During which step of the nursing process does the nurse select nursing diagnoses

A nursing diagnosis is a way for nurses to use a common language to communicate about their patients. This includes the health issues they face and the interventions nurses can provide.

NANDA International, Inc. (NANDA-I) is the organization that develops and publishes evidence-based standardized language including lists of approved nursing diagnoses. 

This article will cover:

• What is a nursing diagnosis?
• How does a nursing diagnosis differ from a medical diagnosis?
• What are the types of nursing diagnoses?
• How to determine a nursing diagnosis
  • What are the 3 parts of a nursing diagnosis?
  • Following up on a nursing diagnosis

What is a nursing diagnosis?

A nursing diagnosis applies a nurse’s clinical judgment about the patient’s response to a potential or actual health condition. It may include circumstances where a patient is at risk of getting sicker or not responding well to the current situation. 

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A nursing diagnosis can incorporate a physical change from an illness or injury or an emotional response to being sick.

Choosing a nursing diagnosis is 1 step in the nursing process. 

The nursing process has 5 steps:

1. Assessment – collecting subjective and objective data
2. Nursing Diagnosis – determining and documenting the nursing diagnosis
3. Plan – establishing goals and nursing interventions to reach the goals
4. Implement – carrying out the plan
5. Evaluation – checking to see the patient’s status and if the plan is moving towards the goals

The nursing process is most often used for individual patients. However, a nurse could apply the same process to a family, group, or community.

NANDA-I continues to refine the list of approved nursing diagnoses over time. New diagnoses are added while others are removed. 

The Twelfth Edition of NANDA International Nursing Diagnoses: Definitions and Classifications, 2021-2023 was published in February 2021. Some of the nursing diagnoses from that edition include:

• Risk for impaired cardiovascular function
• Ineffective health maintenance behaviors
• Maladatpive grieving
• Delayed child development

How does a nursing diagnosis differ from a medical diagnosis?

A healthcare provider like a doctor or nurse practitioner can provide a medical diagnosis. These are usually focused on naming a disease, illness, or other health condition and generally match up with a diagnosis code that is used for insurance and billing. The medical diagnosis is typically determined by signs, symptoms, and other tests.

NANDA-I defines a nursing diagnosis as:

 “a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response…” that “…provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.”

Overall, a nursing diagnosis looks at the whole person and how the health issue is affecting them. There is also a focus on the actions a nurse can take to help care for the patient. 

Nursing diagnoses are written into the nursing care plan. The care plan allows nurses to communicate with the healthcare team. 

What are the types of nursing diagnoses?

NANDA-I divides nursing diagnoses into four categories:

• Problem-focused – an unwanted response to a health condition
• Health promotion – opportunity and motivation to increase well-being and health
• Risk – likely to progress to a problem-focused response
• Syndrome – a cluster of multiple nursing diagnoses

NANDA-I publishes a handbook with definitions for each approved nursing diagnosis. The classification rules are also included for reference.

How to determine a nursing diagnosis

Establishing a nursing diagnosis is the second part of the nursing process. 

First, the nurse assesses the patient. This can include a medical chart review, health history, vital signs, physical assessment, listening to the patient’s description of the issue, and more.

Then, the nurse considers the most pressing issues, the desired outcomes, and the nursing interventions (actions) that could potentially help to resolve the problem. 

What are the 3 parts of a nursing diagnosis?

Each nursing diagnosis is written in the same pattern for consistency and to establish clear communication. A nursing diagnosis may include:

be

• Problem statement – NANDA label of the patient’s health problem
• Etiology (or related factors) – likely cause of the health problem or issue being addressed
• Defining characteristics – signs and symptoms from a nursing assessment that provide evidence for the chosen nursing diagnosis

The parts of the nursing diagnosis are then combined to make a cohesive statement using the following pattern:

Problem statement related to etiology as evidenced by defining characteristics. 

The final statement structure may differ depending on the nursing diagnosis category (see below). Some examples of possible nursing diagnoses include:

• Ineffective gas exchange related to bacterial pneumonia as evidenced by O2 saturation level of 85% on room air.
• Pain related to total hip replacement as evidenced by patient pain score of 8/10.
• Risk for infection related to compound fracture of right femur.
• Risk for falls related to changes in gait and balance.

The nursing diagnoses options are currently divided into 13 domains: health promotion, nutrition, elimination and exchange, activity/rest, perception/cognition, self-perception, role relationships, sexuality, coping/stress tolerance, life principles, safety/protection, comfort, and growth/development.

Following up on a nursing diagnosis

The nursing diagnosis is only 1 step in the nursing process. It is also the foundation of the nursing care plan. 

A nursing care plan is just what it sounds like—it is a written action plan for the nurse about the care they will provide for the patient. The focus is on actions that are in the nurses’ scope of practice.

Planning is the third step in the nursing process. NANDA-I has also standardized the actions and the goals that can be used in the planning process for nurses. The care plan also helps to ensure that nursing care is consistent for the patient even when different nurses are working.

Care plans are specifically made for each patient. They are tailored to the individual but focus on ensuring holistic care. There is some overlap with the nursing process, which may include: assessment, diagnosis, expected outcomes (goals), planned interventions, and evaluation (assessment of effectiveness). 

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Next Steps

Understanding and applying nursing diagnoses can initially challenge nurses. However, having a consistent framework to use when choosing how to provide the best care for patients makes you a better nurse. It is a skill that develops over time.

During your orientation at your workplace, you should be introduced to the care plan tool that is used. Be sure to ask questions about how to customize it for your patient. 

You can also apply the nursing process to your own self-care as a nurse. Nurses are human and have challenges with their health, role, stress, and other domains of life. Nurses can set goals and choose from standardized interventions to improve their own well-being.