B.P.

KOIRALA INSTITUTE OF HEALTH SCIENCES

COLLEGE OF NURSING

DHARAN ,SUNSARI , NEPAL

Seminar on Concept of NANDA’S Nursing Diagnosis

Submitted To: Submitted By:

Ass.Prof. Erina Shrestha Sapana Dahal

Med-Surg Nursing M.Sc. Nursing 1st year

CoN,BPKIHS CoN,BPKIHS

Submitted on:2022/05/27

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Contents

1. Introduction to Nursing Diagnosis

2. History of Nursing Diagnosis
3. Introduction to NANDA’S Nursing Diagnosis
4. Types of Nursing Diagnosis
5. Components of Nursing Diagnosis
6. Writing a Nursing Diagnosis
7. Classification of Nursing Diagnosis
8. References

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 NANDA’S Nursing Diagnosis

Introduction

Nursing Diagnosis

A nursing diagnosis is a part of the nursing process and is a clinical judgment that
helps nurses determine the plan of care for their patients. These diagnoses drive
possible interventions for the patient, family, and community. They are developed
with thoughtful consideration of a patient’s physical assessment and can help
measure outcomes for the nursing care plan.

Nursing diagnosis is a clinical judgment about individual, family, or community

responses to actual or potential health problems/life processes. (NANDA-I)

According to NANDA International, a nursing diagnosis is “a judgment based on

a comprehensive nursing assessment.” The nursing diagnosis is based on the
patient’s current situation and health assessment, allowing nurses and other
healthcare providers to see a patient's care from a holistic perspective. Proper
nursing diagnoses can lead to greater patient safety, quality care, and increased
reimbursement from private health insurance, Medicare, and Medicaid.

Example: Acute pain related to tissue ischemia evidenced by pain rating

7/10,grimacing.

History of Nursing Diagnosis

1973: The first conference to identify nursing knowledge and a classification

system; NANDA was founded

1977: First Canadian Conference takes place in Toronto

1982: NANDA formed with members from the United States and Canada

1984: NANDA established a Diagnosis Review Committee

1987: American Nurses Association (ANA) officially recognizes NANDA to

govern the development of a classification system for nursing diagnosis

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1987: International Nursing Conference held in Alberta, Canada

1990: 9th NANDA conference and the official definition of the nursing diagnosis
established

1997: Official journal renamed from “Nursing Diagnosis” to “Nursing Diagnosis:

The International Journal of Nursing Terminologies and Classifications”

2002: NANDA changes to NANDA International (NANDA-I) and Taxonomy II

released

2020: 244 NANDA-I approved diagnosis

NANDA’s Nursing Diagnosis

Introduction

It is the principal organization for defining, distributing and integrating

standardized nursing diagnoses worldwide.The term nursing diagnosis was first
mentioned in the nursing literature in the 1950s. Two faculty members of Saint
Louis University, Kristine Gebbie and Mary Ann Lavin recognized the need to
identify nurses’ roles in an ambulatory care setting. In 1973, NANDA’s first
national conference was held to identify, develop, and classify nursing diagnoses
formally. Subsequent national conferences occurred in 1975, 1980, and every two
years. In recognition of the participation of nurses in the United States and Canada,
in 1982, the group accepted the name North American Nursing Diagnosis
Association (NANDA).Originally an acronym for the North American Nursing
Diagnosis Association, NANDA was renamed to NANDA International in 2002 as
a response to its broadening worldwide membership. NANDA members can be
found worldwide, specifically in Brazil, Colombia, Ecuador, Mexico, Peru,
Portugal, Germany, Austria, Switzerland, Netherlands, Belgium, and Nigeria-
Ghana .

Nurses can submit diagnoses to the Diagnostic Review Committee for review. The
NANDA-I board of directors gives the final approval for incorporating the
diagnosis into the official list of labels. As of 2021, NANDA-I has approved 267
diagnoses for clinical use, testing, and refinement.

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Mission

 Provide the world’s leading evidence-based nursing diagnoses for use in

practice and to determine interventions and outcomes
 Contribute to patient safety through the integration of evidence-based
terminology into clinical practice and clinical decision-making
 Fund research through the NANDA-I Foundation
 Be a supportive and energetic global network of nurses, who are committed
to improving the quality of nursing care and improvement of patient safety
through evidence-based practice

Types of Nursing diagnosis according to NANDA-I

 Problem-focused/Actual nursing diagnosis

 Risk nursing diagnosis
 Health promotion nursing diagnosis
 Syndrome nursing diagnosis

 Problem –focused diagnosis/Actual nursing diagnosis

It describes a clinical judgement that the nurse has validated because of the
presence of the major defining characteristics.A patient problem present during a
nursing assessment is known as a problem-focused diagnosis. Generally, the
problem is seen throughout several shifts or a patient’s entire hospitalization.
However, it may be resolved during a shift depending on the nursing and medical
care Problem-focused nursing diagnoses are typically based on signs and
symptoms present in the patient. It has three parts. The presence of major signs and
symptoms validates that an actual diagnosis is present.They are the most common
nursing diagnoses and the easiest to identify.

Problem-focused diagnosis have three components.

 Nursing diagnosis
 Related factors
 Defining characteristics

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Examples:
Ineffective Health Maintenance
Definition
Inability to identify, manage, and/or seek out help to maintain health (NANDA-I)
State in which a person experiences or is at risk of experiencing a disruption in
health because of lack of knowledge to manage a condition or basic health
requirement.
Defining Characteristics
 Demonstrated lack of adaptive behaviors to environmental changes
 Demonstrated lack of knowledge about basic health practices
 Lack of expressed interest in improving health behaviors
 History of lack of health-seeking behaviors
 Inability to take responsibility for meeting basic health practices
 Impairment of personal support system
Related Factors
Various factors can produce Ineffective Health Maintenance.
Common causes are listed in the following.
Situational (Personal, Environmental)
Related to:
Misinterpretation of information Insufficient resources
Lack of motivation Lack of education or readiness
Deficient communication skills
Lack of access to adequate health care services Cognitive impairments
Perceptual impairment

Maturational
Related to insufficient of knowledge of age-related risk factors such as

Child
Sexuality and sexual development
Inactivity Substance abuse
Poor nutrition Safety hazards

Adolescent
Same as children practices Vehicle safety

Adult
Parenthood
Safety practices
Sexual function
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Older Adult
Effects of aging Sensory deficits

Example
Anxiety related to unpredictable nature of asthmatic episodes as evident by
statements of “I’m afraid I won’t be able to breathe.”

2. Risk nursing diagnosis

It applies when risk factors require intervention from the nurse and healthcare team
prior to a real problem developing. It requires clinical reasoning and nursing
judgment. It has two parts.The validation for a risk nursing diagnosis is the
presence of risk factors.

Examples: Risk for Impaired Skin Integrity related to immobility secondary to

fractured hip.

3. Health promotion diagnosis/Wellness nursing diagnosis

Wellness nursing diagnoses are “a clinical judgment about an individual, group, or

community in transition from a specific level of wellness to a higher level of
wellness” (NANDA, 2007). A valid wellness nursing diagnosis has two
requirements:

(1) the client has a desire for increased wellnessin a particular area and

(2) the client is currently functioning effectively in a particular area.

Wellness nursing diagnoses are one-part statements with no related factors. The
goals established by the client or group will direct their actions to enhance their
health.There is still confusion about the clinical usefulness of this type ofdiagnosis.
Clinically, data that represent strengths can be important for nurses to know. These
strengths can assist the nurse in selecting interventions to reduce or prevent a
problem in another health pattern. If nurses want to designate strength, it should be
documented as strength on the assessment form or care plan. If the client desires
assistance in promoting a higher level of function,Readiness for Enhanced
(specify) would be useful in certain settings,such as schools, community centers,
and assisted living facilities.

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Examples

Readiness for enhanced parenting

NANDA-I Definition

A pattern of providing an environment for children or other dependent clients that

is sufficient to nurture growth and development and can be strengthened.

Defining Characters

Expresses willingness to enhance parenting.

Children/dependent clients express satisfaction with home environment.

Emotional support of children or dependent clients/person

Needs of children or dependent clients are met

Exhibits realistic expectations of children/dependent person

Readiness for enhanced fluid balance

Readiness for enhanced hope

4. Syndrome diagnosis

A syndrome diagnosis refers to a cluster of nursing diagnoses that occur in a

pattern or can all be addressed through the same or similar nursing interventions.

Examples:

Decreased cardiac output

Ineffective cerebral tissue perfusion

 Possible nursing diagnosis: It applies to problems suspected to arise. This

occurs when risk factors are present and require additional information to
diagnose a potential problem.

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Nursing Diagnosis Components

The three main components of a nursing diagnosis are:

 Problem and its definition

 Etiology or risk factors
 Defining characteristics or risk factors

 The problem and definition:

The problem statement, or the diagnostic label, describes the client’s health
problem or response to which nursing therapy is given concisely. A
diagnostic label usually has two parts: qualifier and focus of the diagnosis.
Qualifiers (also called modifiers) are words that have been added to some
diagnostic labels to give additional meaning, limit, or specify the diagnostic
statement. Exempted in this rule are one-word nursing diagnoses (e.g.,
Anxiety, Constipation, Diarrhea, Nausea, etc.) where their qualifier and
focus are inherent in the one term. Example: In Deficient Fluid Volume
Deficient is qualifier
Fluid volume is the focus of diagnosis

 Etiology or related factors

The etiology or related factors component of a nursing diagnosis label
identifies one or more probable causes of the health problem, are the
conditions involved in the development of the problem, gives direction to
the required nursing therapy, and enables the nurse to individualize the
client’s care. Nursing interventions should be aimed at etiological factors in
order to remove the underlying cause of the nursing diagnosis. Etiology is
linked with the problem statement with the phrase “related to” such as:

Decreased activity tolerance related to generalized weakness.

Impaired physical mobility related to imposed bed rest.

 Defining characteristics:
They are signs and symptoms that allow for applying a specific diagnostic
label. Risk factors are used in the place of defining characteristics for risk
nursing diagnosis. In actual nursing diagnoses, the defining characteristics

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 are the identified signs and symptoms of the client. Defining characteristics
are written following the phrase “as evidenced by” or “as manifested by”
in the diagnostic statement.

Writing a Nursing Diagnosis

Problem-focused and risk diagnoses are the most difficult nursing diagnoses
to write because they have multiple parts. According to NANDA-I, the
simplest ways to write these nursing diagnoses are as follows:

PROBLEM-FOCUSED DIAGNOSIS

Problem-Focused Diagnosis related to ______________________ (Related

Factors) as evidenced by _________________________ (Defining
Characteristics).

RISK DIAGNOSIS

The correct statement for a NANDA-I nursing diagnosis would be: Risk for
_____________ as evidenced by __________________________ (Risk
Factors).

Classification of Nursing Diagnoses

NANDA-I adopted the Taxonomy II in 2002 after consideration and collaboration

with the National Library of Medicine (NLM) in regards to healthcare terminology
codes. Taxonomy II has three levels: domains, classes, and nursing diagnoses. This
refined Taxonomy is based on the Functional Health Patterns assessment
framework of Dr. Mary Joy Gordon. Furthermore, the NLM suggested changes
because the Taxonomy I code structure included information about the location
and the level of the diagnosis. NANDA-I nursing diagnoses and Taxonomy II
comply with the International Standards Organization (ISO) terminology model for
a nursing diagnosis. The terminology is also registered with Health Level Seven
International (HL7), an international healthcare informatics standard that allows
for nursing diagnoses to be identified in specific electronic messages among

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different clinical information systems. It is coded according to seven axes:
diagnostic concept, time, unit of care, age, health status, descriptor, and topology.
In addition, diagnoses are now listed alphabetically by their concept, not by the
first word.There are currently 13 domains and 47 classes:

Domain 1 - Health Promotion

Health Awareness
Health Management

Domain 2 - Nutrition

Ingestion
Digestion
Absorption
Metabolism
Hydration

Domain 3 - Elimination/Exchange

Urinary Function
Gastrointestinal Function
Integumentary Function
Respiratory Function

Domain 4 - Activity/Rest

Sleep/Rest
Activity/Exercise
Energy Balance
Cardiovascular-Pulmonary Responses
Self Care

Domain 5 - Perception/Cognition

Attention
Orientation
Sensation/Perception
Cognition

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 Communication
Domain 6 - Self-Perception
Self-concept
Self-esteem
Body image

Domain 7 - Role Relationship

Caregiving Roles
Family Relationships
Role Performance

Domain 8 - Sexuality

Sexual Identity
Sexual Function
Reproduction

Domain 9 - Coping/Stress Tolerance

Post-trauma Responses
Coping Response
Neuro-Behavioral Stress

Domain 10 - Life Principles

Values
Beliefs
Value/Belief Action Congruence

Domain 11 - Safety/Protection

Infection
Physical Injury
Violence
Environmental Hazards
Defensive Processes
Thermoregulation

Domain 12 - Comfort
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 Physical Comfort
Environmental Comfort
Social Comfort

Domain 13 - Growth/Development

Growth
Development

Client Validation

The process of validating a nursing diagnosis should not be done in isolation from
the client and family. Inferences about data should be discussed with clients for
their input. Clients are given opportunities to select what they want assistance
with,which problems are important to them and which are not.

Clinical Example

Elimination Pattern

After assessing a client’s elimination pattern, the nurse would analyze the data.

Does this person have a possible problem with constipation or diarrhea?

 If yes, the nurse would then ask the person more focused questions to
confirm the presence of the defining characteristics of constipation or
diarrhea .
 If these defining characteristics are not present, then there is no actual
diagnosis of constipation or diarrhea.
If there is a risk diagnosis?
 To determine this, the nurse will assess for risk factors of constipation.
If listed risk factors are not present, there is no risk for constipation or
diarrhea.

If there is no actual or at risk elimination nursing diagnosis, the nurse can ask
whether the individual would like to improve his or her elimination patterns. If the
answer is yes, the wellness diagnosis , Potential for Enhanced Elimination is the
appropriate choice.

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Research Study

The Influence of Nursing Diagnosis on Information Processing by

Undergraduate Students

A quasi-experimental study conducted with two groups (experimental, n = 15;

control, n = 22) of undergraduate nursing students, subjecting only one to a nursing
diagnosis course. The students' ability to identify, cluster, and name clusters of
relevant data were compared between and within groups.FINDINGS:After the
course, the experimental group performed better than the control group in the three
activities studied.CONCLUSIONS:The results of this study suggest that the
nursing diagnosis content in teaching favors clinical reasoning to determine the
patient's nursing care.( Cruz DD, Arcuri EA ,1998)

Evaluation of the nursing process utilization in a teaching hospital, Ogun

State, Nigeria

This study evaluates the utilization of nursing process on the day of admission and
within 24 h of patient admission in a teaching hospital using the descriptive and
retrospective design which concluded that only 24.9% of the medical records
contained the nursing process form. On the day of admission, <25% of the charts
included a complete record of nursing assessment, nursing diagnoses, nursing
intervention, and the evaluation. The highest phase of nursing process recorded is
nursing diagnosis followed by patient assessment. At 24h post admission, no
significant increase was noted in the phases of nursing process recorded. Nursing
process utilization remained poorly incorporated into the activities of nurses in this
institution. Therefore, continuing professional education on nursing process and
supervision should be mandated.( Ojewole FO, Samole AO ,2017)

Summary

According to NANDA International, a nursing diagnosis is “a judgment based on a

comprehensive nursing assessment.” The nursing diagnosis is based on the
patient’s current situation and health assessment, allowing nurses and other
healthcare providers to see a patient's care from a holistic perspective.It has 13

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domains and 47 classes. The process of validating a nursing diagnosis should not
be done in isolation from the client and family.

References

1. Berman A, Snyder SJ, Kozier B,et al. Kozier & Erb's fundamentals of
Nursing Australian edition. Pearson Higher Education AU; 2014 Dec 1.
2. Carpenito-Moyet LJ. Nursing diagnosis: Application to clinical practice (14 th
edition) Lippincott Williams & Wilkins; 2006.
3. Welk DE. Teaching students a pattern of reversals eases the care plan
process. Nurse Educator. 2001 Jan 1;26(1):43-5.
4. Ojewole FO, Samole AO. Evaluation of the nursing process utilization in a
teaching hospital, Ogun State, Nigeria. Journal of Nursing and Midwifery
Sciences. 2017 Jul 1;4(3):97.

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