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Nursing Diagnosis
Chapter 12
12-2Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Nursing Diagnosis
The term nursing diagnosis is used in three different contexts:• Data analysis and decision-making process• Diagnostic label• Classification system
12-3Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Definition of a Nursing Diagnosis (NANDA, 1996)
“A clinical judgment about individual, family or community responses to actual and potential health problems/life processes”
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Comparison of Medical and Nursing Diagnoses
Medical and nursing diagnoses both use the comprehensive diagnostic process in making a clinical judgment and determining expected outcomes.
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Comparison of Medical and Nursing Diagnoses
Medical diagnosis is the terminology used for a clinical judgment by the physician that identifies or determines a specific disease, condition, or pathologic state.
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Nursing Diagnosis
Terminology used for a clinical judgment by the professional nurse that identifies the client’s actual, risk, wellness, or syndrome responses to a health state, problem, or condition.
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Comparison of Nursing and Medical Diagnoses
Nursing diagnoses differ from medical diagnoses in:• Purpose• Goals• Therapeutic Interventions
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Comparison of Medical and Nursing Diagnoses
“Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.” (NANDA, 1996)
12-9Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Historical Perspective
Fry (1953) identified that nursing diagnosis is a tool for individualizing patient care.
First National Conference for the Classification of Nursing Diagnoses, (1973).
American Nurses Association (ANA) published Standards of Nursing Practice (1973).
12-10Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Historical Perspective
North American Nursing Diagnosis Association (NANDA), 1982.
NANDA developed 21 new nursing diagnoses and revised 37 existing diagnoses (1998).
Development of an ad hoc research committee (1998).
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Purposes of Nursing Diagnosis
Identifies areas that nurses can resolve or enhance.
Demonstrates professional judgment. Organizes decision making as part of the
nursing process. Promotes accountability.
12-12Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Purposes of Nursing Diagnosis
Provides communication among nurses and other health care personnel.
Promotes use of standardized language and process.
A means to individualize care. Provides a mechanism for conducting
nursing research.
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Nursing Diagnoses and Diagnostic-Related Groups (DRGs)
The DRG coding system for prospective payment financing (1983) is based on the medical model and medical diagnoses.
There are no set codes for nursing diagnosis or care.
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Components of a Nursing Diagnosis
The two-part statement • Problem statement or diagnostic label • Etiology
The diagnostic label and etiology are linked by the term related to (RT).
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Components of a Nursing Diagnosis
The three-part statement • Diagnostic Label• Etiology • Defining Characteristics
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The Three-Part Statement
Defining characteristics are the signs and symptoms, subjective and objective data, or clinical manifestations.
The phrase, “as evidenced by …” (AEB), is joined to the first two components.
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Categories of Nursing Diagnoses
Actual Diagnoses Risk Diagnoses Wellness Diagnoses
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Taxonomy of Nursing Diagnosis
A taxonomy is a system of classification. Taxonomy II
• Current NANDA-approved system for identification and naming of nursing diagnoses.
• Categorizes NANDA-approved nursing diagnoses by patterns of response.
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Nine Patterns of Human Response
Exchanging Moving Perceiving Knowing Feeling
Communicating Relating Valuing Choosing
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Developing a Nursing Diagnosis
Critical thinking Assessing the
database Validating cues Interpreting cues
Clustering cues Consulting NANDA
list of nursing diagnoses
Writing the nursing diagnostic statement
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Developing a Nursing Diagnosis
Critical thinking is essential to the synthesis and interpretation of information when developing a nursing diagnosis.
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Developing a Nursing Diagnosis
Assessing the Data Base • Cues are small amounts of data gathered
during assessment.• Cues raise suspicion.• Cues stimulate further observation.• Cues stimulate further data collection.
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Developing a Nursing Diagnosis
Validating Cues• Verifying subjective and objective data for
accuracy and completeness
Interpreting Cues• Assigning meaning to data cues
Clustering Cues• Grouping related data together
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Developing a Nursing Diagnosis
Consulting NANDA List of Nursing Diagnoses• The clustered data are matched with a
NANDA diagnosis.
Writing the Nursing Diagnosis Statement• The NANDA list provides the diagnostic
label and etiology.
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Avoiding Errors in Developing a Nursing Diagnosis
Accurate and complete collection of data. Use of an organizational framework for
clustering data cues. Thorough analysis and validation of data. Correct writing of the nursing diagnosis.
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Limitations of Nursing Diagnosis
Lack of consensus among nurses regarding the NANDA-approved nursing diagnosis list.
Disagreement over specific label in the classification system.
Perception that the list is confining, incomplete, medically oriented, confusing.
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Limitations of Nursing Diagnosis
Nurses are overworked and have less time with clients.
Care is still organized around the medical diagnosis.
Nurses are afraid they may be ridiculed for using nursing diagnoses.
The nursing diagnosis list does not always fit the client situation.
12-28Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Limitations of Nursing Diagnosis
Nurses may be unable or unwilling to use nursing diagnoses because of incomplete knowledge.
If a nursing diagnosis is inappropriate, and as a result, the interventions are inappropriate or lacking, the nurse is liable for these errors in judgment.
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Overcoming Barriers to Nursing Diagnosis
Familiarity of nursing diagnosis language empowers the nurse to communicate more effectively.
Health care agency administrators and medical staffs need to be more supportive of the use of nursing diagnoses.
12-30Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Overcoming Barriers to Nursing Diagnosis
Enhanced communication between clinical nurses and leaders will increase the development of nursing diagnoses.
Most nursing education programs offer standardized content related to nursing diagnoses.
Experienced nurses need opportunities to review nursing diagnoses.
12-31Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc.
Overcoming Barriers to Nursing Diagnosis
Every attempt should be made to describe phenomena that do not fit into existing nursing diagnosis language.
The nurse may be on the threshold of documenting a new nursing diagnosis.
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