Nursing Diagnosis Need-to-Know

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In This Section

Down N Dirty on Nursing Diagnosis: 60-Second Summary

About the Nursing Diagnosis

Standardization of Nursing Terminology

NANDA

Purpose

Structure

Components: The 5 Labels

Creating a Quality Diagnosis

Supplies/Materials

References and Nursing Resources

Down N Dirty on Nursing Diagnosis

The 60-Second Summary

What: A statement that addresses the most important patient needs that
fall within the RN's Scope of Practice

Part of the nursing process (APIE): Assessment, problem statement

(nursing diagnosis), interventions, evaluation

Nursing vs. medical diagnosis: Human response versus pathology/disease

Purpose: Standardize language use amongst nurses across the

country/world

NANDA: The primary entity that mandates the "language" or accepted

structure of nursing diagnoses

Benefits: Improve continuity of care, and subsequently, patient outcomes

Students: Develops ability to think critically through the nursing

process and utilize clinical decision making

4 types of nursing diagnoses: 1) Actual. 2) At-risk, 3) Health

promotion. 4) Syndrome

5 components: 1) Diagnostic label. 2) Related factors. 3) Definition. 4)

Risk factors. 5) Support

About the Nursing Diagnosis

What is a Nursing Diagnosis?
Simply put, a nursing diagnosis is a statement made by a Registered Nurse (RN) that addresses
the focus of nursing care to be provided to a patient. The diagnosis reflects an issue or state of
health to direct care planning that falls within the nurses Scope of Practice. The patient
usually refers to an individual person but may also be used in regards to a family (family-based
diagnosis) or a community (community-based diagnosis).
The Nurse as a Diagnostician
The RN serves as a diagnostician through the use of nursing diagnosis (Lunney, 2008). This
dynamic process involves comprehensive clinical decision making derived from assessment
findings and data collection. Priority needs are identified through the use of sound diagnostic
reasoning.
Individualized
A nursing diagnosis is an integral part of the nursing process that encompasses an individualized
approach to the patients unique situation, personal preferences, and needs. It serves to direct the
remaining components of the nursing process: Planning, intervention (and implementation),
and evaluation. Most patient care and educational facilities require nurses or students to use
NANDA-approved diagnoses and supporting terminology in their clinical documentation.
NANDA-approved terminology serves as a blueprint to drive the nursing process into the real
world of clinical practice.
#NurseHack: An ideal nursing diagnosis requires critical thinking to address the
highest priority of a patients needs that fall within the nurses scope of practice.

Nursing and Medical Diagnosis

A rookie error commonly made on behalf of the new nursing student is to diagnosis medical
conditions. While the RN is a diagnostician in a sense, this is by no means synchronous with the
role of a provider. Medical diagnosis falls under the role of a provider, including a medical
doctor (MD), doctor of osteopathy (DO), nurse practitioner (NP), or a physician assistant
(PA). Providers make diagnosis of pathologies. The Registered Nurse provides diagnosis based
upon the human response to a condition or disease.
This differentiation between diagnosticians does not devalue the nurses role by any means. The
relationship between the provider and the nurse is symbiotic, as in each serves a different role yet
enhances the other. The dynamic between RN and provider diagnoses functions in a
manner similar to the checks and balances system used in the American Democracy system. One
branch needs the other in order to best serve the people or in this case, the patients.
While the provider diagnoses and treats disease, the nurse is focused on ensuring that the patient
is provided with the care that will facilitate the treatment in the safest and most effective way
possible. Meeting this goal requires collaboration between interdisciplinary team members. To
effectively coordinate care between the disciplines, the RN must possess a solid understanding of
each individuals role. Nursing diagnosis directs actions that implement the overall goals of
patient care from the RNs perspective while reducing the risk of secondary harm.
Scope of Practice
To differentiate between the nursing and medical diagnoses, it helps to keep in mind that the
nurse must be professionally and legally capable to treat the problem identified within the
diagnosis. Another way to conceptualize the diagnosis is to understand that the associated
intervention must fall within the nurses Scope of Practice. The Scope is outlined in
the Nursing Practice Act. Facilitated by the National Council of State Boards of Nursing, this is a
national act that also incorporates the additional regulations and oversight of individual States.
The RNs scope of practice varies based upon the state in which the nurse is licensed. Although
each state interprets the national scope of practice guidelines with some unique variability, they
still fall within the spectrum of criteria set by national guidelines. Furthermore, the employing
facility, such as a hospital or a wound clinic, further defines scope of practice within the realm of
national and state guidelines through the development of policies and procedures.

Standardization of Nursing Terminology

Nursing Diagnosis and the Continuum of Care
As patient outcomes are best when there is a seamless transition through various health settings,
nurses provide for the continuity of care. One way that this is achieved is through standardized
language use. Nursing diagnosis is structured to convey the same idea across the spectrum of
professional practice. Whether the patient is cared for in Arizona one week and New Jersey the
next, consistency may be obtained through the proper use of nursing diagnosis (Lunney, 2008).

The Standardization of Nursing Diagnosis

While there is no singular comprehensive language, the American Nurses Association
(ANA) serves as the leader to bring conformity to nursing vernacular. The ANA maintains a
Committee for Nursing Practice Information Infrastructure (CNPII), which currently accepts the
use of twelve standardized languages (ANA, 2012). Out of these
languages, NANDA International generates the most commonly utilized source of regulating
nursing diagnoses in the world.

NANDA
The Origins of the Nursing Diagnosis: NANDA-i
Since 1992, NANDA (formally NANDA International; currently just NANDA-i or simply called
NANDA) has been recognized by the ANA to develop standardized terminologies for use in
nursing practice. NANDAs standardized model is derived from evidence-based research. The
non-profit organization is ran by volunteers who perpetually work to revise language use thats
reflects the most current needs in the clinical environment. NANDA collaborates with nursing
professionals and other groups, such as the Nursing Interventions Classification System
(NIC) and Nursing Outcomes Classification (NOC). The end product is
NANDA developed terminologies that fall within the nurses scope of practice (Rutherford,
2008).
In addition to using evidence-based research, NANDA devises revisions or amendments to
standardized language based upon changes in public policies and emerging needs. Other various
organizations that play a role in patient care also serve to influence this language mosaic. For
example, documentation standards reflect the patient safety goals of the Joint Commission, an
organization that provides voluntary accreditation services for hospitals in the United States.
#NurseHack: NANDA is the master of the nursing diagnosis.
Most professional healthcare facilities that employ Registered Nurses support the use NANDA
definitions and classifications in documentation (charting). Likewise, the majority of nursing
programs require the use of NANDA-approved language for use in the students care plan
composure and other paperwork. In fact, nursing schools often use NANDA vocabulary to teach
students the nursing process through the ability to use systematic clinical judgment.
NANDA Nursing Diagnosis Terminologies
The framework developed by NANDA provides standardized terminologies for nursing
interventions which are referred to as NANDA Classifications. Included in the nursing
diagnosis is a diagnosis label, related factors, and defining characteristics (NANDA International
Board of Directors, 2010). NANDA requires a fee in order for publishers or entities to use its
nomenclature.

Purpose
What is the Purpose of a Nursing Diagnosis?
The nursing diagnosis fulfills the second step of the nursing process. It serves as a
guiding methodology to care planning that is standardized to improve communication between
nurses and other members of the interdisciplinary healthcare team. By avoiding
unstandardized language, it prevents assumptions from being made, thereby increasing accuracy
in practice. The diagnosis improves the quality of care given by supporting the thought process
for prioritization in order gauge the most vital care to be given. It assists nurses as well as
other members of interdisciplinary team in understanding the clients problems and promotes
patient-focused care rather than medical or nursing-focused care. Furthermore, it supports the
continuity of care so that treatment remains consistent between transfers to various facilities
(Rutherford, 2008)
#NurseHack: As you go through lectures in nursing school, ask your professor, What are
the priority nursing diagnoses related to this topic? Then use them to guide your studies.

Objectives of the Nursing Diagnoses

Fulfills the second step of the nursing process

Standardization and continuity of care

Improved communication between nurses and members of the interdisciplinary

healthcare team

Prioritizing Nursing Care

The process of nursing diagnosis development enables the nurse to focus care on the most vital
needs that are conducive to optimal patient outcomes. Nursing diagnoses can be applied to any
setting in which the nurse provides care to an individual patient, family, or community.
Learning the Nursing Process
From a student perspective, learning to correctly identify the priority nursing diagnosis or
diagnoses is beneficial to understanding and implementing the steps of the nursing process. It
also assists students in the development of critical thinking, a systematic thought process that
involves going beyond the surface to analyze a clinical situation. Furthermore, it promotes
consistency in education and improved patient outcomes.

#NurseHack: Using nursing diagnoses helps students learn how to apply the process and
develop the ability of critical thinking.

Who are Nursing Diagnoses Written For?

Individual patients

Families

Communities

Types
The Four Types of Nursing Diagnoses
1. Actual
2. At-Risk
3. Health Promotion
4. Syndrome
#1: Actual Nursing Diagnosis

An actual nursing diagnosis addresses an issue pertaining to the human response within
the patient, family or community to a disease, life situation, or other health condition

Examples: Pain or Hypothermia

Must be followed by defining characteristics or factors that relate to the actual portion
of the diagnosis

#2: At-Risk Nursing Diagnosis

An at-risk nursing diagnosis encompasses potential or likely risk factors that a patient is
vulnerable to

Example: At risk for infection

Must be followed by the risk factors pertinent to the at risk portion of the diagnosis

Note: NANDA does not permit at-risk nursing diagnoses to be interchangeable with
actual nursing diagnoses; for instance, its not acceptable to swap out pain with atrisk for pain (NANDA International, n.d.)

#3: Health Promotion Nursing Diagnosis

A health promotion nursing diagnosis is a clinical judgment that encompasses a

patients desire and motivation for a readiness of an enhanced state of health or a
factor that may lead to improved level of health

A health promotion nursing diagnosis does not require a current level of wellness

Example: Readiness for enhanced learning

#4: Syndrome Nursing Diagnosis

Clusters multiple nursing diagnoses together

Nursing care is provided through similar nursing interventions that are applied to the
entire group (4)

Structure
Structure of the Actual Nursing Diagnosis

The problem (diagnostic label) related to (the etiological factor or what is causing it) as
evidenced by (assessment data or clinical markers)

Structure of the At-Risk Nursing Diagnosis

At risk for the problem (diagnostic label) related to (the etiological factor or what is
causing it)

A Priority Problem*

A diagnostic label that pertains to an actual problem, at-risk problem, health promotion,
or the cluster of diagnoses denoted by the syndrome

The diagnostic label must be approved through NANDA to render it as credible and must
also be replicable through nursing assessment so that if another qualified nurse (or
student) were to assess the patient, the same conclusions would be drawn

The problem must fall within the nurses scope of practice to treat: this is a primary
difference that distinguishes the nursing diagnosis from a medical diagnosis

Example: Pain; the treatment of pain falls within the nurses scope of practice whereas
cancer does not

Related To

The etiological factor

Meets the needs of tailoring care to the individual needs of the patient and guides
appropriate selection of interventions

Related to the etiology: this may be derived from the medical diagnosis or from another
factor thats responsible for the identified nursing diagnosis

As Evidenced By

The characteristics that define the nursing diagnosis such as clinical manifestations

As evidenced by is used in the actual risk diagnosis type

#NurseHack: Although the a problem doesnt necessarily have to be the priority in order
to be develop a nursing diagnosis, the student should strive to make a habit of identifying
the priority problem. This helps develop clinical judgment, which is essential for both
testing purposes and professional nursing practice.

Components
The Five Labels
1. Diagnostic label
2. Related factors
3. Definition
4. Risk factors
5. Support
1: Diagnostic Label

The actual NANDA approved diagnosis

May include descriptors such as compromised, decreased, deficient or impaired

2: Related Factors

The etiology or condition that cab be treated by an intervention that falls within the
nurses scope of practice

Determined from data identified during the nursing assessment

3: Definition

A NANDA-approved characteristic of the human response

4: Risk Factors

Factors that impose vulnerability upon a patient, family, or community

Includes elements such environmental, genetic, physiological, or psychological factors

5: Support of the Diagnostic Statement

Data that supports the nursing diagnosis

Collected from assessment

Creating a Quality Nursing Diagnosis

Follow the Nursing Process

The nursing process can be remembered through the acronym APPIE: assessment,
problem or nursing diagnosis, planning, interventions (including imprementation of
interventions), and evaluation of the outcomes

Use the five components when developing an the diagnosis by considering how it is
related go each part (Lunney, 2008)

Individualize the Diagnosis to the Patient

This is where patient-centered care is integrated into the nursing diagnosis. This tends to be
confusing for many nursing students that wonder how to meet the approved language standards
without plagiarizing. Theres no simple solution to this conundrum; it may be in your best
interest to clarify this aspect with your professors. Ideally, standardized terminologies will still
be used but you will select from the specific options that are most conducive to meeting the
needs of your patients unique situation.

Supplies and Materials

Selecting the Best Materials
While your general textbooks will likely contain some care plan templates and sample nursing
diagnoses, you may find that you need more information for particular clinical cases. At the start
of the program, nursing students benefit tremendously from purchasing a quality textbook that
contains nursing diagnoses. These resources should contain nursing diagnoses that use NANDA
approved diagnoses, interventions, and related terminologies such as defining characteristics.
Nursing Diagnosis or Nursing Care Plan Book?
Depending upon the care plan format that your program requires, along with
your individual preferences, you will have two major options to chose from. You may purchase a
book that bases care planning off of the nursing diagnosis, commonly referred to as a Nursing
Diagnosis Book. For example, based upon the nursing diagnosis ineffective breathing patterns,
you will find that pneumonia is one of the possible pathologies associated with the diagnosis.
Another option is to buy a Nursing Care Plan Book, which will contain nursing diagnoses
within the contents of each care plan. In this case, you will look up pneumonia as a care plan
and find ineffective breathing patterns within the contents of the section as a potential nursing
diagnosis.
Reaping the Greatest Benefits
A great topic to address during your new admission orientation at your school is what kind of
supplemental books the program administrators recommend for students. Some programs will
suggest investing in only one comprehensive resource for care planning while others prefer
students to purchase a Nursing Diagnosis Book in addition to a Nursing Care Plan Book. (Be
sure to be prepared to clarify what each are, as some administrators may be fuzzy on the
difference. If you are not confident with the answer you receive, it may be best to wait and ask a
professor instead). Additionally, inquire about how many books you will need to have in order to
write care plans for different classes. Ask: Is only one comprehensive care plan/diagnosis book
sufficient or do they recommend specialized ones for specific classes? For instance, they may
recommend buying a special care plan book for your pediatrics class and a different one for
mental health.
Nursing Diagnosis and Care Plan Books

NANDA International Nursing Diagnoses: Definitions and classification 2012-2014.

Wiley Blackwell.

Nursing care plans: Guidelines for individualizing client care across the life span (8th
ed.). Authors: Doenges, M., Moorhouse, M., & Murr, A. Published in 2009 by F. A Davis
Company.

All-in-One Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and

Psychiatric Nursing Care Plans: 3rd Edition. Published by Mosby in 2012. ISBN:
9780323074209

Mosbys Guide to Nursing Diagnosis, 3rd ed. Authors: Gail B. Ladwig & Betty J.
Ackley. Published by Mosby in 2012. ISBN: 9780323071727

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care: 4th
Edition. Published by Mosby Davis. ISBN-13: 978-0-8036-2804-5

Nursing Care Plans and Documentation: Nursing Diagnoses and Collaborative Problems,
5th Edition. Published by Lippincott. ISBN/ISSN: 9780781770644

References and Nursing Resources

American Nurses Association (June 4, 2012). ANA Recognized Terminologies that

Support Nursing Practice. Retrieved from
http://www.nursingworld.org/npii/terminologies.htm

Cavendish, R. (2004). School nurses use of NANDA, NIC, & NOC to describe
childrens abdominal pain. International Journal of Nursing Terminologies &
Classifications, 14(4), 17-18. Retrieved from
http://onlinelibrary.wiley.com/doi/10.1111/j.1744-618X.2003.017_2.x/abstract

Lunney, M. (2008). Critical need to address accuracy of nurses diagnoses. The Online
Journal of Issues in Nursing, 13(1). Retrieved from
http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/O
JIN/TableofContents/vol132008/No1Jan08/ArticlePreviousTopic/AccuracyofNursesDiag
noses.html

Keenan, G. M., Yakel, E., Tschannen, D., & Mandeville M. Chapter 49.
Documentation & the Nurse Care Planning Process

NANDA International Board of Directors (2010, October). NANDA International

Position Statement for Nursing Education: The Structure of the Nursing Diagnosis
Statement When Included in a Care Plan. Retrieved from http://www.nanda.org/nandainternational-structure-nursing-diagnosis-statement.html

NANDA International. (n.d.). Can I add risk for to an actual diagnosis to make it a
risk diagnosis? Or remove risk for from a risk diagnosis to make it an actual
diagnosis? | NANDA International Knowledgebase. Retrieved from
http://nanda.host4kb.com/article/AA-00488/36/English-/Frequently-Asked-

Questions/Nursing-Diagnosis/Nursing-Diagnosis%3A-Learning-Using/Can-I-add-riskfor-to-an-actual-diagnosis-to-make-it-a-risk-diagnosis-Or-remove-risk-for-from-a-riskdiagnosis-to-make-it-an-actual-diagnosis.html

NANDA International (n.d.). Glossary of terms. Retrieved from

http://www.nanda.org/nanda-international-glossary-of-terms.html

NANDA International (n.d.). What is the difference between a medical diagnosis & a
nursing diagnosis? | NANDA International Knowledgebase. Retrieved from
http://kb.nanda.org/article/AA-00266/38/English-/Frequently-Asked-Questions/NursingDiagnosis/Nursing-Diagnosis-v.-Medical-Diagnosis/What-is-the-difference-between-amedical-diagnosis-and-a-nursing-diagnosis-.html

NANDA International. Nursing diagnoses: Definition and classification 2003-2004.

Philadelphia: NANDA International; 2003.

National Council of State Boards of Nursing (January, 2011). NCSBN Model Nursing
Practice Act and Model Nursing Administrative Rules. Retrieved from
https://www.ncsbn.org/Model_Nursing_Practice_Act_March2011.pdf

Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing
practice? The Online Journal of Issues in Nursing, 13(1). Retrieved from
http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/H
ealth-IT/StandardizedNursingLanguage.html

Legal Disclosure on the Use of Nursing Diagnoses

Please note that all mention of nursing diagnoses are summarized for the learning benefit of the
nursing student for the purpose of learning how to compose student version nursing care plans.
Diagnoses of medical and psychiatric conditions are never made by a Registered Nurse and do
not legally fall under the nurses scope of practice. However, nursing diagnoses that fall under
the NANDA classification may be developed legally by a Registered Nurse who is licensed
authorized to practice nursing care in the United States of America.
In consideration of copyright infringement, iStudentNurse does not list the full language of
potential nursing diagnoses in the format as stated by NANDA. Rather, the information provided
above summarizes the general format in which a nursing diagnosis is developed, with the
intention of learning and not professional nursing practice. A summary of the main,
or etiological concepts may be provided for the purpose of student based knowledge
enhancement, which may later be used independently of iStudentNurse in the process
of developing a nursing diagnosis through the personal use of a resource authorized to
provide NANDA approved terminologies.
For information on the nursing diagnoses, please consult the directly with the source:
NANDA

PO Box 157
Kaukauna, WI 54130
Or contact NANDA through their website at https://www.nanda.org/contact-us.html