This document discusses the nursing process and how nurses analyze patient data to develop nursing diagnoses. It provides an overview of the steps in assessment, including collecting subjective and objective data, validating data, organizing data, and recording/documenting data. It then covers analyzing and interpreting the data to identify patterns and problems, propose nursing diagnoses, and check the diagnoses against defining characteristics before documenting the conclusions. Examples are provided to illustrate analyzing sample data clusters to formulate accurate nursing diagnoses and apply them to care planning. Factors that can lead to diagnostic errors during the data collection and analysis process are also reviewed.

1. ANALYSIS & UTILIZATION OF
DATA IN NURSING PROCESS

2. STEPS OF ASSESSMENT
1. Collection of data
a) Subjective Data
b) Objective Data
2. Validation of data
3. Organization of data
4. Recording/documentation of data

3. ASSESSMENT
• GATHERING
• VALIDATING DATA
• ORGANISING DATA
• IDENTIFYING PATTERNS/ TESTING FIRST IMPRESSIONS
• RECORDING DATA
• INTERPRETING DATA (ANALYSIS & SYNTHESIS)
DIAGNOSIS
• IDENTIFYING PROBLEMS
• IDENTIFYING RISK FACTORS
• PREDICTING POTENTIAL PROBLEMS/COMPLICATIONS
• IDENTIFYING RESOURCES & STRENGTHS
STEPS LEADING TO NURSING DIAGNOSIS:

4. EVOLUTION OF NURSING DIAGNOSIS

6. WHAT IS NOT A NURSING DIAGNOSIS?
 Medical diagnosis
 Medical pathology
 Diagnostic tests
 Treatments
 Equipments

7. MEDICAL DIAGNOSIS v/s
NURSING DIAGNOSIS
 Identify diseases v/s focus on unhealthy responses
 Directs the primary treatment v/s independent nursing practice
 Remains the same v/s change from day to day
 Example:
Myocardial infarction is a Medical Diagnosis
Nursing Diagnosis for a person with myocardial infarction include
fear, altered health maintenance, knowledge deficit, pain, & altered
tissue perfusion.

8. NURSING DIAGNOSIS v/s
COLLABORATIVE PROBLEMS
 Collaborative problems are “certain physiologic
complications”.
 When the nurse writes patient outcomes that require
delegated medical orders for goal achievement, that
situation is not nursing diagnosis but a collaborative
problem
 Collaborative problems involve potential complications,
they must be identified early so that the preventive
nursing care can be instituted early.

9. OVARIAN CANCER RADIOTHERAPY EXP. LAPROTOMY
MEDICAL
DIAGNOSIS
MEDICAL/SURG
ICAL Rx
DIAGNOSTIC
STUDY
PC: acute stress
syndrome r/t
disease condition
PC: infection r/t
stage-iii skin
reaction
PC: paralytic ileus
r/t anesthesia
NURSING DIAGNOSIS v/s
COLLABORATIVE PROBLEMS

10. S.NO CRITERIA NURSING DIAGNOSIS COLLABORATIVE
DIAGNOSIS
MEDICAL
DIAGNOSIS
1 DEFINITION A nursing diagnosis is a
clinical judgment about
individual, family or
community responses to
actual or potential health
problems or life processes.
Nursing diagnosis
provides the basis for
selection of nursing
interventions to achieve
outcomes for which the
nurse is accountable.
Certain physiologic
complications that nurses
monitor to detect onset of
changes in status.
Traumatic or disease
condition or syndrome
validated by medical
diagnostic studies.
DIFFERENCE BETWEEN MEDICAL,COLLABORATIVE &
NURSING DIAGNOSIS

11. S.NO CRITERIA NURSING DIAGNOSIS COLLABORATIVE
DIAGNOSIS
MEDICAL
DIAGNOSIS
2
FOCUS Monitoring human
responses to actual &
potential health
problems.
Monitoring
pathophysiological
responses of body organs
or systems
Correcting or
preventing pathology
of specific organs or
body system.

12. S.NO CRITERIA NURSING DIAGNOSIS COLLABORATIVE
DIAGNOSIS
MEDICAL
DIAGNOSIS
3
SAMPLE DATA
CLUSTER
56yr old mother of 7; 5’4”
; “whenever I sneeze, I
dribble urine. This is
embarrassing”
42yr old woman, 1hour after
delivery, spinal anesthesia,
1500ml fluid infused in past
4hrs without patient voiding;
unable to void
“Whenever I have to
urinate it burns terribly. I
also feel like I have to go
all the time-real bad”
small frequent voiding,
cloudy urine, T-100.8

13. S.NO CRITERIA NURSING DIAGNOSIS COLLABORATIVE
DIAGNOSIS
MEDICAL
DIAGNOSIS
4
DIAGNOSTIC
STATEMENT
Stress urinary
incontinence r/t
degenerative change in
pelvic muscles &
structural supports
associated with advanced
age, obesity, gravid uterus.
Potential complication:
urinary retention r/t fluid
overload & effects of
anesthesia.
Cystitis

14. S.NO CRITERIA NURSING DIAGNOSIS COLLABORATIVE
DIAGNOSIS
MEDICAL
DIAGNOSIS
5
SELECT
NURSING
RESPONSES
Teach Kegal exercises to
increase the muscle tone,
explore patient’s
willingness & motivation
to pursue weight reduction
& exercise program, and
evaluate the need for
bladder training program.
Monitor signs for increasing
urine retention, offer bedpan,
& encourage voiding with
running water, warm water
dripped over perineum, & so
forth, if no result , administer
physician prescribed
medications, if no result,
perform physician prescribed
catheterization.
Report signs & symptoms
to physician, obtain urine
culture, report results to
physician, administer
appropriate physician
prescribed antibiotics.

15. TYPES OF NURSING DIAGNOSIS
1)ACTUAL NURSING DIAGNOSIS
2)RISK NURSING DIAGNOSIS
3)POSSIBLE NURSING DIAGNOSIS
4)WELLNESS DIAGNOSIS
5)SYNDROME DIAGNOSIS

16. ANALYSIS & INTERPRETATIONS
OF DATA
 In the assessment phase, data are initially collected
from a variety of source & validated. The nurse then
applies reasoning & begins to look for patterns in the
assessment data.
 To arrive at nursing diagnosis we must go through the
steps of data analysis. This process requires
diagnostic reasoning skills, often called critical
thinking.

17. ANALYSIS & INTERPRETATIONS
OF DATA
CUE: is often used to denote significant data that
“raises a red flag” for the nurse who then looks for
the patterns or clusters of data that signal an actual,
potential, or possible nursing diagnosis.
DATA CLUSTER: is a grouping of patient data or
cues that points to the existence of a patient health
problem. Nursing diagnosis should always be derived
from clusters of significant data rather than from a
single cue.

18. STEPS OF DATA ANALYSIS

19. 1) IDENTIFY ABNORMAL DATA & STRENGTHS
 Identifying abnormal findings & strengths
 the collected data should be reliable
 the nurse should also have basic knowledge of risk
factors for the client.
 The nurse’s should have basic theoretical knowledge
 Identified strengths are used to formulate wellness
diagnosis.
 Identified potential weaknesses are used in
formulating the risk diagnosis & abnormal findings are
used in formulating actual nursing diagnosis
STEPS OF DATA ANALYSIS

20. 2) CLUSTER THE DATA
STEPS OF DATA ANALYSIS
 Identified abnormal data & strengths:
SUBJECTIVE
 Hair falling out in chunks
 Red rash on face & chest
 So ugly
OBJECTIVE
 Anxious appearing
 Patchy alopecia
 Red raised plaques on face, neck, shoulders, back & chest
 While clustering the data we may find that certain cues are pointing towards a problem but that
more data are required to support the problem

21. STEPS OF DATA ANALYSIS
2) CLUSTER THE DATA
IDENTIFYING STRENGTHS & PROBLEMS
1)Determining patient’s strength
2)Determining patient’s problem areas
3) Determining problems the patient is
likely to experience

22. STEPS OF DATA ANALYSIS
3) DRAW INFERENCES & IDENTIFY THE PROBLEM
The nurse will write what she think the data is
saying & determine where she can treat
independently i.e. something that the nurse
would intervene & treat independently.
Another purpose of this step is the referral of
identified problems for which she cannot
prescribe a definite treatment

23. STEPS OF DATA ANALYSIS
4) PROPOSE POSSIBLE NURSING DIAGNOSIS
 If the situation requires primarily nursing
intervention then the nursing diagnosis may be
wellness diagnosis, risk diagnosis or actual
diagnosis.

24. STEPS OF DATA ANALYSIS
5) CHECK FOR DEFINING CHARACTERISTICS
 To choose the most accurate diagnosis & to delete the
diagnosis which are not valid for the client.
 Example: the diagnostic categories of impaired gas
exchange, ineffective airway clearance & ineffective
breathing pattern, all reflect respiratory problems but
each is used to describe a very different human response
pattern & set of defining characteristics.

25. STEPS OF DATA ANALYSIS
6) CONFIRM OR RULE OUT
The nurse can rule out that particular
diagnosis with the other health care
professionals who are caring for the
client.
The nurse should tell the client what
she perceive his or her diagnosis

26. STEPS OF DATA ANALYSIS
7) DOCUMENT THE CONCLUSION
Wellness Diagnosis
Risk Diagnosis
Actual Nursing Diagnosis

27. NANDAApproved Domains For Formulating Nursing Diagnosis
DOMAIN-1: Health Promotion
DOMAIN-2: Nutrition
DOMAIN-3: Elimination
DOMAIN-4: Activity/Rest

28. NANDAApproved Domains For Formulating Nursing Diagnosis
DOMAIN-5: Perception/Cognition
DOMAIN-6: Self Perception
DOMAIN-7: Role Relationships
DOMAIN-8: Sexuality

29. NANDAApproved Domains For Formulating Nursing Diagnosis
DOMAIN-9: Coping/stress tolerance
DOMAIN-10: Life principles
DOMAIN-11: Safety/protection
DOMAIN-12: Comfort
DOMAIN-13: Growth/development

30. SOURCES OF DIAGNOSTIC ERRORS
A diagnosis should be consistent with all
the cues, supported with highly relevant
cues.

31. DATA COLLECTION ERRORS
The following practices are essential during assessment to avoid
data collection errors:
a. Nurse critically reviews his or her level of comfort &
competence with interview & physical assessment skills
b. Nurse must determine the accuracy of data collected
c. Nurse must check the completeness of assessment data.
Data should not be incomplete, omitted, or inaccurate &
disorganized.

32. INTERPRETATION & ANALYSIS OF DATA
Validate whether the subjective data are
supported by measurable objective physical
findings when necessary

33. DATA CLUSTERING ERRORS
Premature closure of clustering
Incorrect clustering

34. DIAGNOSTIC STATEMENT
 Appropriate, concise & precise language which involves
correct terminology reflecting the client’s response to the
illness.
 Wellness, Risk,Potential &/Actual diagnosis

35. a) Identify the client’s response instead of medical diagnosis
Wrong Example: pain related to myocardial infarction
Right Example: pain related to physical exertion
b) Identify NANDA diagnostic statement rather than the symptom
Wrong Example: excessive mucus production
Right Example: “ineffective breathing pattern related to increased
airway secretions”

36.  Identify a treatable etiology rather than a clinical sign or chronic problem.
Wrong Example: altered respiratory function related to abnormal arterial blood gas
levels
Right Example: "altered tissue perfusion related to the inadequate oxygen intake”
 Identify the problem caused by the treatment or diagnostic study rather than
the treatment or study (client experiences much of responses to diagnostic tests &
medical treatment).
Wrong Example: cardiac catheterization related to angina
Right Example: “anxiety related to cardiac catheterization”

37.  Identify the client’s response to equipments rather than the equipment itself
Wrong Example: anxiety related to cardiac monitor
Right Example: “knowledge deficit regarding the need for cardiac monitoring”
 Identify the client’s problem rather than the nurse’s problem
Wrong Example: potential complications related to poor vascular access indicates
nursing problem in initiating & maintaining intravascular therapy
Right Example: “potential infection related to presence of invasive lines” properly
centers attention on client’s need.

38.  Identify the client’s problem rather than nursing intervention
Wrong Example: offer bedpan frequently because of altered elimination patterns
Right Example: identity the problem & etiology. “Diarrhea related to food
intolerance” corrects the mis-statement & allows proper implementation of the
nursing process.
 Identify the client’s problem rather than the goal
Wrong Example: client need high protein diet related to alteration in nutrition
Right Example: “altered nutrition less than body requirement related to inadequate
nutritional intake” to allow for planning to correct the etiology.

39.  Identify the problem & etiology.
Example: alteration in comfort related to pain can be caused to
identify the client problem & the cause: ineffective breathing
pattern related to incisional pain.

40. S.NO DATA INTERPRETATION & ANALYSIS FORMULATION OF
NURSING DIAGNOSIS
VALIDATION OF
NURSING
DIAGNOSISSIGNIFICANT
CUES
SAMPLE DATA CLUSTER
1. Change in a
patient’s usual
health patterns
that is
unexplained by
expected norms
for growth &
development
“I guess I lost about 20-30 pounds
over the last 6months-I think I have
been just too busy to eat.”
Height-5’8”
Weight-102lb
35yr old mother of 4yr old twin
boys, returned to work (executive
secretary) for the first time since
delivery of twins.
Imbalanced nutrition:less
than body requirements
related to stress of new
job, role conflict &
demands as evidenced by
weight loss.
Accurate diagnosis:
patient validates this
diagnosis, agreeing with
contributing factors.

41. S.NO DATA INTERPRETATION & ANALYSIS FORMULATIO
N OF NURSING
DIAGNOSIS
VALIDATION OF
NURSING DIAGNOSIS
CUES SAMPLE DATA CLUSTER
2. Deviation from
an appropriate
population
norm
-Teacher notices & reports frequency of
bruises on a third grade boy who is
repeatedly observed alone during recess
period & who is withdrawn in the
classroom.
-In conversation with the school nurse,
one of the boy’s parent remarks; “that boy
brings out the worst in me, I don’t know
why but I often have to smack him hard to
make him listen”
Risk for Other
Directed Violence
(Child Abuse)
related to?
Etiology
(deficient
parenting skills?)
Incomplete Diagnosis:
Additional data collection
yields new information:
-Father out of work for the
past 18months
-Father was abused as a
child
Diagnosis Restated:
Risk for Other Directed
Violence (Child Abuse)
related to increased family
stress & father’s history of
being abused.

42. NURSING DIAGNOSIS APPLICATION TO
CARE PLANNING

45. Lisa is a registered nurse in orthopedic unit & Mrs.Divine a 52yrs women who
is scheduled to have a lumber laminectomy for a herniated lumbar disk.
Ms.Divine’s medical diagnosis is herniated lumbar disk. Lisa has conducted an
assessment of Ms.Divine’s health status & needs & has collected information in
four different problem areas. Lisa needs to review clusters & pattern of data
collected to correctly identify the nursing diagnoses that apply to Ms.Divine’s
situation. One cluster of data includes information about Ms.Divine’s
inexperience with the surgery & her statement that she has not received
information about post-operative activities. Lisa decides that the data include
defining characteristics for the nursing diagnosis deficient knowledge regarding
post-operative routines related to inexperience.
Example:

46. DIAGNOSTIC PROCESS:ASSESSMENT OF CLIENT’S STATUS:
 Ms,Divine’s reports being concerned about the surgery
 Has concerns about possible paralysis
 Restless
 Uncertain about what to expect
VALIDATE THE DATA:
 Nursing staff confirms findings & also reports Ms.Divine has poor eye contact when
talking about planned surgery
MORE DATA NEEDED?
INTERPRET & ANALYSE DATA:
 Cluster findings
 Group signs: restlessness, poor eye contact
 Group behaviors: reports concern, uncertain about what to expect
LOOK FOR DEFINING CHARACTERISTICS:
Reveals a problem with coping
NURSING DIAGNOSIS: anxiety related to threat of surgery

47. Application of Nursing Process and Its Affecting Factors
among Nurses Working in Mekelle Zone Hospitals, Northern
Ethiopia
Background:
Nursing process is considered as appropriate method to explain the nursing
essence, its scientific bases, technologies and humanist assumptions that
encourage critical thinking and creativity, and permits solving problems in
professional practice.
Objective:
To assess the application of nursing process and it’s affecting factors in Mekelle
Zone Hospitals.

48. Application of Nursing Process and Its Affecting Factors
among Nurses Working in Mekelle Zone Hospitals, Northern
Ethiopia
Methods:
A cross sectional design employing quantitative and qualitative methods was
conducted in Mekelle zone hospitals March 2011. Qualitative data was
collected from14 head nurses of six hospitals and quantitative was collected
from 200 nurses selected by simple random sampling technique from the six
hospitals proportional to their size. SPSS version 16.1 and thematic analysis was
used for quantitative and qualitative data respectively.

49. Application of Nursing Process and Its Affecting Factors
among Nurses Working in Mekelle Zone Hospitals
Results:
Majority 180 (90%) of the respondents have poor knowledge and 99.5% of the
respondents have a positive attitude towards the nursing process. All of the
respondents said that they did not use the nursing process during provision of care to
their patients at the time of the study. Majority (75%) of the respondent said that the
nurse to patient ratio was not optimal to apply the nursing process.
Conclusion and Recommendation:
The nursing process is not yet applied in all of the six hospitals. The finding revealed
that the knowledge of nurses on the nursing process is not adequate to put it in to
practice and high patient nurse ratio affects its application. The studied hospitals
should consider the application of the nursing process critically by motivating nurses
and monitor and evaluate its progress

50. THANK YOU!!!!!