Chapter 12 Nursing Diagnosis Copyright 2004 by Delmar

Nursing Diagnosis § The term nursing diagnosis is used in three different contexts: • Data analysis and decision-making process • Diagnostic label • Classification system Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 2

Definition of a Nursing Diagnosis (NANDA, 1996) § “A clinical judgment about individual, family or community responses to actual and potential health problems/life processes” Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 3

Comparison of Medical and Nursing Diagnoses § Medical and nursing diagnoses both use the comprehensive diagnostic process in making a clinical judgment and determining expected outcomes. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 4

Comparison of Medical and Nursing Diagnoses § Medical diagnosis is the terminology used for a clinical judgment by the physician that identifies or determines a specific disease, condition, or pathologic state. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 5

Nursing Diagnosis § Terminology used for a clinical judgment by the professional nurse that identifies the client’s actual, risk, wellness, or syndrome responses to a health state, problem, or condition. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 6

Comparison of Nursing and Medical Diagnoses § Nursing diagnoses differ from medical diagnoses in: • Purpose • Goals • Therapeutic Interventions Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 7

Comparison of Medical and Nursing Diagnoses § “Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable. ” (NANDA, 1996) Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 8

Historical Perspective § Fry (1953) identified that nursing diagnosis is a tool for individualizing patient care. § First National Conference for the Classification of Nursing Diagnoses, (1973). § American Nurses Association (ANA) published Standards of Nursing Practice (1973). Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 9

Historical Perspective § North American Nursing Diagnosis Association (NANDA), 1982. § NANDA developed 21 new nursing diagnoses and revised 37 existing diagnoses (1998). § Development of an ad hoc research committee (1998). Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 10

Purposes of Nursing Diagnosis § Identifies areas that nurses can resolve or enhance. § Demonstrates professional judgment. § Organizes decision making as part of the nursing process. § Promotes accountability. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 11

Purposes of Nursing Diagnosis § Provides communication among nurses and other health care personnel. § Promotes use of standardized language and process. § A means to individualize care. § Provides a mechanism for conducting nursing research. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 12

Nursing Diagnoses and Diagnostic. Related Groups (DRGs) § The DRG coding system for prospective payment financing (1983) is based on the medical model and medical diagnoses. § There are no set codes for nursing diagnosis or care. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 13

Components of a Nursing Diagnosis § The two-part statement • Problem statement or diagnostic label • Etiology § The diagnostic label and etiology are linked by the term related to (RT). Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 14

Components of a Nursing Diagnosis § The three-part statement • Diagnostic Label • Etiology

The Three-Part Statement § Defining characteristics are the signs and symptoms, subjective and objective data, or clinical manifestations. § The phrase, “as evidenced by …” (AEB), is joined to the first two components. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 16

Categories of Nursing Diagnoses § Actual Diagnoses § Risk Diagnoses § Wellness Diagnoses Copyright

Taxonomy of Nursing Diagnosis § A taxonomy is a system of classification. § Taxonomy II • Current NANDA-approved system for identification and naming of nursing diagnoses. • Categorizes NANDA-approved nursing diagnoses by patterns of response. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 18

Nine Patterns of Human Response § § § Exchanging Moving Perceiving Knowing Feeling § § Communicating Relating Valuing Choosing Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 19

Developing a Nursing Diagnosis § Critical thinking § Assessing the database § Validating cues § Interpreting cues § Clustering cues § Consulting NANDA list of nursing diagnoses § Writing the nursing diagnostic statement Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 20

Developing a Nursing Diagnosis § Critical thinking is essential to the synthesis and interpretation of information when developing a nursing diagnosis. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 21

Developing a Nursing Diagnosis § Assessing the Data Base • Cues are small amounts of data gathered during assessment. • Cues raise suspicion. • Cues stimulate further observation. • Cues stimulate further data collection. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 22

Developing a Nursing Diagnosis § Validating Cues • Verifying subjective and objective data for accuracy and completeness § Interpreting Cues • Assigning meaning to data cues § Clustering Cues • Grouping related data together Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 23

Developing a Nursing Diagnosis § Consulting NANDA List of Nursing Diagnoses • The clustered data are matched with a NANDA diagnosis. § Writing the Nursing Diagnosis Statement • The NANDA list provides the diagnostic label and etiology. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 24

Avoiding Errors in Developing a Nursing Diagnosis § Accurate and complete collection of data. § Use of an organizational framework for clustering data cues. § Thorough analysis and validation of data. § Correct writing of the nursing diagnosis. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 25

Limitations of Nursing Diagnosis § Lack of consensus among nurses regarding the NANDA-approved nursing diagnosis list. § Disagreement over specific label in the classification system. § Perception that the list is confining, incomplete, medically oriented, confusing. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 26

Limitations of Nursing Diagnosis § Nurses are overworked and have less time with clients. § Care is still organized around the medical diagnosis. § Nurses are afraid they may be ridiculed for using nursing diagnoses. § The nursing diagnosis list does not always fit the client situation. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 27

Limitations of Nursing Diagnosis § Nurses may be unable or unwilling to use nursing diagnoses because of incomplete knowledge. § If a nursing diagnosis is inappropriate, and as a result, the interventions are inappropriate or lacking, the nurse is liable for these errors in judgment. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 28

Overcoming Barriers to Nursing Diagnosis § Familiarity of nursing diagnosis language empowers the nurse to communicate more effectively. § Health care agency administrators and medical staffs need to be more supportive of the use of nursing diagnoses. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 29

Overcoming Barriers to Nursing Diagnosis § Enhanced communication between clinical nurses and leaders will increase the development of nursing diagnoses. § Most nursing education programs offer standardized content related to nursing diagnoses. § Experienced nurses need opportunities to review nursing diagnoses. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 30

Overcoming Barriers to Nursing Diagnosis § Every attempt should be made to describe phenomena that do not fit into existing nursing diagnosis language. § The nurse may be on the threshold of documenting a new nursing diagnosis. Copyright 2004 by Delmar Learning, a division of Thomson Learning, Inc. 31