Nursing Diagnosis: What It Is, What It Is Not

Nursing Diagnosis: What It Is, What It Is Not

Collaboration With Other Disciplines

The practice of nursing requires three different types of nursing responsibilities:

  • Assessing for and validating nursing diagnoses, providing interventions for treatment, and evaluating progress

  • Monitoring for physiologic instability and collaborating with physicians/physician assistants and nurse practitioners, who determine medical treatment

  • Consulting with other disciplines (physical therapy, occupational therapy, social service, respiratory therapy, pharmacology) to increase the nurse’s expertise in providing care to a particular individual

When nurses collaborate with other disciplines such as physical therapy, nutrition, respiratory therapy, and social service, they may offer recommendations for the management of a problem. These recommendations can be either made informally to the nurse and added to the care plan at the discretion of the nurse or ordered by the discipline on the order record according to the institutional policies.

Bifocal Clinical Practice Model

In 1983, Carpenito introduced a model for practice that describes the clinical focus of professional nurses in addition to NANDA-I nursing diagnoses. This bifocal clinical practice model identifies the two clinical situations in which nurses intervene: one as primary prescriber and the other in collaboration with medicine. This model not only organizes the focus of nursing practice, but also helps distinguish nursing from other health-care disciplines (Fig. 4.1).

FIGURE 4.1 Domains of expertise of professional nurses and physicians.

Nursing derives its knowledge from various disciplines, including biology, medicine, pharmacology, psychology, nutrition, and physical therapy. Nursing differs from other disciplines in its broad range of knowledge. Figure 4.2 illustrates the varied types of this knowledge as compared with other disciplines. Certainly, the nutritionist has more expertise in the field of nutrition, and the pharmacist in the field of therapeutic pharmacology, than any nurse has. But every nurse brings knowledge of nutrition and pharmacology to individual interactions that is appropriate for most clinical situations. (Note that when a nurse’s knowledge is insufficient, nursing practice calls for consultation with appropriate disciplines.)

No other discipline has this wide knowledge base, possibly explaining why past attempts to substitute other disciplines for nursing have proved costly and ultimately unsuccessful. For this reason, any workable model for nursing practice must encompass all the varied situations in which nurses intervene while also identifying situations in nursing that nonnursing personnel must address.

Nursing prescribes for and treats individual and group responses to situations. These situations can be organized into five categories:

  • Pathophysiologic (e.g., myocardial infarction, borderline personality, burns)

  • Treatment-related (e.g., anticoagulant therapy, dialysis, arteriography)

    FIGURE 4.2 Comparison of types of knowledge by discipline.

  • Personal (e.g., dying, divorce, relocation)

  • Environmental (e.g., overcrowded school, no handrails on steps, rodents)

  • Maturational (e.g., peer pressure, parenthood, aging)

The bifocal clinical practice model, diagrammed in Figure 4.3, identifies these responses as either nursing diagnoses or collaborative problems. Together, nursing diagnoses and collaborative problems represent the
range of conditions that necessitate nursing care. The major assumptions in the bifocal clinical practice model are as follows:

FIGURE 4.3 Bifocal clinical nursing model. (© 1985 by Lynda Juall Carpenito.)

  • Client1

    • Has the power for self-healing

    • Continually interrelates with the environment

    • Makes health decisions according to individual priorities

    • Is a unified whole, seeking balance

    • Has individual worth and dignity

    • Is an expert on own health

  • Health

    • Is a dynamic, ever-changing state

    • Is defined by the individual

    • Is an expression of optimum physical, spiritual, and psychosocial well-being

    • Is the responsibility of the individual and the health-care system

  • Environment

    • Represents external factors, situations, and people who influence or are influenced by the individual

    • Includes physical and ecologic environments, life events, and treatment modalities

  • 4. Nursing

    • Is accessed by the individual when he or she needs assistance to improve, restore, or maintain health or to achieve a peaceful death (Henderson & Nite, 1960)

    • Ensures the individual has the needed information for an informed consent

    • Supports the right of the individual to refuse recommendations

    • Engages the individual to assume responsibility in self-healing decisions and practices

    • Reduces or eliminates factors that can or do cause compromised functioning, for example, effects of diseases, relationship problems, comprehension barriers, financial issues

Understanding Collaborative Problems

Carpenito (1999) defines collaborative problems as

Certain physiologic complications that nurses monitor to detect onset or changes in status. Nurses manage collaborative problems using physician-prescribed and nursing-prescribed interventions to minimize the complications of the events.

The designation certain clarifies that all physiologic complications are not collaborative problems. If the nurse can prevent the onset of the complication or provide the primary treatment for it, then the diagnosis is a nursing diagnosis. For example:

Nurses can prevent

Nursing diagnosis

Pressure ulcers

Risk for Pressure Ulcers

Complications of immobility

Disuse Syndrome


Risk for Aspiration

Nurses can treat

Nursing diagnosis

Stage I or II pressure ulcers

Impaired Skin Integrity

Swallowing problems

Impaired Swallowing

Ineffective cough

Ineffective Airway Clearance

Nurses cannot prevent

Collaborative problems


Risk for Complication of Seizures


Risk for Complication of Bleeding


Risk for Complication of Dysrhythmias

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Dec 6, 2019 | Posted by in NURSING | Comments Off on Nursing Diagnosis: What It Is, What It Is Not
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