Nursing diagnoses are a cornerstone of modern healthcare, providing a standardized approach to patient care planning. Rooted in the nursing process, these diagnoses are distinct from medical diagnoses and focus on a patient’s response to health conditions. Central to this system is the NANDA nursing diagnosis list, a comprehensive resource that helps nurses formulate accurate and effective care plans. This article delves into the world of nursing diagnoses, exploring their importance, types, and how to utilize NANDA lists to enhance patient outcomes.
What is a Nursing Diagnosis and Why is it Important?
A nursing diagnosis is a clinical judgment made by a registered nurse about a patient’s response to actual or potential health problems or life processes. It’s a crucial step in the nursing process, differing fundamentally from a medical diagnosis. While a medical diagnosis identifies a disease or pathology (e.g., pneumonia), a nursing diagnosis describes the patient’s reaction to that condition (e.g., ineffective airway clearance related to pneumonia).
According to NANDA International, Inc. (NANDA-I), the leading authority in this field, a nursing diagnosis is defined as:
“a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community. A nursing diagnosis provides the basis for selecting nursing interventions to achieve outcomes for which the nurse has accountability.”
This distinction is vital. Nursing diagnoses allow nurses to address the holistic needs of patients, encompassing their physical, psychological, social, and emotional well-being. By focusing on patient responses, nurses can create personalized care plans that target specific needs and promote optimal health outcomes.
Nurse assessing patient records for care plan
Common nursing diagnoses nurses encounter include:
- Pain Management: Acute pain, Chronic pain
- Respiratory Issues: Impaired gas exchange, Ineffective airway clearance, Ineffective breathing pattern
- Infection Control: Risk for infection
- Mobility and Activity: Activity intolerance, Impaired physical mobility, Impaired bed mobility
- Mental Health: Anxiety, Acute confusion, Chronic confusion
- Skin Integrity: Impaired skin integrity, Risk for pressure ulcer
- Cardiac Function: Decreased cardiac output
- Gastrointestinal Issues: Diarrhea, Constipation
- Self-Care Deficits: Bathing self-care deficit, Dressing self-care deficit, Feeding self-care deficit
The Nursing Process: The Foundation for Care Plans and Nursing Diagnoses
The nursing process is a systematic, five-step approach that nurses use to provide patient care. Nursing diagnoses are a critical component of this process, specifically within the second step: Diagnosis. The five steps are:
- Assessment: Gathering comprehensive patient data, including physical, psychological, social, cultural, spiritual, and lifestyle factors. This step often involves a thorough head-to-toe nursing assessment.
- Diagnosis: Analyzing the assessment data to formulate nursing diagnoses. This is where NANDA nursing diagnosis lists become invaluable.
- Planning (Outcomes Identification): Setting patient-centered goals and desired outcomes based on the nursing diagnoses. These outcomes guide the development of the nursing care plan.
- Implementation: Putting the care plan into action, which may involve administering medications, providing patient education, and performing specific nursing interventions.
- Evaluation: Continuously monitoring the patient’s progress, evaluating the effectiveness of interventions, and adjusting the care plan as needed.
The nursing process is iterative and dynamic. Evaluation findings often lead to reassessment and revisions in the care plan, ensuring patient care remains responsive to changing needs.
Nursing Diagnosis vs. Medical Diagnosis: Key Differences
It’s essential to differentiate between nursing and medical diagnoses. Medical diagnoses, made by physicians or advanced practitioners, focus on identifying diseases or pathological conditions. Nursing diagnoses, in contrast, are made by registered nurses and focus on the patient’s response to health conditions or life processes.
Consider a patient with pneumonia. The medical diagnosis is “pneumonia.” However, possible nursing diagnoses could include:
- Ineffective airway clearance related to increased mucus production secondary to pneumonia.
- Impaired gas exchange related to alveolar-capillary membrane changes secondary to pneumonia.
- Activity intolerance related to fatigue and shortness of breath secondary to pneumonia.
Two patients with the same medical diagnosis can have vastly different nursing diagnoses based on their individual responses and needs. Nursing diagnoses consider the patient’s pain levels, emotional state, coping mechanisms, and available resources – elements often outside the scope of a medical diagnosis.
Understanding the Diagnostic Axes in NANDA Nursing Diagnoses
NANDA-I utilizes a multi-axial system to provide a comprehensive framework for nursing diagnoses. These axes represent different dimensions of the human response that nurses must consider for accurate diagnosis:
- Diagnostic Focus (Axis 1): The core concept of the diagnosis, such as “pain,” “anxiety,” or “impaired mobility.”
- Subject of Diagnosis (Axis 2): Who the diagnosis is about: individual, family, group, or community.
- Judgment (Axis 3): Descriptors that refine the diagnostic focus, like “impaired,” “ineffective,” or “readiness for enhanced.”
- Location (Axis 4): The body part or function affected, such as “respiratory system” or “skin.”
- Age (Axis 5): The patient’s age group: infant, child, adolescent, adult, older adult.
- Time (Axis 6): The duration of the issue: acute, chronic, intermittent, continuous.
- Status of Diagnosis (Axis 7): The type of diagnosis: problem-focused, health promotion, risk, or syndrome.
While not every diagnosis explicitly states all axes, understanding them allows for a more nuanced and comprehensive approach to diagnosis formulation. For example, “Acute Pain in Right Knee in Adult” implicitly covers axes 1 (pain), 3 (acute), 4 (knee), and 5 (adult).
Types of Nursing Diagnoses: Tailoring Care to Patient Needs
Nurses utilize four main types of nursing diagnoses to address the diverse needs of patients:
- Problem-Focused Nursing Diagnosis: Identifies an existing problem or undesirable human response to a health condition. It’s supported by defining characteristics (signs and symptoms) and related factors (etiology). Example: “Impaired skin integrity related to prolonged pressure as evidenced by stage II pressure ulcer on sacrum.”
- Health-Promotion Nursing Diagnosis: Focuses on a patient’s desire to improve their well-being and health potential. It’s applicable when a patient expresses readiness to enhance specific health behaviors. Example: “Readiness for enhanced nutrition as evidenced by patient expressing interest in learning about healthy eating habits.”
- Risk Nursing Diagnosis: Indicates a patient’s vulnerability to developing a problem. Risk factors, which are environmental, physiological, psychological, genetic, or chemical factors that increase vulnerability, must be present. Example: “Risk for infection related to surgical incision and immunosuppression.”
- Syndrome Nursing Diagnosis: A cluster of nursing diagnoses that frequently occur together and can be addressed with similar interventions. Example: “Disuse Syndrome” which encompasses diagnoses like Risk for constipation, Risk for impaired skin integrity, and Impaired physical mobility.
Utilizing the NANDA Nursing Diagnosis List in Care Plans
The NANDA-I nursing diagnosis list is an essential tool for nurses. It provides a standardized language for describing patient problems and facilitates clear communication among healthcare team members. The list is organized by domains and classes, covering a wide spectrum of human responses.
Here are examples from the NANDA-I list, categorized by domain and class:
| Domain | Class | Examples of Nursing Diagnoses |
|---|---|---|
| Health Promotion | Health Awareness | Sedentary Lifestyle |
| Health Management | Frail Elderly Syndrome, Ineffective Health Maintenance | |
| Nutrition | Ingestion | Imbalanced Nutrition: Less Than Body Requirements, Readiness for Enhanced Nutrition, Impaired Swallowing |
| Metabolism | Risk for Unstable Blood Glucose Level | |
| Hydration | Risk for Electrolyte Imbalance, Deficient Fluid Volume, Excess Fluid Volume, Risk for Imbalanced Fluid Volume | |
| Elimination and Exchange | Urinary Function | Impaired Urinary Elimination, Functional Urinary Incontinence, Overflow Urinary Incontinence, Reflex Urinary Incontinence, Stress Urinary Incontinence, Urge Urinary Incontinence, Urinary Retention |
| Elimination and Exchange | Gastrointestinal Function | Constipation, Risk for Constipation, Diarrhea, Bowel Incontinence |
| Elimination and Exchange | Respiratory Function | Impaired Gas Exchange |
| Activity/Rest | Sleep/Rest | Insomnia, Disturbed Sleep Pattern |
| Activity/Rest | Activity/Exercise | Risk for Disuse Syndrome, Impaired Bed Mobility, Impaired Physical Mobility, Impaired Wheelchair Mobility, Impaired Sitting, Impaired Standing, Impaired Transfer Ability, Impaired Walking |
| Activity/Rest | Energy Balance | Fatigue, Wandering |
| Activity/Rest | Cardiovascular/Pulmonary Responses | Activity Intolerance, Ineffective Breathing Pattern, Decreased Cardiac Output, Ineffective Peripheral Tissue Perfusion |
| Self-Care | Bathing Self-Care Deficit, Dressing Self-Care Deficit, Feeding Self-Care Deficit, Toileting Self-Care Deficit | |
| Perception/Cognition | Attention | Unilateral Neglect |
| Perception/Cognition | Cognition | Acute Confusion, Chronic Confusion, Deficient Knowledge, Readiness for Enhanced Knowledge, Impaired Memory |
| Perception/Cognition | Communication | Readiness for Enhanced Communication, Impaired Verbal Communication |
| Self-Perception | Self-Concept | Hopelessness, Readiness for Enhanced Self-Concept |
| Self-Perception | Self-Esteem | Chronic Low Self-Esteem |
| Self-Perception | Body Image | Disturbed Body Image |
| Role Relationship | Caregiving Roles | Caregiver Role Strain, Risk for Caregiver Role Strain |
| Role Relationship | Family Relationships | Dysfunctional Family Processes |
| Role Relationship | Role Performance | Impaired Social Interaction |
| Sexuality | Sexual Function | Sexual Dysfunction |
| Coping/Stress Tolerance | Post-Trauma Responses | Risk for Relocation Stress Syndrome |
| Coping/Stress Tolerance | Coping Responses | Anxiety, Ineffective Coping, Death Anxiety, Fear, Grieving, Complicated Grieving, Powerlessness |
| Coping/Stress Tolerance | Neurobehavioral Stress | Risk for Autonomic Dysreflexia |
| Life Principles | Value/Belief/Action | Readiness for Enhanced Spiritual Well-Being, Decisional Conflict, Spiritual Distress |
| Safety/Protection | Infection | Risk for Infection |
| Safety/Protection | Physical Injury | Ineffective Airway Clearance, Risk for Aspiration, Risk for Bleeding, Risk for Falls, Risk for Injury, Impaired Dentition, Risk for Pressure Ulcer, Impaired Skin Integrity, Impaired Tissue Integrity |
| Safety/Protection | Violence | Risk for Suicide |
| Safety/Protection | Environmental Hazards | Risk for Poisoning |
| Safety/Protection | Defensive Processes | Risk for Allergy Response |
| Safety/Protection | Thermoregulation | Hyperthermia, Hypothermia |
| Comfort | Physical Comfort | Impaired Comfort, Nausea, Acute Pain, Chronic Pain |
| Comfort | Social Comfort | Risk for Loneliness |
| Growth/Development | Development | Risk for Delayed Development |
Using this list, nurses can select the most appropriate diagnoses for their patients, ensuring that care plans are comprehensive and address all relevant patient needs.
How to Formulate a Nursing Diagnosis for Effective Care Planning
Formulating a nursing diagnosis involves a specific process that links the diagnosis label with related factors and defining characteristics. A well-written nursing diagnosis statement includes:
- Diagnosis Label (Problem): The NANDA-I approved name for the diagnosis, representing the patient’s problem or health need.
- Related Factors (Etiology): The “related to” phrase, indicating the factors contributing to or associated with the patient’s problem. This helps identify the cause of the diagnosis.
- Defining Characteristics (Signs and Symptoms): The “as evidenced by” phrase, listing the observable cues, signs, and symptoms that support the diagnosis.
For example: “Impaired Physical Mobility related to pain and stiffness as evidenced by patient reports of difficulty walking and limited range of motion in lower extremities.”
To develop accurate nursing diagnoses, nurses should:
- Analyze Assessment Data: Carefully review subjective and objective data collected during the patient assessment.
- Identify Patterns: Look for clusters of signs and symptoms that suggest a particular nursing diagnosis.
- Consult NANDA-I List: Utilize the NANDA-I list to select the most appropriate diagnosis label.
- Determine Related Factors: Identify factors contributing to the problem.
- List Defining Characteristics: Document the specific signs and symptoms that support the diagnosis.
- Document the Diagnosis: Ensure the nursing diagnosis is clearly and accurately documented in the patient’s chart.
Accurate nursing diagnoses are the foundation of effective nursing care plans. They ensure that interventions are targeted, patient-centered, and contribute to positive health outcomes. By mastering the use of NANDA nursing diagnosis lists and the principles of diagnosis formulation, nurses can significantly enhance the quality of care they provide.
Sources:
- NANDA International, Inc.
- American Nurses Association
