Chapter 17

Nursing Diagnosis

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 History of Nursing Diagnosis

 First introduced in 1950.

 In 1953, Fry proposed the formulation of a
nursing diagnosis.
 In 1973, first national conference 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, North American Nursing Diagnosis
Association (NANDA) was founded.
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 Case Study

 John is a first semester nursing student who is

particularly interested in 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. He wanted to select a career that
improves people’s lives.
 John is studying the steps of the nursing
process. He knows this information will help him
care for cardiac patients in the future.

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 Types of Nursing Diagnoses

 NANDA-I (2014) nursing diagnoses include:

 Problem-focused
 Risk
 Health promotion

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 Case Study (Cont.)

 John reviews the phases of the nursing

process, and attempts to put them in the
correct order.

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 Critical Thinking and the
Nursing Diagnostic Process
 The diagnostic process requires you to use
critical thinking.
 Helps to be thorough, comprehensive, and
accurate when identifying nursing diagnoses that
apply to your patients.
 The diagnostic reasoning process involves
using the assessment data gathered about a
patient to logically explain a clinical judgment
or a nursing diagnosis.

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 Data Clustering

 A data cluster is a set of cues, the signs or

symptoms gathered during assessment.
 Data clusters are compared with standards to
reach a conclusion about a patient’s response to
a health problem.
 Each clinical criterion is an objective or
subjective sign, symptom, or risk factor that,
when analyzed with other criteria, leads to a
diagnostic conclusion.

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 Case Study (Cont.)

 Because of John’s interest in cardiac nursing, he

is familiar with the clinical criteria for heart
disease. He is helping Beth, another
fundamentals student, understand them as well.
She tells him, “Hypertension, fatigue, preferring
fried foods, and high cholesterol are all clinical
criteria for heart disease, right?”
 John shakes his head. “Not quite,” he says.

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 Data Interpretation

 It is critical to select the correct diagnostic label

for a patient’s need.
 When comparing patterns, judge whether the
grouped signs and symptoms are expected for a
patient (e.g., consider current condition, history)
and whether they are within the range of healthy
responses.
 By isolating any defining characteristics not within
healthy norms, you can identify a specific problem.

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 Formulating a Nursing
Diagnosis Statement
 Identify the correct
diagnostic label with
associated defining
characteristics or risk
factors and a related
factor.
 A related factor allows
you to individualize a
nursing diagnosis for
a specific patient.

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 Formulating a Nursing
Diagnosis Statement (Cont.)
 Most settings use a two-part format in labeling
health promotion and problem-focused nursing
diagnoses.
 Some agencies prefer a three-part nursing
diagnostic label:
 Problem
 Etiology
 Symptoms

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 Case Study (Cont.)

 John is trying to remember the four types of

nursing diagnoses. He knows this is something
Beth has mastered, so he asks her about it, “Are
the four types of nursing diagnosis actual, risk,
wellness, and disease prevention?”

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 Cultural Relevance of
Nursing Diagnoses
 Consider patients’ cultural diversity when
selecting a nursing diagnosis. Ask questions
such as:
 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 cultural practices are important to you?
 Cultural awareness and sensitivity improve your
accuracy in making nursing diagnoses.

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 Case Study (Cont.)

 After his study session with Beth, John has a

better handle on nursing diagnoses. He knows
that a ______________ diagnosis is applied to
vulnerable populations.

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 Concept Mapping
Nursing Diagnosis
 A concept map helps you critically think about a
patient’s diagnoses and how they relate to one
another.
 Helps organize and link data about a patient’s multiple
diagnoses in a logical way.
 Graphically represents the connections among
concepts that relate to a central subject.

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 Sources of Diagnostic Error

 Errors occur during:

 Data collection
 Interpretation and analysis of data
 Clustering
 Diagnostic statement

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Sources of Diagnostic Error (Cont.)

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.

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Sources of Diagnostic Error (Cont.)

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.

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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.

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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.

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 Documentation and Informatics

 Once you identify a patient’s nursing diagnoses,

enter them either on the written plan of care or in
the electronic health information record (EHR) of
the agency.
 Computer helps organize data into clusters
 Enhances ability to select accurate diagnoses
 When initiating an original care plan, place the
highest-priority nursing diagnosis first.

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 Nursing Diagnosis:
Application to Care Planning
 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.

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