2021 Nursing Diagnosis Guide


    GUIDE
    December 7, 2020
    The 2021 Nursing Diagnosis Guide
    Kathleen Gaines
    By: Kathleen Gaines MSN, RN, BA, CBC

    Developing and implementing a nursing diagnosis helps nurses determine the plan of care for their patients. These diagnoses drive possible interventions for the patient, family, and community. They are developed with thoughtful consideration of a patient’s physical assessment and can help measure outcomes for the patient’s care plan.

    Some nurses may see nursing diagnoses as outdated and arduous. However, it is an essential tool that promotes patient safety utilizing evidence-based nursing research. 

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    Part One What Is a Nursing Diagnosis?

    According to NANDA-I, the official definition of the nursing diagnosis is: 

    “Nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”

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    Part Two Examples of Nursing Diagnoses

    The three main components of a nursing diagnosis are as follows.

    • Problem and its definition
    • Etiology
    • Defining characteristics or risk factors 

    Examples of proper nursing diagnoses may include:

    "Ineffective breathing patterns related to pulmonary hypoplasia as evidenced by intermittent subcostal and intercostal retractions, tachypnea, abdominal breathing, and the need for ongoing oxygen support."

    Or

    "Ineffective airway clearance related to gastroesophageal reflux as evidenced by retching, upper airway congestion, and persistent coughing."

    Part Three What’s the Purpose of a Nursing Diagnosis?

    According to NANDA International, a nursing diagnosis is “a judgment based on a comprehensive nursing assessment.” The nursing diagnosis is based on the patient’s current situation and health assessment, allowing nurses and other healthcare providers to see a patient from a holistic perspective. 

    Proper nursing diagnoses can lead to greater patient safety, quality care, and increased reimbursement from private health insurance, Medicare, and Medicaid. 

    They are just as beneficial to nurses as they are to patients.

    Part Four NANDA Diagnosis 

    NANDA diagnoses help strengthen a nurse’s awareness, professional role, and professional abilities. 

    Formed in 1982, NANDA is a professional organization that develops, researches, disseminates, and refines the nursing terminology of nursing diagnosis. Originally an acronym for the North American Nursing Diagnosis Association, NANDA was renamed to NANDA International in 2002 as a response to its broadening worldwide membership.

    According to its website, NANDA International’s mission is to:

    1. Provide the world’s leading evidence-based nursing diagnoses for use in practice and to determine interventions and outcomes
    2. Contribute to patient safety through the integration of evidence-based terminology into clinical practice and clinical decision-making
    3. Fund research through the NANDA-I Foundation
    4. Be a supportive and energetic global network of nurses, who are committed to improving the quality of nursing care and improvement of patient safety through evidence-based practice

    NANDA members can be found worldwide, specifically in Brazil, Colombia, Ecuador, Mexico, Peru, Portugal, Germany, Austria, Switzerland, Netherlands, Belgium, and Nigeria-Ghana.  

    Part Five The 4 Types of Nursing Diagnoses

    There are 4 types of nursing diagnosis according to NANDA-I. They are:

    1. Problem-focused
    2. Risk
    3. Health promotion
    4. Syndrome

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    1. Problem-focused diagnosis

    A patient problem present during a nursing assessment is known as a problem-focused diagnosis. Generally, the problem is seen throughout several shifts or a patient’s entire hospitalization. However, it may be resolved during a shift depending on the nursing and medical care. 

    Problem-focused diagnoses have three components. 

    • Nursing diagnosis
    • Related factors
    • Defining characteristics

    Examples of this type of nursing diagnosis include:

    • Decreased cardiac output 
    • Chronic functional constipation
    • Impaired gas exchange

    Problem-focused nursing diagnoses are typically based on signs and symptoms present in the patient. They are the most common nursing diagnoses and the easiest to identify. 

    2. Risk nursing diagnosis

    A risk nursing diagnosis applies when risk factors require intervention from the nurse and healthcare team prior to a real problem developing.

    Examples of this type of nursing diagnosis include:

    • Risk for imbalanced fluid volume
    • Risk for ineffective childbearing process
    • Risk for impaired oral mucous membrane integrity

    This type of diagnosis often requires clinical reasoning and nursing judgement.

    3. Health promotion diagnosis

    The goal of a health promotion nursing diagnosis is to improve the overall well-being of an individual, family or community.

    Examples of this type of nursing diagnosis include:

    • Readiness for enhanced family processes
    • Readiness for enhanced hope
    • Sedentary lifestyle

    4. Syndrome diagnosis

    A syndrome diagnosis refers to a cluster of nursing diagnoses that occur in a pattern or can all be addressed through the same or similar nursing interventions.

    Examples of this diagnosis include:

    • Decreased cardiac output
    • Decreased cardiac tissue perfusion
    • Ineffective cerebral tissue perfusion
    • Ineffective peripheral tissue perfusion

    Possible nursing diagnosis

    While not an official type of nursing diagnosis, possible nursing diagnosis applies to problems suspected to arise. This occurs when risk factors are present and require additional information to diagnose a potential problem.

    Part Six Nursing Diagnosis Components

    The three main components of a nursing diagnosis are:

    1. Problem and its definition
    2. Etiology or risk factors 
    3. Defining characteristics or risk factors 

    1. The problem statement explains the patient’s current health problem and the nursing interventions needed to care for the patient. 

    2. Etiology, or related factors, describes the possible reasons for the problem or the conditions in which it developed. These related factors guide the appropriate nursing interventions. 

    3. Finally, defining characteristics are signs and symptoms that allow for applying a specific diagnostic label. Risk factors are used in the place of defining characteristics for risk nursing diagnosis. They refer to factors that increase the patient’s vulnerability to health problems.

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    Part Seven Writing a Nursing Diagnosis

    Problem-focused and risk diagnosis are the most difficult nursing diagnoses to write because they have multiple parts. According to NANDA-I, the simplest ways to write these nursing diagnoses are as follows:

    PROBLEM-FOCUSED DIAGNOSIS

    Problem-Focused Diagnosis related to ______________________ (Related Factors) as evidenced by _________________________ (Defining Characteristics).

    RISK DIAGNOSIS

    The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).

    Part Eight Classification of Nursing Diagnoses

    NANDA-I adopted the Taxonomy II after consideration and collaboration with the National Library of Medicine (NLM) in regards to healthcare terminology codes. Taxonomy II has three levels: domains, classes, and nursing diagnoses. 

    There are currently 13 domains and 47 classes:

    • Domain 1 - Health Promotion
      • Health Awareness
      • Health Management
    • Domain 2 - Nutrition
      • Ingestion
      • Digestion
      • Absorption
      • Metabolism
      • Hydration
    • Domain 3 - Elimination/Exchange
      • Urinary Function
      • Gastrointestinal Function
      • Integumentary Function
      • Respiratory Function
    • Domain 4 - Activity/Rest
      • Sleep/Rest
      • Activity/Exercise
      • Energy Balance
      • Cardiovascular-Pulmonary Responses
      • Self Care
    • Domain 5 - Perception/Cognition
      • Attention
      • Orientation
      • Sensation/Perception
      • Cognition
      • Communication
    • Domain 6 - Self-Perception
      • Self-concept
      • Self-esteem
      • Body image
    • Domain 7 - Role Relationship
      • Caregiving Roles
      • Family Relationships
      • Role Performance
    • Domain 8 - Sexuality
      • Sexual Identity
      • Sexual Function
      • Reproduction
    • Domain 9 - Coping/Stress Tolerance
      • Post-trauma Responses
      • Coping Response
      • Neuro-Behavioral Stress
    • Domain 10 - Life Principles
      • Values
      • Beliefs
      • Value/Belief Action Congruence
    • Domain 11 - Safety/Protection
      • Infection
      • Physical Injury
      • Violence
      • Environmental Hazards
      • Defensive Processes
      • Thermoregulation
    • Domain 12 - Comfort
      • Physical Comfort
      • Environmental Comfort
      • Social Comfort
    • Domain 13 - Growth/Development
      • Growth
      • Development

    This refined Taxonomy is based on the Functional Health Patterns assessment framework of Dr. Mary Joy Gordon. Furthermore, the NLM suggested changes because the Taxonomy I code structure included information about the location and the level of the diagnosis. 

    NANDA-I nursing diagnoses and Taxonomy II comply with the International Standards Organization (ISO) terminology model for a nursing diagnosis. 

    The terminology is also registered with Health Level Seven International (HL7), an international healthcare informatics standard that allows for nursing diagnoses to be identified in specific electronic messages among different clinical information systems. 

    Part Nine Nursing Diagnosis vs Medical Diagnosis vs Collaborative Problems

    While all important, the nursing diagnosis is primarily handled through specific nursing interventions while a medical diagnosis is made by a physician or advanced healthcare practitioner.

    The nursing diagnosis can be mental, spiritual, psychosocial, and/or physical. It focuses on the overall care of the patient while the medical diagnosis involves the medical aspect of the patient’s condition.

     A medical diagnosis does not change if the condition is resolved, and it remains part of the patient’s health history forever. A nursing diagnosis, however, generally refers to a specific period of time. 

    Examples of medical diagnosis include:

    1. Arthritis
    2. Congestive Heart Failure
    3. Diabetes Insipidus
    4. Meningitis
    5. Scoliosis
    6. Stroke

    Collaborative problems are ones that can be resolved or worked on through both nursing and medical interventions. Oftentimes, nurses will monitor the problems while the medical providers prescribe medications or obtain diagnostic tests. 

    Part Ten History of Nursing Diagnosis

    1. 1973: First conference to identify nursing knowledge and a classification system; NANDA was founded
    2. 1977: First Canadian Conference takes place in Toronto
    3. 1982: NANDA formed with members from United States and Canada
    4. 1984: NANDA established a Diagnosis Review Committee
    5. 1987: American Nurses Association (ANA) officially recognizes NANDA to govern the development of a classification system for nursing diagnosis
    6. 1987: International Nursing Conference held in Alberta, Canada
    7. 1990: 9th NANDA conference and the official definition of the nursing diagnosis established
    8. 1997: Official journal renamed from “Nursing Diagnosis” to “Nursing Diagnosis: The International Journal of Nursing Terminologies and Classifications”
    9. 2002: NANDA changes to NANDA International (NANDA-I) and Taxonomy II released
    10. 2020: 244 NANDA-I approved diagnosis 

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    Part Eleven American Nursing Diagnosis vs International Nursing Diagnosis

    There is currently no difference between American nursing diagnoses and international nursing diagnoses. Because NANDA-I is an international organization, the approved nursing diagnoses are the same. 

    Discrepancies may occur when the translation of a nursing diagnosis into another language alters the syntax and structure. However, since there are NANDA-I offices around the world, the non-English nursing diagnoses are essentially the same. 

    Part Twelve Nursing Diagnosis List

    A full list of NANDA-I approved nursing diagnoses can be found here.

    Additional examples include:

    1. Dysfunctional ventilatory weaning response
    2. Impaired transfer ability
    3. Activity intolerance
    4. Situational low self-esteem
    5. Risk for disturbed maternal-fetal dyad
    6. Impaired emancipated decision-making
    7. Risk for impaired skin integrity
    8. Risk for metabolic imbalance syndrome
    9. Urge urinary incontinence
    10. Risk for unstable blood pressure
    11. Impaired verbal communication
    12. Acute confusion
    13. Disturbed body image
    14. Relocation stress syndrome
    15. Ineffective role performance
    16. Readiness for enhanced sleep

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