Types and Components of Nursing Diagnoses
Types and Components of Nursing Diagnoses
Problem-Focused Nursing Diagnoses1
A problem-focused nursing diagnosis “describes human responses to health conditions/life processes that exist in an individual, family, or community. It is supported by defining characteristics (manifestations, signs, and symptoms) that cluster in patterns of related cues or inferences” (NANDA-I, 2009). This type of nursing diagnosis has four components: label, definition, defining characteristics, and related factors.
The label should be in clear, concise terms that convey the meaning of the diagnosis.
For problem-focused nursing diagnoses, defining characteristics are signs and symptoms that, when seen together, represent the nursing diagnosis. If a diagnosis has been researched, defining characteristics can be separated into major and minor designations. Table 3.1
represents major and minor defining characteristics for the researched diagnosis, Defensive Coping
(Norris & Kunes-Connell, 1987).
Major. For researched diagnoses, at least one must be present under the 80% to 100% grouping.
Minor. These characteristics provide supporting evidence but may not be present.
Most defining characteristics listed under a nursing diagnosis are not separated into major and minor.
In problem-focused nursing diagnoses, related factors are contributing factors that have influenced the change in health status. Such factors can be grouped into four categories:
Pathophysiologic, Biologic, or Psychological. Examples include compromised oxygen transport and compromised circulation. Inadequate circulation can cause Impaired Skin Integrity.
Table 3.1 FREQUENCY SCORES FOR DEFINING CHARACTERISTICS OF DEFENSIVE COPING
Frequency Scores (%)
Denial of obvious problems/weaknesses
Projection of blame/responsibility
Hypersensitive to slight criticism
Superior attitude toward others
Difficulty in establishing/maintaining relationships
Hostile laughter or ridicule of others
Difficulty in testing perceptions against reality
Lack of follow-through or participation in treatment or therapy
Norris, J., & Kunes-Connell, M. (1987). Self-esteem disturbance: A clinical validation study. In A. McLane (Ed.), Classification of nursing diagnoses: Proceedings of the seventh NANDA national conference. St. Louis, MO: CV Mosby.
Treatment-Related. Examples include medications, therapies, surgery, and diagnostic study. Specifically, medications can cause nausea. Radiation can cause fatigue. Scheduled surgery can cause Anxiety.
Situational. Examples include environmental, home, community, institution, personal, life experiences, and roles. Specifically, a flood in a community can contribute to Risk for Infection; divorce can cause Grieving; obesity can contribute to Activity Intolerance.
Maturational. Examples include age-related influences, such as in children and the elderly. Specifically, the elderly are at risk for Social Isolation; infants are at Risk for Injury; and adolescents are at Risk for Infection.
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Risk and High-Risk Nursing Diagnoses
NANDA-I defines a risk nursing diagnosis as “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” (NANDA-I, 2009).
The concept of “at risk” is useful clinically. Nurses routinely prevent problems in people experiencing similar situations such as surgery or childbirth who are not at high risk. For example, all postoperative individuals are at risk for infection. All women postdelivery are at risk for hemorrhage. Thus, there are expected or predictive diagnoses for all individuals who have undergone surgery while on chemotherapy or with a fractured hip.
All persons admitted to the hospital are at Risk for Infection
related to increased microorganisms in the environment, risk of person-to-person transmission, and invasive tests and therapies. Refer to Box 3.1
for an illustration of this standard diagnosis and how it is individualized to become a high-risk diagnosis. The high-risk concept is very useful for persons who have additional risk factors that make them more vulnerable for the problem to occur. In the hospital or other health care facilities, individuals should be assessed if they are at high risk for falls, infection, or delayed transition. High-risk individuals need additional preventive measures.
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