Nursing Diagnosis Definition: Understanding Its Types and Components

Nursing diagnoses are fundamental to modern healthcare, acting as the cornerstone of patient-centered care. For both aspiring and practicing nurses, a solid grasp of what constitutes a nursing diagnosis, its various types, and essential components is crucial for delivering effective and tailored patient care. This article delves into the Nursing Diagnosis Definition, exploring its significance, classifications, and the axes that define its scope.

What is a Nursing Diagnosis?

At its core, a nursing diagnosis definition centers around a clinical judgment. Specifically, it’s a judgment made by a registered nurse concerning a human response to health conditions, life processes, or vulnerabilities to such responses. This response can manifest in an individual, a family, a group, or even a community. The primary purpose of a nursing diagnosis is to serve as the foundation for selecting nursing interventions. These interventions are designed to achieve specific patient outcomes for which the nurse is accountable. This definition, approved by the ninth NANDA (North American Nursing Diagnosis Association) Conference and amended in 2009 and 2013, underscores the critical role of nursing diagnoses in guiding nursing practice.

Types of Nursing Diagnoses

Nursing diagnoses are not monolithic; they are categorized to address different aspects of patient health and well-being. Understanding these types is essential for accurate diagnosis and effective care planning. There are primarily five types of nursing diagnoses:

1. Problem-Focused Nursing Diagnosis

A problem-focused nursing diagnosis identifies an existing undesirable human response to health conditions or life processes. This type of diagnosis is made when a nurse identifies a specific health problem that is currently affecting an individual, family, group, or community.

Key Components:

• Defining Characteristics: To establish a problem-focused diagnosis, there must be evident defining characteristics. These are the observable manifestations, signs, and symptoms that cluster together, forming recognizable patterns.
• Related Factors: Equally important are related factors, also known as etiological factors. These are the conditions, circumstances, or influences that are linked to, contribute to, or precede the diagnostic focus.

For example, a patient exhibiting signs of respiratory distress, such as shortness of breath and wheezing (defining characteristics), related to a history of asthma (related factor), might receive a problem-focused nursing diagnosis of “Ineffective Breathing Pattern.”

2. Health-Promotion Nursing Diagnosis

In contrast to problem-focused diagnoses, health-promotion nursing diagnoses are concerned with motivation and desire to enhance well-being and actualize human health potential. These diagnoses are applicable across all health states and are expressed as a readiness to improve specific health behaviors.

Key Component:

• Defining Characteristics: A health-promotion diagnosis is characterized by defining characteristics that begin with the phrase “Expresses desire to enhance…” This indicates the patient’s active willingness to improve their health.

An example is “Readiness for Enhanced Nutrition,” diagnosed when a patient expresses a desire to improve their dietary habits and demonstrates an understanding of healthy eating principles.

3. Risk Nursing Diagnosis

A risk nursing diagnosis is a clinical judgment concerning the vulnerability of an individual, family, group, or community to developing an undesirable human response to health conditions or life processes. It anticipates potential problems before they occur.

Key Component:

• Risk Factors: These diagnoses are supported by risk factors, which are elements that increase vulnerability. Risk factors are not signs or symptoms of an existing problem, but rather indicators of potential future problems.

For instance, a patient who is post-operative and immobile (risk factors) is at risk for developing a “Risk for Impaired Skin Integrity” due to prolonged pressure on certain areas.

4. Syndrome Nursing Diagnosis

A syndrome nursing diagnosis is unique as it represents a cluster of nursing diagnoses that frequently occur together. These diagnoses are best addressed collectively using similar interventions.

Key Components:

• Defining Characteristics: A syndrome diagnosis is characterized by the presence of two or more nursing diagnoses that act as defining characteristics.
• Related Factors (Optional): Related factors may be included to provide further clarity to the definition but are not mandatory for this type of diagnosis.

“Disuse Syndrome” is an example, encompassing a cluster of diagnoses like “Risk for Impaired Skin Integrity,” “Risk for Constipation,” and “Risk for Activity Intolerance,” all stemming from immobility.

Diagnostic Axes: Structuring Nursing Diagnoses

To provide a standardized and comprehensive approach to nursing diagnoses, the NANDA-I framework incorporates seven axes. These axes represent different dimensions of the human response considered in the diagnostic process, mirroring the International Standards Reference Model for Nursing Diagnosis.

1. Axis 1: Diagnostic Focus: This axis represents the core of the diagnostic concept – the fundamental “human response” being addressed. It’s the principal element of the diagnosis. Examples include “Pain,” “Anxiety,” or “Knowledge Deficit.”

2. Axis 2: Subject of the Diagnosis: This axis specifies who the diagnosis is about. It can be an individual, caregiver, family, group, or community. This ensures that the diagnosis is appropriately targeted.

3. Axis 3: Judgment: This axis uses a descriptor or modifier to refine the meaning of the diagnostic focus. Judgments like “Impaired,” “Ineffective,” “Readiness for Enhanced,” or “Compromised” add specificity. For example, “Impaired Physical Mobility” uses “Impaired” as the judgment.

4. Axis 4: Location: This axis indicates the body part or region involved, such as “cardiac,” “respiratory,” or “gastrointestinal.” It provides anatomical context. For example, “Impaired Gas Exchange” refers to a respiratory location.

5. Axis 5: Age: This axis specifies the age group of the patient – fetus, neonate, infant, child, adolescent, adult, or older adult. Age is a significant factor in many health responses.

6. Axis 6: Time: This axis describes the duration of the diagnostic concept, categorized as acute, chronic, intermittent, or continuous. Understanding the time frame helps in planning appropriate interventions.

7. Axis 7: Status of the Diagnosis: This axis classifies the diagnosis type, whether it’s problem-focused, risk, health promotion, or syndrome. This clearly indicates the nature of the nursing diagnosis.

While Axis 1 (diagnostic focus) and Axis 3 (judgment) are always essential, and Axis 2 (subject) is typically essential (though sometimes implied), the other axes are used as needed to provide clarity and detail to the nursing diagnosis.

Components of a Nursing Diagnosis

A well-formulated nursing diagnosis includes several key components that ensure clarity, accuracy, and effective communication among healthcare professionals.

1. Diagnosis Label: This is a concise name for the diagnosis, incorporating at least the diagnostic focus (Axis 1) and nursing judgment (Axis 3). It’s a standardized term that quickly communicates the identified patient issue.

2. Definition: A clear and precise description of the diagnosis is essential. The definition delineates its meaning and helps differentiate it from similar diagnoses, ensuring accurate application.

3. Defining Characteristics: These are the observable cues and inferences that represent the manifestations of a problem-focused, health-promotion diagnosis, or syndrome. They are the evidence that supports the diagnosis.

4. Risk Factors (for Risk Diagnoses): Only risk diagnoses include risk factors. These are the environmental, physiological, psychological, genetic, or chemical elements that heighten vulnerability to an unhealthy event.

5. Related Factors (for Problem-Focused Diagnoses and Syndromes): Problem-focused nursing diagnoses and syndromes typically include related factors. These are factors that show a patterned relationship with the nursing diagnosis and may be antecedent, associated, or contributing to the diagnosis. Health-promotion diagnoses may include related factors if they clarify the diagnosis.

Conclusion

Understanding the nursing diagnosis definition, its types, and components is paramount for nurses to provide patient-centered care. By accurately identifying patient needs and potential problems through nursing diagnoses, nurses can develop effective care plans and interventions, ultimately improving patient outcomes. The structured approach provided by NANDA-I and the diagnostic axes ensures a standardized and comprehensive framework for nursing practice, promoting consistent and high-quality healthcare.

References

• Merriam-Webster, Inc. (2009). Merriam-Webster′s Collegiate Dictionary (11th ed.) Springfield, MA: Author.
• Oxford Dictionary On-Line, British and World Version. (2013). Oxford University Press. Available at: http://www.oxforddictionaries.com/
• Pender, N.J., Murdaugh, C.L., & Parsons, M.A. (2006). Health promotion in nursing practice (5th Ed.). Upper Saddle River, NJ: Pearson Prentice-Hall.
• World Health Organization (2013). Health topics: Infant, newborn. Available at: http://www.who.int/topics/infant_newborn/en/.
• World Health Organization (2013). Definition of key terms. Available at: http://www.who.int/hiv/pub/guidelines/arv2013/intro/keyterms/en/.