Chapter Three
Part Two
Nursing Diagnosis in Education:
A Guideline for Students
Nursing Diagnoses in Education:
A Guideline for Students
Contributors
Fritz Frauenfelder
Maria Müller-Staub
Margaret Lunney
What is Nursing?
ICN Definition of Nursing
• “Nursing Encompasses Autonomous and Collaborative Care of
Individuals of All Ages, Families, Groups and Communities, Sick or
Well and in All Settings”
• “Nursing Includes the Promotion of Health, Prevention of Illness, and
the Care of Ill, Disabled and Dying People”
• “Advocacy, Promotion of a Safe Environment, Research, Participation
in Shaping Health Policy and in Patient and Health Systems
Management, and Education are Also Key Nursing Roles”
(International Council of Nurses 2010)
Be Aware
Nursing is a…
• Complex Process with Different Steps and Facets
• Challenging Process Because Nurses Work with Human
Beings
• Difficult Process that has to be Learned
Nursing Demands…
• A Variety of Skills
• A Huge Amount of Knowledge
Learning Strategy #1
Nursing Process
Nursing Process
Assessment
Diagnosis
Information collection/
gathering data
Information interpretation
Stating problems and strengths
Evaluation
Planning
Patient’s status
and effectiveness
of nursing interventions
Implementation
Setting goals with patients
and
choosing interventions
Performing
nursing interventions
The phases of the nursing process are interrelated, forming a continuous circle of thought and action that is both
dynamic and cyclic (ANA 2009; Doenges and Moorhouse 2008)
Nursing Process
Nursing Process is a Dynamic Interrelated Process that
Requires:
• Critical Thinking
• Critical Reading
• Critical Appraising
• Knowledge from the Arts and Sciences
• Professional Communication Skills
Learning Strategy #2
Nursing Diagnosis
Nursing Diagnosis Definition
Nursing Diagnosis is:
•A Clinical Judgment about Individual, Family, or Community
Experiences/Responses to Actual or Potential Health Problems or Life
Processes
•Nursing Diagnoses Provide the Basis for Selection of Nursing
Interventions to Achieve Outcomes for Which the Nurse has Accountability
(Herdman 2012)
Types of Nursing Diagnoses
Actual Diagnosis (Sometimes Referred to as a “Problem”
Diagnosis)
Describes Human Responses or Experiences to Health Conditions and Life
Processes that Exist in an Individual, Family, or Community
Risk Diagnosis
Describes Human Responses to Health Conditions and Life Processes that
may Develop in a Vulnerable Individual, Family, or Community
(Herdman 2012)
Types of Nursing Diagnoses
Health Promotion Diagnosis
Describes Human Responses to Increase Well-Being and Actualize Human
Health Potential as Expressed in Their Readiness to Enhance Specific Health
Behaviors in an Individual, Family or Community
Syndrome
A Cluster or Group of Nursing Diagnoses that Tend to Occur Together
(Herdman 2012)
Learning Strategy #3
The Structure of Nursing Diagnosis
The Structure of Nursing Diagnosis
Actual or Problem Nursing Diagnoses are Composed of:
• Nursing Diagnosis Label and Problem Definition
 Naming and Defining the Problem
• Etiologies or Causes
 Related Factors
• Signs and Symptoms
 Defining Characteristics
The Structure of Nursing Diagnosis
Nursing Diagnosis Definition
Explains the Patient’s Response or Problem:
• A Concise Phrase Representing the Problem Description
• Describes Individual Response of Patient
• Developed by Nurse Submitters and Approved by NANDA-I
The Structure of Nursing Diagnosis
Related Factors
Are the Etiologies or Causes of a Diagnosis:
• Influence the Response or Problem
• Identify One or More Probable Causes of the Response or Problem that
can be Addressed by Nurses
• Can be Joined to Problem Part of Diagnosis with Phrase “Related to”
• Provide the Basis for Selecting Nursing Interventions for Problem
Resolution or Improvement
The Structure of Nursing Diagnosis
Defining Characteristics
Are the Signs and Symptoms of a Diagnosis:
• Assessment Data Provide Observable and Subjective (Patient
Verbalized) Cues or Evidence that Verify the Presence of the Diagnosis
• Can be Connected to Diagnosis Label with “As Manifested By” or “As
Evidenced By”
• Provide the Basis for Selecting Nursing Interventions for Symptom
Control, When Nurses Cannot Influence the Related Factor(s) of the
Diagnosis
The Structure of Nursing Diagnosis
Risk Diagnoses are Composed of:
• Label
• Definition
• Risk Factors
The Structure of Nursing Diagnosis
Example
Risk for Falls (Nursing Diagnosis Label)
Definition
Increased Susceptibility to Falling that may Cause Physical Harm
The Definition Describes the Risk, Delineates its Meaning and Helps to
Differentiate This Risk from Other Phenomena
The Structure of Nursing Diagnosis
Risk Factors
The Patient is at Risk — the Problem has Not Occurred Yet, Therefore No
Etiologies are Present, But the Patient has Risk Factors
Risk Factors
• Increase the Vulnerability of a Patient
• Influence the Development of Problems
• Provide the Basis for Selecting Nursing Interventions to Prevent the
Condition from Occurring
The Structure of Nursing Diagnosis
Health Promotion Diagnoses are Composed of:
Label and Definition
The Defining Characteristics are Cues Indicating that the Patient Desires
Help with Health Promotion
Defining Characteristics
Express the Patient’s Willingness to Enhance Health Status
Learning Strategy #4
How to Identify the Patient’s Problems, Risk
States, or Readiness for Health Promotion
Assessment
Definition
•The Nursing Assessment is a Systematic Method of Collecting Data that
Consists of the Appraisal of an Individual, Family, Group or Community
for the Purpose of Identifying Health Problems, Risk States, Readiness
for Health Promotion, and Strengths
•The Nursing Assessment has to be Systematic, Holistic, Accessible,
Communicated and Documented
There are Two Kinds of Assessments:
•History and Physical (H&P) Assessment
•Focused Assessments
Assessment
The Purpose of the Assessment Process:
To Understand the Worldview of the Individual, Family, Group or
Community in Consideration of Cultural Aspects, Gender, Age,
Physiological, Psychological and Emotional Responses to Health and Life
Events
NOTE: Worldview Encompasses People’s Philosophies, Beliefs, Attitudes,
and Experiences
Primary Sources: Individual (Patient, Family, Group or Community
Members)
Secondary Sources: Family or Significant Others, Nurses, the Health
Record, Other Health Care Professionals
Learning Strategy #5
How to Identify Nursing Diagnoses
Diagnostic Reasoning
Clustering Information:
•Data Gathered in the Interview, Physical Examination, and from Other
Sources are Recorded in a Systematic Way and Grouped into Similar
Categories
•An Evidence-based Nursing Assessment Framework that Links to Nursing
Diagnoses is a Helpful Tool, e.g. Gordon’s Functional Health Patterns
(Gordon 2008)
•Clustering Data Assists in Focusing the Nurse’s Attention on Relevant
Information
Diagnostic Reasoning
The Challenge:
To Detect Human Responses or Experiences on the Basis of
Interactions with the Individual and the Nurse’s Cultural Competence
Diagnostic Reasoning
Analyzing Assessment Information:
•Organize Data
•Identify Cues to Diagnoses
•Validate Data Interpretations
•Verify Findings:
•Compare Interviews with Physical Exam
•Clarify Ambiguous Statements
•Double-Check Abnormal Findings
•Check Contradicting Findings
(Lunney 2009)
Diagnostic Reasoning
Identifying Cues:
•A Cue is a Unit of Data (For Example, Respiratory Rate is 36 Breaths
Per Minute) that Influences Decisions to Choose a Nursing Diagnosis
• Cues Point to Changes, Strengths, Risk States, and Readiness for
Health Promotion
• Cues may Indicate Developmental Delays or Deviations from Health
Norms
(Gordon 2008)
Diagnostic Reasoning
Validate Diagnostic Hypotheses:
• Compare Information Against Standards
• Identify Gaps and Inconsistencies
• Consider Alternative Explanations for Findings
• Collect Additional Information as Indicated
• Confirm with the Patient or Family
Learning Strategy #6
Implementing and Documenting in
the Nursing Care Plan
Effective Use of Nursing Diagnosis
Linkages:
Connect NANDA-I Diagnoses with Further Evidence-Based
Classifications for the Implementation Phase of the Nursing Process:
•Nursing Outcome Classification (NOC)
•Nursing Interventions Classification (NIC)
(Bulecheck et al. 2008; Herman 2012; Moorhead et al. 2008)
Effective Use of Nursing Diagnosis
General Approach:
•If Possible, Treat the Related Factors with Nursing Interventions to Prevent
or Reduce the Impact of Related Factors on the Individual
•If Not Possible o Treat Related Factors, Treat the Defining Characteristics
to Achieve Symptom Control
References
American Nurses’ Association (2009) The Nursing Process: A Common Thread
Amongst All Nurses. Kansas City: American Nurses Publishing.
Bulecheck G, Butcher H, Dochterman J. (eds) (2008) Nursing Interventions Classification
(NIC), 5th edn. St Louis, MO: Mosby/Elsevier.
Doenges ME, Moorhouse MH. (2008) Application of Nursing Process and Nursing Diagnoses.
Philadelphia: F.A. Davis.
Doenges ME, Moorhouse MH. (2008) Nurse’s Pocket Guide: Diagnoses, Prioritized
Interventions, and Rationales, 11th edn. Philadelphia: F.A. Davis.
Gordon M. (2008) Assess Notes: Nursing Assessment and Diagnostic Reasoning.
Philadelphia: F.A. Davis.
Herdman TH. (ed.) (2012) NANDA International Nursing Diagnoses: Definitions
and Classification, 2011-2014. Oxford: Wiley-Blackwell.
International Council of Nurses (2010) www.icn.ch/
Lunney M. (2009) Critical Thinking to Achieve Positive Health Outcomes. Ames,
IA: Wiley-Blackwell
Moorhead S, Johnson M, Maas M, Swanson E. (eds) (2008) Nursing Outcomes Classification
(NOC), 4th edn. St Louis, MO: Mosby.