A DISCUSSION ON THE NURSING PROCESS SPECIFICALLY ON PLANNING

1. Diagnosing

2. • To use the concept of nursing diagnoses
effectively in generating and completing a
nursing care plan, the nurse must be familiar
with the definitions of terms used and the
components of nursing diagnoses.
NANDA NURSING DIAGNOSES
• Diagnosing refers to the reasoning process.
• Diagnosis is a statement or conclusion regarding the
nature of a phenomenon.
• The standardized NANDA names for the diagnoses
are called diagnostic labels; and the client’s
problem statement, consisting of the diagnostic label
plus etiology (causal relationship between a problem
and its related or risk factors), is called a nursing
diagnosis.
• NURSING DIAGNOSIS (NANDA) - . 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”
Definitions
Status of the Nursing Diagnoses
 “Status of the nursing diagnosis refers to
the actuality or potentiality of the
problem/syndrome or the categorization of
the diagnosis as a health promotion
diagnosis”.
The kinds of nursing diagnoses
according to status are:
 Actual
 health promotion
 Risk
 Syndrome
Components of a NANDA Nursing Diagnosis
 A nursing diagnosis has three
components:
(1) the problem and its definition
(2) the etiology
(3) the defining characteristics

3. Differentiating Nursing Diagnoses from
Medical Diagnoses
 A nursing diagnosis is a statement of nursing
judgment and refers to a condition that nurses,
by virtue of their education, experience, and
expertise, are licensed to treat.
 A medical diagnosis is made by a physician and
refers to a condition that only a physician can
treat. Medical diagnoses refer to disease
processes—specific pathophysiologic
responses that are fairly uniform from one client
to another.

4. Differentiating Nursing Diagnoses from Collaborative Problems
 A collaborative problem is a type of potential problem that nurses manage using both independent and
physician-prescribed interventions.
Comparison of Nursing Diagnoses, Medical Diagnoses, and Collaborative Problems

5. THE DIAGNOSTIC PROCESS
 The diagnostic process uses the critical
thinking skills of analysis and synthesis. In
critical thinking, 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 its parts (deductive reasoning).
The diagnostic process has three steps:
• Analyzing data
• Identifying health problems, risks, and strengths
• Formulating diagnostic statements
In the diagnostic process, analyzing involves the
following steps:
1. Compare data against standards (identify
significant cues).
2. Cluster the cues (generate tentative
hypotheses).
3. Identify gaps and inconsistencies.
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.
A cue is considered significant if it does any
of the following:
 Points to negative or positive change in a client’s
health status or pattern.
 Varies from the norms of the client population.
 • Indicates a developmental delay.

7. CLUSTERING CUES
 Data clustering or grouping of cues is a process
of determining the relatedness of facts and
determining whether any patterns are present,
whether the data represent isolated incidents,
and whether the data are significant.
IDENTIFYING GAPS AND
INCONSISTENCIES IN DATA
 Skillful assessment minimizes gaps and
inconsistencies in data. However, data analysis
should include a final check to ensure that data
are complete and correct.
Identifying Health Problems, Risks, and
Strengths
 After data are analyzed, the nurse and client
can together identify strengths and problems.
This is primarily a decision-making process.
DETERMINING PROBLEMS AND
RISKS
 After grouping and clustering the data, the
nurse and client together identify problems
that support tentative actual, risk, and possible
diagnoses.
DETERMINING STRENGTHS
 At this stage, the nurse and client also
establish the client’s strengths, resources,
and abilities to cope.

8. Formulating Nursing Diagnoses for Margaret O’Brien

11. Formulating Diagnostic Statements
 Most nursing diagnoses are written as two-part or
three-part statements, but there are variations of
these.
BASIC TWO-PART STATEMENTS
 The basic two-part statement 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 responses.
BASIC THREE-PART STATEMENTS
• The basic three-part 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.

12. ONE-PART STATEMENTS
 Some diagnostic statements, such as health
promotion diagnoses and syndrome nursing
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.
VARIATIONS OF BASIC FORMATS
 Variations of the basic one-, two--, and three-part statements include the following:
1. Writing unknown etiology when the defining characteristics are present, but the nurse
does not know the cause or contributing factors.
2. Using the phrase complex factors when there are too many etiologic factors or when
they are too complex to state in a brief phrase.
3. Using the word possible to describe either the problem or the etiology.
4. Using secondary to divide the etiology into two parts, thereby making the statement
more descriptive and useful.
5. Adding a second part to the general response or NANDA label to make it more
precise.
COLLABORATIVE PROBLEMS
 Carpenito-Moyet (2013) has suggested that all
collaborative (multidisciplinary) problems begin
with the diagnostic label Potential Complication
(PC).
 Nurses should include in the diagnostic statement
both the possible complication they are monitoring
and the disease or treatment that is present to
produce it.

13. EVALUATING THE QUALITY OF THE DIAGNOSTIC STATEMENT
 In addition to using the correct format, nurses must consider the content of their diagnostic statements.
Avoiding Errors in Diagnostic Reasoning
 Some error is inherent in any human undertaking, and diagnosis is no exception. However, it is
important for nurses to make nursing diagnoses with a high level of accuracy
The following suggestions help to minimize diagnostic errors:
 Verify
 Build a good knowledge base and acquire clinical experience.
 Have a working knowledge of what is normal.
 Consult resources.
 Base diagnoses on patterns—that is, on behavior over time— rather than on an isolated incident.
ONGOING DEVELOPMENT OF NURSING DIAGNOSES
 The first taxonomy of nursing diagnoses was alphabetical. This ordering was considered unscientific by
some, and a hierarchic structure was sought.
 In 1982, NANDA accepted the “nine patterns of unitary man” as an organizing principle.
 In 1984, NANDA renamed the “patterns of unitary man” as “human response patterns” based more on
the work of Marjorie Gordon (Kim, McFarland, & McLane, 1984), as listed in Box 12–4.

15. ONGOING DEVELOPMENT OF NURSING
DIAGNOSES
 The first taxonomy of nursing diagnoses was
alphabetical. This ordering was considered
unscientific by some, and a hierarchic structure was
sought.
 In 1982, NANDA accepted the “nine patterns of
unitary man” as an organizing principle.
 In 1984, NANDA renamed the “patterns of unitary
man” as “human response patterns” based more on
the work of Marjorie Gordon (Kim, McFarland, &
McLane, 1984), as listed in Box 12–4.

16. Taxonomy II