Nursing diagnoses are the cornerstone of effective patient care. They provide a standardized approach for nurses to identify, address, and monitor patient health needs within their scope of practice. Unlike medical diagnoses, which focus on disease pathology, nursing diagnoses center on a patient’s response to illness or life situations. This article delves into the essential aspects of nursing diagnoses, with a particular focus on the NANDA-I classification for 2024-2026, offering a comprehensive guide for healthcare professionals.
Understanding the Nursing Process and Nursing Diagnosis
The nursing process is a systematic, five-step approach that serves as the foundation for all nursing practice. Nursing diagnoses are integral to this process, providing a framework for clinical decision-making and patient-centered care. These steps are:
Assessment: This initial phase involves gathering both subjective and objective data about the patient. This data encompasses physical, emotional, psychological, lifestyle, socioeconomic, and cultural factors. Assessments may include vital signs, activity levels, medication history, lab results, and overall health history.
Diagnosis: Following data collection and analysis, nurses identify actual or potential health problems. This is where nursing diagnoses become crucial. By analyzing assessment data, nurses develop a clinical picture, understanding potential health issues and their underlying causes, which then informs the patient’s care plan.
Planning: In this stage, nurses develop individualized care plans with both short-term and long-term goals, tailored to the patient’s specific needs. Prioritization is key, with immediate, life-threatening conditions taking precedence, followed by identified risks.
Implementation: This involves putting the care plan into action. Nurses carry out the planned interventions, documenting all actions to ensure continuity of care and effective communication among the healthcare team.
Evaluation: The final step evaluates the effectiveness of the implemented interventions. Goals are reviewed to determine if they have been met or if modifications are needed. This may necessitate revisiting earlier stages of the nursing process to revise the care plan based on changes in the patient’s health status.
The nursing process is dynamic and adaptable, not always linear, requiring nurses to adjust their approach based on evolving patient data and health outcomes. Nursing diagnoses are the driving force within this process, facilitating ongoing assessment, prioritization, organization, and ultimately, positive health outcomes.
The Significance of Nursing Diagnoses in Healthcare
Nursing diagnoses are vital in all healthcare settings, promoting evidence-based, high-quality patient care. Their benefits are multifaceted:
- Enhanced Team Collaboration: Nursing diagnoses foster clear and consistent communication among nurses and the entire healthcare team. Standardized terminology ensures everyone is on the same page regarding patient needs and care strategies.
- Framework for Consistent Care: The standardized language of nursing diagnoses outlines specific assessments and interventions, promoting consistent, evidence-based practice and informed clinical decision-making across different nurses and shifts.
- Educational Tool for Nurses: For new nurses, understanding nursing diagnoses is crucial for developing critical thinking skills and building confidence. It helps them grasp how diagnoses fit into the nursing process, familiarizing them with potential interventions and care pathways.
- Improved Risk Identification: Many nursing diagnoses are risk-focused, alerting the care team to potential problems before they escalate. For example, “Risk for Bleeding” prompts nurses to monitor patients on anticoagulants for signs of hemorrhage.
- Goal Setting for Patient Care: Nursing diagnoses highlight care priorities, encompassing current issues, potential risks, and health promotion opportunities. Once a diagnosis is established, nurses can collaborate with patients to set priorities, interventions, and achievable goals.
- Patient Education and Empowerment: Many nursing diagnoses inherently involve patient teaching. Nurses can identify knowledge deficits related to medication management, health conditions, nutrition, coping mechanisms, and more. Addressing these deficits through targeted education empowers patients to actively participate in their care and achieve wellness goals.
- Documentation and Accountability: Accurate documentation is paramount in healthcare. Documenting nursing diagnoses, interventions, and outcomes provides a clear record of care provided, ensuring continuity and protecting nurses legally.
Nursing diagnoses are the bedrock of effective nursing care plans. They guide nursing actions, ensuring structured assessment, prioritization, organization, and ultimately, better patient outcomes.
Nursing Diagnosis vs. Medical Diagnosis: Key Distinctions
While both nursing and medical diagnoses rely on clinical judgment and share some terminology, they are fundamentally different. Medical diagnoses, typically made by physicians, identify diseases or pathologies using systems like the International Classification of Diseases (ICD). Mental health professionals utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Nurses, while understanding these systems, use nursing diagnoses developed and standardized by NANDA International, Inc. (NANDA-I).
A key difference lies in who makes the diagnosis. Nursing diagnoses are made by nurses within their scope of practice, whereas medical diagnoses are made by physicians (or in some cases, by nurse practitioners who can also make medical diagnoses in many states).
Furthermore, the focus differs. Medical diagnoses pinpoint the disease itself. Nursing diagnoses, conversely, focus on the patient’s response to health problems or life processes. This response can be physiological, psychological, or psychosocial. By focusing on the patient’s unique response, nurses can tailor interventions to address and modify these responses, promoting patient well-being.
Consider these examples to clarify the distinction:
Example 1:
A patient with a medical diagnosis of stroke (cerebrovascular accident) might also receive the nursing diagnosis of Risk for Aspiration. The medical diagnosis informs the nurse about the underlying condition, which is crucial for anticipating potential complications. The nursing diagnosis then directs care towards preventing aspiration and ensuring patient safety.
Example 2:
For a patient medically diagnosed with dehydration, the corresponding nursing diagnosis might be Deficient Fluid Volume. Recognizing the medical diagnosis helps the nurse understand the physiological basis for the fluid deficit. The nursing diagnosis then guides interventions such as administering IV fluids and monitoring fluid balance.
Nursing and medical diagnoses are complementary. They work together to create a holistic understanding of the patient’s condition, guiding comprehensive and effective care.
NANDA-I: The Global Authority on Nursing Diagnoses
Originally, NANDA was an acronym for the North American Nursing Diagnosis Association. However, with its global reach, it is now known simply as NANDA International, Inc. (NANDA-I). This organization is the leading authority in standardized nursing terminology, providing resources, education, and a framework for nursing diagnoses used worldwide.
NANDA-I’s Mission and Purpose
NANDA International’s core mission is to improve patient care globally by standardizing nursing terminology. They achieve this through rigorous, evidence-based research and the development of clear, consistent nursing diagnoses. Standardized diagnoses are essential for:
- Evidence-Based Practice: Providing a foundation for evidence-based nursing practice by offering a clear, research-backed terminology.
- Improved Communication: Facilitating effective communication among nurses and across healthcare disciplines through a common language.
- Consistent Documentation: Ensuring consistent and standardized documentation of nursing care, enhancing patient safety and data analysis for quality improvement.
NANDA-I continually updates and refines its classification system, releasing new editions biennially with revised, added, or retired diagnoses, reflecting the evolving nature of healthcare and nursing knowledge. The latest edition is the 2024-2026 NANDA-I Nursing Diagnoses: Definitions and Classification.
Key Components of a NANDA Nursing Diagnosis
NANDA-I nursing diagnoses are structured with specific components to ensure clarity and facilitate accurate application. Not all components are required for every diagnosis, but understanding them is crucial for effective diagnosis and intervention planning.
Diagnosis Label
This is the concise, standardized term or name given to a specific nursing diagnosis. It’s derived from the NANDA-I taxonomy and provides a common language for nurses. The diagnosis label should accurately reflect the patient’s health state or response.
Related Factors
Related factors are the underlying causes, contributing factors, or “etiology” of a problem-focused, syndrome, or sometimes health promotion nursing diagnosis. They are conditions or circumstances associated with the patient’s health issue. Identifying related factors is crucial for developing targeted interventions. While the exact cause may not always be known, understanding contributing factors guides effective care.
Defining Characteristics
These are observable signs, symptoms, and clinical findings that provide evidence for a problem-focused, health promotion, or syndrome diagnosis. They are the clinical manifestations that signal the presence of a particular health problem or the potential for health enhancement. Defining characteristics must be present for a problem-focused diagnosis to be validated.
Risk Factors
Risk factors are primarily used in risk-focused nursing diagnoses. They indicate why a patient is more susceptible to developing a particular health problem. Unlike defining characteristics, risk factors are not signs or symptoms of an existing problem, but rather factors that increase vulnerability. They can be biological, psychological, situational, or environmental.
At-Risk Populations
These are groups of individuals who share characteristics that make them more vulnerable to certain health outcomes. These factors are often non-modifiable, such as age, gender, genetic predisposition, or life events. Identifying at-risk populations helps nurses proactively address potential health concerns.
Associated Conditions
These are medical conditions, procedures, devices, or pharmaceutical agents that are related to a nursing diagnosis. Examples include diabetes, surgery, mechanical ventilation, or chemotherapy. Understanding associated conditions provides context and helps nurses anticipate potential nursing diagnoses.
Types of Nursing Diagnoses in the NANDA-I Classification
NANDA-I categorizes nursing diagnoses into several types, each addressing different aspects of patient health and well-being:
Problem-Focused Nursing Diagnoses
These diagnoses describe a current, existing health problem. To use a problem-focused diagnosis, defining characteristics (signs and symptoms) must be present at the time of assessment. These diagnoses are often written using the PES format (Problem, Etiology, Signs/Symptoms).
Example: Deficient Fluid Volume related to excessive vomiting as evidenced by dry mucous membranes and decreased urine output.
Health Promotion Nursing Diagnoses (Potential to Improve)
These diagnoses are used when an individual, family, or community is already functioning effectively in a health area but desires to enhance their well-being. A key characteristic is the expressed readiness or desire for improvement. They often begin with “Readiness for Enhanced…”
Example: Readiness for Enhanced Nutrition as evidenced by patient expressing interest in learning about healthy eating and meal planning.
Risk-Focused Nursing Diagnoses (Potential to Deteriorate)
These diagnoses identify potential problems. They are used when a patient is vulnerable to developing a health problem if preventive measures are not taken. Risk factors are present, but the problem has not yet manifested.
Example: Risk for Infection as evidenced by surgical incision and immunosuppression.
Syndrome Nursing Diagnoses
Syndrome diagnoses represent clusters of two or more nursing diagnoses that are related and can be addressed with similar interventions. They describe constellations of diagnoses that commonly occur together in specific situations or events.
Example: Relocation Stress Syndrome as evidenced by anxiety, loneliness, and sleep disturbance.
Constructing a NANDA Nursing Diagnosis Statement
Standardized formats for writing nursing diagnoses ensure clear communication and understanding of the diagnosis’s components and implications for care.
Writing Problem-Focused Nursing Diagnosis Statements (P-E-S Format)
Problem-focused diagnoses follow a three-part statement structure known as PES:
Problem (Diagnostic Label) + Etiology (Related Factors) + Signs/Symptoms (Defining Characteristics)
The format is: [Diagnostic Label] related to [Etiology] as evidenced by [Defining Characteristics].
Examples:
- Acute Pain related to surgical incision as evidenced by patient report of pain 7/10 and guarding behavior.
- Impaired Physical Mobility related to knee surgery as evidenced by limited range of motion and difficulty ambulating.
When writing the ‘Problem’ component, always use a NANDA-I approved diagnostic label if possible. For the ‘Etiology’ (related factors), be as specific as possible to guide interventions. Use “related to” (R/T) unless the etiology is directly linked to a medical diagnosis or pathophysiology, in which case use “secondary to.” If multiple complex factors contribute, “related to complex factors” can be used, but should not replace efforts to identify specific etiologies. For ‘Signs/Symptoms’ (defining characteristics), link them to the etiology using “as evidenced by” (AEB) or “as manifested by” (AMB).
Writing Risk-Focused Nursing Diagnosis Statements
Risk-focused diagnoses are two-part statements:
Risk (Diagnostic Label) + Risk Factors
The format is: [Diagnostic Label] as evidenced by [Risk Factors].
Examples:
- Risk for Falls as evidenced by history of falls, impaired balance, and use of multiple medications.
- Risk for Pressure Injury as evidenced by immobility, incontinence, and poor nutritional status.
Start the ‘Problem’ with “Risk for…” and use a NANDA-I label when available. For ‘Risk Factors’, list the specific factors that increase the patient’s vulnerability. Defining characteristics are not used because the problem has not yet occurred.
Writing Health Promotion Nursing Diagnosis Statements
Health promotion diagnoses are also two-part statements:
Health Promotion (Diagnostic Label) + Signs & Symptoms (Defining Characteristics)
The format is: [Diagnostic Label] as evidenced by [Defining Characteristics].
Examples:
- Readiness for Enhanced Knowledge related to diabetes management as evidenced by patient expressing interest in learning more and asking questions.
- Readiness for Enhanced Spiritual Well-being as evidenced by patient seeking opportunities for reflection and expressing a desire for stronger spiritual connection.
Start the ‘Problem’ with “Readiness for Enhanced…” and use a NANDA-I label when possible. ‘Signs/Symptoms’ should reflect the patient’s expressed readiness or desire for improvement.
Writing Syndrome Nursing Diagnosis Statements
Syndrome diagnoses are two-part statements:
Syndrome (Diagnostic Label) + Supporting Nursing Diagnoses
The format is: [Diagnostic Label] as evidenced by [Nursing Diagnosis 1], [Nursing Diagnosis 2], ...
Examples:
- Frailty Syndrome as evidenced by Self-Care Deficit, Risk for Falls, and Social Isolation.
- Disuse Syndrome as evidenced by Impaired Physical Mobility and Risk for Constipation.
Use a recognized NANDA-I syndrome label for the ‘Problem’. The ‘Etiology’ is described by listing at least two supporting nursing diagnoses that contribute to the syndrome. Each supporting diagnosis should be written in its complete, appropriate format (including etiology, signs/symptoms, or risk factors as applicable).
Alt text: Diagram illustrating the two-part structure of a Risk-Focused Nursing Diagnosis statement, showing the ‘Risk (Diagnostic Label)’ component connected to ‘Risk Factors’ by “as evidenced by”.
Alt text: Diagram illustrating the two-part structure of a Syndrome Nursing Diagnosis statement, showing the ‘Syndrome (Diagnostic Label)’ component connected to ‘2 or more supporting Nursing Diagnoses’ by “as evidenced by”.
NANDA-I Domains and List of Nursing Diagnoses 2024-2026
The 2024-2026 edition of NANDA-I Nursing Diagnoses organizes diagnoses into 13 domains, further divided into classes. This hierarchical structure provides a comprehensive framework for understanding and applying nursing diagnoses. Below is a list of the 13 domains, their classes, and an example diagnosis from each domain. For the complete and most up-to-date list, always refer to the official “NANDA-International Nursing Diagnoses: Definitions and Classification, 2024-2026.”
Domain 1: Health Promotion
- Class 1: Health Awareness
- Class 2: Health Management
- Diagnosis Example: Readiness for Enhanced Health Self-Management
Domain 2: Nutrition
- Class 1: Ingestion
- Class 2: Digestion
- Class 3: Absorption
- Class 4: Metabolism
- Class 5: Hydration
- Diagnosis Example: Imbalanced Nutrition: Less Than Body Requirements
Domain 3: Elimination and Exchange
- Class 1: Urinary Function
- Class 2: Gastrointestinal Function
- Class 3: Integumentary Function
- Class 4: Respiratory Function
- Diagnosis Example: Impaired Urinary Elimination
Domain 4: Activity/Rest
- Class 1: Sleep/Rest
- Class 2: Activity/Exercise
- Class 3: Energy Balance
- Class 4: Cardiovascular/Pulmonary Responses
- Class 5: Self-Care
- Diagnosis Example: Activity Intolerance
Domain 5: Perception/Cognition
- Class 1: Attention
- Class 2: Orientation
- Class 3: Sensation/Perception
- Class 4: Cognition
- Class 5: Communication
- Diagnosis Example: Acute Confusion
Domain 6: Self-Perception
- Class 1: Self-Concept
- Class 2: Self-Esteem
- Class 3: Body Image
- Diagnosis Example: Disturbed Body Image
Domain 7: Role Relationship
- Class 1: Caregiving Roles
- Class 2: Family Relationships
- Class 3: Role Performance
- Diagnosis Example: Impaired Social Interaction
Domain 8: Sexuality
- Class 1: Sexual Identity
- Class 2: Sexual Function
- Class 3: Reproduction
- Diagnosis Example: Ineffective Sexuality Pattern
Domain 9: Coping/Stress Tolerance
- Class 1: Post-Trauma Responses
- Class 2: Coping Responses
- Class 3: Neurobehavioral Stress
- Diagnosis Example: Anxiety
Domain 10: Life Principles
- Class 1: Values
- Class 2: Beliefs
- Class 3: Value/Belief/Action Congruence
- Diagnosis Example: Spiritual Distress
Domain 11: Safety/Protection
- Class 1: Infection
- Class 2: Physical Injury
- Class 3: Violence
- Class 4: Environmental Hazards
- Class 5: Defensive Processes
- Class 6: Thermoregulation
- Diagnosis Example: Risk for Infection
Domain 12: Comfort
- Class 1: Physical Comfort
- Class 2: Environmental Comfort
- Class 3: Social Comfort
- Diagnosis Example: Chronic Pain
Domain 13: Growth/Development
- Class 1: Growth
- Class 2: Development
- Diagnosis Example: Delayed Growth and Development
Common Nursing Diagnoses in Practice
While the complete NANDA-I list is extensive, certain nursing diagnoses are more frequently encountered in clinical practice. These common diagnoses form the backbone of many nursing care plans. Understanding these diagnoses is essential for both nursing students and experienced professionals. (Note: While NANDA-I updates terminology, some commonly used, though potentially older, diagnoses remain relevant in practice. This section includes some of these alongside current terminology for practical application.)
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References
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (Eds.). (2024). NANDA-I International Nursing Diagnoses: Definitions and Classification, 2024-2026. Thieme. 10.1055/b-0000000928
- NANDA International. What is the difference between a medical diagnosis and a nursing diagnosis? Accessed January 7, 2023. http://nanda.host4kb.com/article/AA-00266/0/What-is-the-difference-between-a-medical-diagnosis-and-a-nursing-diagnosis-.html
- NANDA International. Our Story. Accessed January 7, 2023. https://nanda.org/who-we-are/our-story/
- NANDA International. Glossary of Terms. Accessed January 3, 2023. https://nanda.org/publications-resources/resources/glossary-of-terms/
- Carpenito LJ, Books@Ovid Purchased eBooks. Handbook of Nursing Diagnosis. 15th ed. Wolters Kluwer; 2017.
- Open Resources for Nursing. DIAGNOSIS. In: Nursing Fundamentals.
- NANDA International. The Structure and Development of Syndrome Diagnoses. Accessed January 7, 2023. https://nanda.org/publications-resources/resources/position-statement/
