Chapter 7 Nursing Diagnosis Fundamentals of Nursing: Standards & Practices, 2E

 Copyright 2002 by Delmar, a division of Thomson Learning 7-2 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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-3 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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-4 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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-5 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).

 Copyright 2002 by Delmar, a division of Thomson Learning 7-6  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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-7 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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-8  They provide a means to individualize nursing care.  They have the potential of providing an avenue for theory development and nursing research.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-9 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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-10  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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-11 Components of a Nursing Diagnosis  Two-part statement: diagnostic label, etiology  Three-part statement: diagnostic label, etiology, defining characteristics

 Copyright 2002 by Delmar, a division of Thomson Learning 7-12 Categories of Nursing Diagnoses  Actual diagnoses  Risk diagnoses  Wellness diagnoses  Syndrome diagnoses

 Copyright 2002 by Delmar, a division of Thomson Learning 7-13 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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-14 Exchanging Moving Perceiving Knowing Feeling Communicating Relating Valuing Choosing  Nine patterns of human response

 Copyright 2002 by Delmar, a division of Thomson Learning 7-15 Developing a Nursing Diagnosis  Assessing the database  Validating cues  Interpreting cues  Clustering cues  Consulting NANDA list of nursing diagnoses  Writing the nursing diagnostic statement

 Copyright 2002 by Delmar, a division of Thomson Learning 7-16 Avoiding Errors in Developing a Nursing Diagnosis  Problem with assessment data  Incomplete collection of assessment data  Restricted data collection  Failure to validate data

 Copyright 2002 by Delmar, a division of Thomson Learning 7-17  Misinterpretation of data  Inappropriate data clustering associated with lack of clinical knowledge  Incorrect writing of the nursing diagnostic statement

 Copyright 2002 by Delmar, a division of Thomson Learning 7-18 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

 Copyright 2002 by Delmar, a division of Thomson Learning 7-19 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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-20  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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-21 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.

 Copyright 2002 by Delmar, a division of Thomson Learning 7-22  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.