Post on 17-Jan-2016
Chapter 7
Nursing Diagnosis
Fundamentals of Nursing: Standards & Practices, 2E
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Nursing Diagnosis
Nursing diagnosis (the second step of the nursing process) is the clinical judgment about individual, family, or community responses to actual or risk health problems, wellness states, or syndromes.
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What is a Nursing Diagnosis?
It provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.
It is focused on client-centered problems.
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Comparison of Nursing and Medical Diagnoses
Medical diagnosis is the terminology used for a clinical judgment by the physician that identifies or determines a specific disease, condition, or pathological state.
Nursing diagnosis is the terminology used for a clinical judgment by the professional nurse that identifies the client’s responses to a health state, problem, or condition.
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Historical Perspective
Fry (1953) identified that nursing diagnosis is integral to the plan of nursing care.
In 1973, the First National Conference for the Classification of Nursing Diagnoses convened in St. Louis, Missouri.
In 1982, the organization was renamed the North American Nursing Diagnosis Association (NANDA).
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Additional endorsement for nursing diagnosis came from the American Nurses Association (ANA) in 1973 in the publication, Standards of Nursing Practice (ANA, 1973).
In 1998, NANDA developed 21 new nursing diagnoses and revised 37 existing diagnoses.
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Purposes of Nursing Diagnoses
They contribute to the professional status of the discipline.
They provide a means for effective communication.
They facilitate holistic client, family, and community-focused care.
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They provide a means to individualize nursing care.
They have the potential of providing an avenue for theory development and nursing research.
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Nursing Diagnoses and Diagnostic-Related Groups
Diagnostic-related groups (DRGs) were implemented in 1983 as a response to escalating health care costs.
DRGs were developed on the basis of the medical model and medical diagnosis.
The reimbursement system is centered on medical diagnoses, not nursing diagnoses.
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There have been attempts to identify nursing’s contribution to the over 400 DRGs.
Nursing care costs have been derived for many of the DRGs.
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Components of a Nursing Diagnosis
Two-part statement: diagnostic label, etiology
Three-part statement: diagnostic label, etiology, defining characteristics
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Categories of Nursing Diagnoses
Actual diagnosesRisk diagnosesWellness diagnosesSyndrome diagnoses
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Taxonomy of Nursing Diagnoses
Type of classification under which the diagnostic label is grouped
Based on human responses to actual or perceived stressors
NANDA Taxonomy II organizes the NANDA-approved nursing diagnoses under the corresponding human response category.
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• Exchanging• Moving• Perceiving• Knowing• Feeling
• Communicating• Relating• Valuing• Choosing
Nine patterns of human response
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Developing a Nursing Diagnosis
Assessing the database Validating cues Interpreting cues Clustering cues Consulting NANDA list of nursing
diagnoses Writing the nursing diagnostic statement
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Avoiding Errors in Developing a Nursing Diagnosis
Problem with assessment dataIncomplete collection of assessment
dataRestricted data collectionFailure to validate data
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Misinterpretation of dataInappropriate data clustering
associated with lack of clinical knowledge
Incorrect writing of the nursing diagnostic statement
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Limitations of Nursing Diagnosis
Lack of consensus among nurses regarding the NANDA-approved nursing diagnosis list
Disagreement over specific label in the classification system
Perception that the list is confining, incomplete, medically oriented, confusing
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Barriers to Use of Nursing Diagnosis
Nurses are overworked and have less time with clients.
Care is still organized around the medical diagnosis.
Nurses are afraid they may be ridiculed for using nursing diagnoses.
The nursing diagnosis list does not always fit the client situation.
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There are many approaches for application of a nursing diagnosis in the nursing literature, and it may be difficult for the nurse to choose best approach.
Nurses may be unable or unwilling to use nursing diagnoses because of incomplete knowledge.
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Overcoming Barriers to Nursing Diagnosis
Familiarity of nursing diagnosis language empowers the nurse to communicate more effectively.
Health care agency administrators and medical staffs need to be more supportive of the use of nursing diagnoses.
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Enhanced communication between clinical nurses and leaders will increase the development of nursing diagnoses.
Most nursing education programs offer standardized content related to nursing diagnoses.
Experienced nurses need opportunities to review nursing diagnoses.