In this video we are going to review the following
types of nursing diagnoses: Actual Diagnosis
Problem-focused Diagnosis Risk Diagnosis
Wellness Diagnosis Health-Promotion Diagnosis
Possible Diagnosis and
Syndrome Diagnosis Then I will briefly talk about Potential Complication
or Collaborative Diagnoses even though they are not actually types of nursing diagnoses.
Not all textbooks will discuss all of the types of Diagnoses in this video so be sure
to check with your professor which ones you need to know and apply.
Also, depending on how old your textbook is you may see some terminology used to describe
a type of nursing diagnosis that has since been re-labeled. This video will define the
types of nursing diagnoses you see on your screen, and identify how they have been re-labeled
in the 2015 – 2017 NANDA International Definitions and Classifications textbook.
NANDA only uses three categories of nursing diagnoses – Problem-focused, Health Promotion
and Risk Diagnoses. They also use syndromes within these three categories to cluster diagnoses
that are closely related. Throughout this video I will be making reference
to different components of nursing diagnoses. If you are not familiar with the components
of nursing diagnoses or the PES format please watch the video about their components after
you have watched this video. When I was in school we were taught that an
Actual nursing diagnosis is present when a client has signs and symptoms that match the
defining characteristics of the diagnostic label you have selected. Basically, like the
name suggests, an actual nursing diagnosis is a response that the client actually has.
It currently exists. Makes sense right? You may see an actual nursing diagnosis written
as a two-part statement or in PES format with or without a “secondary to” clause.
With the new NANDA guidelines, an actual diagnosis would be classified as a problem-focused diagnosis.
A problem focused diagnosis, like the name suggests, is the nurse’s judgment regarding
a problem that the client is experiencing. By definition, a problem is an undesirable
response to an existing health condition or life process.
To me, NANDA’s definition of a problem-focused diagnosis looks a lot like the definition
of an actual diagnosis but it clarifies that the issue being diagnosed is undesirable.
Like an actual diagnosis, the components of a problem-focused diagnosis will include the
diagnostic label, related factors and defining characteristics. Other information may be
added to clarify the diagnosis as long as you are careful to be succinct and avoid adding
un-necessary information. NANDA also uses risk diagnoses as one of the
three categories of nursing diagnoses. Again, like the name suggests, a risk diagnosis identifies
an area where the client is vulnerable to develop a problem. If a client is at risk
for a problem it means that there is not enough evidence to say that the problem exists, otherwise
it would become a problem-focused or actual diagnosis. A risk diagnosis may not yet exist,
but if no interventions are initiated it is likely to develop. You may also see some older
textbooks call this a potential diagnosis. Since the problem does not yet exist, risk
diagnoses are identified by risk factors not defining characteristics. You can still use
the label and etiology format however, the etiology is replaced by the risk factors.
There are no related factors or etiology since only a vulnerability is being identified.
NANDA recommends using the phrase “as evidenced by” if you are following a PES-like format
for your diagnosis because it is clearer than “related to” since “as evidenced by”
does not point to an etiology. Keep in mind that the number of risk factors
that need to exist to diagnose a patient with a particular risk-for diagnosis varies based
on the diagnosis because some assessment tools have been more validated than others. It is
best to consult your diagnostic handbook for each risk diagnosis you are considering.
In older textbooks or online you may hear of wellness nursing diagnoses. These diagnoses
were used to identify client progress towards healthy behaviors. These diagnoses were focused
on improving client well-being. Carpenito (2013) identifies that NANDA International
has eliminated the wellness diagnosis category and reclassified them as health promotion
diagnoses. You may still see them discussed separately in older textbooks or online. Some textbooks will indicate that wellness
diagnoses should have only one part while others suggest more.
Health promotion diagnoses are used by NANDA international to identify the nurse’s judgment
about a client’s motivation and desire to increase their well-being and reach their
potential for health. That means that these diagnoses are focused on improving client
health. Like other types of diagnoses, they need to be specific to a particular health
goal or behavior (like diet or exercise for example). These diagnoses are also great for
nurses working with populations that are generally considered healthier like new parents, children
in schools, at playgroups or well-baby clinics. In the most recent edition of the NANDA international
textbook changes were made to the definition of these diagnoses to ensure that it was clear
that health promotion diagnoses can be used in any part of the health-illness continuum.
That means that even if your client is very sick they may still have one or more health
promotion diagnosis. A client does not need to be healthy to have a health promotion diagnosis.
However, they do need to have a desire to improve their health. In fact, the defining
characteristics of these diagnoses now all begin with “expresses the desire to enhance”
since these diagnoses are driven by the client’s desire and willingness to improve their health.
Health Promotion diagnoses generally have only defining characteristics, although some
books will suggest that related factors may be used if they improve the understanding
of the diagnosis. You may see potential or possible nursing
diagnoses used when there is not enough data to confirm or rule out a diagnosis that is
suspected or when it is possible to confirm the problem but not an etiology. Possible
nursing diagnoses are useful for describing a suspected problem while data collection
is ongoing. If a potential diagnosis is noted then the assessment is not complete. Keep
in mind that possible nursing diagnoses should not have associated goals until enough data
is collected to turn them into a confirmed diagnosis.
NANDA international indicates that it is problematic if nurses stop their assessment too early
after identifying possible nursing diagnoses. Part of the nursing process involves identifying
potential nursing diagnoses, but the assessment cannot stop there. Be sure to do an in-depth
assessment that can be used to either confirm it or rule out the diagnoses you are considering.
Do not just pick the one that has the best sounding label. It is important to complete
and clearly document an in-depth assessment to confirm or refute these diagnoses. If you
cannot support your diagnosis then it isn’t appropriate for the client. Whenever new data
are collected, however, any previously considered potential diagnoses will be evaluated along
side determined diagnoses when they are reviewed and evaluated by you or another nurse. For
clear communication it is important to use standardized terminology when formulating
any nursing diagnosis. If nurses just make up their own terminology then it has no consistent
meaning and cannot be validated, confirmed or analyzed correctly.
There are a limited number of syndromes outlined in NANDA International taxonomy. When a syndrome
exists it means that there are several nursing diagnoses that are interrelated, occur together
and are best addressed together using similar interventions. When you look up a syndrome
diagnosis you will notice that the defining characteristics may include other diagnoses.
Syndrome diagnoses are helpful since they help nurses become aware of complex clinical
situations or conditions that require attention, assessment and intervention.
I have listed the Potential Complication or Collaborative Diagnosis in this video because
a lot of students seem to think it is a type of Nursing Diagnosis – and they are discussed
in some handbooks. However, this pesky diagnosis type does not follow the PES format and for
a good reason … it actually isn’t a nursing diagnosis. Carpenito (2013) identifies that
a collaborative problem is a situation whereby the nurse cannot legally order the primary
interventions to achieve the client’s goal but medical and nursing interventions are
needed to achieve it. With a collaborative problem the nurse’s focus is to reduce the
severity of the problem. When writing collaborative problem diagnostic statements the label “Risk
for Complications of” is always used. For more information about the difference
between a nursing diagnosis and a collaborative problem please watch my video about Medical
versus Nursing Diagnoses and Collaborative problems.
Please comment below if you have questions or you come across a type of nursing diagnosis
that is not covered in this video and I will help you figure it out. I recommend watching
the PES video to familiarize yourself with components of nursing diagnoses. While NANDA
international states that no one format must be used for nursing diagnoses, many schools
use PES format to teach students how to write nursing diagnoses. This format helps students
remember to include key information in their diagnoses.
Thank you for watching. I am continuing work on this series to help you through the nursing
process. Don’t forget to subscribe to be notified when new videos are released. In
the meantime please comment below with any questions you have about nursing diagnoses.
Links to helpful resources are provided below. You may also want to check out my related
videos.