Nursing Diagnosis in Education:A Guideline for Students

Chapter ThreePart Two

Nursing Diagnoses in Education: A Guideline for Students

ContributorsFritz Frauenfelder

Maria Müller-StaubMargaret Lunney

ICN Definition of Nursing

• “Nursing Encompasses Autonomous and Collaborative Care of Individuals of All Ages, Families, Groups and Communities, Sick or Well and in All Settings”

• “Nursing Includes the Promotion of Health, Prevention of Illness, and the Care of Ill, Disabled and Dying People”

• “Advocacy, Promotion of a Safe Environment, Research, Participation in Shaping Health Policy and in Patient and Health Systems Management, and Education are Also Key Nursing Roles”

(International Council of Nurses 2010)

What is Nursing?

Nursing is a…

• Complex Process with Different Steps and Facets

• Challenging Process Because Nurses Work with Human Beings

• Difficult Process that has to be Learned

Nursing Demands…

• A Variety of Skills

• A Huge Amount of Knowledge

Be Aware

Learning Strategy #1

Nursing Process

The phases of the nursing process are interrelated, forming a continuous circle of thought and action that is both dynamic and cyclic (ANA 2009; Doenges and Moorhouse 2008)

EvaluationPatient’s status

and effectiveness of nursing interventions

Implementation Performing

nursing interventions

PlanningSetting goals with patients

and choosing interventions

Diagnosis Information interpretation

Stating problems and strengths

AssessmentInformation collection/

gathering data

Nursing Process

Nursing Process is a Dynamic Interrelated Process that Requires:

• Critical Thinking

• Critical Reading

• Critical Appraising

• Knowledge from the Arts and Sciences

• Professional Communication Skills

Nursing Process

Learning Strategy #2

Nursing Diagnosis

Nursing Diagnosis is:

•A Clinical Judgment about Individual, Family, or Community Experiences/Responses to Actual or Potential Health Problems or Life Processes

•Nursing Diagnoses Provide the Basis for Selection of Nursing Interventions to Achieve Outcomes for Which the Nurse has Accountability(Herdman 2012)

Nursing Diagnosis Definition

Actual Diagnosis (Sometimes Referred to as a “Problem” Diagnosis)Describes Human Responses or Experiences to Health Conditions and Life Processes that Exist in an Individual, Family, or Community

Risk DiagnosisDescribes Human Responses to Health Conditions and Life Processes that may Develop in a Vulnerable Individual, Family, or Community(Herdman 2012)

Types of Nursing Diagnoses

Health Promotion DiagnosisDescribes Human Responses to Increase Well-Being and Actualize Human Health Potential as Expressed in Their Readiness to Enhance Specific Health Behaviors in an Individual, Family or Community

Syndrome A Cluster or Group of Nursing Diagnoses that Tend to Occur Together(Herdman 2012)

Types of Nursing Diagnoses

Learning Strategy #3

The Structure of Nursing Diagnosis

Actual or Problem Nursing Diagnoses are Composed of:

• Nursing Diagnosis Label and Problem Definition Naming and Defining the Problem

• Etiologies or Causes Related Factors

• Signs and Symptoms Defining Characteristics

The Structure of Nursing Diagnosis

Nursing Diagnosis Definition

Explains the Patient’s Response or Problem:

• A Concise Phrase Representing the Problem Description

• Describes Individual Response of Patient

• Developed by Nurse Submitters and Approved by NANDA-I

The Structure of Nursing Diagnosis

Related Factors

Are the Etiologies or Causes of a Diagnosis:

• Influence the Response or Problem

• Identify One or More Probable Causes of the Response or Problem that can be Addressed by Nurses

• Can be Joined to Problem Part of Diagnosis with Phrase “Related to”

• Provide the Basis for Selecting Nursing Interventions for Problem Resolution or Improvement

The Structure of Nursing Diagnosis

Defining Characteristics

Are the Signs and Symptoms of a Diagnosis:

• Assessment Data Provide Observable and Subjective (Patient Verbalized) Cues or Evidence that Verify the Presence of the Diagnosis

• Can be Connected to Diagnosis Label with “As Manifested By” or “As Evidenced By”

• Provide the Basis for Selecting Nursing Interventions for Symptom Control, When Nurses Cannot Influence the Related Factor(s) of the Diagnosis

The Structure of Nursing Diagnosis

Risk Diagnoses are Composed of:

• Label

• Definition

• Risk Factors

The Structure of Nursing Diagnosis

Example

Risk for Falls (Nursing Diagnosis Label)

DefinitionIncreased Susceptibility to Falling that may Cause Physical Harm

The Definition Describes the Risk, Delineates its Meaning and Helps to Differentiate This Risk from Other Phenomena

The Structure of Nursing Diagnosis

Risk Factors

The Patient is at Risk — the Problem has Not Occurred Yet, Therefore No Etiologies are Present, But the Patient has Risk Factors

Risk Factors

• Increase the Vulnerability of a Patient

• Influence the Development of Problems

• Provide the Basis for Selecting Nursing Interventions to Prevent the Condition from Occurring

The Structure of Nursing Diagnosis

Health Promotion Diagnoses are Composed of:

Label and DefinitionThe Defining Characteristics are Cues Indicating that the Patient Desires Help with Health Promotion

Defining CharacteristicsExpress the Patient’s Willingness to Enhance Health Status

The Structure of Nursing Diagnosis

Learning Strategy #4

How to Identify the Patient’s Problems, Risk States, or Readiness for Health Promotion

Definition

•The Nursing Assessment is a Systematic Method of Collecting Data that Consists of the Appraisal of an Individual, Family, Group or Community for the Purpose of Identifying Health Problems, Risk States, Readiness for Health Promotion, and Strengths

•The Nursing Assessment has to be Systematic, Holistic, Accessible, Communicated and Documented

There are Two Kinds of Assessments:•History and Physical (H&P) Assessment

•Focused Assessments

Assessment

The Purpose of the Assessment Process:To Understand the Worldview of the Individual, Family, Group or Community in Consideration of Cultural Aspects, Gender, Age, Physiological, Psychological and Emotional Responses to Health and Life Events

NOTE: Worldview Encompasses People’s Philosophies, Beliefs, Attitudes, and Experiences

Primary Sources: Individual (Patient, Family, Group or Community Members)

Secondary Sources: Family or Significant Others, Nurses, the Health Record, Other Health Care Professionals

Assessment

Learning Strategy #5

How to Identify Nursing Diagnoses

Clustering Information:

•Data Gathered in the Interview, Physical Examination, and from Other Sources are Recorded in a Systematic Way and Grouped into Similar Categories

•An Evidence-based Nursing Assessment Framework that Links to Nursing Diagnoses is a Helpful Tool, e.g. Gordon’s Functional Health Patterns(Gordon 2008)

•Clustering Data Assists in Focusing the Nurse’s Attention on Relevant Information

Diagnostic Reasoning

The Challenge:To Detect Human Responses or Experiences on the Basis of Interactions with the Individual and the Nurse’s Cultural Competence

Diagnostic Reasoning

Analyzing Assessment Information:

•Organize Data

•Identify Cues to Diagnoses

•Validate Data Interpretations

•Verify Findings: •Compare Interviews with Physical Exam•Clarify Ambiguous Statements•Double-Check Abnormal Findings•Check Contradicting Findings

(Lunney 2009)

Diagnostic Reasoning

Identifying Cues:

•A Cue is a Unit of Data (For Example, Respiratory Rate is 36 Breaths Per Minute) that Influences Decisions to Choose a Nursing Diagnosis

• Cues Point to Changes, Strengths, Risk States, and Readiness for Health Promotion

• Cues may Indicate Developmental Delays or Deviations from Health Norms

(Gordon 2008)

Diagnostic Reasoning

Validate Diagnostic Hypotheses:

• Compare Information Against Standards

• Identify Gaps and Inconsistencies

• Consider Alternative Explanations for Findings

• Collect Additional Information as Indicated

• Confirm with the Patient or Family

Diagnostic Reasoning

Learning Strategy #6

Implementing and Documenting in the Nursing Care Plan

Linkages:

Connect NANDA-I Diagnoses with Further Evidence-Based Classifications for the Implementation Phase of the Nursing Process:

•Nursing Outcome Classification (NOC)

•Nursing Interventions Classification (NIC)(Bulecheck et al. 2008; Herman 2012; Moorhead et al. 2008)

Effective Use of Nursing Diagnosis

General Approach:

•If Possible, Treat the Related Factors with Nursing Interventions to Prevent or Reduce the Impact of Related Factors on the Individual

•If Not Possible o Treat Related Factors, Treat the Defining Characteristics to Achieve Symptom Control

Effective Use of Nursing Diagnosis

American Nurses’ Association (2009) The Nursing Process: A Common ThreadAmongst All Nurses. Kansas City: American Nurses Publishing.

Bulecheck G, Butcher H, Dochterman J. (eds) (2008) Nursing Interventions Classification (NIC), 5th edn. St Louis, MO: Mosby/Elsevier.

Doenges ME, Moorhouse MH. (2008) Application of Nursing Process and Nursing Diagnoses. Philadelphia: F.A. Davis.

Doenges ME, Moorhouse MH. (2008) Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales, 11th edn. Philadelphia: F.A. Davis.

Gordon M. (2008) Assess Notes: Nursing Assessment and Diagnostic Reasoning.Philadelphia: F.A. Davis.

Herdman TH. (ed.) (2012) NANDA International Nursing Diagnoses: Definitionsand Classification, 2011-2014. Oxford: Wiley-Blackwell.

International Council of Nurses (2010) www.icn.ch/Lunney M. (2009) Critical Thinking to Achieve Positive Health Outcomes. Ames, IA: Wiley-BlackwellMoorhead S, Johnson M, Maas M, Swanson E. (eds) (2008) Nursing Outcomes Classification

(NOC), 4th edn. St Louis, MO: Mosby.

References