The DCO was first suggested as a nursing diagnosis during a regular organization meeting of the North American Nursing Diagnosis Association, now called NANDA International. Its defining characteristics were developed by a group of nurses attending the Second Conference Group on the Classification of Nursing Diagnosis in the USA in 1975. In 1980, the diagnosis of DCO was accepted and added to the classification; however, its related factors were not discussed until 1982 at the Fifth Conference Group on the Classification of Nursing Diagnosis and changes were made to its definition and defining characteristics at that time (Dougherty 1985, 1997). No further modifications have been made since then.