STEPS OF NURSING

PROCESS
NURSING DIAGNOS
 Introduction
• 2nd phase of nursing process Critical
thinking
• Pivotal step in nursing process
• North American Nursing Diagnosis
Association (NANDA) 1982
 North American Nursing Diagnosis
Association (NANDA)
• The purpose of NANDA is to define refine and
promote a taxonomy of nursing diagnostic
terminology.
• Taxonomy : A taxonomy is a classification
system or set of categories arranged based on a
single principles.
• In 2000, taxonomy 1 revised to taxonomy 2
• Currently, approved,13 domains and 47
classes, 247 nursing diagnosis.
NANDA NURSING DIAGNOSIS
Definitions
• Diagnosis : diagnosis is a statement or
conclusion regarding the nature of
phenomenon.
• Diagnostic label: the standardized NANDA
names for the diagnoses are diagnostic label.
• In 1990 ,NANDA adopted on official working
definition of nursing diagnosis,
 Nursing diagnosis
“A clinical judgment about individual family, or
community responses to actual or potential
health problems / life process”.
A nursing diagnosis provides the basis for
selection of nursing interventions to achieve
outcome for which the nurse’s accountable

 Professional nurses are responsible for making

nursing diagnosis
 13 domains …………
• Health promotion • Coping or stress
• Nutrition tolerance
• Elimination exchange • Life principle
• Activity /rest • Safety /protection
• Perception or cognition • Comfort
• Self perception • Growth and
• Role relationships development
• Sexuality
 Characteristics of nursing
diagnosis…
• It states clear and concise health problem
• It derived from existing evidences about the
client
• It is potentially amenable to nursing therapy
• It is the basis for planning and carrying
out nursing care
Types of nursing diagnosis …….
Actual nursing diagnosis

Risk nursing diagnosis

Health promotion nursing diagnosis

Possible nursing diagnosis

Syndrome nursing diagnosis

Actual nursing diagnosis…….

“A clinical judgment about human

experience/responses to health conditions /life
processes that exist in an individual ,family or
community.”
 Actual client problem present at the time of
assessment.
 It is based on the presence of signs and symptoms
 Eg :
 Ineffective breathing pattern
 Disturbed sleep pattern
Risk nursing diagnosis…..
• It is a clinical judgment that a problem doesn't
exist but the presence of risk factors indicates
that a problem is likely to develop unless
nurses intervene.
• No subjective or objective cues
• Eg : A client with DM or compromised
immune system is at high risk than others
Risk for infection
Risk for injury
Health promotion nursing diagnosis…
• Describes human responses to level of wellness in an
individual, family or community that have a readiness
for enhancement.
• Clinical judgment about a person’s ,families or
communities motivation and desire to increase well
being
• Eg :
 Readiness for enhanced family coping
 Readiness for enhanced self esteem
 Possible nursing diagnosis……….
• A possible nursing diagnosis is one in which evidence
about a health problem is incomplete or unclear.
• A possible diagnosis requires more data either to
support or to refuse it
• Eg :
– Possible social isolation related to unknown etiology
potential risk of constipation as a result of enforced bed
rest
 Syndrome nursing
diagnosis………..
• A clinical judgment describing a specific cluster of
nursing diagnoses that occurs together and are best
addressed together and through similar
interventions.
• Eg:
– Rape trauma syndrome
Components of nursing diagnosis
……

Nursing
diagnosi
s
Problem and Defining
its definition characteristics

The etiology
 1. Problem (diagnostic
label)/definition
The problem statement describes the client health
problem or response for which nursing therapy is given
• The diagnostic label should be specific
• Each diagnostic label approved by NANDA carries a
definition that clarifies its meaning
• Qualifiers ; Are words that have been added to some
NANDA labels to give additional meaning to the diagnostic
statement
Acute
Deficient
Chronic
Impaired Imbalanced
Ineffective Interrupted
Decreased
 2. Etiology (related factors or risk
factor)….
• Identifies one or more probable causes of the
health problem, gives directions to the
required nursing therapy.
• Enables the nurses to individualized client care
PROBLEM ETIOLOGY
Constipation Long term laxative use,
inactivity and insufficient fluid
intake
Anxiety Threat to physiologic integrity
Possible cancer diagnosis
 3. Defining characteristics.........
The cluster of signs and symptoms that
indicate the presence of a particular diagnostic
label .
Actual diagnosis: client signs and symptoms
Risk diagnosis : no subjective signs are present
THE DIAGNOSTIC PROCESS
Diagnostic process….

synthesi
s

Analysis

Critical
thinking
 Steps of diagnostic process…..

1. Analyzing data

2. Identifying
health problems
risks and strengths
3. Formulate
diagnostic
statement
 1. Analyzing data………

Compare data against the standard

Cluster cues

Identifies gaps and inconsistencies

2. Identifying health problems…
• The nurse and client can together identify
strengths and problems
• Primarily decision making process
Determine problems
• Medical diagnosis
• Nursing diagnosis
• Collaborative problem

Determine strengths
• Resources
• Ability to cope up
Formulating diagnostic
statement……
Two part
statement
Three
One part
part
statement
statement

Nursing
diagnosis
Basic two parts………..
1. Problem :statement of the client responses
2. Etiology :factors contributing to or probable
causes of the responses
 “related to” phrase implies a relation ship
 Eg :
 Constipation related to insufficient fluid intake
 Acute pain related to presence of surgical
incision
 Insomnia related to hospitalization
Basic three parts…………..
Also called PES format;
1. Problem
2. Etiology
3. Signs and symptoms (defining characteristics
manifested by the client)
 Actual nursing diagnoses can be documented
by using the three part statement
 Not used for risk diagnosis
Basic three parts…………..
• Eg :
– Acute pain r/t surgical incision as evidenced by
verbalization
– Ineffective airway clearance r/t accumulation of
pulmonary secretions as evidenced by crackles
on auscultation
– Hyperthermia r/t underlying infectious process
as evidenced by temperature 100 F
 Basic one part…………
The diagnostic label are defined and
tend to become more specific ,the
interventions can be derived from the label
itself …… etiology may not be needed.
 Syndrome and wellness diagnosis consist
Nanda label only
 Eg :
 Rape trauma syndrome
 Spiritual well being
 Variations of basic formats……..
• Writing unknown etiology
– Noncompliance (medication regimen) related to unknown etiology
• Using the phrase complex factors
– Chronic low self esteem r/t complex factors
• Using the word possible to describe either problem or etiology
– Possible low self-esteem r/t loss of job and rejection by family
– Altered thought processes possibly r/t unfamiliar surroundings
• Using secondary to divide the etiology into two parts
– Risk for impaired skin integrity r/t decreased peripheral circulation
secondary to diabetes
• Adding second part to the general response or NANDA label to make it
more precise
– Impaired skin integrity (left lateral ankle) r/t decreased peripheral
circulation.
 Correct
format

Descriptive Qualities Accurate

of
diagnosti
c
statement

Specific Concise
 What all are the errors
can be
 Errors in diagnostic
reasoning…..,……….
• Verify
• Build a very good knowledge base
and acquire clinical experience
• Have a working knowledge of what is normal
• Consult resources
• Base diagnosis on pattern that is , on behavior
over time –rather than on an isolated
incident
• Improving critical thinking skills
 Nursing diagnosis v/s medical diagnosis
Nursing diagnosis Medical diagnosis
Care focused Etiology focused

Identifies risk and problems of the Identifies as nearly possible the

patient specific clinical entity that is
causing illness
Focused on the signs and The medical diagnosis specify the
symptoms on the patient and his pathology
/her care givers
Focused on the person and their Focuses on illness
physiological / psychologic all
responses to illness
Eg : Ineffective denial related to Eg : Myocardial infarction
difficulty coping with new
diagnosis of “heart attack”
Are You Ready To Plan Care ? ……………………….

THANK YOU