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Creating nursing diagnoses requires the application of detailed
assessment skills, critical thinking, and decision making. The
formulation of nursing diagnoses is related to competency in diagnostic
reasoning which students begin in their first year.
A diagnosis is a statement that synthesizes (brings together) assessment
data. It is a label that describes a situation (or state) and implies an
etiology (reason) and gives evidence to support the inference.
The North American Nursing Diagnosis Association (NANDA) defines
nursing diagnosis as a clinical judgment about individual, community or
family responses to community to actual or potential health problems or
life processes. All types of diagnoses are similar.
A nursing diagnosis limits the diagnostic process to those
diagnoses that represent individual responses to actual or potential
health problems that nurses are licensed to treat. Outcomes are usually
noticeable within a designated time frame.
A family nursing diagnosis is an extension of a nursing
diagnosis to the family system and/or subsystems and is the outcome of
family assessment. It includes actual or potential health problems that
nurses are capable and licensed to treat by virtue of their education and
A community diagnosis differs in that it is focused on an
aggregate or a community (rather than an individual). It requires a
multidisciplinary action to address or treat, and multiple determinants
must be considered when planning interventions. Outcomes of an action
may not be visible for a long time.
A wellness diagnosis describes human responses to levels
of wellness in an individual, family or community that have the

potential for enhancement to a higher state. This document will focus on

writing wellness diagnoses for the community.
A Diagnostic Statement has at least three parts:
1. The first part is the human response of the client to illness,
injury or significant change. This response could be an actual
problem, an increased risk of developing a problem, or an
opportunity /intent to improve the clients health.
2. The second part of the diagnostic statement names those factors
related to the response. Usually there is more than one factor.
The diagnostic statement does not necessarily claim a cause &
effect link between these factors and the response, ONLY that
there is a connection between them. We use the term related to
to express this section of the statement
3. The third part lists the clues/evidence/cues/data that supports the
nurses claim that the diagnosis is in fact the case. This portion is
expressed by the phrase: as evidenced by.
EXAMPLE: possible death anxiety related to lack of knowledge about
diabetes control as evidenced by patient sobbing and
asking how much time she has left.
The family diagnosis is basically written like a nursing diagnosis except
that it refers to a family system or subsystem.
EXAMPLE: Ineffective marital and parental role performance related
to arrival of another baby, heavy child-care
responsibilities, and inadequate family coping patterns as
evidenced by mother stating that she is feeling
overwhelmed, is unable to stop siblings from fighting,
and husband working overtime every day.

There are four parts to a community diagnosis;
1. a description of the problem, response, or state (risk, concern,
issue, potential or actual),
2. a statement of the aggregate, population, community, or focus
DIAGNOSIS, the focus is added
3. an identification of factors etiologically related to the problem
( factors), and
4. those signs and symptoms (manifestations) that are
characteristic of the problem.
EXAMPLE: a risk of low birth rate among pregnant adolescents in
the downtown area related to inadequate income and use of
tobacco as evidenced by insecure housing, use of the food bank,
unemployment rates, and smoking rates among pregnant teens.
NOTE: The italicized area indicates the focus portion of the
diagnosis (for teaching purposes only).
a. Characteristics:
Sometimes called positive or health oriented diagnoses.
Focus is on a community or aggregate.
Require multidisciplinary action to address or enhance.
Multiple determinants must be considered when planning
Outcomes/ actions may not be visible in the short term.
There is usually a desire for a higher level of wellness.
Sometimes an effective program or status is present and there is a
desire to improve the functioning.
Focus is on existing or potential community strengths.

b. Nurses Role in Wellness Diagnoses:

The role of the nurse is basically to facilitate healthy responses in order
to reach a higher level of health oriented goals. There is a progression
from one level of wellness to a higher level of wellness. For example, the
nurse can help clients to complete transitions, to achieve higher levels of
wellness or to attain wellness status. Health promotion plays a
significant role.
c. Components:
As stated above, there are four (4) components to any community
diagnosis including a wellness diagnosis.
a. Issue or State: A description of the response or state.
b. Focus: the population, aggregate or community of focus.
c. Etiology: Causal factors. The identification of the factors
etiologically (causally) related to the desired response or statewritten as related to.
d. Manifestation: Data that support the etiologic inference.
Manifestations or signs & symptoms that are characteristic of the
current status or condition written as: as evidenced by.

A. There is an opportunity to improve the health status (Issue

Description) of adolescent pregnant women (Focus) related to
effective parenting, stress reduction & smoking cessation (Etiology)
as evidenced by maintaining presence at school, receiving social
assistance, enrolling in the Best Beginning Program & providing
support ( Manifestations).
B. There is a potential for healthy life styles in adolescents in the
Greater Essex County District School Board related to their
expressed desire to learn about nutrition and physical activity as
evidenced by their participation in the integrated school
curriculum with its emphasis on healthy life style components.

C. There is a potential for enhanced parenting skills for mothers of

preschool children in the downtown Windsor area related to their
information seeking behaviours and their attendance at Parenting
Classes as evidenced by staff reports and self assessments.
The following guidelines can be used to develop the statement:
1. State a human response and not a client need.
2. Start the diagnostic statement with the human response.
3. Connect the first part (human response) to the second part
(etiology) with the term related to not due to or caused
4. Be sure that the first two sections are not just restatements of
each other.
5. Do not mention a medical diagnosis in either of the first two
6. Several factors may be involved in the etiology (part two) so you
can include them.
7. Select an etiology that can be changed by nursing intervention.
8. Avoid judging the client as bad in any part of the diagnostic
9. Avoid suggesting that any member of the health care team is not
doing his/her job.
10. Put the cues that led to the diagnosis in the third part (defining
characteristics), preceded by the phrase as evidenced by.


Since the etiology will drive the nursing interventions, this must be an
area in which nursing can intervene.
If the client has a knowledge deficit this will be indicated in the
etiology section and not stated as a client response to a problem. A
knowledge deficit is a reason for a client response. (e.g. Potential risk

for falls related to a knowledge deficit of home safety measures as

evidenced by). We would not say, A knowledge deficit of home
safety measures related to potential risk for falls as evidenced by.
The knowledge deficit itself is not a response but rather a reason for a
clients response or lack of response.


Freidman, M.M., Bowden, V.R., & Jones, E.G. (2003). Family nursing:
Research, theory, and practice. (5th ed.). New Jersey: Prentice Hall.
Sparks, S.M., & Taylor, C.M. (2001). Nursing diagnosis reference
manual. (5th ed.). Pennsylvania: Springhouse.
Stammler, L.L. & Yiu, L. (Eds.). (2008). Community health nursing: A
Canadian perspective. (2nd.ed.). Toronto: Pearson.
Stolte, K.M. (1996). Wellness: Nursing diagnosis for health promotion.
Philadelphia: J.B. Lippincott.
Vollman, A.R., Anderson, E.T. & McFarlane, J. (2004). Canadian
community as partner: Theory and practice in nursing. Philadelphia:
Lippincott Williams & Wilkins.

Prof. M Sutton Fall 2008

Revised September 10, 2012