.

There are also grammatical inconsistencies that may not catch the attention of those of us who are English speaking, but which make a significant difference when trying to translate accurately. When a term is used in the singular in one place in a diagnosis, but in the plural in another, this is confusing and can, in some instances, lead to different words being used.

Finally, there are terms which may have apparently clear meanings, but which change across culture, or as knowledge and common use evolve over time. For example, how does NANDA-I define substance abuse? Does this relate to addictive chemical substances only, or could addiction to food be an example? When we say “addiction”, does this mean any addiction (e.g., gambling) or are we really meaning addictions to a chemical substance? Issues such as these need clarified to help with translation, but they will also help all clinicians to clearly understand the intent of the diagnoses.

Ultimately, clarification of what we mean when we say something translates to safer patient care, as a result of standardizing terms that can therefore support more accurate diagnosis – and isn’t that the point?