Chapter 17
Nursing Diagnosis
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Nursing Diagnosis
1. Medical
diagnosis
Identification of a disease
condition based on specific
evaluation of signs and symptoms
2. Nursing
diagnosis
Clinical judgment about the
patient in response to an actual or
potential health problem
3. Collaborative
problem
Actual or potential physiological
complication that nurses monitor
to detect a change in patient
status
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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History of Nursing Diagnosis
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First introduced in 1950
In 1953, Fry proposed the formulation of a
nursing diagnosis.
In 1973, the first national conference was
held.
In 1980 and 1995, the American Nurses
Association (ANA) included diagnosis as a
separate activity in its publication Nursing: a
Social Policy Statement.
In 1982, NANDA was founded.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study
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John is a first semester nursing student who is
particularly interested in the cardiac system and
specifically heart disease since his father died of a
heart attack at age 48. John decided to go into
nursing because of his father’s death, which
prompted him to select a career that improves
people’s lives.
John is studying nursing diagnoses in his nursing
fundamentals course and is learning the steps of the
nursing diagnostic process. He knows this
information will help him care for cardiac patients in
the future.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Nursing Diagnostic Process
Assessment of patient’s health status:
• Patient, family, and health care resources
constitute database.
• Nurse clarifies inconsistent or unclear
information.
• Critical thinking guides and directs line of
questioning and examination to reveal detailed
and relevant database.
Validate data with other sources.
Are additional data needed? If so, reassess.
If not, continue…
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Nursing Diagnostic Process
(cont’d)
If no additional data are needed, proceed:
Interpret and analyze meaning of data
Data clustering
• Group signs and symptoms.
• Classify and organize.
Look for defining characteristics
and related factors.
Identify patient needs.
Formulate nursing diagnoses
and collaborative problems.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Nursing Diagnostic Statements
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Provides a precise definition of a patient’s problem
that gives nurses and other members of the health
care team a common language for understanding
patients’ needs
Allows nurses to communicate what they do among
themselves and with other health care professionals
and the public
Distinguishes the nurse’s role from that of the
physician or other health care provider
Helps nurses focus on the scope of nursing practice
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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John reviews the phases of the nursing
process.
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Rank in correct order the phases of the nursing
process:
• Evaluation
• Planning
• Assessment
• Diagnosis
• Implementation
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Critical Thinking and the
Nursing Diagnostic Process
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The diagnostic reasoning process involves
using the assessment data you gather about
a patient to logically explain a clinical
judgment or a nursing diagnosis.
Nursing diagnoses and definitions
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Defining characteristics = Clinical criteria or
assessment findings
Related factors pertinent to the diagnoses
Interventions suited for treating the diagnoses
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Data Clustering
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A data cluster is a set of signs or symptoms
gathered during assessment that you group
together in a logical way.
Data clusters are patterns of data that contain
defining characteristics—clinical criteria
that are observable and verifiable.
Each clinical criterion is an objective or
subjective sign, symptom, or risk factor that,
when analyzed with other criteria, leads to a
diagnostic conclusion.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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Because of John’s interest in cardiac nursing,
he is familiar with the clinical criteria for heart
disease.
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Which of the following is an example of a clinical
criterion?
(Select all that apply.)
• Hypertension
• Fatigue
• Food preference
• High cholesterol
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Interpretation—
Identifying Health Problems
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It is critical to select the correct diagnostic label for a
patient’s need.
From assessment to diagnosis, move from general
information to specific.
Think of the problem identification phase in
assessment as the general health care problem
and the formulation of the nursing diagnosis as the
specific health problem.
The absence of certain defining characteristics
suggests that you reject a diagnosis under
consideration.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Formulating a Nursing Diagnosis
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A related factor is a condition, historical factor, or
causative event that gives a context for the defining
characteristics and shows a type of relationship with
the nursing diagnosis.
A related factor allows you to individualize a nursing
diagnosis for a specific patient.
When you are ready to form a plan of care and select
nursing interventions, a concise nursing diagnosis
allows you to select suitable therapies.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Types of Nursing Diagnoses
Actual Nursing Describes human responses
Diagnosis
to health conditions or life
processes
Risk Nursing
Diagnosis
Health
Promotion
Nursing
Diagnosis
Describes human responses to
health conditions/life processes
that may develop
A clinical judgment of
motivation, desire, and
readiness to enhance well-being
and actualize human health
potential
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Components of a Nursing Diagnosis
Diagnostic Label (NANDA-I) Definition
Related Factors/Etiology:
Treatment-related
Pathophysiological (biological or psychological)
Maturational
Situational (environmental or personal)
PES Format:
Problem
Etiology
Symptoms (or defining characteristics)
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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John learns the four types of nursing
diagnoses.
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Which of the following are the four types of
nursing diagnoses?
(Select all that apply.)
• Actual diagnoses
• Risk diagnoses
• Wellness diagnoses
• Health promotion diagnoses
• Disease prevention diagnoses
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Cultural Relevance of
Nursing Diagnoses
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Consider patients’ cultural diversity when
selecting a nursing diagnosis. Ask questions
such as:
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How has this health problem affected you and
your family?
What do you believe will help or fix the problem?
What worries you most about the problem?
Which practices within your culture are important
to you?
Cultural awareness and sensitivity improve
your accuracy in making nursing diagnoses.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Case Study (cont’d)
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John knows that a ______________
diagnosis is applied to vulnerable
populations.
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Concept Mapping
Nursing Diagnosis
A visual representation of a patient’s
nursing diagnoses and their relationships
with one another
Concept maps promote problem solving and
critical thinking skills by
organizing complex patient data,
analyzing concept relationships, and
identifying interventions.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Sources of Diagnostic Error
Data collection
Data clustering
Interpretation and analysis of data
Labeling the diagnosis/
the diagnostic statement
Documentation and informatics
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Quick Quiz!
1. Concept mapping is one way to
A. Connect concepts to a central subject.
B. Relate ideas to patient health problems.
C. Challenge a nurse’s thinking about patient
needs and problems.
D. Graphically display ideas by organizing data.
E. All of the above
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Diagnostic Statement Guidelines
1. Identify the patient’s response, not the medical
diagnosis.
2. Identify a NANDA-I diagnostic statement rather
than the symptom.
3. Identify a treatable cause or risk factor rather than
a clinical sign or chronic problem that is not
treatable through nursing intervention.
4. Identify the problem caused by the treatment or
diagnostic study rather than the treatment or study
itself.
5. Identify the patient response to the equipment
rather than the equipment itself.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Diagnostic Statement Guidelines
(cont’d)
6. Identify the patient’s problems rather than your
problems with nursing care.
7. Identify the patient problem rather than the nursing
intervention.
8. Identify the patient problem rather than the goal of care.
9. Make professional rather than prejudicial judgments.
10. Avoid legally inadvisable statements.
11. Identify the problem and its cause to avoid a circular
statement.
12. Identify only one patient problem in the diagnostic
statement.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Quick Quiz!
2. For a student to avoid a data collection error, the
student should
A. Assess the patient and, if unsure of the finding, ask a
faculty member to assess the patient.
B. Review his or her own comfort level and competency
with assessment skills.
C. Ask another student to perform the assessment.
D. Consider whether the diagnosis should be actual,
potential, or risk.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Nursing Diagnosis:
Application to Care Planning
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By learning to make accurate nursing
diagnoses, your care plan will help
communicate the patient’s health care
problems to other professionals.
A nursing diagnosis will ensure that you
select relevant and appropriate nursing
interventions.
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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