Nursing Diagnosis Chapter 12

12-2 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  The term nursing diagnosis is used in three different contexts: Data analysis and decision-making process Diagnostic label Classification system

12-3 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Definition of a Nursing Diagnosis (NANDA, 1996)  “A clinical judgment about individual, family or community responses to actual and potential health problems/life processes”

12-4 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Comparison of Medical and Nursing Diagnoses  Medical and nursing diagnoses both use the comprehensive diagnostic process in making a clinical judgment and determining expected outcomes.

12-5 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Comparison of Medical and Nursing Diagnoses  Medical diagnosis is the terminology used for a clinical judgment by the physician that identifies or determines a specific disease, condition, or pathologic state.

12-6 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnosis  Terminology used for a clinical judgment by the professional nurse that identifies the client’s actual, risk, wellness, or syndrome responses to a health state, problem, or condition.

12-7 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Comparison of Nursing and Medical Diagnoses  Nursing diagnoses differ from medical diagnoses in: Purpose Goals Therapeutic Interventions

12-8 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Comparison of Medical and Nursing Diagnoses  “Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.” (NANDA, 1996)

12-9 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Perspective  Fry (1953) identified that nursing diagnosis is a tool for individualizing patient care.  First National Conference for the Classification of Nursing Diagnoses, (1973).  American Nurses Association (ANA) published Standards of Nursing Practice (1973).

12-10 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Historical Perspective  North American Nursing Diagnosis Association (NANDA),  NANDA developed 21 new nursing diagnoses and revised 37 existing diagnoses (1998).  Development of an ad hoc research committee (1998).

12-11 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Purposes of Nursing Diagnosis  Identifies areas that nurses can resolve or enhance.  Demonstrates professional judgment.  Organizes decision making as part of the nursing process.  Promotes accountability.

12-12 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Purposes of Nursing Diagnosis  Provides communication among nurses and other health care personnel.  Promotes use of standardized language and process.  A means to individualize care.  Provides a mechanism for conducting nursing research.

12-13 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nursing Diagnoses and Diagnostic- Related Groups (DRGs)  The DRG coding system for prospective payment financing (1983) is based on the medical model and medical diagnoses.  There are no set codes for nursing diagnosis or care.

12-14 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Components of a Nursing Diagnosis  The two-part statement Problem statement or diagnostic label Etiology  The diagnostic label and etiology are linked by the term related to (RT).

12-15 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Components of a Nursing Diagnosis  The three-part statement Diagnostic Label Etiology Defining Characteristics

12-16 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. The Three-Part Statement  Defining characteristics are the signs and symptoms, subjective and objective data, or clinical manifestations.  The phrase, “as evidenced by …” (AEB), is joined to the first two components.

12-17 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Categories of Nursing Diagnoses  Actual Diagnoses  Risk Diagnoses  Wellness Diagnoses

12-18 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Taxonomy of Nursing Diagnosis  A taxonomy is a system of classification.  Taxonomy II Current NANDA-approved system for identification and naming of nursing diagnoses. Categorizes NANDA-approved nursing diagnoses by patterns of response.

12-19 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Nine Patterns of Human Response  Exchanging  Moving  Perceiving  Knowing  Feeling  Communicating  Relating  Valuing  Choosing

12-20 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Developing a Nursing Diagnosis  Critical thinking  Assessing the database  Validating cues  Interpreting cues  Clustering cues  Consulting NANDA list of nursing diagnoses  Writing the nursing diagnostic statement

12-21 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Developing a Nursing Diagnosis  Critical thinking is essential to the synthesis and interpretation of information when developing a nursing diagnosis.

12-22 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Developing a Nursing Diagnosis  Assessing the Data Base Cues are small amounts of data gathered during assessment. Cues raise suspicion. Cues stimulate further observation. Cues stimulate further data collection.

12-23 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Developing a Nursing Diagnosis  Validating Cues Verifying subjective and objective data for accuracy and completeness  Interpreting Cues Assigning meaning to data cues  Clustering Cues Grouping related data together

12-24 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Developing a Nursing Diagnosis  Consulting NANDA List of Nursing Diagnoses The clustered data are matched with a NANDA diagnosis.  Writing the Nursing Diagnosis Statement The NANDA list provides the diagnostic label and etiology.

12-25 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Avoiding Errors in Developing a Nursing Diagnosis  Accurate and complete collection of data.  Use of an organizational framework for clustering data cues.  Thorough analysis and validation of data.  Correct writing of the nursing diagnosis.

12-26 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

12-27 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Limitations 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.

12-28 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Limitations of Nursing Diagnosis  Nurses may be unable or unwilling to use nursing diagnoses because of incomplete knowledge.  If a nursing diagnosis is inappropriate, and as a result, the interventions are inappropriate or lacking, the nurse is liable for these errors in judgment.

12-29 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 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.

12-30 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Overcoming Barriers to Nursing Diagnosis  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.

12-31 Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. Overcoming Barriers to Nursing Diagnosis  Every attempt should be made to describe phenomena that do not fit into existing nursing diagnosis language.  The nurse may be on the threshold of documenting a new nursing diagnosis.