What stands out as one of the most indispensable tools in a nurse’s repertoire? While a stethoscope or a blood pressure monitor might come to mind, the cornerstone of exceptional patient care lies in the nursing diagnosis.
This guide offers a deep dive into nursing diagnoses, clarifying their purpose, the process of formulating them, and effective writing techniques, with a special focus on the Pes Nursing Diagnosis format.
Understanding Nursing Diagnosis
A nursing diagnosis is a nurse’s clinical judgment about individual, family, or community experiences/responses to actual or potential health problems and life processes. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.
It’s crucial to distinguish nursing diagnoses from medical diagnoses. Medical diagnoses pinpoint diseases, whereas nursing diagnoses concentrate on:
- A patient’s response to a health condition or life process
- The signs and symptoms exhibited
- The impact of these symptoms on the patient’s daily living
For instance, a medical diagnosis might be myocardial infarction, but a corresponding nursing diagnosis could be decreased cardiac output related to altered contractility as evidenced by dyspnea and fatigue. This distinction enables nurses to devise a tailored nursing care plan (NCP) that specifically addresses the patient’s needs.
NANDA International (NANDA-I) serves as the global authority for standardized nursing diagnoses. NANDA-I maintains and updates a comprehensive classification, ensuring that nurses worldwide use a common language to describe patient problems, thereby enhancing the quality and consistency of care. NANDA-I’s work in standardizing nursing diagnoses began in the 1970s, and they continue to refine the classification to reflect current nursing practice and research.
The Significance of Nursing Diagnosis
The primary aim of a nursing diagnosis is to establish a structured approach for identifying and tackling a patient’s health needs, ultimately leading to improved health outcomes. It encourages a holistic patient view, encompassing physical, emotional, social, and environmental aspects.
Here’s why nursing diagnoses are vital:
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Pinpointing Patient Needs: Nursing diagnoses enable nurses to pinpoint the most pressing health issues a patient is facing. Through methodical assessment, nurses can determine immediate concerns such as pain management, infection risks, or anxiety levels.
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Guiding Care Plan Development: Nursing diagnoses are fundamental in crafting effective NCPs. They offer a clear framework for necessary interventions and desired outcomes. This ensures that care is targeted, efficient, and directly responsive to the patient’s specific needs.
Nursing Diagnosis within the Nursing Process
The nursing process is a systematic, patient-centered approach that nurses employ to deliver quality care. It’s structured into five key phases, often remembered by the acronym ADPIE: Assessment, Diagnosis, Planning, Implementation, and Evaluation.
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Assessment: This initial phase involves gathering extensive data about the patient’s physical, psychological, sociocultural, and spiritual health.
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Diagnosis: Utilizing the assessment data, nurses identify specific patient problems and formulate nursing diagnoses. This is where the PES format nursing diagnosis becomes particularly useful.
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Planning: In this stage, nurses define measurable goals, both short-term and long-term, and select appropriate nursing interventions to achieve these goals.
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Implementation: This involves putting the nursing care plan into action, carrying out the planned interventions.
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Evaluation: The final phase assesses the effectiveness of the implemented interventions and adjusts the care plan as needed based on the patient’s response.
Consider a patient presenting with chest pain. During assessment, a nurse might observe signs of distress and gather data on pain characteristics and vital signs. Based on this, a nurse could formulate a nursing diagnosis such as Acute Pain related to myocardial ischemia as evidenced by patient report of chest pain 7/10, elevated heart rate, and anxiety. This PES nursing diagnosis then directs the care plan, which might include pain management, cardiac monitoring, and patient education. The nurse will continuously evaluate the effectiveness of these interventions and modify the plan accordingly.
Nursing diagnoses are integral to the nursing process as they provide a structured method for addressing patient needs and facilitate clear communication among healthcare team members, ensuring a unified approach to patient care.
Common Nursing Diagnoses
Below are examples of frequently used nursing diagnoses, illustrating their application across different healthcare settings.
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Deficient Fluid Volume: Applicable when a patient experiences decreased intravascular, interstitial, and/or intracellular fluid. Nursing interventions include monitoring fluid balance, administering fluids as prescribed, and identifying the underlying cause of fluid loss.
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Impaired Gas Exchange: This diagnosis is used for patients with difficulties in oxygenation and carbon dioxide elimination. Nursing care involves monitoring respiratory status, providing oxygen therapy, and teaching effective breathing techniques.
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Ineffective Airway Clearance: This diagnosis is relevant for patients with airway obstructions. Nurses assess for signs like cough, wheezing, and dyspnea and implement interventions such as suctioning, encouraging deep breathing, and chest physiotherapy.
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Anxiety: Used when patients exhibit excessive worry, fear, or nervousness, often related to health conditions or hospitalization. Interventions may include emotional support, relaxation techniques, and counseling referrals.
Mastering the PES Format in Nursing Diagnosis
The PES format is a standardized method for writing nursing diagnoses, ensuring clarity, completeness, and accuracy. PES stands for Problem, Etiology, and Symptoms (or Signs and Symptoms/Defining Characteristics). It is widely taught and used because it provides a structured approach to diagnostic reasoning.
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Problem (P) – Diagnostic Label: This is a concise statement of the patient’s health problem. It is typically selected from a standardized nursing diagnosis taxonomy like NANDA-I. The problem statement describes the patient’s altered health status or functional ability. Using standardized labels ensures that nurses are using a common language.
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Etiology (E) – Related Factors: This identifies the probable cause(s) or contributing factors to the identified problem. It’s linked to the problem statement using the phrase “related to.” Etiologies are not medical diagnoses but rather factors that contribute to the nursing diagnosis. Examples include “related to immobility,” “related to knowledge deficit,” or “related to effects of medication.” Identifying the etiology is crucial because nursing interventions are often directed at modifying or removing these factors.
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Symptoms (S) – Defining Characteristics: These are the observable signs and symptoms, or defining characteristics, that provide evidence for the nursing diagnosis. They are linked to the etiology using the phrase “as evidenced by” or “as manifested by.” These are the clinical cues gathered during assessment that demonstrate the presence of the problem. Examples include “as evidenced by patient report of pain 8/10 and guarding behavior,” or “as evidenced by productive cough and abnormal breath sounds.” Defining characteristics must be patient-specific and observable.
Example of a Correctly Written PES Nursing Diagnosis:
- Acute pain related to surgical incision as evidenced by patient report of pain 8/10, guarding behavior, and increased heart rate.
In this example:
- P (Problem): Acute pain
- E (Etiology): surgical incision
- S (Symptoms): patient report of pain 8/10, guarding behavior, and increased heart rate.
Example of an Incorrectly Written Nursing Diagnosis:
- Pain due to surgery.
This is incorrect because it lacks the structured PES format. It doesn’t clearly identify the defining characteristics that support the diagnosis and is too vague to guide specific nursing interventions. It also uses “due to surgery” which is closer to a medical explanation than a nursing-focused etiology.
NANDA-I Nursing Diagnosis: Four Types, PES Primarily Used for Problem-Focused
NANDA-I recognizes four main types of nursing diagnoses, but the PES format is primarily applied to Problem-Focused Diagnoses:
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Problem-Focused Nursing Diagnoses: These diagnoses describe a current problem response that is present at the time of the nursing assessment. They are supported by defining characteristics (signs and symptoms) that cluster together in patterns of related cues. PES format is specifically designed for problem-focused diagnoses.
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Risk Nursing Diagnoses: These diagnoses describe human responses to health conditions/life processes that may develop in a vulnerable individual, family, or community. They are supported by risk factors that contribute to increased vulnerability. Risk diagnoses do not have defining characteristics because the problem has not yet occurred. The format for risk diagnoses is typically a two-part statement: Diagnostic label “Risk for [Problem]” related to [Risk Factors]. PES format is not used for risk diagnoses.
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Health Promotion Nursing Diagnoses: These diagnoses describe a motivation and desire to increase well-being and actualize human health potential. These responses are expressed by a readiness to enhance specific health behaviors and can be used in any health state. Health promotion diagnoses may be one-part statements (Diagnostic label) or two-part statements (Diagnostic label “Readiness for Enhanced [Specific Behavior]” as evidenced by [Defining Characteristics]). PES format is generally not used for health promotion diagnoses.
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Syndrome Nursing Diagnoses: These diagnoses represent a cluster of actual or risk nursing diagnoses that are predicted to be present because of a certain event or situation. Syndrome diagnoses are also typically one-part statements (Diagnostic label). PES format is not applicable.
Therefore, while NANDA-I classifies various types of nursing diagnoses, the PES format is most relevant and essential for constructing problem-focused nursing diagnoses, which are the most common type encountered in daily nursing practice.
6 Key Tips for Writing Effective PES Nursing Diagnoses
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Use Precise and Specific Language: Choose words that clearly and accurately describe the Problem, Etiology, and Symptoms. Avoid vague terms.
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Steer Clear of Medical Diagnoses in the Problem Statement: The Problem (P) should be a nursing diagnosis, not a medical diagnosis. Focus on the patient’s response, not the disease itself.
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Ensure Etiology is Causally Linked: The Etiology (E) should logically contribute to or cause the Problem (P). Think “Why is this problem occurring?”
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Defining Characteristics Must Support the Problem: The Symptoms (S) must be observable and provide evidence that the stated Problem is present. They should be specific and patient-derived.
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Reference NANDA-I for Standardized Language: Utilize the NANDA-I taxonomy for diagnostic labels to ensure consistency and clarity.
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Review and Validate with the Patient: Whenever possible, involve the patient in the diagnostic process to confirm accuracy and gather further insights. Patient input is invaluable in validating the nursing diagnosis.
PES Nursing Diagnoses and Nursing Care Plans
PES nursing diagnoses are the bedrock upon which effective NCPs are built. They serve as the foundation for:
- Setting Patient-Centered Goals: The nursing diagnosis directly indicates what needs to be changed or improved for the patient. Goals are then formulated to counteract the problem stated in the diagnosis.
- Selecting Targeted Nursing Interventions: Interventions are chosen to directly address the etiology and alleviate the symptoms of the nursing diagnosis. The PES statement guides the selection of appropriate and effective nursing actions.
- Evaluating Patient Outcomes: The defining characteristics in the “Symptoms” part of the PES statement provide measurable criteria for evaluating whether the interventions have been successful in resolving the problem.
A well-constructed care plan, rooted in accurate PES nursing diagnoses, ensures focused, effective interventions and ultimately leads to better patient health outcomes.
For example, if a nurse identifies a PES nursing diagnosis of Deficient Knowledge related to lack of prior exposure to insulin administration as evidenced by patient statement “I don’t know how to give myself insulin” and inability to demonstrate proper injection technique, the care plan will specifically include patient education on insulin administration, demonstration, and return demonstration. By directly addressing the knowledge deficit identified in the diagnosis, the nurse can empower the patient to manage their diabetes effectively.
Effective nursing diagnoses, particularly when using the PES format, also foster collaboration. When nurses clearly articulate patient problems using a standardized format, it improves communication within the healthcare team, leading to more coordinated and comprehensive care.
Sample Care Plan Incorporating PES Nursing Diagnosis
Here’s an example of how a PES nursing diagnosis integrates into a care plan:
- Nursing Diagnosis (PES): Impaired Physical Mobility related to joint stiffness and pain secondary to rheumatoid arthritis as evidenced by limited range of motion in knees and hips, and patient report of pain 6/10 with movement.
- Goals: Patient will demonstrate improved joint mobility within 1 week as evidenced by increased range of motion and decreased pain with movement reported at 3/10 or less.
- Interventions:
- Administer prescribed pain medication before physical therapy sessions.
- Assist patient with range-of-motion exercises twice daily.
- Apply warm compresses to affected joints for 20 minutes prior to exercise.
- Educate patient on energy conservation techniques.
- Evaluation: After one week, patient demonstrates improved range of motion in knees and hips, and reports pain level of 3/10 with movement, indicating progress towards goal achievement.
Interventions Driven by PES Nursing Diagnoses
Choosing the right interventions is crucial for effectively addressing the problems identified in the PES nursing diagnosis. Interventions should be personalized to the patient’s unique needs and circumstances to ensure the most effective and individualized care plan.
Interventions can be nurse-initiated (independent) or physician-initiated (dependent/collaborative). The PES diagnosis helps determine both types of interventions.
For instance, for a patient with a PES nursing diagnosis of Risk for Infection related to surgical incision as evidenced by break in skin integrity, independent nursing interventions would include teaching proper hand hygiene and wound care techniques. Collaborative interventions might involve consulting with the physician regarding prophylactic antibiotics or a wound care specialist for complex wound management.
Nurses must integrate evidence-based practices and standards of care when selecting interventions, ensuring they are grounded in current research and best practices. Here are further examples of interventions linked to PES nursing diagnoses:
PES Nursing Diagnosis: Risk for Falls related to muscle weakness and impaired balance as evidenced by history of falls and unsteady gait.
- Interventions:
- Ensure the patient’s environment is free of hazards.
- Provide assistive devices such as a walker or cane.
- Implement hourly rounding to assist with toileting and ambulation.
- Collaborate with physical therapy for gait and balance training.
PES Nursing Diagnosis: Ineffective Breathing Pattern related to anxiety as evidenced by rapid, shallow respirations and patient report of feeling short of breath.
- Interventions:
- Teach and encourage slow, deep breathing exercises.
- Provide a calm and quiet environment.
- Administer prescribed anxiolytics if appropriate.
- Monitor respiratory rate, depth, and oxygen saturation.
Learn more about nursing interventions and their critical role in patient care with SimpleNursing resources.
NANDA-I Updates and PES Nursing Diagnosis Relevance
Staying updated with NANDA-I guidelines is vital for accurate nursing diagnosis, especially when formulating the “Problem” component of the PES nursing diagnosis.
Key updates from the latest NANDA-I edition include:
- Introduction of new diagnoses, revisions of existing ones, and retirement of outdated diagnoses. For example, the retirement of “constipation” and “diarrhea” as standalone diagnoses, now incorporated into “Impaired Intestinal Elimination,” reflects a shift towards more holistic and accurate diagnostic labels.
- Refinement of nursing diagnosis definitions, particularly for risk diagnoses, to enhance clarity and precision.
- Standardization of terminology for diagnostic indicators (related factors, risk factors, defining characteristics) to improve consistency in diagnostic language, which directly impacts the Etiology and Symptoms parts of the PES format.
- Updates to diagnostic labels to align with current literature and better represent human responses, ensuring the “Problem” in PES is current and reflective of contemporary nursing knowledge.
For nurses utilizing the PES format, these updates emphasize the importance of regularly consulting the latest NANDA-I resources to ensure that the diagnostic labels (Problem component) are accurate, current, and evidence-based. Using outdated or retired diagnoses can lead to inaccurate patient assessments and ineffective care plans.
Continuous Learning with SimpleNursing
PES nursing diagnoses are an indispensable tool for providing high-quality, patient-centered care. They empower nurses to accurately identify and address patient health issues, guide the development of tailored care plans, and ultimately improve patient outcomes. To further enhance your understanding of nursing diagnoses, interventions, and other essential nursing topics, explore SimpleNursing’s comprehensive nursing school resources.
SimpleNursing offers a wealth of resources, including video lectures, quizzes, and study tools, designed to support your nursing education and professional development. Join SimpleNursing today and elevate your nursing knowledge to deliver the best possible care to your patients, mastering the art and science of PES nursing diagnosis along the way.
