This document discusses nursing diagnosis and the diagnostic process. It covers: - The difference between medical and nursing diagnosis - The importance of critical thinking in forming nursing diagnoses - The diagnostic process of gathering data, analyzing patterns, and formulating diagnoses - Components of a nursing diagnosis including the label, related factors, definition, and risk factors - Using mind maps to visualize interconnections between a client's diagnoses - Common errors in interpreting data and formulating diagnoses, and how to avoid them

1. NURSING DIAGNOSIS
PRESENTED BY
PROF. A. HAMIDHUNNIZA
NANDHA COLLEGE OF NURSING

2. A medical diagnosis is the identification of a disease condition
based on a specific evaluation of physical signs, symptoms, the
client’s medical history and result of diagnostics test and
procedure, physicians are licensed to treat diseases or
pathological process.
Nursing diagnosis is a clinical judgement about individual ,
family or community response to actual and potential health
problems or life processes.

3. CRITICAL THINKING AND NURSING DIAGNOSIS
Critical thinking is an active , organized cognitive process
used to carefully examine one’s thinking and thinking of
others
The process is applicable to the formation of nursing
diagnosis . a nurse integrates what is known from previous
experiences and scientific and practical knowledge bases,
applies critical thinking attitudes and intellectual standards

4. DAIGNOSTIC PROCESS
Diagnostic reasoning is a process of using the data gathered about a client to
logically explain a clinical judgement
Diagnostic process includes decision making steps, including gathering the
assessment database validating data, analysing and interpreting data ,
identifying client needs and formulating nursing diagnosis.
The diagnostic process is dynamic and requires the nurse to reflect on existing
assessment data and health care needs. The nurses uses scientific knowledge
and experience to analyse and interpret data collection about the client.

5. ANALYSE AND INTERPRETATION OF DATA
Once data are gathered , the nurse validates findings and then applies
reasoning to look for patient in the assessment data.
Patterns form as data is sorted in to clusters or categories. The database is
continuously revised when additional information is needed to include
changes in client’s physical and emotional status.
Data analyse involves recognizing patterns or trends comparing them with
standard and coming to a reasoned.

6. CONCLUSIONS
Clusters and patterns of data often contain defining characteristics, the
clinical criteria or assessment findings that support an actual nursing
diagnoses. Clinical criteria are objectives or subjective sign and
symptoms, clusters of sign and symptoms.
North American Nursing Diagnosis Association (NANDA) was
established to develop refine and promote a taxonomy of nursing
diagnostic terminology of general use for professional nurse.
.

7. As a nurse analyse data, he or she may begin to consider
various , diagnoses that might apply to the client. Defining
characteristics support or eliminate a particular diagnosis must
be examined carefully.
Before finalizing a nursing diagnosis, the nurse identifies
the client’s general health care needs or problems. It is
important to revise the assessment data to identify clients needs
and not to focus solely on clients illness or medical diagnosis

9. FORMULATION OF NURSING DIAGNOSIS
Once patterns and clusters of data containing defining
characteristics are sorted and clients needs or problems are
identified, the nurse is ready to formulate nursing diagnoses.
An actual nursing diagnosis describe human response to health
condition / life processes that exist in an individual family or
community. It is a judgement that is supported by defining
characteristics theat clusters in patterns of related cues.

10. A RISK NURSING DIAGNOSIS describe human response to health
conditions / life processes that may develop in a vulnerable individual
or family
Eg: a client with spinal cord injury that limits mobility is at risk for
impaired skin integrity.
The key assessment for this type of diagnosis is presence of data
revealing risk factors that support the client vulnerability . such data
include physiological, psychosocial, familial, lifestyle and
environmental factors.

11. A wellness nursing diagnosis describes human
responses that to levels of wellness in an individual ,
family or community that have a readiness for
enhancement
It is a clinical judgement about an individual, group. Or
community transition from a specific level of wellness
to a higher level of wellness

12. COMPONENTS OF
NURSING DIAGNOSIS

13. DIAGNOSTIC LABEL
RELATED FACTORS
DEFINITION
RISK FACTORS
SUPPORT OF DIAGNOSTIC STATMENT

14. DIAGNOSTIC LABEL
It is the name of the nursing diagnosis as approved by NANDA
S.NO DIAGNOSTIC STATEMENT RELATED FACTORS
1. Constipation Inadequate dietary fibre
2. Fatigue Decreased activity
Discomfort
Increased energy
3. Skin integrity, impaired Fluid retention
Excessive secretions
Immobilization
Altered circulation

15. RELATED FACTORS
Related factors are causative or others contributing factors that
have influenced the client’s actual or potential response to the
health problem and can be changed by nursing interventions.
For Eg; the nursing diagnosis statement includes the diagnostic
label ( eg ; impaired physical mobility) and the related factor
The aetiology or cause of the nursing diagnosis must be within the
domain of nursing practice and a condition that responds to nursing
interventions

16. Sometimes medical diagnosis are record ads the aetiology of
the nursing diagnosis . this is incorrect. Nursing interventions
cannot change a medical diagnosis however this can be directed
at behaviour or conditions that a nurse can treat or manage.
DEFINTION
NANDA approve a definition for each diagnosis following
clinical use and testing . the definition describes the
characteristics of the human responses identified.

17. RISK FACTORS
Risk factors are environmental, physiological, psychological,
genetic or chemical elements that increase the vulnerability of an
individual, family or community to a unhealthful event. They
serve as cues to indicate a risk nursing diagnosis is applicable to a
client’s condition
Eg; risk for infection includes invasive procedures trauma ,
malnutrition, immunosuppression and insufficient knowledge to
avoid exposure to pathogen.

18. SUPPORT OF THE DIAGNOSTIC STATEMENT
Nursing assessment data must support the diagnostic label
and related factors must support the aetiology.
To collect complete, relevant and correct assessment data it
may help to identify assessment activities that produce
specific kind of data.

19. MIND MAPPING NURSING DIAGNOSIS
When caring for a client or groups of client a nurse must critically
thinks about clients needs and how to prevent problem from
developing. Often a nurse cares for a client with multiple nursing
diagnosis. Therefore a picture of each client usually consists of a
myriad of interconnections between sets of data all associated with
identified client problems.
Mind mapping is one way to graphically represent the connections
between concepts and ideas that are related to a central subject.

20. The benefit of mind mapping is to allow a student nurse to plot
out associated thoughts , links together lines of reasoning and
the relationship of one problem or diagnosis with other.
A mind map provides whole picture of a clients health situation
with all of its interrelationships seen spatially. As a students
nurse develops a mind map for nursing diagnosis, eventually it
expands and develops in to a plan of care.

21. The mind map helps the student to see the total picture and the way
each of the diagnoses are related ultimately the nurse selects nursing
interventions on the basis of each nursing diagnosis.
The advantage of a mind map is its central focus on the client rather
than the clients disease or health alteration. This encourages students
of nursing to concentrate on client specific health problem and
nursing diagnosis. This focus promotes client participation with
eventual paln of care.

23. ERRORS IN INTERPRETATION AND
ANALYSIS OF DATA

24. Following data collection, the nurse reviews the
database to determine if it is accurate and complete.
The nurse reviews the data are supported by
measurable objective, physical findings
The nurse may also review supportive literature to
ensure an adequate knowledge base to form a
correct nursing diagnosis

25. ERRORS IN DATA CLUSTERING
Errors in data clustering occur when data are clustered
prematurely, incorrectly. Premature closure of clustering occurs
when the nurse makes the nursing diagnosis before all data
have been grouped.
However incorrect clustering occurs when the nurse tries to
make the nursing diagnosis fits the signs and symptoms
obtained. An incorrect nursing diagnosis affects quality of
nursing care.

26. ERRORS IN DIAGNOSTIC STATEMENT
• The correct selection of a diagnostic statement is more likely to result
in appropriate selection of nursing interventions and outcome
• There are some common guidelines for reducing errors in diagnostic
statement. The statement should be worded in appropriate concise and
precise language which involves using correct terminology reflecting
the clients response to the illness or condition.
• Use of standardized nursing language such as NANDA international
diagnostic helps to ensure accuracy.

27. AVOIDING AND CORRECTING ERRORS
Nursing diagnosis are easy to write when the nurse
remembers that the problem portion of the statement is
concerned with a clients response to the illness or
condition and that aetiology portion must be within the
scope of nursing practice.

28. 1. Identify the client’s response , not the medical diagnosis. Because the
medical diagnosis requires medical interventions, it is legally inadvisable
to include it is the nursing diagnosis.
2. Identify a NANDA international diagnosis statement rather than the
symptom nursing diagnosis are derived from a cluster of defining
characteristics.
3. Identify a treatable aetiology rather than a clinical sign or chronic problem
. nursing interventions are directed toward correcting the aetiology of the
problem.
4. To identify the problem caused by the treatment or diagnostic study rather
than the treatment or study itself.

29. 5. Identify the client response to the equipment rather than the equipment
itself.
6. Identify the client’s problem rather than the nurses problems. Nursing
diagnosis are always client cantered and form the basis for goal directed
care.
7. Identify the clients problem rather than nursing intervention. Nursing
intervention are planned to alleviate client problem and are not part of the
diagnostic statement.
8. Identify the client’s problem rather than goals. Goals are based upon
accurate identification of a client’s problem

30. 9. Make professional rather than prejudicial judgement. Nursing diagnosis
are based on subjective and objective client data and should not include the
nurse’s personal belief and values.
10. Avoid legally inadvisable statements that imply blame negligence or mal
practise can result in litigation.
11. Identify the problem and etiology.be careful to avoid a circular statement
are vague and give no direction to nursing care.
12. Identify only one client problem in the diagnostic statement. every
problem has different specific expectant outcomes. Confusion during the
planning step occurs when multiple problems are included in nursing
diagnosis

31. NURSING DIAGNOSES: APPLICATION TO CARE
PLANNING
The use of nursing diagnosis is mechanism for identifying the
domain in nursing .the formulated nursing diagnosis provide
direction for the planning process and the selection of nursing
intervention to achieve desired outcomes.

32. ADVANTAGES OF NURSING DIAGNOSIS
• They facilitate communication among nurses about a
client’s level of wellness and assist in discharge
planning.
• Easily obtainable reference to the client’s current
health care needs.
• Helps to prioritize the needs.

33. • Encourage organized communication relevant to the
client’s goal and priorities.
• Used for charting the progress notes, referrals, providing
effective transition of care from one unit to another.
• Focus for quality improvement quality improvement is the
monitoring and evaluation of process and outcomes to
identify opportunities for improvement

34. NURSING DIAGNOSIS VERSUS MEDICAL DIAGNOSIS
MEDICAL DIAGNOSIS NURSING DIAGNOSIS
Identify disease Focus on unhealthy responses to health
and illness
Describe problems for which physician
directs primary treatment
Describes problems treated by nurses
within the scope of independent nursing
practice
Remains the same for aslong as the disease
is present
May change from day to day as the patient
response change

35. DIAGNOSTIC REASONING AND CRITICAL THINKING
Successful implementation of each step of nursing process requires high
level skills in critical thinking
• Be familiar with nursing diagnoses and other health problems, read
professional literature and keep reference.
• Trust clinical experience and judgement but be willing to ask for help
when the situation demands more than your qualifications and experience
can provide.
• Respect your clinical institutions, increase the frequency of your
observations
• Recognize personal biases and keep an open mind.

36. NANDA NURSING DIAGNOSIS
❑ North American nursing diagnosis Association NANDA . define
redefine and promote a taxonomy of nursing diagnosis terminology of
general use to professional nurses.
❑ Taxonomy is a classification system or set of categories arranged
based on a single principle or set of principle. The number of
NANDA include staff nurses, clinical researcher.
❑ The term diagnosing refers to the reasoning process, whereas
the term diagnosis is a statement or
conclusion regarding the nature of a phenomenon

37. ❑The standardized NANDA names for the diagnoses are called diagnostic label and
the client’s problem statement, consisting of the diagnostic label plus aetiology.
❑In 1990, NANDA adopted an official working definition of nursing diagnosis, a
clinical judgement about individual , family or community responses to actual and
potential health problems/ life processes.
❑ A nursing diagnosis provides the basis for selection of nursing intervention to
achieve outcomes for which the nurse is accountable.
❑Professional nurses are responsible for making nursing diagnoses, even though
other nursing personnel may contribute data to the process of diagnosing and may
implement specified nursing care.

38. ACTUAL NURSING DIAGNOSIS
RISK NURSING DIAGNOSIS
WELLNESS NURSING DIAGNOSIS
POSSIBLE NURSING DIAGNOSIS
SYNDROME NURSING DIAGNOSIS
TYPES OF NURSING DIAGNOSES

39. ACTUAL DIAGNOSIS
An actual diagnosis is a client problem that is
present at the time of the nursing assessment.
Eg : ineffective breathing pattern and anxiety.
An actual nursing diagnosis is based on the
presence of associated signs and symptoms

40. A RISKS NURSING DIAGNOSIS
It is s clinical judgement that a problem does not exist, but
the presence of risk factors indicates that a problem is likely
to develop unless nurses intervene. For eg ; Nosocomial
infection & diabetes . therefore , the nurses would
appropriately are the label risk for infection to describe the
client health status.

41. A WELLNESS DIAGNOSIS
Describes human responses to levels of
wellness in an individual family or
community that have a readiness for
enhancement

42. A POSSIBLE NURSING DIAGNOSIS
It 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.
For Eg; An elderly widow who lives alone is admitted to the hospital.
The nurse notices that she has no visitors and pleased with attention
from nursing staff. The nurse may write a nursing diagnosis of
possible social isolation

43. A SYNDROME DIAGNOSIS
A syndrome diagnosis that is associated with a duster of other
diagnosis. Currently six syndrome diagnosis are on the
NANDA International list. Risk for disuse syndrome, for Eg;
may be experienced by long term bed ridden client cluster of
diagnosis associated with this syndrome include impaired
physical mobility. Risk for impaired tissue integrity, risk for
activity intolerance, risk for constipation.

44. COMPONENT OF A NANDA NURSING DIAGNOSIS
PROBLEM ( DIAGNOSTIC LABEL)
AND DEFINITION
QUALIFIERS
ETIOLOGY ( RELATED FACTORS
AND RISK FACTORS)
DEFINING CHARACTERISTICS

45. PROBLEM ( DIAGNOSTIC LABEL) AND DEFINITION
The problem statement or diagnosis label, describe the client’s health
problem or response for which nursing therapy is given . it describe the client’s
health status clearly and concisely in few words. The purpose of diagnostic
label is to direct the formation of client goals and desired outcomes.
To be clinically useful, diagnostic labels need to be specific , when the word
specify follows a NANDA label. The nurse states the area in which the problem
occurs. For Eg; Deficient knowledge ( medication).deficient knowledge (
dietary adjustments)

46. QUALIFIERS
Qualifiers are words that have been added in some NANDA labels to
give additional meaning to diagnostic statement.
• Deficient ( inadequate in amount, quality or degree, not sufficient)
• Impaired (made worse, weakened, damaged, reduced, deteriorated)
• Decreased ( lesser in size, amount, or degree)
• Ineffective( not producing the desired effect)
• Compromised( to make vulnerable to threat)

47. ETIOLOGY ( RELATED FACTORS AND RISK
FACTORS)
The aetiology component of a nursing diagnosis identifies
one or more probable cause of health problem gives
direction to the required nursing therapy and enables the
nurses to individualize the client care

48. DEFINING CHARACTERISTICS
Defining characteristics are the cluster of signs and symptoms
that indicate the presence of particular diagnostic label. For
actual nursing diagnosis, the defining characteristics are client’s
sign and symptoms.
For risk nursing diagnosis, no subjective and objective signs are
present. Thus, the factors that cause the client to be more
vulnerable to the problem form the aetiology of risk nursing
diagnosis

49. THE DIAGNOSTIC PROCESS

50. The diagnostic process uses the critical thinking skills of
analyses and synthesis. critical thinking is a cognitive process
during which a person reviews data and considers explanation
before forming an opinion.
Analysis is the separation in to components that is , the breaking
down of the whole in to its part (deductive reasoning). Synthesis
is the opposite, that is the putting together of parts in the whole
(inductive reasoning).

51. The diagnostic process is used consciously by most nurses. An
experienced nurse may enter a client’s room and immediately
observe significant data and draw conclusions about the client. As a
result of attaining knowledge, skill and expertise in practice setting,
the expert nurse may seem to perform these mental processes
automatically. Novice nurses however, need guidelines to understand
and formulate nursing diagnosis.
➢ Analysing data
➢ Identifying health problems, risks and strength
➢ Formulating diagnostic statements.

52. COMPARE DATA
AGAINST STANDARDS
CLUSTER
CUES
IDENTIFY GAPS
AND
CONSISTENCIES
ANALYSING DATA

53. COMPARING DATA WITH STANDARDS
Nurses draw on knowledge and experience to compare client
data to standards and norms and identify significant and
relevant cues. A standard or norm is a generally accepted
measure, rule , model or pattern. The nurse uses a wide range
of standards such as growth and development patterns, normal
vital signs and laboratory values.

54. CLUSTERING CUES
Data clustering or grouping cue is a process of determining
the relatedness of facts and determining whether any pattern
are present. Data clustering involves making inference about
the data . the nurse interpret the possible meaning of the
cues, and labels the cue cluster with tentative diagnostic
hypothesis.

55. IDENTIFYING GAPS AND INCONSISTENCIES IN
DATA
Skill full assessment minimize gaps and inconsistencies
in data. However, data analysis should include a final check to
ensure that data are complete and correct . inconsistencies are
conflicting data possible source of conflicting data include
measurement error, expectations and inconsistent or unreliable
reports.

56. IDENTIFYING HEALTH PROBLEMS, RISK AND
STRENGTH
DETERMINING
PROBLEMS AND RISKS
DETERMINING
STRENGTH

57. DETERMINING PROBLEMS AND RISKS
After grouping and clustering the data, nurse and
client together identify problem that support
tentative actual, risk and possible diagnosis in
addition the nurse must determine whether the
clieny’s problem is a nursing diagnosis, medical
diagnosis or collaborative problem.

58. DETERMINING STRENGTH
Nurse and client also establish the client’s strength,
resource and abilities to cope. Most people have a clear
perception of their problem or weakness than their
strength and assets. By taking inventory of strength, the
client can develop a more well rounded self concept, self
image. Strength can be an aid to mobilizing health and
regenerative processes.

59. FORMULATING DIAGNOSTIC STATEMENT
BASIC TWO PART STATEMENT
1. PROBLEM(P); STATEMENT OF THE CLIENT
RESPONSE
2. ETIOLOGY (E) ; FACTORS CONTRIBUTING TO OR
PROABLE CAUSE OF THE RESPONSE
3. The two parts are joined by the word ”related to “ rather than “
due to”

60. BASIC THREE PART STATEMENT
Called as PES format
1. Problem(p) – statement of the client’s response
2. Aetiology (e) – factors contributing to or probably causes or
the response
3. Signs and symptoms (s) – defining characteristics manifested
by the client

61. Actual nursing diagnosis can be documented by using the three part
statement because the signs and symptoms of the diagnosis
The PES format is especially recommended for beginning diagnosticians
because the sign and symptoms validate why the diagnosis was chosen
and make the problem statement more descriptive.
The PES format can create very long problem statements, sometimes
making the problem and aetiology unclear. To minimize long problem
statement, the nurse can record the signs and symptoms in the nursing
notes instead of on care plan.

62. ONE PART STATEMENT
Some diagnostic statement, such as wellness diagnosis and syndrome nursing diagnosis, consist of
NANDA label only. As the diagnostic label are refined, they tend to become more specific, so that
nursing intervention can be derived from the label itself. Therefore, an aetiology may be needed.
BASIC TWO PART STATEMENT
PROBLEM RELATED TO ETIOLOGY
CONSTIPATION RELATED TO PROLONGED LAXATIVE
SEVERE ANXIETY RELATED TO THREAT TO PHYSIOLOGIC INTEGRITY

63. BASIC THREE PART STATEMENT
PROBLEM RELATED TO ETIOLOGY
AS
MANIFESTED BY SIGNS/SYMP
SITUATIONAL LOW
SELF ESTEEM
RELATED TO FEELINGS OF
REJECTION
AS MANIFESTED BY HYPERSENSITIVITY TO
CRITICISM

64. VARIATION IN BASIC FORMAT
❑ WRITING UNKNOWN ETIOLOGY when the defining characteristics are
present but the nurse does not know the cause or contributing factors
❑ Using the phrase complex factors when there are too many etiologic factors or when
they are too complex to sate in a brief phase. The actual causes of chronic low self
esteem, for instance may be long term and complex as in the following nursing
diagnosis
For Eg; chronic low self esteem related to complex factors
❑ Using possible to describe either the problem or the aetiology, when the nurse
believes more data are needed about the client’s problem or aetiology, the word
possible is inserted.
Eg; possible low self esteem related to loss of job or rejection by family.

65. ❑Using secondary to divide the aetiology in to two parts, there by
making the statement more descriptive and useful. the part
following secondary to is often pathophysiologic or disease
process or medical diagnosis.
Eg; risk for impaired skin integrity related to decreased peripheral
circulation secondary to diabetes.
❑Adding a second part to the general response to make it more
precise.
For Eg; impaired skin integrity does not indicate the location
of the problem. Impaired skin integrity (left ankle) can be used.

66. AVOIDING ERRORS IN DIAGNOSTIC REASONING
Some error is inherent in any human undertaking and diagnosis is no
exception
➢ VERIFY - Hypothesize possible explanations of data, but realize that all
diagnosis are only tentative until they are verified. Begin and end process by
talking with the client.
➢Build a good knowledge base and acquire clinical experiences. Nurse must
apply knowledge from different areas to recognize significant cues and
patterns.

67. ➢ Have a working knowledge of what is normal.. nurse need to know the population
norms for vital signs, laboratory test, speech development, breath sounds.
➢ In addition , nurses must determine what is usual for a particular person, taking in
to account age, physical make up, lifestyle, culture and the person’s own
perception of his/her status.
➢ CONSULT RESOURCES - both novice and experienced nurses should consult
appropriate resources whenever in doubt about a diagnosis. Professional
literatures, nursing colleagues and other professionals are all appropriate
resources.
➢ Base diagnoses on patterns that is on behaviour over time, rather than on isolated
incident.
➢ Improve critical thinking skills. These skills help the nurse to be aware of and
avoid errors in thinking.