The term diagnosis is a statement or conclusion regarding the nature of phenomenon. A nursing diagnosis is a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.

1. Nursing Diagnosis:
• Nursing diagnosis is the 2nd step of nursing process
where the patient’s nursing problems is identified.
• Nursing diagnosis is the process of reasoning or the
clinical act of identifying problems.
• It forms a link between the assessment and planning
steps of nursing process.
• The effectiveness of any intervention depends upon
the accuracy of the nursing diagnosis.
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2. Contd…..
• In order to make accurate nursing diagnosis, the
nurse should have clear understanding of what data
to collect and should have ability to make judgment
based on the data.
• To use the concept of nursing diagnosing effectively in
generating and completing a nursing care plan, the
nurse must be familiar with the definitions of terms
used, the types and the components of nursing
diagnoses.
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3. Definitions:
• The term diagnosis is a statement or conclusion
regarding the nature of phenomenon.
• A nursing diagnosis is a clinical judgment concerning a
human response to health conditions/life processes,
or a vulnerability for that response, by an individual,
family, group or community. A nursing
diagnosis provides the basis for selection of nursing
interventions to achieve outcomes for which the
nurse has accountability. (Approved at the ninth
NANDA Conference; amended in 2009 and 2013.)
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4. • A nursing diagnosis is a statement of the high risk or
actual problems in the client’s health status the nurse
is licensed competent to treat
• Note: It is not medical diagnosis
Data Analysis + Problem Identification = Formulation Of
Nursing Diagnosis
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5. PURPOSE OF NURSING DIAGNOSES
a. For client:
1. Individualization of care
2. Appropriate selection of interventions
3. Establishment of goal
b. For Nursing:
1. Facilitates communication, documentation
2. Continuity of care among health care providers
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6. CHARACTERISTICS OF NURSING DIAGNOSIS
• 1. It states a clear and concise health problem
• 2. It is derived from existing evidences about the
client
• 3. It is potentially amenable to nursing therapy
• 4. It is the basis for planning and carrying out nursing
care
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9. 1. Actual diagnosis:
•An actual diagnosis is a client problem that is present at
time of the nursing assessment.
•An actual nursing diagnosis is based on the presence of
associated signs and symptoms.
•Examples are ineffective breathing pattern, imbalance
nutrition, acute pain and anxiety.
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10. EXAMPLES OF ACTUAL NURSING DIAGNOSIS
• Ineffective breathing pattern related to bacterial / viral
inflammatory Process.
• Ineffective breathing pattern related to Tracheo-bronchial
obstruction
• Anxiety related to changes in the environment and routines,
threat to socio economic status.
• Anxiety related to change in health status and situational
crisis
• Body image disturbance related to temporary presence of a
visible drain/ tube.
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11. Contd….
2. A risk nursing diagnosis:
• It is a clinical judgment that a problem does not exist, but the
presence of risks factors indicate that a problem is likely to
develop unless nurse intervene.
• For example, all people admitted to a hospital have some
possibility of acquiring an infection; however, a client with
diabetes or a compromised immune system is at higher risk
than others.
• Therefore, the nurse would appropriately use the label risk for
infection to describe the client’s health status.
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12. • EXAMPLES OF RISK NURSING DIAGNOSIS
• Eg. Admission in hospital prone for acquiring infection- compromised immune system
• 1. Risk for infection related to compromised immune system.
• 2. Risk for injury related to altered mobility and disorientation.
• 3. Risk for aspiration related to decreased cough and gag reflex
• Risk for impaired skin integrity related to immobility.
• Risk for impaired skin integrity related to edema and neuropathy
• Risk for injury related to generalized weakness
• Risk for Impaired skin integrity (left ankle) related to decrease peripheral circulation in
diabetes.
• Risk for Impaired skin integrity related to loss of pain perception
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13. Contd….
3. Wellness diagnosis:
• Wellness nursing diagnoses involves a judgment
about an individual, family or community in transition
from one level of wellness to a higher level of
wellness.
• Example of wellness diagnosis would be readiness for
enhanced spiritual well- being or readiness for
enhanced family coping.
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14. Contd….
4. A possible nursing diagnosis:
• Possible nursing diagnoses are statements describing
a suspected problem for which additional data are
needed to confirm or rule out the suspected problem.
• A possible nursing diagnosis also provides the nurse
the ability to communicate to other nurses that a
diagnosis may be present but additional data
collection is indicated to rule out or confirm the
diagnosis. Examples include Possible Chronic Low Self-
Esteem, Possible Social Isolation.
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15. • For example, an elderly widow who lives alone is admitted to the
hospital. The nurse notices that she has no visitors and is pleased
with attention and conversation from the nursing staff. Until more
data are collected, the nurse may write a nursing diagnosis of
possible social isolation related to unknown etiology; possible
nutritional deficit RT nausea, Possible low self esteem RT loss job
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16. Contd….
5. A syndrome diagnosis:
• It is a diagnosis that is associated with a cluster of
other diagnoses.
• Currently, only two syndrome diagnoses on the
NANDA list are:
Disuse syndrome
Rape trauma syndrome
• For example:
1. Rape trauma syndrome related to anxiety about
potential health problems as manifested by anger ,
genitourinary discomfort, and sleep pattern
disturbance.
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17. Contd….
2. Risk for disuse syndrome, for example, may be
experienced by long-term bedridden patients.
• Clusters of diagnoses associated with this syndrome
include Impaired Physical Mobility, Risk For Impaired
Tissue Integrity, Risk for Activity Intolerance, Risk for
constipation, Risk for Infection, Risk for Injury, Risk for
Powerlessness, Impaired Gas exchange, and so on.
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18. Contd…..
The nursing diagnosis should:
• Be clear and brief
• Be based on data
• Be related to only one problem
• State the cause of problem if known
• For e.g.:-
Problem (Difficulty in breathing) + Cause (related to
ineffective coughing) = Nursing Diagnosis (Difficulty in
breathing related to ineffective coughing)
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19. Components of a NANDA Nursing
Diagnosis
• A nursing diagnosis has three components:
1) The problem and its definition :P
2) The etiology/ related factors/ causes: E
3) The defining characteristics/ signs and symptoms: S
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20. Problem (Diagnostic Label) and Definition:
• The problem statement, or diagnostic label,
describes the client’s actual or potential health
problem or response for which nursing therapy is
given.
• It describes the client’s health status or problems
clearly and concisely as possible.
• The purpose of the diagnostic label is to direct the
information of the client goals and desired
outcomes.
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21. Contd……
• NANDA recommends the use of quantifiers when
writing the problems statement, which includes
altered (changed), impaired (reduced/
diminished), deficient (lacking/incomplete),
excessive (extreme), ineffective (unproductive).
etc.
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22. Etiology (Related factors and Risk Factors)
• The etiology component of a nursing diagnosis
identifies one or more probable causes of the health
problem, gives direction to the required nursing
therapy, and enables the nurse to individualize the
client’s care.
• In other words, the etiology identified physiologic
(e.g. Incision pain), psychologic (fear of loss of
control), sociologic (inability to speak English
language), spiritual (conflict between the beliefs and
prescribed medical practice) and environmental
(excessive noise).
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23. Contd…..
• It reflects the factors believed to be related to
problem as either as cause or a contributing
factors for the problem while stating the diagnosis
the problem and etiology are connected by
“related to (R/T) which shows the relationship,
‘nor’ ‘cause’ and ‘effect’.
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25. Defining Characteristics
• Defining characteristics are the cluster signs and symptoms that indicate
the presence of a particular diagnostic label.
• For actual nursing diagnoses, the defining characteristics are the client’s
sign and symptoms.
• For risk nursing diagnosis, no subjective and objective signs are present.
• Thus, the factors that causes the client to be more vulnerable to the
problem from the etiology of a risk nursing diagnosis.
• The NANDA lists of defining characteristics are still being developed and
refined.
• Characteristics are listed separately according to whether they are
subjective or objective in nature.
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26. The Diagnostic Process
The diagnostic process uses the critical thinking skills of
analysis and synthesis.
• Critical thinking is a cognitive process during which a person
reviews data and considers explanations before forming an
opinion.
• Analysis is the separation into components, that is, the breaking
down of the whole into parts (deductive reasoning).
• Synthesis is the opposite, that is, the putting together of parts into
the whole (inductive reasoning).
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27. Contd…..
The diagnostic process has three
steps:
•Analyzing the data
•Identifying health problems, risks and
strengths.
•Formulating diagnostic statements
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28. Contd…..
1. Analyzing the data:
• In the diagnostic process, analyzing involves the
following steps:
a. Compare data against standards (identify significant
cues)- normal V/S, Lab. Values, growth and
development patterns
b. Cluster cues and
c. Identify gaps and inconsistencies.
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29. Contd…..
2. Identifying health problems, risks and strength:
• After data are analyzed, the nurse and client can
together identify strengths and problems. This is
primarily a decision-making process.
• After grouping and clustering the data, the nurse and
client together identify problems that support
tentative, actual, risk and possible diagnoses.
• In addition the nurse must determine whether the
client problem is a nursing diagnosis, medical
diagnosis or collaborative problem.
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30. Contd….
3. Formulating Diagnostic Statement
• Most nursing diagnoses are written as two-part or
three-part statements, but there is variation of these.
Basic two-part statement
The basic two-part statements include the
following:
• Problem(P): statements of client’s response (NANDA
label)
• Etiology (E): factors contributing to or probable
causes of responses
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31. Contd….
• The two parts are joined by the words Related to .
• By contrast, the phrase Related to merely implies
a relationship.
• For example, constipation related to prolong
laxative use, severe anxiety related to threat to
physiologic integrity.
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32. • A risk nursing diagnosis is written as problem/diagnosis related to
(r/t) x factor/cause.
• A syndrome nursing diagnosis is written as problem/diagnosis related
to (r/t) x factor/cause.
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34. Basic three-part statements:
• The basic three parts nursing diagnosis statement is
called the PES format and includes the following:
1. Problem (P): statement of the client’s response
(NANDA label)
2. Etiology (E): factors contributing to or probable
causes of the response
3. Signs and symptoms (S): defining characteristics
manifested by the client
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35. Contd…..
• Actual nursing diagnoses can be documented by
using the three-part statement because the signs
and symptoms have been identified.
• This format cannot be used for risk diagnoses
because the client does not have signs and
symptoms of the diagnosis.
• The PES format is especially recommended for
beginning diagnosticians because the signs and
symptoms validate why the diagnosis was chosen
and the make the problem statement more
descriptive.
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36. • An actual nursing diagnosis is written as the
problem/diagnosis related to (r/t) x factor/cause as evidenced
by data/observations.
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38. One-Part Statements:
• Some diagnostic statements, such as wellness
diagnoses consist of a NANDA label only.
• As the diagnostic labels are refined, they tend to
become more specific, so that nursing interventions
can be derived from the label itself.
• Therefore, an etiology may not be needed. NANDA
has specified that any new wellness diagnoses will be
developed as one-part statements beginning with the
words Readiness for Enhanced followed by the
desired higher level wellness for example, Readiness
for Enhanced parenting.
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39. Avoiding Errors in Diagnostic Reasoning
• Some error is inherent in any human undertaking, and
diagnosis is no exception.
• However, it is important that nurses make nursing
diagnoses with a high level of accuracy.
• Nurses can avoid some common errors of reasoning
by recognizing them and applying the appropriate
critical-thinking skills.
• Error can occur at any point in the diagnostic process:
data collection, data interpretation, and data
clustering.
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40. Contd…
The following suggestions help to minimize diagnostic
error:
• Verify: Hypothesize possible explanations of data, but
realize that all diagnoses are only tentative until they
are verified. Begin and end the diagnostic process by
talking with the client and family.
• Build a good knowledge base and acquire clinical
experience.
• Have a working knowledge of what is normal: nurses
need to know the population norms for vital signs,
laboratory tests, speech development, and breath
sound so on.
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41. Contd…
• Consults resources: Both novices and experienced
nurses should consult appropriate resources
whenever in doubt about diagnosis.
• Improve critical thinking skills: These skills help
the nurse to be aware of and avoid error in
thinking, such as over generalizing and making
unwarranted assumptions.
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