Nursing Diagnosis in Education

The use of nursing diagnoses is central to nursing education. The assessment and diagnosis of individuals, families, and communities teach students hypothetical reasoning and critical thinking. Further, those who come to nurses for assistance expect the achievement of improved health outcomes for which nurses are increasingly held accountable. Outcomes and the selection of interventions rest on accurate and valid nursing diagnoses.

Teaching nursing students to use nursing diagnoses begins with assessment and history-taking. As students assess and collect data (information) about individuals, families, and communities, they are identifying the “signs and symptoms” or defining characteristics of the nursing diagnosis concepts. The factors or variables influencing diagnoses are integrated with the history, charts, and other evidence. These variables provide the context, the “related factors”, that are combined with the defining characteristics to make nursing diagnoses. When possible, nurses treat related factors with interventions to prevent or reduce their impact. When it is not possible for nurses to treat a related factor, they treat the defining characteristics with selected nursing interventions.

Assessment and Identifying Defining Characteristics

The defining characteristics are those characteristics in individuals, families, and communities that are observable and verifiable. They serve as cues or inferences that cluster as manifestations of an actual illness or wellness health state, or nursing diagnosis. Suppose, for example, that an individual (Sarah) states to nursing student that she is “sick to my stomach” and asks for emesis basin. The nursing student further observes that Sarah is swallowing a great deal and gagging. These defining characteristics are suggestive of the nursing diagnoses Nausea.

History and Identifying Related Factors

The related factors provide the context for the defining characteristics. Related factors are factors that appear to show some type of patterned relationship with the nursing diagnosis. These factors may be described as antecedent to, associated with, related to, contributing to, or abetting the diagnosis. They are identified as characteristics or history of individuals, families, and communities. In the case of Sarah, she may tell us that she is taking large doses of aspirin on the advice of her physician, and that she takes the aspirin on an empty stomach. In this case students can establish an outcome of “freedom from nausea” and use the NIC nursing intervention of “Nausea Management” (Dochterman and Bulechek, 2004) especially the activity of “Reduce or eliminate personal factors that precipitate or increase the nausea (taking aspirin on an empty stomach)”.

Selecting the Nursing Diagnosis Label

The nursing diagnosis label is selected based on two characteristics. First, the definition of the diagnosis label should convey a combination of the defining characteristics and related factors. Second, the diagnosis selected is the term with defining characteristics and related factors that fits the data that students collect on assessment and history-taking. In this case the definition of Nausea is “A subjective unpleasant, wave-like sensation in the back of the throat, epigastrium, or abdomen that may lead to the urge or need to vomit”. In the example, Sarah stated that she is “sick to my stomach” and exhibited other defining characteristics. Her history provided an antecedent of nausea – the ingestion of large doses of aspirin on an empty stomach.

Risk Diagnoses

Nurses have always been responsible for identifying individuals, families, and communities at risk and protecting them from this risk. A risk diagnosis “describes human responses to health conditions/life processes that may develop in a vulnerable individual, family, or community. It is supported by risk factors that contribute to increased vulnerability”. For example, the diagnosis of Risk for Impaired Skin Integrity includes both internal and external factors that influence vulnerability. The interventions that a nurse selects to reach the out comes are based on these influencing factors.

Health-Promotion Diagnoses

A health-promotion diagnosis is a clinical judgment of a person’s, family’s, or community’s motivation and desire to increase well-being and actualize human health potential as expressed by a readiness to enhance specific health behaviors such as nutrition and exercise. Health-promotion diagnoses can be used in any health state and do not required current levels of wellness. This readiness is supported by defining characteristics. Interventions are selected in concert with the individual/family/community to best ensure the ability to reach the stated outcomes.

Wellness Diagnoses

A wellness diagnosis describes human responses to levels of wellness in individual, family, or community that have a readiness for enhancement. This readiness is supported by defining characteristics. As with all diagnoses, nurse-sensitive (sensitive to nursing interventions) outcomes are identified and nursing interventions are selected that provide a high likelihood of reaching the outcomes.

Prioritizing Diagnoses

Prioritizing diagnoses is one type of critical thinking that most nursing educators expect from students. Faculty members often request a list of nursing diagnoses from students. Students compile this list while they are reading the history of individuals, families, and communities. After assessment, the students need to make decisions about prioritizing diagnoses. Priorities are established based on the needs of individuals, families, and communities. When nursing students are assigned to clinical experience for a short period of time, faculty members may ask them to choose nursing diagnoses that they can address during this time frame.

Linking Nursing Diagnoses to Outcomes and Interventions

Accurate and valid nursing diagnoses determine the nurse-sensitive outcomes. These outcomes guide the selection of interventions that are likely to produce the desired treatment effects. Again, interventions will treat either related factors (or risk factors) or defining characteristics. Faculty members and their students can use the linkage book (Johnson et al., 2006) or the linkages to nursing diagnoses provided in the back of the NIC (Dochterman and Bulechek, 2004) and NOC (Moorhead et al., 2004) books. These lingkages

Martha Craft-Rosenberg, PhD, RN, FAAN and
Kelly Smith, MSN, RN

NURSING DIAGNOSES

Definitions and Classification 2009-2011