how to write a community health nursing diagnosis statement

The Ultimate Guide to Nursing Diagnosis in 2024

What is a nursing diagnosis.

NANDA Nursing Diagnosis
Classification

NANDA Nursing Diagnosis List

Writing a nursing diagnosis.

Nursing Diagnosis vs Medical Diagnosis
American vs International

A nursing diagnosis is a part of the nursing process and is a clinical judgment that helps nurses determine the plan of care for their patients. These diagnoses drive possible interventions for the patient, family, and community. They are developed with thoughtful consideration of a patient’s physical assessment and can help measure outcomes for the nursing care plan .

In this article, we'll explore the NANDA nursing diagnosis list, examples of nursing diagnoses, and the 4 types.

Some nurses may see nursing diagnoses as outdated and arduous. However, it is an essential tool that promotes patient safety by utilizing evidence-based nursing research.

According to NANDA-I, the official definition of the nursing diagnosis is:

“Nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”

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What is The Purpose of a Nursing Diagnosis?

According to NANDA International , a nursing diagnosis is “a judgment based on a comprehensive nursing assessment.” The nursing diagnosis is based on the patient’s current situation and health assessment, allowing nurses and other healthcare providers to see a patient's care from a holistic perspective.

Proper nursing diagnoses can lead to greater patient safety, quality care, and increased reimbursement from private health insurance, Medicare, and Medicaid.

They are just as beneficial to nurses as they are to patients.

NANDA Nursing Diagnosis

NANDA diagnoses help strengthen a nurse’s awareness, professional role, and professional abilities.

Formed in 1982, NANDA is a professional organization that develops, researches, disseminates, and refines the nursing terminology of nursing diagnosis. Originally an acronym for the North American Nursing Diagnosis Association, NANDA was renamed to NANDA International in 2002 as a response to its broadening worldwide membership.

According to its website, NANDA International’s mission is to:

Provide the world’s leading evidence-based nursing diagnoses for use in practice and to determine interventions and outcomes
Contribute to patient safety through the integration of evidence-based terminology into clinical practice and clinical decision-making
Fund research through the NANDA-I Foundation
Be a supportive and energetic global network of nurses, who are committed to improving the quality of nursing care and improvement of patient safety through evidence-based practice

NANDA members can be found worldwide, specifically in Brazil, Colombia, Ecuador, Mexico, Peru, Portugal, Germany, Austria, Switzerland, Netherlands, Belgium, and Nigeria-Ghana.

NANDA Classification of Nursing Diagnoses

NANDA-I adopted the Taxonomy II after consideration and collaboration with the National Library of Medicine (NLM) in regards to healthcare terminology codes. Taxonomy II has three levels: domains, classes, and nursing diagnoses.

There are currently 13 domains and 47 classes:

Health Awareness
Health Management
Urinary Function
Gastrointestinal Function
Integumentary Function
Respiratory Function
Activity/Exercise
Energy Balance
Cardiovascular-Pulmonary Responses
Orientation
Sensation/Perception
Communication
Self-concept
Self-esteem
Caregiving Roles
Family Relationships
Role Performance
Sexual Identity
Sexual Function
Reproduction
Post-trauma Responses
Coping Response
Neuro-Behavioral Stress
Value/Belief Action Congruence
Physical Injury
Environmental Hazards
Defensive Processes
Thermoregulation
Physical Comfort
Environmental Comfort
Social Comfort
Development

This refined Taxonomy is based on the Functional Health Patterns assessment framework of Dr. Mary Joy Gordon. Furthermore, the NLM suggested changes because the Taxonomy I code structure included information about the location and the level of the diagnosis.

NANDA-I nursing diagnoses and Taxonomy II comply with the International Standards Organization (ISO) terminology model for a nursing diagnosis.

The terminology is also registered with Health Level Seven International (HL7), an international healthcare informatics standard that allows for nursing diagnoses to be identified in specific electronic messages among different clinical information systems.

A full list of NANDA-I-approved nursing diagnoses can be found here . Additional examples include:

Dysfunctional ventilatory weaning response
Impaired transferability
Activity intolerance
Situational low self-esteem
Risk for disturbed maternal-fetal dyad
Impaired emancipated decision-making
Risk for impaired skin integrity
Risk for metabolic imbalance syndrome
Urge urinary incontinence
Risk for unstable blood pressure
Impaired verbal communication
Acute confusion
Disturbed body image
Relocation stress syndrome
Ineffective role performance
Readiness for enhanced sleep

Examples of Nursing Diagnoses

The three main components of a nursing diagnosis are as follows.

Problem and its definition
Defining characteristics or risk factors

Examples of proper nursing diagnoses may include:

>> Related: What is the Nursing Process?

NANDA Nursing Diagnosis Types

There are 4 types of nursing diagnoses according to NANDA-I. They are:

Problem-focused
Health promotion

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1. Problem-focused diagnosis

A patient problem present during a nursing assessment is known as a problem-focused diagnosis. Generally, the problem is seen throughout several shifts or a patient’s entire hospitalization. However, depending on the nursing and medical care, it may be resolved during a shift.

Problem-focused diagnoses have three components.

Nursing diagnosis
Related factors
Defining characteristics

Examples of this type of nursing diagnosis include:

Decreased cardiac output
Chronic functional constipation
Impaired gas exchange

Problem-focused nursing diagnoses are typically based on signs and symptoms present in the patient. They are the most common nursing diagnoses and the easiest to identify.

2. Risk nursing diagnosis

A risk nursing diagnosis applies when risk factors require intervention from the nurse and healthcare team prior to a real problem developing.

Risk for imbalanced fluid volume
Risk for ineffective childbearing process
Risk for impaired oral mucous membrane integrity

This type of diagnosis often requires clinical reasoning and nursing judgment.

3. Health promotion diagnosis

The goal of a health promotion nursing diagnosis is to improve the overall well-being of an individual, family, or community.

Readiness for enhanced family processes
Readiness for enhanced hope
Sedentary lifestyle

4. Syndrome diagnosis

A syndrome diagnosis refers to a cluster of nursing diagnoses that occur in a pattern or can all be addressed through the same or similar nursing interventions.

Examples of this diagnosis include:

Decreased cardiac output
Decreased cardiac tissue perfusion
Ineffective cerebral tissue perfusion
Ineffective peripheral tissue perfusion

Possible nursing diagnosis

While not an official type of nursing diagnosis, possible nursing diagnosis applies to problems suspected to arise. This occurs when risk factors are present and require additional information to diagnose a potential problem.

Nursing Diagnosis Components

The three main components of a nursing diagnosis are:

Etiology or risk factors

1. The problem statement explains the patient’s current health problem and the nursing interventions needed to care for the patient.

2. Etiology, or related factors , describes the possible reasons for the problem or the conditions in which it developed. These related factors guide the appropriate nursing interventions.

3. Finally, defining characteristics are signs and symptoms that allow for applying a specific diagnostic label. Risk factors are used in place of defining characteristics for risk nursing diagnosis. They refer to factors that increase the patient’s vulnerability to health problems.

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Problem-focused and risk diagnoses are the most difficult nursing diagnoses to write because they have multiple parts. According to NANDA-I , the simplest ways to write these nursing diagnoses are as follows:

PROBLEM-FOCUSED DIAGNOSIS

Problem-Focused Diagnosis related to ______________________ (Related Factors) as evidenced by _________________________ (Defining Characteristics).

RISK DIAGNOSIS

The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).

Nursing Diagnosis vs Medical Diagnosis

While all important, nursing diagnoses are primarily handled through specific nursing interventions, while medical diagnoses are made by a physician or advanced healthcare practitioner.

The nursing diagnosis can be mental, spiritual, psychosocial, and/or physical. It focuses on the overall care of the patient while the medical diagnosis involves the medical aspect of the patient’s condition.

A medical diagnosis does not change if the condition is resolved, and it remains part of the patient’s health history forever. A nursing diagnosis, however, generally refers to a specific period of time.

Examples of medical diagnosis include:

Congestive Heart Failure
Diabetes Insipidus

Collaborative problems are ones that can be resolved or worked on through both nursing and medical interventions. Oftentimes, nurses will monitor the problems while the medical providers prescribe medications or obtain diagnostic tests.

History of Nursing Diagnoses

1973: The first conference to identify nursing knowledge and a classification system; NANDA was founded
1977: First Canadian Conference takes place in Toronto
1982: NANDA formed with members from the United States and Canada
1984: NANDA established a Diagnosis Review Committee
1987: American Nurses Association (ANA) officially recognizes NANDA to govern the development of a classification system for nursing diagnosis
1987: International Nursing Conference held in Alberta, Canada
1990: 9th NANDA conference and the official definition of the nursing diagnosis established
1997: Official journal renamed from “Nursing Diagnosis” to “Nursing Diagnosis: The International Journal of Nursing Terminologies and Classifications”
2002: NANDA changes to NANDA International (NANDA-I) and Taxonomy II released
2020: 244 NANDA-I approved diagnosis

American vs. International Nursing Diagnosis

There is currently no difference between American nursing diagnoses and international nursing diagnoses. Because NANDA-I is an international organization, the approved nursing diagnoses are the same.

Discrepancies may occur when the translation of a nursing diagnosis into another language alters the syntax and structure. However, since there are NANDA-I offices around the world, the non-English nursing diagnoses are essentially the same.

What is an example of a nursing diagnosis?

A nursing diagnosis is something a nurse can make that does not require an advanced provider’s input. It is not a medical diagnosis. An example of a nursing diagnosis is: Excessive fluid volume related to congestive heart failure as evidenced by symptoms of edema.

What is the most common nursing diagnosis?

According to NANDA, some of the most common nursing diagnoses include pain, risk of infection, constipation, and body temperature imbalance.

What is a potential nursing diagnosis?

A potential problem is an issue that could occur with the patient’s medical diagnosis, but there are no current signs and symptoms of it. For instance, skin integrity breakdown could occur in a patient with limited mobility.

How is a nursing diagnosis written?

Nursing diagnoses are written with a problem or potential problem related to a medical condition, as evidenced by any presenting symptoms. There are 4 types of nursing diagnoses: risk-focused, problem-focused, health promotion-focused, or syndrome-focused.

What is the clinical diagnosis?

A clinical diagnosis is the official medical diagnosis issued by a physician or other advanced care professional.

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how to write a community health nursing diagnosis statement

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17.4 Formulating a Nursing Community Diagnosis and Plan of Care

Learning outcomes.

By the end of this section, you should be able to:

17.4.1 Utilize various approaches and assessment findings to identify and prioritize individual, family, community, system, and population health concerns.
17.4.2 Appraise the level of nursing intervention to make the most impact.
17.4.3 Integrate individual, family, community, system, and population experiences and perspectives in designing plans of care.
17.4.4 Develop a nursing community diagnosis and plan of care tailored to community culture.

Formulating a nursing community diagnosis and plan of care is similar to individual nursing community diagnosis and care planning. First, the CHA team identifies and prioritizes community health concerns. Next, the team develops community nursing diagnoses. Finally, the team tailors a community health improvement plan to community culture.

Prioritize Health Concerns

The CHA team uses the identified problem list created during analysis to prioritize community problems based on:

Extent of the problem (percent of the population affected by the problem and perception of health needs)
Relevance of the problem (degree of risk and economic loss)
Estimated effect of the intervention (impact, improvement of health outcomes, and potential adverse effects)

Health priorities should be those for which intervention would make the most impact on the community as a whole or for a specific at-risk population. Health priorities are those that have the

highest community perception of need,
largest reach,
highest degree of risk if unaddressed,
greatest economic impact,
greatest opportunity for improvement in health outcomes,
opportunity to promote health equity and reduce health disparities, and
least adverse effect on the population.

The team should base priorities on community strengths and available resources to increase the possibility of successful implementation of programs targeting those priorities. Resources include current and potential partnerships and collaborations, human resources or capacity, and funding. Health concerns may also be prioritized because they align with state and federal priorities, allowing for benchmarking and comparison to state and local data. Additionally, monies are usually available to fund programs that align with state or federal priorities.

The method the CHA uses to prioritize health concerns is determined by the CHA model, framework, or tool it chose at the beginning of the process. For example, a CHA team using the MAPP framework will first rank identified problems individually and then use a consensus to choose priorities or strategic issues. MAPP offers several tools to guide this process (NACCHO, 2023). In contrast, a CHA team using the Community Health Assessment toolkit would first identify specific criteria for prioritization and then choose an approach, such as group vote with majority deciding, averaging individual rankings, or using a matrix to weigh and rank criteria according to several factors (baseline data, feasibility, availability of resources, etc.) (AHA, 2017).

PHAB (2022) requires at least two health priorities, but most community care plans or community health improvement plans include at least three priority topics. Choosing health priorities also includes picking at least one health outcome indicator to measure health problem changes and identify the priority population of focus. For example, a team may choose mental health and addiction as a health priority. The priority outcome of this focus should then align with data collected during the CHA. Examples of mental health and addiction topic priority outcomes are “decrease the percentage of the community with depression,” “decrease suicide deaths,” and “decrease drug overdose deaths.”

Develop the Community Nursing Diagnosis

The community nursing diagnosis includes only one identified priority and the aggregate (population) affected, and it provides a rationale. A community nursing diagnosis should be written for each selected priority and include these three parts:

Risk of: Identifies a specific problem or health risk faced by the community
Among: Identifies the specific community aggregate with whom the nurse will be working in relation to the identified problem or risk
Related to: Describes characteristics of the community

The community problem must be observable and measurable at the aggregate level. It considers which aggregate the risk affects most and which intervention will have the biggest impact. The community’s characteristics may contribute to the identified problem and/or be strengths of the community that can be built upon.

Examples of appropriately written community nursing diagnoses are as follows:

Risk of drug overdose among Hardin County adults related to increased opioid usage, presence of fentanyl, lack of available naloxone, ineffective drug misuse prevention programs, and decreased access to drug rehabilitation programs
Risk of infant and child malnutrition among families in Richmond County related to lack of regular developmental screenings, knowledge deficit about infant-related and child-related nutrition, knowledge deficit about available community resources, and lack of access to healthy foods
Risk for cardiovascular disease among Bailey County adults related to sedentary lifestyles, lack of walking trails, lack of safe sidewalks, and lack of affordable exercise facilities

Unfolding Case Study

Part b: conducting a cha.

Read the scenario, and then answer the questions that follow based on all the case information provided in the chapter thus far. This case study is a follow-up to Case Study Part A.

After selecting the PRECEDE-PROCEED model, Tia’s CHA team completed phases 1–3. During the assessment, the team collected the following data:

GIS data shows one neighborhood with a disproportionate number of drug overdoses. This area also has high poverty and unemployment rates and is located by an entrance/exit on the interstate.
EMS calls for overdoses have tripled since the last CHA.
Drug overdose deaths are higher than the national benchmark (Healthy People 2030).
Provider opioid prescriptions have decreased in the area.
Reported opioid use (attained by any method—legal or illegal) has increased. Heroin usage has increased by 10 percent.
Availability of heroin mixed with fentanyl has increased over the past 6 months.
Infection rates related to needle use have increased at the local hospital.
Local schools continue to educate on drug abstinence using the Drug Abuse Resistance Education (DARE) program.
Naloxone training is available from the public health department, but utilization goals have not been reached.
Local EMS staff are volunteers, and the station is not regularly staffed.
A drug rehabilitation center is located within the community but frequently has a waiting list for outpatient appointments and inpatient admission.

Although the PRECEDE-PROCEED model does not require a community nursing diagnosis, the team decided to create one in order to clearly identify the aggregate and characteristics of the community.

The team has started planning for program implementation and wants to begin by promoting and enhancing available community resources, such as education within the schools, community naloxone training, education for providers related to opioid prescriptions, and drug rehabilitation. According to the PRECEDE-PROCEED model, phase 4, administrative and policy diagnosis, the team focuses on administrative and organizational concerns that should be addressed prior to program implementation.

Risk for overdose among opioid/heroin users related to increased availability of heroin mixed with fentanyl, inconsistent EMS staffing, lack of availability/access to drug rehabilitation resources, increased opioid usage in the community, lack of knowledge of consequences of opioid misuse, and lack of utilization of community naloxone training
Opioid misuse among community members living next to the highway who are unemployed and lack financial resources
Risk for infection related to heroin injection, lack of knowledge of aseptic technique for injection, and availability of clean needles
Increased opioid use in the county related to availability of heroin
Reduced rates of opioid prescriptions by providers in the area
Availability of appointments at the local drug rehabilitation center
Response times of local EMS to overdose calls
Increased availability of heroin in the community

Develop the Community Health Improvement Plan

The CHA team uses the identified priorities and community nursing diagnoses to develop the community health improvement plan (CHIP), the care plan for the entire community. PHAB (2022) defines the CHIP as a long-term systematic plan to address issues identified in the CHA that describes how the health department and community will work together to improve population health. Frequently, the public health department holds a leadership role, collaborating with various diverse community organizations to create the CHIP. The members of the CHA team are also usually involved in the CHIP process. As stated previously, the team members are individuals who either work or live within the community, ensuring the CHIP represents the community culture and values. The plan outlines goals and strategies community organizations, coalitions, and members will use to address priority health problems.

The team considers potential intervention s for each identified priority. First, the team discusses existing community programs that may meet the community health need. The team performs a gap analysis to determine where the community should expand its efforts to meet community health needs. A gap analysis identifies and addresses the disparity between what is desired and real-world conditions (Davis-Ajami et al., 2014). For example, access to primary health care is a desired community health outcome for all. In reality, all people do not have access to a primary health care provider. A gap analysis identifies the disparity and potential solutions to reduce it. The team brainstorms strategies to enhance current programming and identify potential new interventions to fill the gaps noted to promote health and prevent disease. The team searches for new interventions that meet community needs and are innovative, evidence-based, most impactful, and sustainable. The team should also consider new partnerships to assist with planning or implementation. Finally, the team may complete a SWOT analysis to identify strengths, weaknesses, opportunities, and threats that may influence health outcomes or may promote or hinder possible interventions. The Minnesota Department of Health provides more information on completing a SWOT analysis . Overall, the team should select the best intervention after considering the various factors discussed.

The CHIP is designed to immediately follow the CHA and is updated with the CHA. So if the CHA process occurs every 3 years, the CHIP should be written as a three-year plan. CHIP interventions must align with chosen priorities and include measures for evaluation related to the rationale identified within the corresponding community nursing diagnosis. Current community resources and strengths are considered and integrated into interventions. The CHIP development also considers currently available and potential resources (such as grants) and partnerships. Community interventions are chosen when they are impactful, have the largest reach, are feasible, are innovative, are evidence-based, and can be completed within the CHIP time frame.

CHIP development continues by detailing goals and objectives, action steps, timetables, priority target populations, indicators to measure strategy impact, and accountability. Objectives should be SMART (specific, measurable, achievable, relevant, and time-bound). Action steps are specific and are listed by year of implementation. The time to complete each action step, target population, health indicator to measure the strategy, and responsible individual or organization is determined. Other details of the interventions are further detailed by the responsible individual or organization during program planning. See Planning Health Promotion and Disease Prevention Interventions for more information on writing SMART objectives .

The CHA and CHIP provide community organizations and health care systems with a common plan for addressing community health issues. The community is a partner in planning for health promotion and disease prevention efforts with community perspectives and community engagement at the center of the process. A comprehensive CHA provides evidence for community health priorities and social determinants of health impacting community health outcomes. The CHIP utilizes established community resources to combat identified priorities and reduce health disparities caused by determinants of health.

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NANDA: How to Write a Nursing Diagnosis

What is a nursing diagnosis?

A nursing diagnosis is a clinical judgment concerning human response to health conditions/life processes, or vulnerability for that response, by an individual, family, group, or community. A nursing diagnosis provides the basis for the selection of nursing interventions to achieve outcomes for which the nurse has accountability. Nursing diagnoses are developed based on data obtained during the nursing assessment and enable the nurse to develop the care plan. Medical and nursing diagnoses have different goals: a medical diagnosis identifies a variation from a norm, while a nursing diagnosis should judge the existence of a potential for enhancing self-care.

Purposes of Nursing Diagnosis

The purpose of the nursing diagnosis is as follows:

Helps identify nursing priorities and help direct nursing interventions based on identified priorities.
Helps the formulation of expected outcomes for quality assurance requirements of third-party payers.
Nursing diagnoses help identify how a client or group responds to actual or potential health and life processes and knowing their available resources of strengths that can be drawn upon to prevent or resolve problems.
Provides a common language and forms a basis for communication and understanding between nursing professionals and the healthcare team.
Provides a basis of evaluation to determine if nursing care was beneficial to the client and cost-effective.
For nursing students, nursing diagnoses are an effective teaching tool to help sharpen their problem-solving and critical thinking skills.

Difference between Medical and Nursing Diagnoses

The term nursing diagnosis is associated with three different concepts. It may refer to the distinct second step in the nursing process, diagnosis. Also, nursing diagnosis applies to the label when nurses assign meaning to collected data appropriately labeled with NANDA -I-approved nursing diagnosis. For example, during the assessment, the nurse may recognize that the client is feeling anxious, fearful, and finds it difficult to sleep. It is those problems which are labeled with nursing diagnoses: respectively, Anxiety, Fear, and Disturbed Sleep Pattern. Lastly, a nursing diagnosis refers to one of many diagnoses in the classification system established and approved by NANDA. In this context, a nursing diagnosis is based upon the response of the patient to the medical condition. It is called a ‘nursing diagnosis’ because these are matters that hold a distinct and precise action that is associated with what nurses have autonomy to take action about with a specific disease or condition. This includes anything that is a physical, mental, and spiritual type of response. Hence, a nursing diagnosis is focused on care.

Comparison of Nursing and Medical Diagnoses

Nursing diagnoses vs medical diagnoses

A medical diagnosis, on the other hand, is made by the physician or advance health care practitioner that deals more with the disease, medical condition, or pathological state only a practitioner can treat. Moreover, through experience and know-how, the specific and precise clinical entity that might be the possible cause of the illness will then be undertaken by the doctor, therefore, providing the proper medication that would cure the illness. Examples of medical diagnoses are Diabetes Mellitus, Tuberculosis, Amputation, Hepatitis, and Chronic Kidney Disease. The medical diagnosis normally does not change. Nurses are required to follow the physician’s orders and carry out prescribed treatments and therapies.

As explained above, now it is easier to distinguish nursing diagnosis from that of a medical diagnosis. Nursing diagnosis is directed towards the patient and his physiological and psychological response. A medical diagnosis, on the other hand, is particular with the disease or medical condition. Its center is on the illness.

NANDA International (NANDA-I)

NANDA–International earlier known as the North American Nursing Diagnosis Association (NANDA) is the principal organization for defining, distribution and integration of standardized nursing diagnoses worldwide.

The term nursing diagnosis was first mentioned in the nursing literature in the 1950s. Two faculty members of Saint Louis University, Kristine Gebbie and Mary Ann Lavin, recognized the need to identify nurses’ role in an ambulatory care setting. In 1973, NANDA’s first national conference was held to formally identify, develop, and classify nursing diagnoses. Subsequent national conferences occurred in 1975, in 1980, and every two years thereafter. In recognition of the participation of nurses in the United States and Canada, in 1982 the group accepted the name North American Nursing Diagnosis Association (NANDA).

In 2002, NANDA became NANDA International (NANDA-I) in response to its significant growth in membership outside of North America. The acronym NANDA was retained in the name because of its recognition.

Review, refinement, and research of diagnostic labels continue as new and modified labels are discussed at each biennial conference. Nurses can submit diagnoses to the Diagnostic Review Committee for review. The NANDA-I board of directors give the final approval for incorporation of the diagnosis into the official list of labels. As of 2020, NANDA-I has approved 244 diagnoses for clinical use, testing, and refinement. READ: How To Become An Auxiliary Nurse In Nigeria

History and Evolution of Nursing Diagnosis

In this section, we’ll look at the events that led to the evolution of nursing diagnosis today:

The need for nursing to earn its professional status, the increasing use of computers in hospitals for accreditation documentation, and the demand for a standardized language from nurses lead to the development of nursing diagnosis.

Post-World War II America saw an increase in the number of nurses returning from military service. These nurses were highly skilled in treating medical diagnoses with physicians. Returning to peacetime practice, nurses were faced with renewed domination by physicians and social pressures to return to traditionally defined female roles with reduced status to make room in the workforce for returning male soldiers. With that, nurses felt increased pressure to redefine their unique status and value.

Nursing diagnosis was seen as the approach that could provide the “frame of reference from which nurses could determine what to do and what to expect” in a clinical practice situation.

Nursing diagnoses were also intended to define nursing’s unique boundaries with respect to medical diagnoses. For NANDA, the standardization of nursing language through nursing diagnosis was the first step towards having insurance companies pay nurses directly for their care.

In 1953, Virginia Fry and R. Louise McManus introduced the discipline-specific term “nursing diagnosis” to describe a step necessary in developing a nursing care plan.

In 1972, the New York State Nurse Practice Act identified diagnosing as part of the legal domain of professional nursing. The Act was the first legislative recognition of nursing’s independent role and diagnostic function.

In 1973, the development of nursing diagnosis formally began when two faculty members of the Saint Louis University, Kristine Gebbie and Mary Ann Lavin, perceived a need to identify nurses’ roles in ambulatory care settings. In the same year, the first national conference to identify nursing diagnoses was sponsored by the Saint Louis University School of Nursing and Allied Health Profession in 1973.

Also in 1973, the American Nurses Association’s Standards of Practice included diagnosing as a function of professional nursing. Diagnosing was subsequently incorporated into the component of the nursing process. The nursing process was used to standardize and define the concept of nursing care, hoping that it would help to earn professional status.

In 1980, the American Nurses Association (ANA) Social Policy Statement defined nursing as: “the diagnosis and treatment of human response to actual or potential health problems.”

International recognition of the conferences and the development of nursing diagnosis came with the First Canadian Conference in Toronto (1977) and the International Nursing Conference (1987) in Alberta, Canada.

In 1982, the conference group accepted the name “North American Nursing Diagnosis Association (NANDA)” to recognize the participation and contribution of nurses in the United States and Canada. In the same year, the newly formed NANDA used Sr. Callista Roy’s “nine patterns of unitary man” as an organizing principle since the first taxonomy listed nursing diagnosis alphabetically – which was deemed unscientific.

In 1984, NANDA renamed “patterns of unitary man” as “human response patterns” based on the work of Marjorie Gordon. Currently, the taxonomy is now called Taxonomy II.

In 1990 during the 9th conference of NANDA, the group approved an official definition of nursing diagnosis:

“Nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable.”

In 1997, NANDA changed the name of its official journal from “Nursing Diagnosis” to “Nursing Diagnosis: The International Journal of Nursing Terminologies and Classifications.”

In 2002, NANDA changed its name to NANDA International (NANDA-I) to further reflect the worldwide interest in nursing diagnosis. In the same year, Taxonomy II was released based on the revised version of Gordon’s Functional health patterns. As of 2018, NANDA-I has approved 244 diagnoses for clinical use, testing, and refinement.

Classification of Nursing Diagnoses (Taxonomy II)

How are nursing diagnoses listed , arranged or classified? In 2002, Taxonomy II was adopted, which was based from the Functional Health Patterns assessment framework of Dr. Mary Joy Gordon. Taxonomy II has three levels: Domains (13), Classes (47), and nursing diagnoses. Nursing diagnoses are no longer grouped by Gordon’s patterns but coded according to seven axes: diagnostic concept, time, unit of care, age, health status, descriptor, and topology. In addition, diagnoses are now listed alphabetically by its concept, not by the first word.

Nursing Diagnosis Taxonomy II

Taxonomy II for nursing diagnosis contains 13 domains and 47 classes. Image via: Wikipedia.com

Domain 1. Health Promotion

Class 1. Health Awareness

Class 2. Health Management

Domain 2. Nutrition

Class 1. Ingestion

Class 2. Digestion

Class 3. Absorption

Class 4. Metabolism

Class 5. Hydration

Domain 3. Elimination and Exchange

Class 1. Urinary function

Class 2. Gastrointestinal function

Class 3. Integumentary function

Class 4. Respiratory function

Domain 4. Activity/Rest

Class 1. Sleep/Rest

Class 2. Activity/Exercise

Class 3. Energy balance

Class 4. Cardiovascular/Pulmonary responses

Class 5. Self-care

Domain 5. Perception/Cognition

Class 1. Attention

Class 2. Orientation

Class 3. Sensation/Perception

Class 4. Cognition

Class 5. Communication

Domain 6. Self-Perception

Class 1. Self-concept

Class 2. Self-esteem

Class 3. Body image

Domain 7. Role relationship

Class 1. Caregiving roles

Class 2. Family relationships

Class 3. Role performance

Domain 8. Sexuality

Class 1. Sexual identity

Class 2. Sexual function

Class 3. Reproduction

Domain 9. Coping/stress tolerance

Class 1. Post-trauma responses

Class 2. Coping responses

Class 3. Neurobehavioral stress

Domain 10. Life principles

Class 1. Values

Class 2. Beliefs

Class 3. Value/Belief/Action congruence

Domain 11. Safety/Protection

Class 1. Infection

Class 2. Physical injury

Class 3. Violence

Class 4. Environmental hazards

Class 5. Defensive processes

Class 6. Thermoregulation

Domain 12. Comfort

Class 1. Physical comfort

Class 2. Environmental comfort

Class 3. Social comfort

Domain 13. Growth/Development

Class 1. Growth

Class 2. Development

Nursing Process

The five stages of the nursing process are assessment, diagnosing, planning, implementation, and evaluation. In the diagnostic process, the nurse is required to have critical thinking. Apart from the understanding of nursing diagnoses and their definitions, the nurse promotes awareness of defining characteristics and behaviors of the diagnoses, related factors to the selected nursing diagnoses, and the interventions suited for treating the diagnoses.

The Nursing Process, also known as the “ADPIE”

What data is collected? The first step of the nursing process is called assessment. When the nurse first encounters a patient, the former is expected to perform an assessment to identify the patient’s health problems as well as the physiological, psychological, and emotional state. The most common approach to gathering important information is through an interview. Physical examinations, referencing a patient’s health history, obtaining a patient’s family history, and general observation can also be used to collect assessment data.

What is the problem? Once the assessment is completed, the second step of the nursing process is where the nurse will take all the gathered information into consideration and diagnose the patient’s condition and medical needs. Diagnosing involves a nurse making an educated judgment about a potential or actual health problem with a patient. More than one diagnoses are sometimes made for a single patient.

How to manage the problem? When the nurse, any supervising medical staff, and the patient agree on the diagnosis, the nurse will plan a course of treatment that takes into account short- and long-term goals. Each problem is committed to a clear, measurable goal for the expected beneficial outcome. The planning step of the nursing process is discussed in detail in Nursing Care Plans (NCP): Ultimate Guide and Database.

Implementation

Putting the plan into action. The implementation phase of the nursing process is when the nurse put the treatment plan into effect. This typically begins with the medical staff conducting any needed medical interventions. Interventions should be specific to each patient and focus on achievable outcomes. Actions associated in a nursing care plan include monitoring the patient for signs of change or improvement, directly caring for the patient or conducting important medical tasks, educating and guiding the patient about further health management, and referring or contacting the patient for a follow-up.

Did the plan work? Once all nursing intervention actions have taken place, the team now learns what works and what doesn’t by evaluating what was done beforehand. The possible patient outcomes are generally explained under three terms: the patient’s condition improved, the patient’s condition stabilized, and the patient’s condition worsened. Accordingly, evaluation is the last, but if goals were not sufficed, the nursing process begins again from the first step.

Types of Nursing Diagnoses

The four types of NANDA nursing diagnosis are Actual (Problem-Focused), Risk, Health promotion, and Syndrome. Here are the four categories of nursing diagnosis provided by the NANDA-I system.

Four Types of Nursing Diagnoses

The four types of nursing diagnosis are Actual (Problem-Focused), Risk, Health promotion, and Syndrome.

Problem-Focused Nursing Diagnosis

A problem-focused diagnosis (also known as actual diagnosis) is a client problem that is present at the time of the nursing assessment. These diagnoses are based on the presence of associated signs and symptoms. Actual nursing diagnoses should not be viewed as more important than risk diagnoses. There are many instances where a risk diagnosis can be the diagnosis with the highest priority for a patient.

Problem-focused nursing diagnoses have three components: (1) nursing diagnosis, (2) related factors, and (3) defining characteristics. Examples of actual nursing diagnosis are:

Ineffective Breathing Pattern
Impaired Skin Integrity.

Risk Nursing Diagnosis

The second type of nursing diagnosis is called risk nursing diagnosis. These are clinical judgment that a problem does not exist, but the presence of risk factors indicates that a problem is likely to develop unless nurses intervene. The individual (or group) is more susceptible to develop the problem than others in the same or a similar situation because of risk factors. For example, an elderly client with diabetes and vertigo has difficulty walking refuses to ask for assistance during ambulation may be appropriately diagnosed with Risk for Injury.

Components of a risk nursing diagnosis include: (1) risk diagnostic label, and (2) risk factors. Examples of risk nursing diagnosis are:

Risk for Falls
Risk for Injury

Health Promotion Diagnosis

Health promotion diagnosis (also known as wellness diagnosis) is a clinical judgment about motivation and desire to increase well-being. Health promotion diagnosis is concerned in the individual, family, or community transition from a specific level of wellness to a higher level of wellness.

Components of a health promotion diagnosis generally include only the diagnostic label or a one-part-statement. Examples of health promotion diagnosis:

Readiness for Enhanced Spiritual Well Being
Readiness for Enhanced Family Coping
Readiness for Enhanced Parenting

Syndrome Diagnosis

A syndrome diagnosis is a clinical judgment concerning with a cluster of problem or risk nursing diagnoses that are predicted to present because of a certain situation or event.

They, too, are written as a one-part statement requiring only the diagnostic label. Examples of a syndrome nursing diagnosis are:

Chronic Pain Syndrome
Post-trauma Syndrome
Frail Elderly Syndrome

Possible Nursing Diagnosis

A possible nursing diagnosis is not a type of diagnosis as are actual, risk, health promotion, and syndrome. Possible nursing diagnoses are statements describing a suspected problem for which additional data are needed to confirm or rule out the suspected problem. It provides the nurse with the ability to communicate with other nurses that a diagnosis may be present but additional data collection is indicated to rule out or confirm the diagnosis. Examples include

Possible Chronic Low Self-Esteem
Possible Social Isolation.

Components of a Nursing Diagnosis

A nursing diagnosis has typically three components: (1) the problem and its definition, (2) the etiology, and (3) the defining characteristics.

Components of a Nursing Diagnosis Statement

A common format used when writing or formulating nursing diagnosis is the PES format.

Problem and Definition

The problem statement, or the diagnostic label, describes the client’s health problem or response for which nursing therapy is given as concisely as possible. A diagnostic label usually has two parts: qualifier and focus of the diagnosis. Qualifiers (also called modifiers) are words that have been added to some diagnostic labels to give additional meaning, limit or specify the diagnostic statement. Exempted in this rule are one-word nursing diagnoses (e.g., Anxiety, Fatigue, Nausea) where their qualifier and focus are inherent in the one term.

The etiology, or related factors and risk factors, component of a nursing diagnosis label identifies one or more probable causes of the health problem, are the conditions involved in the development of the problem, gives direction to the required nursing therapy, and enables the nurse to individualize the client’s care. Nursing interventions should be aimed at etiological factors in order to remove the underlying cause of the nursing diagnosis. Etiology is linked with the problem statement with the phrase “as related to”.

Defining Characteristics

Defining characteristics are the clusters of signs and symptoms that indicate the presence of a particular diagnostic label. In actual nursing diagnoses, the defining characteristics are the identified signs and symptoms of the client. For risk nursing diagnosis, no signs and symptoms are present therefore the factors that cause the client to be more susceptible to the problem form the etiology of a risk nursing diagnosis. Defining characteristics are written “as evidenced by” or “as manifested by” in the diagnostic statement.

How to Write a Nursing Diagnosis?

In writing nursing diagnostic statements, describe the health status of an individual and the factors that have contributed to the status. You do not need to include all types of diagnostic indicators. Diagnostic statements can be one-part, two-part, or three-part statements. A common format used when writing or formulating nursing diagnosis is the PES format.

Writing Diagnostic Statements

Nursing diagnostic statements can be one-part, two-part, or three-part statements

One-Part Nursing Diagnosis Statement

Health promotion nursing diagnoses are usually written as one-part statements because related factors are always the same: motivated to achieve a higher level of wellness though related factors may be used to improve the of the chosen diagnosis. Syndrome diagnoses also have no related factors. Examples of one-part nursing diagnosis statement include:

Readiness for Enhance Breastfeeding
Readiness for Enhanced Coping
Rape Trauma Syndrome

Two-Part Nursing Diagnosis Statement

Risk and possible nursing diagnoses have two-part statements: the first part is the diagnostic label and the second is the validation for a risk nursing diagnosis or the presence of risk factors. It’s not possible to have a third part for risk or possible diagnoses because signs and symptoms do not exist. Examples of two-part nursing diagnosis statement include:

Risk for Infection related to compromised host defenses
Risk for Injury related to abnormal blood profile
Possible Social Isolation related to unknown etiology
Three-part Nursing Diagnosis Statement

An actual or problem nursing diagnosis have three-part statements: diagnostic label, contributing factor (“related to”), and signs and symptoms (“as evidenced by”). Three-part nursing diagnosis statement is also called the PES format which includes the Problem, Etiology, and Signs and Symptoms. Examples of three-part nursing diagnosis statement include:

Impaired Physical Mobility related to decreased muscle control as evidenced by inability to control lower extremities.

Acute Pain related to tissue ischemia as evidenced by statement of “I feel severe pain on my chest!”

References and Sources

References for this Nursing Diagnosis guide and recommended resources to further your reading.

Ackley, B. J., & Ladwig, G. B. (2010). Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences. [Link]

Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s Fundamentals of Nursing: Concepts, process and practice. Boston, MA: Pearson. [Link]

Edel, M. (1982). The nature of nursing diagnosis. In J. Carlson, C. Craft, & A. McGuire (Eds.), Nursing diagnosis (pp. 3-17). Philadelphia: Saunders.

Fry, V. (1953). The Creative approach to nursing. AJN, 53(3), 301-302.

Gordon, M. (1982). Nursing diagnosis: Process and application. New York: McGraw-Hill.

Gebbie, K., & Lavin, M. (1975.) Classification of nursing diagnoses: Proceedings of the First National Conference. St. Louis, MO: Mosby.

McManus, R. L. (1951). Assumption of functions in nursing. In Teachers College, Columbia University, Regional planning for nurses and nursing education. New York: Columbia University Press.

For the Complete List of NANDA-I Nursing Diagnosis: Herdman, H. T., & Kamitsuru, S. (Eds.). (2017). NANDA International Nursing Diagnoses: Definitions & Classification 2018-2020. Thieme. [Link]

NANDA. International. (2014). Nursing Diagnoses 2012-14: Definitions and Classification. Wiley.

Powers, P. (2002). A discourse analysis of nursing diagnosis. Qualitative health research, 12(7), 945-965. [Scribd]