Understanding Nursing Diagnoses
In healthcare, a “diagnosis” represents a clinically agreed-upon judgment. While often associated with medical conditions like hypertension, nursing diagnoses are distinct, yet equally vital. Defined by nurses within their professional scope and clinical expertise, these diagnoses are fundamental in guiding patient care. They encompass individuals, families, and communities, addressing diverse health conditions and life processes. Crucially, research indicates that nursing diagnoses, when properly applied, offer greater predictive accuracy than medical diagnoses alone in critical areas such as hospital stay duration and readmission rates [1].
The Foundation: The Nursing Process
A nursing diagnosis is inseparable from the nursing process – the very bedrock of nursing practice. This process hinges on the application of nursing knowledge, drawing from nursing theory, science, and core nursing principles [1]. It’s important to remember that the nursing process isn’t rigidly linear; it demands flexibility, adapting to individual patient data and evolving health outcomes. The nursing process unfolds in five key stages:
1. Assessment: Nurses initiate care by gathering comprehensive subjective and objective data about the patient. This includes physical, emotional, and psychological health, alongside lifestyle factors, socioeconomic status, and cultural background. Assessment data can range from vital signs and activity levels to medication history, lab results, and medical history.
2. Diagnosis: Following data collection and analysis, nurses identify actual or potential health issues. This is where nursing diagnoses become central. By creating a holistic clinical picture from patient assessments, nurses pinpoint potential problems that will shape the patient’s care plan.
3. Planning: Nurses then formulate a tailored care plan with both short and long-term goals, customized to the patient’s unique needs. This phase involves prioritizing care, recognizing that immediate physiological threats always take precedence, while potential risks also demand attention.
4. Implementation: The care plan is put into action, with nurses carrying out the prescribed interventions. Detailed documentation ensures consistent care delivery.
5. Evaluation: The final step involves evaluating the effectiveness of implemented interventions. Goals are reassessed – were they met, or do they require modification? This step may necessitate revisiting earlier stages of the nursing process to refine the care plan based on changes in the patient’s health status.
Nursing diagnoses are the driving force behind nursing actions, enabling continuous assessment, prioritization, organization, and ultimately, positive health outcomes.
Image alt text: Diagram illustrating the five steps of the Nursing Process: Assessment, Diagnosis, Planning, Implementation, and Evaluation, showing a cyclical flow and interconnectedness.
The Significance of Nursing Diagnoses
Nursing diagnoses are essential across all healthcare settings, promoting high-quality, evidence-based patient care. They strengthen nursing practice in several key ways:
- Enhancing Team Collaboration: Nursing diagnoses improve communication and consistency among nurses and the broader healthcare team. Standardized terminology ensures everyone is on the same page.
- Providing a Framework for Consistent Care: With standardized terminology outlining assessments and interventions, nursing diagnoses promote consistent, evidence-based practice and informed clinical decision-making.
- Serving as a Teaching Tool: For nurses new to the profession, nursing diagnoses are invaluable for honing critical thinking skills and boosting confidence. Understanding their role in the nursing process helps new nurses grasp interventions and care pathways effectively.
- Improving Risk Identification: Many nursing diagnoses directly address potential risks, prompting proactive interventions. For instance, a “Risk for Bleeding” diagnosis immediately alerts nurses to patients on anticoagulants, emphasizing the need for vigilant monitoring.
- Establishing Clear Care Goals: Nursing diagnoses highlight care priorities, encompassing current problems, future risks, and opportunities for health promotion. Once a diagnosis is made, collaborative goal setting with the patient becomes possible.
- Promoting Patient Education: Many nursing diagnoses inherently involve patient education and learning opportunities. Nurses can identify knowledge gaps in areas like medication adherence, health management, nutrition, and coping strategies, using diagnoses to guide patients toward their wellness goals.
- Facilitating Documentation: Accurate documentation is paramount in healthcare. Documented nursing care provides proof of completion, ensures care continuity between staff, and offers professional protection for nurses.
Nursing diagnoses are the cornerstone of effective nursing care plans, driving actions and supporting ongoing assessment, prioritization, organization, and the achievement of optimal health outcomes.
Nursing Diagnoses vs. Medical Diagnoses: Key Differences
While nursing and medical diagnoses share similarities, such as the use of clinical judgment and some shared terminology, they are fundamentally distinct [2]. Physicians use the International Classification of Diseases (ICD) to classify medical conditions, and mental health professionals utilize the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Nurses, while familiar with these systems, rely on nursing diagnoses developed and standardized by NANDA International, Inc. (NANDA-I) [1].
A primary difference lies in who determines the diagnosis. Nursing diagnoses are universally applied by all nurses, whereas medical diagnoses are made by physicians (or nurse practitioners in many regions, who can determine both).
The focus of each diagnosis type also differs. Medical diagnoses pinpoint diseases or pathologies affecting a patient. In contrast, nursing diagnoses center on a patient’s response to illness or life situations, whether physiological or psychological. By focusing on this response, nurses can tailor interventions to address and modify it.
Consider these examples to clarify the distinction:
Example 1:
A patient with a medical diagnosis of stroke (cerebrovascular accident) might also receive a nursing diagnosis of Risk for Aspiration. The medical diagnosis provides crucial context, while the nursing diagnosis guides preventative care planning to manage potential deficits and enhance patient safety and quality of life.
Example 2:
For a patient medically diagnosed with dehydration, a nurse would identify the nursing diagnosis of Deficient Fluid Volume. This nursing diagnosis then directs interventions such as administering IV fluids and meticulously monitoring fluid intake and output.
Nursing and medical diagnoses are complementary. They work in tandem to create a comprehensive clinical picture, guiding holistic patient care.
NANDA-I: The Standard for Nursing Diagnoses
Initially known as the North American Nursing Diagnosis Association (NANDA), the organization has expanded globally and now uses NANDA as its name, with the full formal name being NANDA International, Inc. (NANDA-I). NANDA-I serves as a global hub for networking and education, driving advancements in nursing through task forces focused on diagnosis development, informatics, and research.
NANDA-I’s Mission
NANDA International’s core mission is to standardize and support the use of nursing terminology across all clinical settings [3]. It strives to improve patient care quality by promoting evidence-based research and consistent language in nursing diagnoses. Standardized diagnoses provide a clear framework for communication and documentation, enhancing clinical practice. NANDA-I continuously updates its classifications, releasing new editions with revisions, additions, and retirements of nursing diagnoses, along with updates to diagnostic criteria.
Key Components of a Nursing Diagnosis
Several diagnostic indicators guide nurses in formulating accurate diagnoses and planning effective interventions. Not all indicators are required for every diagnosis.
Diagnosis Label
The diagnosis label is the concise name given to a nursing diagnosis. It provides a standardized term for the identified patient problem or health state.
Related Factors
Related factors are the underlying causes or contributing factors to a nursing diagnosis [4]. They are used in problem-focused, syndrome, and sometimes health promotion diagnoses. These factors represent the conditions or circumstances associated with the patient’s health issue. While the exact cause may not always be known, understanding related factors is crucial for developing targeted interventions.
Defining Characteristics
Defining characteristics are the observable signs and symptoms that provide evidence for a problem-focused or health promotion diagnosis [4]. They are the clinical manifestations of the patient’s condition.
Risk Factors
Risk factors are primarily used for risk diagnoses. They indicate why a patient is at an increased risk of developing a particular health problem. Unlike defining characteristics, risk factors highlight vulnerabilities and predict potential negative health outcomes. These factors can be biological, psychological, familial, or community-related.
At-Risk Populations
These are groups of individuals who share characteristics making them more susceptible to certain health problems. These non-modifiable factors include age, gender, life events, and family history.
Associated Conditions
Medical conditions, surgical procedures, medical devices, and medications can all be associated conditions that relate to a nursing diagnosis. Examples include autoimmune diseases, chemotherapy, oxygen therapy, and pregnancy.
Types of Nursing Diagnoses
NANDA-I categorizes nursing diagnoses into several types to address different aspects of patient health.
Problem-Focused Nursing Diagnoses
Problem-focused diagnoses address current health problems [4]. They describe existing conditions identified by the presence of defining characteristics at the time of assessment. These diagnoses always include related factors.
Example: A nurse observes a patient with decreased urine output, concentrated urine, and reports of thirst. The problem-focused nursing diagnosis is Deficient Fluid Volume, defined by NANDA-I as “Decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone without change in sodium.” [5] Interventions would focus on fluid replacement and identifying the cause of the deficit.
Health Promotion Nursing Diagnoses
Health promotion diagnoses apply when an individual, family, or community is already functioning effectively in a health area but desires enhancement of well-being. These diagnoses are characterized by an expressed readiness to improve health behaviors.
Example: A patient attending a wellness clinic expresses interest in improving their diet to enhance energy levels. The nurse identifies the health promotion nursing diagnosis Readiness for Enhanced Nutrition, defined as “A pattern of nutrient intake that is sufficient for meeting metabolic needs and can be strengthened.” [5] Interventions would involve providing nutritional counseling and resources.
Risk Nursing Diagnoses
Risk diagnoses indicate a patient’s vulnerability to developing a health problem if preventive measures are not taken. The problem has not yet occurred, but risk factors are present that increase susceptibility.
Example: A postoperative patient with a surgical incision is identified as having Risk for Infection. NANDA-I defines this as “Vulnerable to invasion and multiplication of pathogenic organisms, which may compromise health.” [5] Risk factors include the surgical incision and invasive procedures. Interventions would focus on infection prevention protocols and monitoring for signs of infection.
Syndrome Nursing Diagnoses
Syndrome diagnoses are used when a cluster of nursing diagnoses are related and can be addressed with similar interventions [7]. They represent a constellation of problem and risk diagnoses associated with specific events or conditions.
Example: A patient experiencing homelessness presents with malnutrition, fatigue, and poor hygiene. The nurse identifies Risk for Disuse Syndrome as the overarching diagnosis. NANDA-I defines this as “At risk for deterioration of body systems as the result of prescribed or unavoidable musculoskeletal inactivity.” [5] This syndrome encompasses related diagnoses like Imbalanced Nutrition: Less Than Body Requirements and Self-Care Deficit (Hygiene). Interventions would address the complex needs related to homelessness and health.
Image alt text: Diagram illustrating the concept of Syndrome Nursing Diagnosis, showing multiple related nursing diagnoses clustering together to form a syndrome diagnosis, requiring coordinated interventions.
Crafting Effective Nursing Diagnoses
Standardized formats for writing nursing diagnoses ensure clear communication and rationale for interventions and care goals.
Writing Problem-Focused Diagnoses (P-E-S Format)
Problem-focused diagnoses are structured as three-part statements using the P-E-S format: Problem, Etiology, and Signs/Symptoms.
Problem (Diagnostic Label) + Etiology (Related Factors) + Signs/Symptoms (Defining Characteristics)
Format: [Diagnostic Label] related to [Etiology] as evidenced by [Defining Characteristics]
Examples:
- Deficient Fluid Volume related to excessive vomiting as evidenced by decreased urine output and dry mucous membranes.
- Acute Confusion related to medication side effects as evidenced by disorientation and hallucinations.
Problem (Nursing Diagnosis Label)
Use NANDA-I approved labels whenever possible for consistency. If no suitable label exists, clearly and concisely describe the problem using non-judgmental language.
Etiology (Related Factors)
This section identifies the underlying cause or contributing factors. It is crucial for selecting appropriate interventions. Specify the etiology as precisely as possible, including onset and duration. Use “related to” (R/T) unless the etiology is a medical diagnosis or pathophysiology, in which case use “secondary to.” “Related to” indicates association, not necessarily direct cause-and-effect. For complex, multi-factorial etiologies, use “related to complex factors” sparingly, only when a primary etiology cannot be determined.
Signs/Symptoms (Defining Characteristics)
These are the observable cues that validate the diagnosis. Link them to the etiology using “as manifested by” (AMB) or “as evidenced by” (AEB).
Writing Risk Diagnoses (Two-Part Format)
Risk diagnoses are two-part statements: Risk (Diagnostic Label) + Risk Factors.
Format: [Diagnostic Label] as evidenced by [Risk Factors]
Examples:
- Risk for Infection as evidenced by surgical incision and immunosuppression.
- Risk for Falls as evidenced by history of falls and impaired mobility.
Problem (Nursing Diagnosis Label)
Use NANDA-I approved “Risk for…” diagnoses. If creating a unique risk diagnosis, start with “Risk for…”.
Risk Factors
Instead of etiology, list the risk factors that justify the diagnosis, following “as evidenced by.” Defining characteristics are not applicable to risk diagnoses as the problem hasn’t occurred yet.
Writing Health Promotion Diagnoses (Two-Part Format)
Health promotion diagnoses are also two-part statements: Health Promotion (Diagnostic Label) + Signs & Symptoms (Defining Characteristics).
Format: [Diagnostic Label] as evidenced by [Defining Characteristics]
Examples:
- Readiness for Enhanced Knowledge as evidenced by patient expressing interest in learning more about diabetes management.
- Readiness for Enhanced Spiritual Well-being as evidenced by patient seeking spiritual support and expressing a desire for deeper meaning in life.
Problem (Nursing Diagnosis Label)
Use NANDA-I approved health promotion diagnoses. If creating a new one, begin with “Readiness for enhanced…”.
Signs/Symptoms (Defining Characteristics)
These indicate the patient’s, family’s, or community’s expressed readiness or desire for health improvement. This can be verbal statements, actions, or other cues.
Writing Syndrome Diagnoses (Two-Part Format)
Syndrome diagnoses are two-part statements: Syndrome (Diagnostic Label) + Supporting Nursing Diagnoses.
Format: [Diagnostic Label] as evidenced by [Nursing Diagnosis 1] and [Nursing Diagnosis 2] (and so on for additional supporting diagnoses)
Examples:
- Relocation Stress Syndrome as evidenced by Anxiety and Sleep Disturbance.
- Impaired Environmental Interpretation Syndrome as evidenced by Chronic Confusion and Impaired Memory.
Problem (Nursing Diagnosis Label)
Use recognized NANDA-I syndrome diagnoses.
Etiology (Supporting Nursing Diagnoses)
List at least two nursing diagnoses that provide evidence for the syndrome diagnosis. Each supporting diagnosis should be written in its complete, appropriate format (including etiology, signs/symptoms, or risk factors).
NANDA-I Domains and Current Nursing Diagnoses (2023 and Beyond)
The NANDA-I classification is organized into domains, providing a hierarchical structure for nursing diagnoses. The most recent edition, NANDA-International Nursing Diagnoses: Definitions and Classification, 2024-2026, outlines 13 domains, each further divided into classes and specific diagnoses. While the 2024-2026 edition is the most current, the Nanda Diagnosis List 2023, and prior versions, remain foundational and relevant in many clinical settings. Understanding the structure and evolution of NANDA-I is key to utilizing nursing diagnoses effectively.
Here’s an overview of the 13 NANDA-I domains, their classes, and examples of diagnoses. For a complete and updated NANDA diagnosis list 2023 and beyond, consult the official NANDA-International publications.
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 Falls
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 comprehensive NANDA-I list includes hundreds of diagnoses, some are more frequently used in daily nursing practice. These common diagnoses address prevalent patient needs across various settings. Familiarity with these diagnoses is essential for both new and experienced nurses. Remember that NANDA-I regularly updates the diagnosis list; therefore, staying current with the latest editions is crucial for accurate and effective nursing practice. For a practical NANDA diagnosis list 2023 reference, and to ensure you are using the most up-to-date terminology, always refer to the official NANDA-I resources and publications.
(Note: While specific care plan examples are beyond the scope of this article focusing on the NANDA diagnosis list 2023, further resources can provide detailed care plans for each diagnosis. It is also important to note that NANDA-I continuously refines terminology, so some diagnoses may have updated wording in the newest editions.)**
Conclusion
Nursing diagnoses are the cornerstone of patient-centered care. Grounded in the nursing process and standardized by NANDA-I, they provide a common language and framework for nurses to identify patient problems, plan effective interventions, and evaluate outcomes. Understanding the NANDA diagnosis list 2023 and staying updated with the latest NANDA-I editions are crucial for all nurses. By utilizing nursing diagnoses effectively, nurses contribute significantly to improved patient safety, quality of care, and overall health outcomes.
References
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (Eds.). (2024). NANDA-I International Nursing Diagnoses: Definitions and Classification, 2024-2026. Thieme. 10.1055/b-000000928
- 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/
