Nursing diagnoses are critical for delivering effective and patient-centered care. They represent a standardized approach for nurses to evaluate patient health conditions within their professional scope. Unlike medical diagnoses that focus on diseases, nursing diagnoses address a patient’s responses to health issues and life processes. Utilizing nursing diagnoses enhances patient outcomes, reduces hospital stays, and decreases readmission rates. The cornerstone of this practice is the nursing process, which integrates nursing knowledge, theory, and science to adapt care to individual patient needs. Let’s delve into the essential aspects of nursing diagnosis, particularly focusing on the most current NANDA-I classifications for 2024-2026.
Understanding the Nursing Process
The nursing process is fundamental to nursing practice and essential for formulating nursing diagnoses. It’s a dynamic, cyclical process, not always linear, adapting to patient data and health outcomes. The five key steps are:
Assessment: This initial phase involves nurses gathering both subjective and objective data. Subjective data comes from the patient’s perspective, including feelings and perceptions. Objective data is measurable and observable, such as vital signs, lab results, and physical assessments. This comprehensive data collection covers physical, emotional, psychological, lifestyle, socioeconomic, and cultural aspects.
Diagnosis: Following data analysis, nurses identify actual or potential health problems. This is where NANDA nursing diagnoses come into play. Nurses develop a clinical picture based on assessment data to pinpoint possible health issues, forming the basis of the patient’s care plan.
Planning: In this stage, nurses create individualized care plans, setting both short-term and long-term goals. Interventions are developed, and priorities are established. Immediate physiological needs are paramount, but potential risks also require attention.
Implementation: This is the action phase where nurses carry out the planned interventions. All actions are meticulously documented to ensure consistent care and communication among the healthcare team.
Evaluation: The final step involves evaluating the effectiveness of the interventions. Goals are reviewed to determine if they have been met or if modifications are needed. This step may necessitate revisiting earlier stages of the nursing process to adjust the care plan based on the patient’s evolving health status.
Nursing diagnoses are the engine that drives these actions, ensuring structured assessment, prioritization, organization, and ultimately, better patient health outcomes.
The Purpose and Impact of Nursing Diagnosis
Nursing diagnoses are vital across all healthcare settings, promoting evidence-based, high-quality care. Their benefits are numerous:
- Enhanced Team Collaboration: Nursing diagnoses standardize terminology, fostering clear and consistent communication among nurses and other healthcare team members. This shared language reduces ambiguity and improves teamwork.
- Framework for Consistent Care: By providing a standardized framework for assessment and interventions, nursing diagnoses ensure consistent, evidence-based practice and clinical decision-making. This is crucial for maintaining quality of care across different settings and providers.
- Effective Teaching Tool: Nursing diagnoses are invaluable for new nurses, enhancing critical thinking and boosting confidence. Understanding their role in the nursing process helps new graduates learn about interventions and care pathways, accelerating their professional development.
- Improved Risk Identification: Many nursing diagnoses are specifically designed to highlight potential risks, prompting timely interventions. For instance, “Risk for Bleeding” alerts nurses to monitor patients on anticoagulants closely, preventing potential complications.
- Goal Setting and Care Priorities: Nursing diagnoses clarify care priorities by identifying current issues, potential future risks, and health promotion opportunities. Once a diagnosis is made, nurses can collaboratively set goals, interventions, and priorities with patients.
- Patient Education and Empowerment: Nursing diagnoses often reveal knowledge deficits related to medication, health management, nutrition, and coping. Addressing these through targeted education empowers patients to actively participate in their care and achieve their health goals.
- Essential Documentation: Accurate documentation is paramount in healthcare. Nursing diagnoses provide a structured way to document care, proving interventions were carried out, ensuring continuity of care, and offering legal protection for nurses.
Nursing diagnoses are the bedrock of effective nursing care plans, guiding actions and promoting continuous assessment, organization, and positive health outcomes. They are not just labels; they are the starting point for tailored, patient-centered care.
Nursing Diagnosis vs. Medical Diagnosis: Key Differences
While both nursing and medical diagnoses are forms of clinical judgment and share some terminology, they are fundamentally different. Medical diagnoses, often classified using the International Classification of Diseases (ICD), identify diseases or pathologies. Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Nurses, while aware of these systems, utilize nursing diagnoses developed and refined by NANDA International, Inc. (NANDA-I).
The key distinction also lies in who makes the diagnosis. Medical diagnoses are made by physicians (and in many regions, nurse practitioners), while nursing diagnoses are within the purview of all registered nurses. Nurse practitioners, in many jurisdictions, can make both types of diagnoses.
The focus of each diagnosis type also differs. Medical diagnoses pinpoint the disease or pathology affecting a patient. Nursing diagnoses, conversely, focus on the patient’s response to the health condition or life situation, whether physiological or psychological. By concentrating on this response, nurses can implement interventions to manage or alter it.
Consider these examples to clarify the complementary nature of medical and nursing diagnoses:
Example 1: A patient with a medical diagnosis of stroke (cerebrovascular accident) might have a related nursing diagnosis of Risk for Aspiration. The medical diagnosis provides crucial context, informing the nurse about the potential for swallowing difficulties and aspiration risk. The nursing diagnosis then guides the development of specific interventions focused on patient safety and quality of life.
Example 2: For a patient medically diagnosed with dehydration, the corresponding nursing diagnosis might be Deficient Fluid Volume. The medical diagnosis identifies the condition, while the nursing diagnosis specifies the patient’s response. This leads to nursing interventions such as administering IV fluids and monitoring fluid balance.
Nursing and medical diagnoses are not mutually exclusive but work in tandem to create a comprehensive understanding of the patient’s health status, leading to holistic care.
NANDA-I: The Authority in Nursing Diagnoses
Originally known as the North American Nursing Diagnosis Association, NANDA has evolved into NANDA International, Inc. (NANDA-I) to reflect its global reach. NANDA-I is the leading organization dedicated to standardizing nursing terminology worldwide. It serves as a hub for education, networking, and collaborative initiatives in areas like diagnosis development and nursing research.
NANDA-I’s Mission and Goals
NANDA International’s core mission is to enhance patient care quality through the universal adoption and ongoing development of standardized nursing terminology. It champions evidence-based research to refine and validate nursing diagnoses, ensuring they reflect current clinical practice. By regularly updating and publishing new editions of nursing diagnoses, NANDA-I keeps the terminology relevant and effective. This standardized language promotes clearer communication, more accurate documentation, and ultimately, improved patient outcomes globally. The latest edition, NANDA-I Nursing Diagnoses: Definitions and Classification 2024-2026, is the essential resource for nurses worldwide.
Key Components of a Nursing Diagnosis
Several components are crucial for constructing accurate and effective nursing diagnoses. Not all are required for every diagnosis, but understanding them is key.
The Diagnostic Label
The diagnosis itself is the starting point. It’s formulated in the diagnosis phase of the nursing process, following data analysis from patient assessments, observations, and diagnostic tests. Nurses analyze collected data to identify patterns and clusters of information, forming hypotheses about appropriate nursing diagnoses. At this point, the nurse either finalizes the diagnosis or seeks further information for confirmation or refinement.
Related Factors: Uncovering the ‘Why’
Related factors are the underlying causes or contributing factors to the nursing diagnosis. They are used in problem-focused, syndrome, and sometimes health promotion diagnoses. Identifying these factors is crucial for developing targeted interventions. While the exact cause may not always be clear, understanding contributing conditions is essential for effective care planning.
Defining Characteristics: The ‘What’
Defining characteristics are the observable signs and symptoms that provide evidence for a problem-focused or health promotion diagnosis. They are the clinical manifestations of the health issue. These characteristics must be present at the time of assessment for a problem-focused diagnosis to be valid.
Risk Factors: Identifying Vulnerabilities
Risk factors are primarily used in risk-focused nursing diagnoses. They indicate why a patient is at an increased risk of developing a particular health problem. Unlike defining characteristics, risk factors describe vulnerabilities and predispositions. These can be biological, psychological, familial, or community-related. A patient may have multiple risk factors contributing to a single risk diagnosis.
At-Risk Populations: Recognizing Broader Susceptibilities
Nurses may identify populations sharing characteristics that make them more susceptible to certain health outcomes. These non-modifiable factors, like age, gender, genetics, or significant life events, help nurses proactively identify and address potential health risks within specific groups.
Associated Conditions: Contextualizing the Diagnosis
Medical conditions, surgical procedures, medical devices, and pharmaceutical agents can all be associated conditions that provide context for a nursing diagnosis. Understanding these associations, such as autoimmune diseases, chemotherapy treatments, or pregnancy, helps nurses develop more nuanced and effective care plans.
Types of Nursing Diagnoses: A Detailed Overview
NANDA-I classifies nursing diagnoses into several types, each serving a distinct purpose in patient care.
Problem-Focused Nursing Diagnoses: Addressing Current Challenges
Problem-focused diagnoses address existing health problems. These diagnoses are about current, known conditions, not potential issues. For this type, defining characteristics must be present. These characteristics—signs, symptoms, and patient history—act as clues that, when clustered, lead to a diagnosis. Related factors are also crucial components of a problem-focused diagnosis.
Example: A nurse observes a patient with decreased fluid intake compared to output, dry mucous membranes, and weight loss. The problem-focused nursing diagnosis is Deficient Fluid Volume. According to NANDA-I, this is defined as “Decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone without change in sodium.” Interventions would then focus on increasing fluid intake, identifying the cause of the deficit, and monitoring fluid balance.
Health Promotion Nursing Diagnoses: Fostering Wellness
Health promotion diagnoses are used when an individual, family, or community is already functioning effectively in a health area but desires enhancement and improved well-being. A key criterion is the expressed desire for improvement, often indicated by phrases like “Readiness for Enhanced…” The defining characteristic is this expressed desire to improve health behaviors. These diagnoses are proactive, aiming to optimize health potential rather than prevent problems.
Example: A pregnant patient expresses a strong desire to exclusively chestfeed (breastfeed) during a prenatal visit. The nurse identifies the health promotion nursing diagnosis Readiness for Enhanced Breastfeeding. NANDA-I defines this as “A pattern of providing human milk to an infant or child, which can be strengthened.” The nurse then facilitates this by providing resources and referrals to lactation consultants.
Risk-Focused Nursing Diagnoses: Preventing Potential Problems
Risk-focused diagnoses identify potential health problems a patient is vulnerable to. The issue hasn’t yet developed, but risk factors indicate susceptibility. Care plans here emphasize preventative measures to avoid undesirable health outcomes.
Example: A nurse caring for a post-operative patient three days after major surgery recognizes several risk factors for infection. The nursing diagnosis becomes Risk for Infection, defined by NANDA-I as “Vulnerable to invasion and multiplication of pathogenic organisms, which may compromise health.” Risk factors include the surgical incision and post-operative state. Interventions might include teaching hand hygiene and ensuring a sterile environment.
Alt text: Diagram illustrating the components of a risk-focused nursing diagnosis, showing the diagnostic label “Risk for…” and the supporting risk factors.
Syndrome Nursing Diagnoses: Recognizing Clusters of Diagnoses
Syndrome diagnoses are used when multiple nursing diagnoses are related and can be addressed with similar interventions. They cluster problem and risk-focused diagnoses often seen together in specific health processes or life events.
Example: A patient who witnessed a traumatic car accident reports sleep difficulties, increased alcohol use, and irritability. The nurse identifies Post-Trauma Syndrome. NANDA-I defines this as a “Sustained maladaptive response to a traumatic, overwhelming event.” Other related diagnoses might include Disturbed Sleep Pattern, Anxiety, and Ineffective Coping. Interventions focus on acknowledging the trauma and connecting the patient with support resources.
Alt text: Diagram illustrating the components of a syndrome nursing diagnosis, showing the diagnostic label “Syndrome…” and at least two supporting nursing diagnoses.
Mastering the Art of Writing Nursing Diagnoses
Standardized formats for writing nursing diagnoses ensure clarity and effective communication of their purpose and underlying factors. A well-written diagnosis clarifies the nurse’s reasoning for chosen interventions and care goals.
Writing Problem-Focused Diagnoses: The PES Format
Problem-focused diagnoses follow a three-part PES format: Problem, Etiology, and Symptoms.
P-E-S Format Breakdown:
Problem (Diagnostic Label) + Etiology (Related Factors) + Signs/Symptoms (Defining Characteristics)
Formula: [Diagnostic Label] + “related to” + [Etiology] + “as evidenced by” + [Defining Characteristics]
Examples:
- Deficient Fluid Volume related to prolonged vomiting as evidenced by increased pulse rate and poor skin turgor.
- Acute Confusion related to alcohol abuse as evidenced by hallucinations and increased agitation.
Problem (Nursing Diagnosis Label)
Always use a NANDA-I label if available. If not, describe the problem clearly and concisely, avoiding judgmental language.
Etiology (Related Factors)
This identifies the underlying cause(s). It’s crucial for selecting appropriate interventions. Describe the etiology as precisely as possible, including timing and duration. Use “secondary to” for known pathophysiology or disease, and “related to” (R/T) otherwise, as it acknowledges potentially unidentified contributing factors. For complex, multi-factor etiologies, use “related to complex factors,” but avoid this as a shortcut to detailed etiology identification.
Signs/Symptoms (Defining Characteristics)
These are the observable signs and symptoms supporting the diagnosis. Link etiology to symptoms using “as manifested by” (AMB) or “as evidenced by” (AEB).
Writing Risk-Focused Diagnoses: A Two-Part Approach
Risk-focused diagnoses are two-part statements including the problem and risk factors.
Formula: [Diagnostic Label] + “as evidenced by” + [Risk Factors]
Examples:
- Risk for Infection as evidenced by a history of cancer and recent surgery.
- Risk for Falls as evidenced by a history of falls, use of assistive device, and visual difficulties.
Alt text: Diagram illustrating the structure of a risk-focused nursing diagnosis, highlighting the ‘Risk for’ diagnostic label and the supporting ‘Risk Factors’.
Problem (Nursing Diagnosis Label)
Use a NANDA-I approved “Risk for…” diagnosis. If creating a new one, start with “Risk for…”.
Risk Factors
Instead of etiology, risk-focused diagnoses are supported by risk factors. Follow the problem statement with “as evidenced by” and list the relevant risk factors. Defining characteristics are not applicable as the problem hasn’t occurred yet.
Writing Health Promotion Diagnoses: Focusing on Enhancement
Health promotion diagnoses are also two-part statements.
Formula: [Diagnostic Label] + “as evidenced by” + [Defining Characteristics]
Examples:
- Readiness for Enhanced Breastfeeding as evidenced by the patient stating their desire to exclusively breastfeed and requesting information.
- Readiness for Enhanced Coping as evidenced by the patient expressing a desire to enhance social support and spiritual resources.
Problem (Nursing Diagnosis Label)
Recognize the opportunity for health improvement, using a NANDA-I health promotion diagnosis if possible. Otherwise, start with “Readiness for enhanced…”.
Signs/Symptoms (Defining Characteristics)
These relate to the patient’s expressed readiness or desire for health improvement. This can be verbal, actions, or other cues.
Writing Syndrome Diagnoses: Grouping Related Issues
Syndrome diagnoses are two-part statements grouping related nursing diagnoses.
Formula: [Diagnostic Label] + “as evidenced by” + [Nursing Diagnosis 1] + [Nursing Diagnosis 2] + …
Examples:
- Post-Trauma Syndrome as evidenced by Disturbed Sleep Pattern and Impaired Resilience.
- Frail Elderly Syndrome as evidenced by Social Isolation and Chronic Confusion.
Alt text: Diagram outlining the structure of a syndrome nursing diagnosis, showing the ‘Syndrome’ diagnostic label and the supporting ‘Nursing Diagnoses’.
Problem (Nursing Diagnosis Label)
Use a recognized NANDA-I syndrome diagnosis.
Etiology (Supporting Nursing Diagnoses)
The etiology is described by at least two nursing diagnoses that provide evidence for the syndrome. Each supporting diagnosis should be written in its complete form (PES or two-part).
NANDA-I Domains and Current Nursing Diagnoses (2024-2026)
The NANDA-I 2024-2026 edition categorizes nursing diagnoses into 13 domains, each further divided into classes and individual diagnoses. Here’s an overview of the domains, classes, and examples. For a complete list, refer to the NANDA-International Nursing Diagnoses Definitions and Classification, 13th Edition.
Domain 1: Health Promotion
- Class 1: Health Awareness
- Class 2: Health Management
- Diagnosis Example: Readiness for Enhanced Health 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: Urinary Retention
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: Impaired Memory
Domain 6: Self-Perception
- Class 1: Self-Concept
- Class 2: Self-Esteem
- Class 3: Body Image
- Diagnosis Example: Chronic Low Self-Esteem
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: Risk for Disturbed Maternal-Fetal Dyad
Domain 9: Coping/Stress Tolerance
- Class 1: Post-Trauma Responses
- Class 2: Coping Responses
- Class 3: Neurobehavioral Stress
- Diagnosis Example: Caregiver Role Strain
Domain 10: Life Principles
- Class 1: Values
- Class 2: Beliefs
- Class 3: Value/Belief/Action Congruence
- Diagnosis Example: Moral 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: Acute Pain
Domain 13: Growth/Development
- Class 1: Growth
- Class 2: Development
- Diagnosis Example: Delayed Growth and Development
Common Nursing Diagnoses in Practice
Here are some commonly used NANDA-I nursing diagnoses in clinical settings. Remember that NANDA-I regularly updates diagnoses, so always refer to the latest edition for the most current terminology.
(Note: Some diagnoses may reflect older terminology for familiarity, with updated terms in parentheses where applicable.)
[Will include a list of common nursing diagnoses and care plan examples in a future iteration, as per original article structure if needed, but focusing on the core request for now.]
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/
