how to write a community health nursing diagnosis statement

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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• Authors: Jessica Ochs, Sherry L. Roper, Susan M. Schwartz
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• Book title: Population Health for Nurses
• Publication date: May 15, 2024
• Location: Houston, Texas
• Book URL: https://openstax.org/books/population-health/pages/1-introduction
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Understanding the NANDA Nursing Diagnosis List with Examples

‍ The information for this article was primarily sourced from NANDA International, Inc. , an authority on standardized nursing diagnostic terminology, and the American Nurses Association , an organization whose mission is shaping the future of nursing and healthcare.

What Is a Nursing Diagnosis?

A nursing diagnosis is an essential step of the nursing process and is crucial to ensure quality of care. Nurses initiate the nursing diagnosis, which describes a response to the medical diagnosis. 

According to the North American Nursing Diagnosis Association ( NANDA ), a nursing diagnosis is:

“a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community. A nursing diagnosis provides the basis for selecting nursing interventions to achieve outcomes for which the nurse has accountability.”

What Are Some of the Most Common Nursing Diagnoses?

A few of the more common nursing diagnoses include the following: 

• Impaired gas exchange
• Risk for infection
• Ineffective airway clearance
• Activity intolerance
• Acute confusion
• Chronic pain
• Impaired skin integrity
• Decreased cardiac output
• Ineffective breathing pattern

What Is a Medical Diagnosis?

A healthcare provider creates a medical diagnosis after assessing the signs and symptoms present and then identifies a condition, injury, or disease.

To create a nursing diagnosis, a medical diagnosis must first be present. Keep reading to learn more about nursing practice, a nursing diagnosis, and how to write or create one.

What Is the Nursing Process?

Regardless of a nurse’s work setting, their role revolves around implementing the five steps of the nursing process:

• Assessment: The first step of the nursing process is collecting and analyzing patient data, including physiological, psychological, sociocultural, lifestyle, economic, and spiritual information. Read more about the complete head-to-toe nursing assessment .
• Diagnosis: The next step of the process is making a diagnosis based on a clinical judgment of the patient’s medical condition. This diagnosis becomes the basis of the nursing care plan .
• Outcomes/Planning: Based on the previous steps, nurses set goals for the patient and include them in the treatment plan in order to achieve the desired outcome.
• Implementation: In this step, nurses implement and document nursing interventions according to the care plan. This may include administering medications, educating the patient, monitoring vital signs, etc.
• Evaluation: Throughout the nursing process, nurses evaluate the patient’s status and the impact of the care they provide, which can lead to modifications in the care plan. 

Nursing vs. Medical Diagnoses: What’s the Difference?

The most evident difference between a medical and a nursing diagnosis is the healthcare professional who makes the diagnosis. Whereas physicians, physician’s assistants (PAs), and advanced nurse practitioners (ANPs) make medical diagnoses—registered nurses (RNs) are responsible for nursing diagnoses. They also educate patients on these diagnoses.

However, the healthcare provider’s credentials are not the only distinction . Medical diagnoses focus on diseases or other medical problems; nursing diagnoses deal with the human response to health conditions and life processes. 

The nursing diagnosis contemplates the level of pain a patient reports, whether they are experiencing mental health conditions as a result of their physical illness, their attitudes, challenges, resources, etc. Therefore, two patients with the same medical diagnosis, such as pneumonia, diabetes, or hypertension, can have different nursing diagnoses.

For example, the nursing diagnosis of a patient with chronic obstructive pulmonary disease (COPD) may address the patient’s feelings of depression, hopelessness, and pessimism , commonly observed behaviors among patients with this disease. 

Which Are the 7 Diagnostic Axes?

In a nursing diagnosis, the axes are the dimensions of the human response that nurses must consider. NANDA identifies seven axes in line with the International Standards Reference Model for a Nursing Diagnosis .

Axis 1: The Diagnostic Focus

This axis describes the human response at the center of the nursing diagnosis; it is the root of the diagnostic concept. The diagnostic focus may consist of one or more words, such as “nausea,” “activity intolerance,” or “spiritual distress.”

Axis 2: Subject of the Diagnosis

The subject of the diagnosis refers to the person or persons the diagnosis is for. The subject may be any of the following:

• Individual: A single human being
• Caregiver: A family member or helper who provides regular care for a child or a sick, elderly, or disabled person
• Family: Two or more people related by blood or choice who have sustained relationships, perceive reciprocal obligations, sense common meaning, and share certain obligations toward others
• Group: Several people with shared characteristics
• Community: A group of people living in the same location under the same governance, such as the same neighborhood or city

Axis 3: Judgment

A nurse’s judgment is a descriptor or modifier—such as impaired or ineffective—that limits or specifies the meaning of the diagnostic focus. The diagnostic focus and the nurse’s judgment about it form the nursing diagnosis. 

Axis 4: Location

The location of the diagnosis refers to the parts of the body or their related functions: tissues, organs, anatomical sites, or structures. Examples include bladder, auditory, cerebral, etc.

Axis 5: Age

This axis refers to the age of the subject of the diagnosis:

• Fetus: An unborn human from eight weeks after conception until birth
• Neonate: A child under 28 days of age
• Infant: A child over 28 days and under one year of age
• Child: A person aged one to nine years (inclusive)
• Adolescent: A person aged 10 to 19 years (inclusive)
• Adult: A person over 19 years of age (unless national law defines a person as being an adult at an earlier age)
• Older adult: A person over 65 years of age

Axis 6: Time

This axis describes the duration of the diagnostic concept (Axis 1). Nurses can describe time with the following terms:

• Acute: Lasting less than three months
• Chronic: Lasting more than three months
• Intermittent: Occurring at intervals, periodic, cyclic
• Continuous: Uninterrupted

Axis 7: Status of the Diagnosis

The diagnosis status can also be called the categorization or type of nursing diagnosis: problem-focused, health promotion, risk, or syndrome.

Nurses may name the axes implicitly or explicitly. For example, in the diagnosis “compromised family coping,” the nurse explicitly identifies the subject and judgment. On the contrary, in an “activity intolerance” diagnosis, the subject is implied to be an individual patient. Furthermore, in other cases, an axis may not be relevant and, therefore, not mentioned either implicitly or explicitly.   

As mentioned, the nursing diagnosis requires the diagnostic focus and the nurse’s judgment. On occasions, the diagnostic focus may contain the judgment, such as in a diagnosis of nausea. In this case, the judgment is implicit and, therefore, not explicitly stated in the label. Nurses may include the other axes when they are relevant to or clarify the nursing diagnosis.

4 Types of Nursing Diagnoses

The type of diagnosis a nurse can reach depends on several factors. Is the patient experiencing the effects of a medical condition, or are they at risk of developing a disease or other undesirable human response? Is the patient experiencing one cluster of related symptoms, or is the condition more complex? How involved does the patient want to be in their treatment and care plan? These factors converge to determine the type of nursing diagnosis registered nurses can reach in order to maintain optimal health status. Neglecting the nursing diagnosis increases the risk of negative outcomes.

1. Problem-Focused Nursing Diagnosis

This type of nursing diagnosis relates to undesirable human responses (a.k.a. problems) to specific conditions or life processes in individuals, families, groups, or communities. Problem-focused nursing diagnoses require defining characteristics—such as manifestations, signs, and symptoms—that cluster in patterns of related cues and etiological factors that are related to, contribute to, or are antecedent to the diagnostic focus.

2. Health-Promotion Nursing Diagnosis

A health-promotion nursing diagnosis concerns the motivation and desire to increase well-being and reach human health potential. This motivation may exist in individuals, families, groups, or communities and applies to any health state. Nurses can make this type of diagnosis when patients express a desire to enhance their health.

3. Risk Nursing Diagnosis

This nursing diagnosis refers to the vulnerability of individuals, families, groups, or communities to develop undesirable human responses to health conditions or life processes. Risk factors contributing to increased vulnerability must be present for nurses to make this type of diagnosis.

4. Syndrome

A syndrome relates to a specific cluster of nursing diagnoses that occur together and can be treated simultaneously through similar interventions, including providing pain control, alleviating chest pain, and caring for patients in a way to help increase blood flow, i.e., via correct positioning—to name a few. Nurses can make this type of diagnosis when two or more nursing diagnoses are present as defining characteristics. Although not required, nurses may also use related factors to clarify the definition.

NANDA Nursing Diagnosis List 

The following table includes NANDA nursing diagnosis examples by domain, encompassing environmental, physical, psychosocial, and spiritual areas:

How to Write a Nursing Diagnosis

According to NANDA recommendations , a nursing diagnosis is a statement that includes both the diagnosis itself and related factors seen through defining characteristics. Nurses should also try to link the defining characteristics, associated factors, and risk factors discovered during the patient’s assessment.

A nursing diagnosis should include the following components: 

• Diagnosis label: This is the name for a diagnosis and reflects the diagnostic focus and the nursing judgment. It is a term or phrase representing a pattern of related signs and symptoms.
• Definition: This clear description helps set the diagnosis apart from other diagnoses.
• Defining characteristics: These are all the observable signs and symptoms that cluster to indicate a problem-focused or health-promotion nursing diagnosis or a syndrome. These signs and symptoms may be perceived through any of the senses (sight, touch, smell, etc.) or communicated by the patient or family members.
• Risk factors: These are only part of risk diagnoses; they increase an individual’s, family’s, group’s, or community’s vulnerability to experiencing an unhealthy event. They may be environmental, physiological, psychological, genetic, or chemical.  
• Related factors: These factors appear to be related to the nursing diagnosis. Nurses may describe these factors as being antecedent to, associated with, related to, contributing to, or abetting. Problem-focused nursing diagnoses and syndromes must have related factors, whereas health-promotion diagnoses only include related factors if they help to clarify the diagnosis.

Aren’t sure where to start? First, registered nurses must analyze patients’ subjective and objective data and identify patterns. 

Then, nurses develop hypotheses based on how these patterns correlate with defining characteristics of a nursing diagnosis. 

Nurses must also include the cause—or related factors—of a patient’s problem. If possible, nursing care plans created based on these diagnoses should modify or remove the associated factors that cause the problem identified in the nursing diagnosis.

As with any part of the nursing process, if a nursing diagnosis was not documented, it didn’t happen. Thankfully with modern charting technology, most of the nursing diagnoses are now digitally created after you document your assessment, and they are automatically added to the plan of care.

Want to brush up on your nurse charting skills? Discover essential principles for nurse documentation and tips . Stay up-to-date with the latest nursing trends by reading our blogs about the best water bottles for nurses and which scrubs are most popular for healthcare workers.

• American Nurses Association: The Nursing Process
• NANDA International, Inc.: What is Nursing Diagnosis - And Why Should I Care?
• National Library of Medicine: Use and Significance of Nursing Diagnosis in Hospital Emergencies: A Phenomenological Approach

Laila is a contributing copywriter and editor at Nursa who specializes in writing compelling long-form content about nursing finances, per diem job locations, areas of specialization, guides, and resources that help nurses navigate their career paths.

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Nursing Diagnosis Guide: All You Need to Know to Master Diagnosing

In this ultimate tutorial and nursing diagnosis list, we’ll walk you through the concepts behind writing nursing diagnosis. Learn what a nursing diagnosis is, its history and evolution, the nursing process , the different types and classifications, and how to write nursing diagnoses correctly. Included also in this guide are tips on how you can formulate better nursing diagnoses, plus guides on how you can use them in creating your nursing care plans .

Table of Contents

• What is a Nursing Diagnosis? 

Purposes of Nursing Diagnosis

Differentiating nursing diagnoses, medical diagnoses, and collaborative problems, classification of nursing diagnoses (taxonomy ii), nursing process, problem-focused nursing diagnosis, risk nursing diagnosis, health promotion diagnosis, syndrome diagnosis, possible nursing diagnosis, problem and definition.

• Etiology 

Risk Factors

Defining characteristics, analyzing data, identifying health problems, risks, and strengths, formulating diagnostic statements, one-part nursing diagnosis statement, two-part nursing diagnosis statement, three-part nursing diagnosis statement, nursing diagnosis for care plans, recommended resources, references and sources, what is a nursing diagnosis.

A nursing diagnosis is a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability to that response, by an individual, family, group, or community. A nursing diagnosis provides the basis for selecting 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.

The purpose of the nursing diagnosis is as follows:

• For nursing students, nursing diagnoses are an effective teaching tool to help sharpen their problem-solving and critical thinking skills.
• Helps identify nursing priorities and helps 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.

The term nursing diagnosis is associated with different concepts. It may refer to the distinct second step in the nursing process , diagnosis (“D” in “ ADPIE “). Also, nursing diagnosis applies to the label when nurses assign meaning to collected data appropriately labeled a nursing diagnosis. For example, during the assessment , the nurse may recognize that the client feels anxious , fearful, and finds it difficult to sleep . Those problems are labeled with nursing diagnoses: respectively, Anxiety , Fear , and Disturbed Sleep Pattern. In this context, a nursing diagnosis is based upon the patient’s response to the medical condition. It is called a ‘nursing diagnosis’ because these are matters that hold a distinct and precise action associated with what nurses have the 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.

On the other hand, a medical diagnosis is made by the physician or advanced 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 must follow the physician’s orders and carry out prescribed treatments and therapies.

Collaborative problems are potential problems that nurses manage using both independent and physician-prescribed interventions. These are problems or conditions that require both medical and nursing interventions , with the nursing aspect focused on monitoring the client’s condition and preventing the development of the potential complication.

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

How are nursing diagnoses listed, arranged, or classified? In 2002, Taxonomy II was adopted, which was based on 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 their concept, not by the first word.

• Class 1. Health Awareness
• Class 2. Health Management
• Class 1. Ingestion
• Class 2. Digestion
• Class 3. Absorption
• Class 4. Metabolism
• Class 5. Hydration
• Class 1. Urinary function
• Class 2. Gastrointestinal function
• Class 3. Integumentary function
• Class 4. Respiratory function
• Class 1. Sleep/Rest
• Class 2. Activity/Exercise
• Class 3. Energy balance
• Class 4. Cardiovascular/Pulmonary responses
• Class 5. Self-care
• Class 1. Attention
• Class 2. Orientation
• Class 3. Sensation/Perception
• Class 4. Cognition
• Class 5. Communication
• Class 1. Self-concept
• Class 2. Self-esteem
• Class 3. Body image
• Class 1. Caregiving roles
• Class 2. Family relationships
• Class 3. Role performance
• Class 1. Sexual identity
• Class 2. Sexual function
• Class 3. Reproduction
• Class 1. Post-trauma responses
• Class 2. Coping responses
• Class 3. Neurobehavioral stress
• Class 1. Values
• Class 2. Beliefs
• Class 3. Value/Belief/Action congruence
• Class 1. Infection
• Class 2. Physical injury
• Class 3. Violence
• Class 4. Environmental hazards
• Class 5. Defensive processes
• Class 6. Thermoregulation
• Class 1. Physical comfort
• Class 2. Environmental comfort
• Class 3. Social comfort
• Class 1. Growth
• Class 2. Development

The five stages of the nursing process are assessment, diagnosing, planning , implementation , and evaluation . All steps in the nursing process require critical thinking by the nurse. Apart from understanding 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 steps, importance, purposes, and characteristics of the nursing process are discussed more in detail here: “ The Nursing Process: A Comprehensive Guide “

Types of Nursing Diagnoses

The four types of nursing diagnosis are Actual (Problem-Focused), Risk, Health Promotion , and Syndrome. Here are the four categories of nursing diagnoses:

A problem-focused diagnosis (also known as actual diagnosis ) is a client problem present at the time of the nursing assessment . These diagnoses are based on the presence of associated signs and symptoms. Actual nursing diagnosis 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 diagnoses are:

• Anxiety related to stress as evidenced by increased tension, apprehension, and expression of concern regarding upcoming surgery
• Acute pain related to decreased myocardial flow as evidenced by grimacing, expression of pain , guarding behavior.

The second type of nursing diagnosis is called risk nursing diagnosis.  These are clinical judgments that a problem does not exist, but the presence of risk factors indicates that a problem is likely to develop unless nurses intervene. A risk diagnosis is based on the patient’s current health status, past health history , and other risk factors that may increase the patient’s likelihood of experiencing a health problem. These are integral part of nursing care because they help to identify potential problems early on and allows the nurse to take steps to prevent or mitigate the risk.

There are no etiological factors (related factors) for risk diagnoses. The individual (or group) is more susceptible to developing the problem than others in the same or a similar situation because of risk factors. For example, an elderly client with diabetes and vertigo who has difficulty walking refuses to ask for assistance during ambulation may be appropriately diagnosed with risk for injury or risk for falls.

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

• Risk for injury
• Risk for infection

Health promotion diagnosis (also known as wellness diagnosis ) is a clinical judgment about motivation and desire to increase well-being. It is a statement that identifies the patient’s readiness for engaging in activities that promote health and well-being. For example, if a first-time mother shows interest on how to properly breastfeed her baby, a nurse make make a health promotion diagnosis of “Readiness for Enhanced Breastfeeding .” This nursing diagnosis will be then used to guide nursing interventions aimed at supporting the patient in learning about proper breastfeeding.

Additionally, health promotion diagnosis is concerned with 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 health literacy

A syndrome diagnosis is a clinical judgment concerning 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

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 or risk factors (for risk diagnosis).

The problem statement , or the diagnostic label , describes the client’s health problem or response to which nursing therapy is given concisely. 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, Constipation , Diarrhea , Nausea , etc.) where their qualifier and focus are inherent in the one term.

The etiology , or related 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 “ related to ” for example:

• Activity intolerance related to generalized weakness .
• Decreased cardiac output related to abnormality in blood profile

Risk factors are used instead of etiological factors for risk nursing diagnosis. Risk factors are forces that put an individual (or group) at an increased vulnerability to an unhealthy condition. Risk factors are written following the phrase “as evidenced by” in the diagnostic statement.

• Risk for falls as evidenced by old age and use of walker.
• Risk for infection as evidenced by break in skin integrity .

Defining characteristics are the clusters of signs and symptoms that indicate the presence of a particular diagnostic label. In actual nursing diagnosis, 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 following the phrase “as evidenced by” or “as manifested by” in the diagnostic statement.

Diagnostic Process: How to Diagnose

There are three phases during the diagnostic process: (1) data analysis, (2) identification of the client’s health problems, health risks, and strengths, and (3) formulation of diagnostic statements.

Analysis of data involves comparing patient data against standards, clustering the cues, and identifying gaps and inconsistencies.

In this decision-making step, after data analysis, the nurse and the client identify problems that support tentative actual, risk, and possible diagnoses. It involves determining whether a problem is a nursing diagnosis, medical diagnosis, or a collaborative problem. Also, at this stage, the nurse and the client identify the client’s strengths, resources, and abilities to cope.

Formulation of diagnostic statements is the last step of the diagnostic process wherein the nurse creates diagnostic statements. The process is detailed below.

How to Write a Nursing Diagnosis?

In writing nursing diagnostic statements, describe an individual’s health status and the factors that have contributed to the status. You do not need to include all types of diagnostic indicators. Writing diagnostic statements vary per type of nursing diagnosis (see below).

Another way of writing nursing diagnostic statements is by using the PES format, which stands for Problem (diagnostic label), Etiology (related factors), and Signs/Symptoms (defining characteristics). Diagnostic statements can be one-part, two-part, or three-part using the PES format.

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 through related factors may be used to improve the chosen diagnosis. Syndrome diagnoses also have no related factors. Examples of one-part nursing diagnosis statements include:

• Readiness for enhanced coping
• Rape Trauma Syndrome

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 statements include:

• Risk for infection as evidenced by weakened immune system response
• Risk for injury as evidenced by unstable hemodynamic profile

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

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

Variations on Basic Statement Formats

Variations in writing nursing diagnosis statement formats include the following:

• Using “ secondary to ” to divide the etiology into two parts to make the diagnostic statement more descriptive and useful. Following the “secondary to” is often a pathophysiologic or disease process or a medical diagnosis. For example, Risk for Decreased Cardiac Output related to reduced preload secondary to myocardial infarction .
• Using “ complex factors ” when there are too many etiologic factors or when they are too complex to state in a brief phrase. For example, Chronic Low Self-Esteem related to complex factors.
• Using “ unknown etiology ” when the defining characteristics are present but the nurse does not know the cause or contributing factors. For example, Ineffective Coping related to unknown etiology.
• Specifying a second part of the general response or diagnostic label to make it more precise. For example, Impaired Skin Integrity (Right Anterior Chest) related to disruption of skin surface secondary to burn injury .

This section is the list or database of the common nursing diagnosis examples that you can use to develop your nursing care plans .

See also: Nursing Care Plans (NCP): Ultimate Guide and List

• Chronic Pain
• Constipation
• Decreased Cardiac Output
• Hopelessness
• Hyperthermia
• Hypothermia

Recommended nursing diagnosis and nursing care plan books and resources.

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care We love this book because of its evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions showing how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.

Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition) Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues, and on electrolytes and acid-base balance.

Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions and an alphabetized listing of nursing diagnoses covering more than 400 disorders.

Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care  Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!

All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health   Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ! Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.

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

• Berman, A., Snyder, S., & Frandsen, G. (2016).  Kozier & Erb’s Fundamentals of Nursing: Concepts, process and practice . Boston, MA: Pearson.
• 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.
• Gordon, M. (2014).  Manual of nursing diagnosis . Jones & Bartlett Publishers.
• 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.
• Powers, P. (2002). A discourse analysis of nursing diagnosis . Qualitative health research , 12 (7), 945-965.

89 thoughts on “Nursing Diagnosis Guide: All You Need to Know to Master Diagnosing”

Very useful document indeed.

Thank you Sima! Hope it helps come up with great nursing care plans!

Thank you for this resource material. This is very simple, concise and easy to understand. This would be of great help both for the students and the teacher.

Please make proper table for nursing diagnosis it’ll be easy to read and understand .

This is simple and easy to understand.

Happy to know! Hope you visit our guide on nursing care plans too! Thanks for dropping by Modupe!

I need a complete pdf file

Hi! If you want to save it as a PDF file, simply “Print” this page and “Save as PDF”.

So very happy to stumble upon nurseslabs. Thanks so much

Happy to have helped you. Please do check out our nursing care plans list too! Thanks for visiting, Hussaina!

I want to acknowledge the writer of Understand, Matt Vera for using the initiative in simplifying the nursing notes into simple English that we as upcoming nursing students can understand nursing notes in order to practice them in our clinical. I’ve learned so much from this website and I want to be part of the nurses website so I can gather some more informations. Get me on my email. Thanks so much..

Thank you Lawrencia. Glad to be of help!

VERY NICE EXPLANATION .THANK YOU . DEAR MADAM /SIR PLEASE CAN YOU PROVIDE ME LIST OF NURSING DIAGNOSIS ALONG WITH REVISED ONE TILL DATE . I am Lecturer in college of nursing ,India Thank You

this is so educative thank you

Thank you! Glad you liked it.

really simple and effective, thank you so much.

This is great! Simple and easy to understand for the nursing students.

Comment:nice work, great nurses.

I am a nurse more than 30 yeras and try to teach my team how to used nursing process but it not success. You make me feel it simple and easy to understand . I will use your concept for my team. Thank you somuch

THANK, THANK YOU, THANK YOU FOR THE RESOURCEFUL INFORMATION.

please i want care plan on risk for unstable blood pressure i am a nursing student

@joseph auarshie jnr, can you please send me your care plan if you made it already ? I am a nursing student too. Thank you appreciated

Thanks, I look forward to learning more from you and maybe joining you in writing once am done with school. It’s awesome.

You’re very much welcome! Please feel free to ask further questions. Thank you and goodluck!

I what to check out nursing care plan

Comment: good explanation of health issue pattern

This is great. Thanks for given your time to this. Is so educative. Up thumb

Thanks alot am so interested on this

Great Work!

Thank you for the resourceful information which I was thought in school but almost forgotten until now, brain refresh, thanks

Excellent job done congratulations to all the team worker .

Please is the component of nursing diagnosis the same as type of nursing diagnosis

Each time I research about nursing diagnoses, there is something new to learn. This is a very well written piece giving great insights about nursing. More than ever, I have a better understanding of the unique body of nursing knowledge. Bravo to the Matt and entire Nurseslabs team

Thank you! Be sure to visit also our nursing care plans here .

Sorry madam the risk factors thus the potential problem has the related factors not the sign and symptom because that something has not happed yet so there is no sign and symptoms. Thank you

Excellent work and expertise team work

Usefull information

Nice work Sir/Madam thank you for giving us more hints on Nursing Diagnoses. Excellent team work.

Thank you so much for this nursing diagnosis.

Formulations of the DX has been hectic but thanks to matt vera has been of great help especally answering medsurge quizes just try to expand more on the second part (related to)of actual diagnosis

Hi Mary, Thanks you so much for your comment and endorsement. We welcome your students, thanks again!

Very useful indeed. thank you

I’m practicing nursing diagnosis by using the practice case studies my professor provided but I’m not sure if I’m doing it correctly. Here’s what I’m thinking: Problem:Anxiety Etiology: morning bouts of fear Signs and symptoms: patient stated waking nervous, light headed, agitated, and having a pounding heart Anxiety related to morning bouts of fear as evidenced by patient’s reports of waking light headed, agitated, and having a pounding heart.

In this case study we know to patient has been experiencing anxiety since childhood and was verbally abused by his father. His anxiety is causing difficulties for him to make decisions and he fears he’ll experience misfortunes whenever going to school. We also know about these bouts he has ever morning, which I thought would be a good primary diagnosis because they almost seem like a panic attack which would be extreme anxiety which is a big deal right? Am I thinking about this the right way or not and if not, what should I be concerned about as most important and how should my diagnosis be worded?

The nursing diagnostic statement you made sounds right. For the “as evidenced by” part, I would add the statement of the patient in verbatim since this is a subjective data (place it also under quotation marks) and if possible, do your own assessment and objectively obtain the data.

I would write it this way:

Anxiety related to morning bouts of fear as evidenced by increased in heart rate, apprehensiveness, and patient stating “waking lightheaded, agitated, and having a pounding heart”

well precised and nice to read.

Thanks so much for this readings, am so interested with this website I hope i could use this for my whole time

Hello Professor Matt Vera

I am Mai Ba Hai, from Hue University of Medicine and Pharmacy,faculty of nursing.I found that this content is very useful and helpful to me. I think that this content is really fit to my teaching, so I would like to ask your permission that I can translate this content into my languages (Vietnamese) to teach for my nursing students in Vietnam. I will cite you as author of this document. If you are willing to help in this point I really appreciate about it. I am looking forward to receiving your agreement. Yours sincerely.

This is so fantastic!! Thank you for taking out time to create this wonderful piece

You guys are wonderful. Thanks so much.

Very nice and very interested More ink to your pen I pray

Very useful, thank you so much

Thanks so much for the good job. Nurse Timothy Idachaba (RN, RNE, .MSC in view) from Nigeria

Matt Vera, BSN, R.N, First, I want to thank you for your amazing, short and precise note you provided for us. But I think I’ve got some trouble understanding about 3 components of Nursing diagnosis. This is because there is some variation between defining characteristics among your examples of actual and potential nursing diagnosis. Actual nursing diagnosis -Ineffective breathing pattern related to decreased lung expansion AS EVIDENCED BY dyspnoea, coughing, and difficulty of breathing. Risk diagnosis -Risk for ineffective airway clearance AS EVIDENCED BY accumulation_of_secreations_in_the_Lung. -Risk for fall AS EVIDENCED BY Muscle_weakness ……………………………………………………. As I know before, risk Nursing diagnosis misses Defining characteristics. because, the problem is not happened. but it is to happen.

So, when I compare defining characteristics among actual and risk diagnosis, there is disagreement. Accumulation of secretion in the lung is aetiology for ineffective airway clearance. But you provided it as defining characteristics. So, please make it clear.

Well elaborated, i like using nurseslabs, i always understand easily

Educative I appreciate

Such a beautiful explanation. Thank you

Very comprehensive and understandable. A job Well done by the group

Nice piece, thanks for painstakingly organizing this concise notes, God bless you

Very educative and simple to understand. Thank you for the effort

This is very handy. Your work is appreciated

This is an excellent work . I was having lectures just now on nursing diagnosis and care plan and this note helps me a lot

Its so helpful. Thank you!

Very good content. Happy to learn the Nursing diagnosis. Thanks Nurseslabs

This is a great educative article, kind of review of the nursing diagnosis. Thanks a lot for refreshing my memory.

Sorry, it’s not.

This was so simple and very helpful

So simple, concise and very helpful.

I APPRECIATE THIS WORK, USEFUL AND EASY TO UNDERSTAND.

Beautiful. I love the nursing care plan links. it is just what I have been searching for to assist my students. Thank you

I’ve been a nurse (currently working PRN) since 2015 and not having used nursing diagnosis in my day to day, this source was super helpful and a great refresher! Much thanks to the author!

Thanks for this it was very good and easy to comprehend

Thank you for your opinion; however, I agree with Mebratu. The description shown in your article for statement of “risk for” problem is confusing to me.

My view is as follows: “Actual problem” has 3 parts: nursing diagnosis (client’s problem) related to etiology (pathophysiology of what is causing the problem) as evidenced by defining characteristics (signs and symptoms of the problem)

“Risk for problem” has 2 parts: nursing diagnosis (client’s potential problem) related to etiology (client condition that may cause the problem) There is no “as evidenced by” because there IS no evidence of the problem since the problem does not yet exist.

Very nice and easy explanation, thanku

Please I need the actual manual that’s currently being used or at least a link to it -the NANDA-I document.

For the most current NANDA-I Nursing Diagnosis manual, you might want to check out the latest edition of the “Nursing Diagnosis Handbook” by NANDA International. This handbook is frequently updated with new diagnoses and guidelines.

congratulations MATT VERA, for the very nice and usefully presentation in nursing diagnosis. it has been very usefully for patient care and teaching activities. simple and very nice understandable.

Thanks a lot Matt Vera for the simplicity of the nursing diagnoses. Continue with other pieces of work

You’re welcome! I’m thrilled to hear you found the simplicity of the nursing diagnoses helpful. Your encouragement means a lot, and I’m definitely motivated to keep creating and simplifying more content for you and others in the nursing community.

If there are any specific topics or areas you’d like to see covered next, please let me know. Your feedback is invaluable in guiding the work I do.

Really interesting I thank you

Very impressive step by step explanations

Its good explanation. how to download

Really helpful Thank you

Hi Aneena, You’re welcome! I’m glad to hear you found the nursing diagnosis guide helpful. Is there a particular area or diagnosis you’d like to explore more deeply, or do you have any other questions about nursing diagnoses? Always here to help!

what a wonderful text,i really love it…….

Thank you for this material. It is much easier to understand and will be useful to both teachers and students.

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What is one of the most essential tools in a nurse’s toolkit?

If you answered a stethoscope or a blood pressure cuff, you’re right. But another important tool is the foundation of quality client care — the nursing diagnosis.

In this comprehensive guide, we’ll explore everything you need to know about nursing diagnoses, including their purpose, process, and how to write one effectively.

What is a Nursing Diagnosis?

A nursing diagnosis is a clinical judgment a nurse makes to identify client problems and their causes.

It serves as the basis for planning interventions and evaluating client outcomes.

Unlike medical diagnoses, which focus on identifying diseases, nursing diagnoses focus on:

• The client’s response to the illness
• The associated symptoms
• How the symptoms affect the client’s daily lives

For example, while a medical diagnosis might identify pneumonia, a nursing diagnosis might focus on the client’s ineffective airway clearance due to the disease. A nursing diagnosis allows nurses to create a nursing care plan (NCP) to guide how they care for the client. 

NANDA International (NANDA-I) provides a comprehensive list of standardized nursing diagnoses to ensure consistency and accuracy globally. NANDA-I continuously updates its guidelines to reflect the latest in nursing knowledge, making it easier for nurses to deliver high-quality care.

The standards date back to the 1950s, and about 20 years later, NANDA-I held its first national conference to classify nursing diagnoses.

The organization continues to host these meetings to keep the definitions of diagnoses current.   Nurses can also submit new diagnoses to the organization for review.

Purpose of Nursing Diagnosis

The primary purpose of nursing diagnosis is to provide a framework for identifying and addressing the client’s health needs to improve client outcomes.

It provides a holistic view of the client by considering physical, emotional, social, and environmental factors.

Here’s why nursing diagnoses matter:

• Identification of client needs : Nursing diagnoses help nurses identify the most critical issues affecting a client’s health. By systematically assessing the client, nurses can determine the most pressing concerns, such as pain, risk of infection, or anxiety.
• Early detection and intervention : Early identification of potential health problems allows for timely interventions , preventing complications and improving client outcomes. For example, identifying the risk for falls early on can lead to preventive measures that keep the client safe.

Guidance in developing care plans : Nursing diagnoses are integral in creating effective NCPs. They provide a clear framework for the interventions needed and the expected outcomes. This ensures that care is efficient and effective, meeting the client’s needs.

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Nursing Diagnosis within the Nursing Process

The nursing process is a systematic, client-centered method nurses use to ensure quality care.

It consists of five steps: assessment, diagnosis, planning, implementation, and evaluation (often referred to as ADPIE ).

• Assessment : Gather comprehensive information about the client’s physical, psychological, sociocultural, and spiritual needs.
• Diagnosis : Use the data gathered during the assessment to identify the client’s problems.
• Planning : Set measurable, achievable short- and long-term goals for the client, then identify appropriate nursing interventions.
• Implementation : Carry out the planned interventions.
• Evaluation : Assess the effectiveness of the interventions and adjust the care plan as necessary.

For example, a nurse might note a client experiencing shortness of breath during the assessment phase. Based on this assessment, the nurse might diagnose the client with an ineffective breathing pattern (IBP) , a common nursing diagnosis.

This diagnosis will guide the care plan, which might include interventions such as oxygen therapy and teaching the client breathing exercises. The nurse will then evaluate the effectiveness of these interventions and adjust as needed to improve the client’s breathing pattern.

Nursing diagnoses are essential to the nursing process because they provide a framework for identifying and addressing the client’s needs. They also allow nurses to communicate effectively with other health care professionals, ensuring all team members work towards common goals.

Common Nursing Diagnoses

Below is a common nursing diagnosis list with brief descriptions of how nurses might apply diagnoses in different settings.

• Acute pain : This diagnosis applies to clients experiencing pain that has a sudden onset, typically associated with injury, surgery, or a medical condition. Nurses assess the severity and cause of the pain and implement interventions such as administering pain medication or teaching relaxation techniques.
• Impaired gas exchange : This diagnosis applies to clients with a decreased ability to oxygenate and eliminate carbon dioxide. Nurses monitor respiratory status, administer oxygen therapy as needed, and educate the client on breathing techniques.
• Activity intolerance : An activity intolerance diagnosis applies to clients who have difficulty moving or performing activities of daily living independently. This may arise because of a medical condition or injury. Nurses assess the client’s level of mobility and implement interventions such as range-of-motion exercises, ambulation assistance, or assistive devices.
• Ineffective airway clearance: This diagnosis applies to clients with an obstruction that hinders airflow in the respiratory tract. Nurses assess for signs and symptoms such as coughing, wheezing, or shortness of breath. They then implement interventions such as suctioning, deep breathing exercises, and chest physiotherapy.
• Impaired skin integrity : This diagnosis is for clients with conditions that affect the skin, such as pressure ulcers, surgical wounds, or burns. Nurses would then focus on wound care, repositioning the client regularly, and using moisture barriers to protect the skin.
• Anxiety : This diagnosis is for clients experiencing excessive worry, fear, or nervousness, often related to a medical condition or hospitalization. Interventions may include providing emotional support, teaching relaxation techniques, or referring the client to a counselor.

How to Write a Nursing Diagnosis

Writing a nursing diagnosis involves a systematic approach to ensure clarity and accuracy.

The PES format is widely used in nursing and stands for Problem, Etiology, and Symptoms.

• Problem (P) : Give a problem statement, also known as the diagnostic label, articulating the client’s condition. It might include modifiers or qualifiers that provide additional information about the diagnosis. You’ll also have a focus that explains the diagnosis’ center point.
• Etiology (E) : This refers to the cause or contributing factors of the problem. It’s linked to the problem using the phrase “related to.” For example, “related to immobility” or “related to surgical incision.”
• Symptoms (S) : These are the signs and symptoms the nurse identified during the assessment, providing evidence for the nursing diagnosis. They’re linked to the etiology using the phrase “as evidenced by.” For example, “as evidenced by redness and swelling at the incision site” or “as evidenced by a pain rating of 8/10.”

Correctly written nursing diagnosis example :

• Acute pain related to a surgical incision as evidenced by a pain rating of 8/10 and guarding behavior.

Incorrectly written nursing diagnosis example :

• Pain due to surgery.

The incorrect example is vague and lacks the structure to create an effective care plan. It doesn’t follow the PES format or provide clear evidence to support the diagnosis.

NANDA-I Nursing Diagnosis: 4 Types

There are four main categories of nursing diagnoses. 

• Problem-Focused

A problem-focused diagnosis revolves around the symptoms and signs that the client presents with.

This category comprises the largest proportion of nursing diagnoses. The diagnosis in this situation aims to identify the client’s central problem.

The problem-focused diagnosis includes three main parts:

• The nursing diagnosis itself
• Any related factors
• Any defining characteristics

Nurses use risk nursing diagnoses to determine the interventions needed to prevent certain medical conditions or other problems from developing.

Nurses must use their training and experience to help them see the risks that will impact the client.

A risk nursing diagnosis will include:

• The nursing diagnosis
• Any risk factors
• Health Promotion

A nurse uses this diagnosis to help improve the client’s health.

These diagnoses take a holistic look at the client treated and determine how interventions can help them improve their condition globally. These diagnoses help to promote self-care.

A health promotion diagnosis will include:

However, a nurse can complete the health promotion diagnosis with just a diagnostic label.

A syndrome diagnosis looks for patterns or clusters of nursing diagnoses that all call for related interventions.

For example, a nurse might note that an older adult meets the requirements for frail elderly syndrome. This syndrome requires related interventions that are all targeted at helping the client improve their quality of life while remaining protected from common risks and ailments that come with advanced aging.

A syndrome diagnosis requires only the diagnostic label component.

6 Tips for Writing a Nursing Diagnosis

• Use clear and specific terms to describe the PES.
• Avoid using medical jargon or abbreviations.
• Refer to evidence-based resources such as NANDA-I or your institution’s standardized nursing language.
• Collaborate with the client to verify accuracy and gather additional information.
• Continuously reassess and revise the nursing diagnosis as the client’s condition changes.
• Seek guidance from experienced nurses or use tools such as concept maps or care plans to develop a comprehensive and individualized nursing diagnosis.

Nursing Diagnoses and Care Plans

Nursing diagnoses are the foundation upon which nurses build NCPs.

They provide the basis for:

• Setting goals
• Selecting interventions
• Evaluating outcomes

A well-formulated care plan ensures targeted, effective interventions and better health outcomes.

For example, if a nurse diagnoses a client with a “knowledge deficit” about administering medication, the care plan should include education on drug safety and correct administration techniques. By addressing this problem directly, the nurse can improve client understanding and decrease medication errors.

Effective nursing diagnoses also involve collaboration with clients. Clients often have valuable insight into their health and can provide information to help accurately identify problems.

By involving clients in the process, nurses promote autonomy and encourage active participation in their care. Additionally, collaborating with clients helps build trust between the nurse and client, leading to better communication.

Sample Care Plan Including Nursing Diagnoses

In this sample care plan, the nursing diagnosis of “risk for injury” directly addresses the identified problem and sets specific goals or interventions to decrease the risk of falls.

• Diagnosis : Risk for injury related to unsteady gait and decreased muscle strength secondary to Parkinson’s disease.
• Goals : Client will maintain safety during daily activities.
• Educate client on proper use of assistive devices, such as a walker or cane.
• Ensure clear pathways and remove any potential tripping hazards in the home environment.
• Assist client with transfers and ambulation as needed.
• Evaluation : After two weeks, the client has not experienced any falls or injuries, demonstrating improved safety during daily activities.

Interventions Based on Nursing Diagnoses

Selecting appropriate interventions is critical to addressing the issues identified in the nursing diagnosis.

Tailor interventions to the client’s unique needs and circumstances. This will ensure the most effective and individualized care plan.

Interventions can include independent nursing and collaborative actions with other health care professionals.

For example, in the case of a client with diabetes who is at risk for infection due to poor wound healing, an independent intervention is educating the client on proper wound care and hygiene. A collaborative intervention could involve consulting with a wound care specialist or dietitian to develop a specialized diet plan to promote healing.

Nurses should also incorporate evidence-based practices and standards of care when selecting interventions, ensuring they’re rooted in current research and best practices.  Here are more examples of interventions based on common nursing diagnoses.

Risk for surgical site infection

• Educate client and family on proper wound care techniques.
• Monitor the incision site and look for signs of infection, such as redness or drainage.

Impaired physical mobility

• Encourage regular range of motion exercises to maintain joint mobility.
• Collaborate with physical therapy to develop an exercise plan.

Deficient fluid volume

• Monitor fluid intake and output.
• Provide oral or IV fluids as prescribed.

Ineffective coping

• Encourage the client to express their concerns and feelings.
• Refer to counseling or support groups as needed.

Learn more about nursing interventions and what they are with SimpleNursing.

NANDA-I Nursing Diagnoses: Key Updates

Staying current with NANDA-I guidelines is essential for accurate nursing diagnosis and effective intervention selection.

Here are some key updates from the latest version of NANDA-I:

• Introduced 54 new diagnoses
• Revised 98 diagnoses
• Retired unilateral neglect (00123) due to a lack of research evidence to support diagnoses
• Retired “constipation” and “diarrhea,” which are now defining characteristics in a new diagnosis — impaired intestinal elimination (00344)
• Retired “decreased cardiac output” because it’s another name for a medical diagnosis instead of an independent nursing judgment
• Insomnia and sleep are now diagnostic indicators of an ineffective sleep pattern (00337)
• Revised nursing diagnosis definitions, including those related to risk diagnoses
• Standardized terminology for diagnostic indicators — associated conditions, at-risk populations, defining characteristics, related factors, and risk factors — to provide clarity
• Updated nursing diagnosis labels that align with current literature and accurately represent human responses

Keep Learning with SimpleNursing

Nursing diagnoses are an essential tool for providing high-quality client care.

They help nurses identify and address the most pressing health issues, guide the development of care plans, and ultimately improve client outcomes. To continue learning about nursing diagnoses, interventions, and other important topics in nursing, check out SimpleNursing’s nursing school resources .

Our platform offers a range of materials, including video lectures, quizzes, and study tools to help you succeed.

Join SimpleNursing today to enhance your nursing knowledge and provide the best possible care for clients.

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Community Diagnosis, Planning, and Intervention

Chapter 16 Community Diagnosis, Planning, and Intervention Frances A. Maurer and Claudia M. Smith Chapter Outline Population-Focused Health Planning Population Targets and Intervention Levels History of U.S. Health Planning Rationale for Nursing Involvement in the Health Planning Process Nursing Role in Program Planning Planning for Community Change Community Organization Models Structures for Health Planning Steps of Program Planning Assessment Analysis of Data Diagnosis Validation Prioritization of Needs Identification of the Target Population Identification of the Planning Group Establishment of the Program Goal Identification of Possible Solutions Matching Solutions with At-Risk Aggregates Identification of Resources Selection of the Best Intervention Strategy Delineation of Expected Outcomes Delineation of the Intervention—Work Plan Planning for Program Evaluation Tools Used to Present and Monitor Program Progress Implementation Types of Interventions Strategies for Implementing Programs Focus Questions What is the history of contemporary health planning in the United States? What are the responsibilities of community/public health nurses in planning health-related changes with communities? How do models of community organization relate to health planning? What principles and steps can assist the nurse and community in developing an effective plan? What are examples of community diagnoses? How are priorities determined in health planning with communities? What is a target population? What are common types of interventions typically planned by community/public health nurses? What are strategies for implementing plans? Key Terms Community empowerment Community organization models Data gap Gantt Chart Management objectives North American Nursing Diagnosis Association (NANDA) classification system Nursing Outcomes Classification (NOC) Omaha System Outcome objectives Planned Approach to Community Health (PATCH) Planning, Programming, and Budgeting System (PPBS) Population-focused health planning Process objectives Program Evaluation and Review Technique (PERT) Social action Social planning Target population Chapter 15 provides community/public health nurses with the basics of community assessment, the first step in the nursing process. The chapter illustrates the use of a systems-based community assessment tool to assist nurses in gathering information about a community. This chapter continues the nursing process with communities ( Figure 16-1 ), introducing the process of planning and implementing population-focused health care in communities. The components of and steps used in program planning, the types of interventions appropriate for the community level, and the responsibilities of the community/public nurse in planning and implementing care with populations are described. The nursing process is dynamic, not static, as the arrows in the figure illustrate. Health intervention plans may be modified as new information becomes available. It is important to include community members in as many steps in the process as possible. Input from the population(s) should be elicited regarding analyzing the assessment data to determine population diagnoses and priorities, identifying desired outcomes, planning, and evaluation ( American Nurses Association [ANA], 2007 ). Figure 16-1 Illustration of the nursing process with communities. Population-focused health planning Health planning is a continuous social process by which data about clients are collected and analyzed for the purpose of developing a plan to generate new ideas, meet identified client needs, solve health problems, and guide changes in health care delivery. To date, you have been responsible primarily for developing a plan of care for the individual client. How do you go about developing a plan of action to meet the health needs of a community? How is the plan different from that for the health of an individual or a family? What types of nursing actions and interventions are appropriate for the community? Population Targets and Intervention Levels Population-focused health planning is the application of a problem-solving process to a particular population. In population-focused health planning, communities are assessed, needs and problems are prioritized, desired outcomes are determined, and strategies to achieve the outcomes are delineated. Persons for whom you desire change to occur are referred to as the target population . Planning care for groups or populations results in programs, and hence the term program planning is often used when planning care at the community level. Programs may be aimed at the primary, secondary, or tertiary level of prevention. For example, a health education program about safer sex is aimed at preventing sexually transmitted diseases through health-promotion measures (primary prevention); a program to screen preadolescent girls for scoliosis is geared toward early detection and treatment (secondary prevention); and an exercise program for stroke victims to limit or minimize their disability is an example of a tertiary level of prevention. Population-focused health planning can range from planning health care for a small group of people to planning care for a large aggregate or an entire city, state, or nation. The planning process described in this chapter is applicable to all types of communities (phenomenological and geopolitical) and to all levels of planning (local, state, national, and international). Health planning can be proactive or reactive. The goal is to use a more proactive approach and for nurses to be an integral part of the planning process. History of U.S. Health Planning The history of health planning in the United States has alternated between the federal and state governments. Before the 1960s, health planning occurred primarily at the state level. In the 1960s, health planning became a federal effort. In 1966, the Comprehensive Health Planning and Public Health Service Amendment was passed to enable states and local communities to plan for better health resources. Inadequate funding allocation led to the National Health Planning and Resources Development Act of 1974. This legislation created a national network of health system agencies and statewide coordinating councils responsible for health planning. The intent was to improve health status and care, while reducing cost. These goals were to be achieved by preventing unneeded or duplicate services, decreasing fragmentation of services, and coordinating resources. New services were encouraged based on regional needs assessments. In the 1980s, President Reagan aimed to reduce both the size of the federal government and the influence the federal government had on states. His administration eliminated the federal budget and planning requirements while encouraging states to make their own planning decisions. The federal health objectives for the years 2000, 2010, and 2020 suggest targets for local communities and states to consider ( U.S. Department of Health and Human Services [USDHHS], 2010a ). Increasing costs have placed heavy demands on the health care system (see Chapters 3 and 4 ). As a result health planning has essentially become economically focused. The federal government has attempted to control its share of health care costs by changing reimbursement methods, and shifting some of the budget responsibilities to the states. Because the federal government mandates health care services in those specific programs, states are left with limited autonomy to plan and deliver health care services. In 1980, the Omnibus Budget Reconciliation Act encouraged the use of noninstitutional services, such as home health care, to fight escalating costs. In 1983 the Prospective Payment System drastically changed hospital reimbursement, resulted in shorter hospital stays for patients, shifted care into the community, and placed greater responsibilities for care of relatives on family members (see Chapters 3 4 and 28 ). The Gramm-Rudman-Hollings Budget and Deficit Control Act of 1985 added additional budget controls and cutbacks to health care. Taken together, these and subsequent federal efforts have presented a challenge to all health care professionals to plan and implement cost-effective health care programs that meet the needs of the people they serve. It is imperative that nurses become more cognizant of the health care planning process and their role within it. The 1990s and early 2000s offered new opportunities for nurses to be involved in efforts to reform the nation’s health care system ( ANA, 1991 ). Debate continues about the degree to which government should be involved in health planning and whether federal or state planning is preferred (see Chapter 3 ). The federal Patient Protection and Affordable Care Act (Affordable Care Act) of 2010 requires access to health care for most Americans. Some states have already passed their own health care legislation, ensuring access to health care, identifying standard health benefit packages, and budgeting or requiring finance mechanisms. A greater interest has developed in ensuring that planning efforts also address the quality of health care. Furthermore, Healthy People 2020 includes a goal that federal, state, and local public health infrastructures should have the capacity to provide essential public health services ( USDHHS, 2010a ). Health care planning for specific geopolitical communities continues at the state and local levels. Community/public health nurses are involved with specific communities to assess community needs. Nurses explore how the Healthy People 2020 objectives apply to these geopolitical or phenomenological communities. Based on the assessments, community/public health nurses participate with others to develop plans to meet the health care needs of the people. There are federal requirements for hospitals to report in detail their community benefits activities (uncompensated care and other services) to the Secretary of the Treasury ( Internal Revenue Service, 2011 ). In addition the 2010 Patient Protection and Affordable Care Act requires tax-exempt hospitals to do a community-needs assessment every three years. That assessment is intended to assist in planning how to best use hospital resources to the community’s benefit ( Public Law 148, 2010 ). Rationale for Nursing Involvement in the Health Planning Process Florence Nightingale and Lillian Wald pioneered health planning based on an assessment of the health needs of the communities they served (see Chapter 2 ). Additionally, nurses have long been involved in implementing programs planned by other disciplines. Both the American Nurses Association (ANA) (2007) and the American Public Health Association (APHA) (1996) state that the primary responsibility of community/public health nurses is to the community or population as a whole and that nurses must acknowledge the need for comprehensive health planning to implement this responsibility. Both professional organizations identify program planning as a primary function of the community/public health nurse. In addition to mandates from professional organizations, nurses should be involved in program planning for several reasons. Nurses make up more than one-third of all health care workers in the United States and implement the majority of health care programs. Our involvement in numerous and diverse health programs has given us experience in seeing what works and what does not. This experience helps identify difficulties that can be avoided in the future. Nurses spend a greater amount of time in direct contact with their clients than do any other health care professionals. We are with the clients in the community, gaining first-hand information about their health, their lifestyles, their needs, and what it is like to be a member of that community. This exposure to the community places us in the unique position of possessing valuable information that is useful to the planning and implementation of successful health programs. Not only do nurses make up a large portion of health care providers, they also make up a large portion of health care consumers in the United States. With the emphasis on consumer participation in health planning, nurses are in a unique position to make an impact in the planning of population-focused health programs. Nursing Role in Program Planning Planning for change at the community level is more complex than at the individual level. Components to the client system have been increased, and more people and more complex organizations are involved. Baccalaureate-prepared community/public nurses are expected to apply the nursing process with subpopulations or aggregates with limited supervision ( American Association of Colleges of Nursing, 1986 ; ANA, 2007 ). If nurses practice in agencies with a broad public health mandate, they will find that the scope of their focus shifts to larger populations ( APHA, 1996 ). Community/public health nurses prepared at the baccalaureate level are expected to collaborate with others to assess the entire population and multiple aggregates in a geopolitical community ( ANA, 2007 ). Therefore community health planning often takes a multidisciplinary approach, which requires excellent teamwork and thorough communication. The roles of collaborator, coordinator, and facilitator are important when working with the community as client. A necessary task is to collaborate with people from the community to validate nursing diagnoses made from the assessment; to plan with, not for, the community; and to enlist community members’ support and assistance in implementing change. If the community is not involved from the beginning, the program may not be effective. Just as you will have better adherence and outcome from planning care with an individual client, so, too, you will have a more successful program if you involve the community in the assessment and planning phases. The coordinator role emerges when working with a variety of community members and organizations within and outside of the community. The nurse is in a key position to coordinate the activities and facilitate the community’s ability to achieve a higher level of health. However, to effect change at the community level, community organization must be understood. Planning for community change To plan and implement programs at a community level effectively, the community/public health nurse must understand how the community works, how it is organized, who its key leaders are, how the community has approached similar problems, and how other programs have been introduced in the past. The health care professional who is facilitating the community organization process with regard to a specific health need or problem must work with the community members. To be an effective change agent in applying the nursing process, the nurse must be aware not only of the community and how it works, but also of methods of community organization that facilitate change. Community Organization Models Rothman (1978 , 2008) identifies three community organization models designed to facilitate change in a community: community development (now called empowerment), social planning, and social action. The three models can be used separately or in combination. Although the models are presented here in pure form, in reality, they are generally combined. Social planning was the model most used by community health nurses and other public health care practitioners between the 1970s and the early 1990s. However, community organization approaches used by Lillian Wald and others during the nineteenth century, as well as during the 1960s, are reemerging as models for community empowerment. Each model contains four components: goals, strategy, practitioner role, and medium of change. Table 16-1 summarizes the salient points from each of the three models. A thorough understanding of the components is necessary in planning for change in a community. Each model involves community change. Table 16-1 Three Models of Community Organization Practice According to Selected Practice Variables Variables Community Empowerment Social Planning Social Action Goal categories of community action Self-help; community capacity and integration (process goals) Problem solving with regard to substantive community problems (task goals) Shifting of power relationships and resources; basic institutional change (task or process goals) Basic change strategy Broad cross-section of people involved in determining and solving their own problems Fact gathering about problems and decisions on the most logical course of action Crystallization of issues and organization of people to take action against obstructive targets Salient practitioner role Enabler-catalyst; coordinator; teacher of problem-solving skills and ethical values Fact gatherer and analyst; program and policy designer and implementer; facilitator Activist or advocate; agitator; broker; negotiator; partisan Medium of change Guiding of small task-oriented groups Guiding of formal organizations and of data Guiding ongoing action groups and mobilizing of ad hoc mass action groups Adapted from Rothman, J. (1978). Three models of community organization practice. In F. Cox, J. Erlich, J. Rothman, et al. (Eds.), Strategies of community organization: A book of readings (pp. 25-45). Itasca, IL: Peacock Publications; and Rothman, J. (2008). Approaches to community intervention. In J. Rothman, J. Erlich, & J. Tropman (Eds.), Strategies of community intervention (7th ed., p. 163). Peosta, IA: Eddie Bowers Publishing Company. Community Empowerment Models The community empowerment model is an approach designed to create conditions of economic and social progress for the whole community and involves the community in active participation. The community empowerment approach is also referred to as the locality development approach because of its work within the community. The community-locality development model is a grassroots approach that uses a democratic decision-making process, encourages self-help, seeks voluntary cooperation from the members, and develops leadership within the group ( Milio, 1971 ). In this approach, community members believe they have some control over their destiny and therefore become actively involved. The change strategy is characterized by, “We know we have a problem, let’s get together and discuss it.” The theory underlying this model is that if people are involved in determining their own needs and desires, they will become more active in solving their problems than if someone else comes in and solves the problems for them. If they are more active in working out solutions to their own problems, they will be more satisfied with the solutions and will continue to expend energy to make them work. That is, if they are vested in the solutions, they will have more of a commitment to them. The solutions will be more sustainable ( Bent, 2003 ). This model seeks to build on community assets and strengthen community competence. The community empowerment model is especially important for communities with vulnerable and underserved populations. This model is being used successfully in both urban and rural communities. Urban example . In the inner city of Chicago, Illinois, a team of nurses identified a community need to improve maternal and infant health outcomes because the community had higher rates of maternal and infant complications than the national norm. Assessment indicated that women from minority groups (African American and Hispanic) in the community needed support to follow through with prenatal and postpartum care, education to improve parenting skills, and encouragement to use health prevention behaviors, such as immunizations, to improve the health status of both the mothers and the infants. The nurses implemented the REACH-Futures program, which is a home-visiting program designed to monitor the health status of participants, provide appropriate health services as needed, and improve the health and welfare of both young mothers and their infants. The project enrolled 588 African American and Hispanic pregnant women into an intervention program that used both health professionals (nurses) and community workers to deliver health services. Each team consisted of one nurse and two community workers. Home visits were initiated in the last trimester of pregnancy and continued at 1-month intervals, or more often as necessary, for a planned 36 months. The community workers, who did most of the home visits, were trained in child development milestones, appropriate parenting skills and techniques, the identification of home safety and health hazards, and strategies to improve compliance with immunization schedules and well-baby visits ( Norr et al., 2003 ). Initial evaluation of the program, after 1 year, indicated that the community workers were effective in supporting young mothers and improving parenting skills and compliance with immunization schedules and well-baby visits. Rural example . Community health nurses enlisted the use of “community guides and community leaders” to identify health resources and solutions for older adult residents and their caregivers in a Mexican American community in Arizona ( Crist & Dominguez, 2003 ). The health interventions were secondary and tertiary, aimed at increasing the knowledge and use of health care services by the older adults and their caregivers. The nurses recruited nanas (grandmothers) as actors in a short play or telenovela designed to reduce resistance to use of health services. Additional community collaborative efforts included development of an Elders Use of Services Community Advisory Council to assist and guide the nurses toward community-acceptable interventions. This approach, then, has the potential of having the longest lasting effect of the three models to be discussed. However, the task is also the most time-consuming to initiate because time is required to discuss the problems, to make decisions democratically, and to develop leadership within the group that will be able to sustain the program. Therefore even though the community-locality development approach to community organization is successful, it may not always be used in pure form because of the amount of time required to accomplish the action. Social Planning Model The social planning approach emphasizes a process of rational, deliberate problem solving to bring about controlled change for social problems. This method is an expert approach in which knowledgeable people (experts) take responsibility for solving problems. The degree of community involvement may be very small or very great. (The greater the involvement is, the more successful the outcome will be.) The social planning approach is characterized by, “Let’s get the facts and proceed logically in a systematic manner to solve the problem.” Pertinent data are considered before decisions are made about a feasible course of action to meet the need. Agencies and organizations frequently use this approach as they attempt to effect desired change. The legislative and regulatory process is one example of a social planning approach. Problems are identified, data are collected, and bills are introduced into local, state, or national legislative bodies to effect change. A social planning approach is also used when a local health department institutes a program of directly observed therapy for treating tuberculosis. Public health nurses use facts gathered about the prevalence of tuberculosis in the community, as well as public health and nursing literature about effective treatment programs, to plan a program to directly observe persons with active tuberculosis take their antituberculosis medications. The social planning approach can be effective, but it has one major pitfall: the potential for lack of community involvement. Much money has been spent and many health programs have failed because experts have planned programs for the community instead of with the community. The health planners, the nurse experts, must develop a partnership with the community for effective health care planning ( ANA, 2007 ). Social Action Model The social action approach is a process in which a direct, often confrontational, action mode seeks redistribution of power, resources, or decision making in the community or a change in the basic policies of formal organizations, or both. In this approach, one group of people or segment of an organization or community is feeling oppressed, and the organization or community is viewed as needing basic changes in its institutions or practices. Nonviolent civil disobedience or aggressive actions may be taken to facilitate these changes. This approach, which is direct and often confrontational and radical, may be characterized as follows: “Let’s organize to rectify an imbalance of power.” In the 1960s the social action approach was used a great deal. The civil rights movements and protests against the Vietnam War are examples of the social action approach. Current examples include welfare rights organizations and advocacy groups for the environment or for the homeless, as well as some antiabortion groups. Citizens in the Chattanooga Creek area of Tennessee became concerned about the quality and safety of water in the Chattanooga Creek. A local environmental activist group, Stop Toxic Pollution (STOP), organized. STOP contacted local public health nurses, other health professionals, and the Agency for Toxic Substances and Disease Registry (ATSDR). ATSDR is a federal agency responsible for preventing and mitigating the health hazards of exposure to toxic wastes. An assessment conducted by local health personnel, area residents, and a nurse researcher from ATSDR revealed several potential sources of pollution and 42 hazardous waste sites. A nursing diagnosis was developed: Potential for injury —residents who were exposed to creek water or ate fish from the creek were at risk of short-term gastrointestinal and skin problems, and long-term skin or liver cancer. The following three-pronged intervention strategy was devised: 1.  Public education 2.  Public protection 3.  Clean up hazardous waste sites ( Phillips, 1995 ) STOP, community nurses, and other local health providers were actively involved in developing and implementing the public education program aimed at both adults and children. The group also cooperated in ensuring that the problems with the creek remained in the news. Publicity about the situation facilitated the public education aspect of the intervention and also spurred public officials to take remedial actions to isolate the hazards. Finally, the site was placed on the National Priorities List for pollution cleanup. Change Theory Each of the community organization models involves change. Change can be threatening and stressful or it can be exciting and rewarding. Understanding some theory about planned change will provide a guide to use in the planning process. Lewin (cited in Dever, 1991 ) describes change as being a three-stage process: unfreezing, moving, and refreezing. In the first stage, unfreezing, a need for change is identified. The stimulus for the perceived need may be within the client or come from an outside force. Disequilibrium exists or is created, making a disruption in the status quo (unfreezing), and change is initiated. Moving, the second stage of the change process, occurs when the proposed change is tried out by the people involved, old actions are questioned, and attitude changes occur, creating movement toward acceptance of the proposed change. This phase is a vulnerable time for the people involved, because change is threatening and anxiety producing. Individuals will need help and support while trying out the proposed change. Refreezing, the third stage of the change process, occurs when the change is established and accepted as a permanent part of the system. Stabilization of the situation occurs. Lewin also describes forces that facilitate (driving forces) or impede (restraining forces) change. Driving forces must exceed restraining forces for change to occur. Structures for Health Planning Several structures or schemes have been developed by national organizations to help communities plan for improving their health. These structures encourage collaborative partnerships and comprehensive assessments as building blocks for community health planning. Planned Approach to Community Health (PATCH) is a program initiated by the Centers for Disease Control and Prevention. PATCH attempts to engage entire geopolitical communities in a comprehensive assessment of their health needs rather than focusing solely on high-risk groups or those served by a specific health institution. PATCH depends on the participation of citizens and the cooperation of several organizations within the community in partnership with local and state government resources. Gage County, Nebraska has used PATCH strategy to plan interventions to address health issues found as a result of a county-wide behavioral risk survey. The PATCH coalition identified several priority risk areas and developed programs to address them, including the following: •  Improve nutrition through school and work site education •  Reduce injuries through increasing car seat and seat belt use •  Improve physical fitness by increasing opportunities for county residents to engage in physical activities ( Gage County PATCH, 2011 ). The National Association of County and City Health Officials (NACCHO) developed a strategic planning tool, Mobilizing for Action through Planning and Partnerships (MAPP) ( NACCHO, 2008 ). MAPP is intended for use by local health departments in planning with geopolitical communities to improve health status and public health system capacities (see Chapters 15 and 29 ). The tool emphasizes community ownership of the process. The action cycle of MAPP includes planning, implementation, and evaluation. The World Health Organization adopted the Healthy Cities program in the 1980s to promote the health of urban communities ( Kegler et al., 2009 ). Collaboration among multiple community sectors and community participation are hallmarks of this model, which focuses on the role of local government in creating physical, social and economic environments that promote health ( Rabinowitz, 2001 ). Over 3000 projects exist worldwide in both urban and rural areas. The Healthy People 2020 objectives are introduced in Chapter 2 and used as examples throughout the text. Many state and local jurisdictions have developed health improvement plans that link the national perspective of Healthy People 2020 with local needs. Steps of program planning The planning process consists of a series of specific steps. Although each of these steps is necessary, the steps do not have to occur in the exact sequence given here. Occasionally, several steps may be undertaken simultaneously, or they may occur in a slightly different order. Identification of the planning group may occur much earlier in the sequence. The steps are as follows: 1.  Assessment 2.  Diagnosis 3.  Validation 4.  Prioritization of needs 5.  Identification of the target population 6.  Identification of the planning group 7.  Establishment of the program goal 8.  Identification of possible solutions 9.  Matching solutions with at-risk aggregates 10.  Identification of resources 11.  Selection of the best intervention strategy 12.  Delineation of expected outcomes 13.  Delineation of the intervention work plan 14.  Planning for program evaluation Some researchers call steps 8 through 14 operations planning (e.g., Hale et al., 1994 ). Assessment A thorough, accurate assessment of the community is the first essential step in program planning. Chapter 15 provides a framework for community assessment and assessments of a geopolitical and a phenomenological community. Analysis of Data A systematic analysis of the data collected is necessary to identify the problems, needs, strengths, and trends in the community. Categorizing the data first is always helpful to identify the inferences that are descriptive of actual or potential health problems. The community assessment described in Chapter 15 provides a framework in which to categorize the data about community functioning. Within each subsystem, nurses identify resources (assets, strengths) and demands (deficits, weaknesses), looking not only at whether something is present, but also to what extent, how it is working, and how it relates to the past and future to provide an idea of trends over time. Nurses also consider the health status of the population. Typically, the nurse identifies high-risk aggregates among the population as well. In addition to illustrating the community’s strengths and weaknesses, an analysis will provide information about demographic and personal characteristics, which are important to consider when planning and implementing health programs. For example, if you are working with a group of senior citizens enrolled in a senior center and your assessment indicates a potential risk for injury by fire, what other factors should you consider in the assessment data before you plan a fire prevention program? One factor that comes to mind is the educational level of the senior citizens. Knowing the educational level provides information about the appropriate level at which to plan the teaching interventions. The level of disability and social functioning indicates the presence of visual or hearing impairments that might affect the type of teaching strategy you use. Additionally, if many seniors are in wheelchairs or need assistive devices, you would focus the program on fire safety involving limited mobility and would need to modify practice sessions to the participants’ level of ability. In other words, analysis of community data provides information not only about what is needed, but also about what will be appropriate in the intervention. Data Gaps Assessment sometimes reveals areas in which all the information is not available. This lack of information is called a data gap . The nurse must identify areas of insufficient information and devise a strategy to collect additional data if possible. Data gaps themselves may sometimes be informative. For example, if you cannot find out the date of a town council meeting, it might imply that the council is not open to citizen input. Ways to Display Data for Analysis As shown in Chapter 7 , displaying data that aid in the analysis process can be done in a variety of ways. Graphs, charts, histograms, and mapping techniques are some of the most common visual displays. Computer-based geographical information systems (GIS) that map data spatially are becoming more widely used (see Chapter 15 ). Obtaining as much data as possible that are specific to the target population is important. Table 16-2 includes the age and sex of people living in census tract 1 and city X. Census tract 1 data are included in city X totals, but, as can be seen, census tract 1 is quite different from city X. The population of the census tract is younger than the total city population, and data from the city cannot be used to describe the residents of the census tract. Looking at city X data only and thinking that the data would apply specifically to census tract 1 would not be accurate. Table 16-2 Comparison of Age by Sex of Populations in Census Tract I and City X, 2000   Census Tract 1 City X Age (Year) Number Percentage Number Percentage Male Under 5 548 6.9 38,512 4.3  5-9 743 9.4 44,204 4.9 10-19 1280 16.2 84,037 9.3 20-34 401 5.1 85,373 9.4 35-54 293 3.7 95,793 10.6 55-64 89 1.1 41,788 4.6 65-74 33 0.4 25,938 2.9 75 and above 21 0.3 11,822 1.3 Total 3408 43.0 427,467 47.2 Female Under 5 522 6.6 37,567 4.1  5-9 782 9.9 43,502 4.8 10-19 1323 16.7 86,668 9.6 20-34 930 11.7 95,611 10.6 35-54 701 8.8 108,122 11.9 55-64 140 1.8 48,920 5.4 65-74 80 1.0 36,165 4.0 75 and above 41 0.5 21,737 2.4 Total 4516 57.0 478,292 52.8 Total population 7924 100 905,759 100 Diagnosis After analyzing the data, the next step is to make a definitive statement (diagnosis) identifying what the problem is or the needs are. Nursing diagnoses for communities may be formulated regarding the following issues: •  Inaccessible and unavailable services •  Mortality and morbidity rates •  Communicable disease rates •  Specific populations at risk for physical or emotional problems •  Health-promotion needs for specific populations •  Community dysfunction •  Environmental hazards ( ANA, 1986 ) The format of the problem statement varies, depending on the philosophy of the agency conducting the assessment. For example, problems or needs may be stated simply in epidemiological terms, such as a high rate of adolescent pregnancies, whereas in other instances you may be asked to state the problem or need as a nursing diagnostic statement. Nursing diagnosis has evolved since 1973 as a result of the efforts of the North American Nursing Diagnosis Association (NANDA) ( NANDA, 2009 ). The initial North American Nursing Diagnosis Association (NANDA) classification system of nursing diagnoses focused on the physical needs of individual clients but was not applicable to the family and community situations faced by community health nurses. Over the years, the NANDA classification system has expanded to include biological, psychological, and social needs of individuals and families. Because of ongoing refinement, the taxonomy of nursing diagnoses at present has 11 functional health patterns. Tools have been developed to assess the community using the functional health pattern typology ( Gikow & Kucharski, 1987 ; Wright, 1985 ). Newer NANDA diagnoses may also apply to communities; examples include the diagnoses impaired home maintenance and impaired social interaction . Other classification systems have been developed in an attempt to address the community. One example is the Omaha System , written by community/public health nurses for community/public health nursing practice ( Martin, 2005 ). The system was designed by the Omaha Visiting Nurse Association and has been used in home care, public health, and school health practice settings, among others. Client problems/needs/concerns are organized into four domains: physiological, psychosocial, health-related behaviors, and environmental. Each domain may involve actual or potential problems or opportunities for health promotion. The system includes four categories of interventions: teaching, guidance, and counseling; treatments and procedures; case management; and surveillance. Although originally developed for application with individuals or families, users are now applying the problem domains and interventions with communities ( Martin, 2005 ).The Omaha System includes more environmental and community factors than are considered in the NANDA system. Because of the multiple nursing diagnostic and classification systems, the NNN Alliance has formed to develop a consistent classification system. The NNN Alliance is a collaboration of NANDA and the Center for Nursing Classification and Clinical Effectiveness (CNC). The taxonomy developed by the NNN Alliance has four domains ( Dochterman & Jones, 2003 ). The one relevant to community health practice is the environmental domain, with three subsets: health care system, populations, and aggregates. All three subsets have diagnosis, outcome, and intervention arenas. Because community/public health nursing is concerned with health promotion, other nurses have developed ways to add wellness diagnoses to the problem-focused diagnoses of NANDA. Neufield and Harrison (1990) recommend that wellness nursing diagnoses for populations and groups include three components: the name of the specific target population, the healthful response desired, and related host and environmental factors. For example, high school students with children (target population) have the potential for responsible parenting (desired response); this potential is related to a desire to learn about child development (host factor) and the presence of a family life education curriculum and an availability of teachers (environmental factor). During the late 1990s and early 2000s, NANDA added several community-focused diagnoses: readiness for enhanced community coping, ineffective community coping ( NANDA, 2002 ) and risk for contamination ( NANDA, 2007 ). These diagnoses address a community’s ability to adapt and solve problems. How does the nurse formulate a community-focused nursing diagnosis? A diagnosis is a statement that synthesizes assessment data; it is a label that describes a situation (state) and implies an etiological component (reason). A nursing diagnosis limits the diagnostic process to the diagnoses that represent human responses to actual or potential health problems that are within the legal scope of nursing practice. A nursing diagnosis has three components: a descriptive statement of the problem, response, or state; identification of factors etiologically related to the problem; and signs and symptoms that are characteristic of the problem ( Carpenito, 2000 ). Using this information, let us take a moment to try to state nursing diagnoses for some problems on the community level. Situation 1 Howard County is a suburban county with a rapidly increasing number of older adults. The assessment data indicate the presence of only one taxicab company serving that area. No public bus system is available. Obviously, the problem is lack of transportation; but how might this be worded in nursing diagnosis format? Suggestion: Altered health-seeking behaviors related to inadequate transportation services for senior citizens However, inadequate transportation probably also affects other areas of seniors’ lives, such as socialization and community participation. If this factor were validated through further assessment, an additional diagnosis might be as follows: Impaired social interactions related to inadequate transportation for senior citizens Situation 2 Students in Johnson High test very low on an acquired immunodeficiency syndrome (AIDS) awareness survey. Further investigation reveals that no information is provided to the students, and the parents do not want information taught in the school. Ninety-eight percent of the students stated that they do not believe they are in any danger of getting human immunodeficiency virus (HIV). Suggestion: Lack of knowledge about HIV/AIDS in high school students related to: •  Inadequate information provided in school curriculum •  Parental attitudes about the disease •  Perception that they are not at risk for the disease

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Nursing Diagnosis: Examples & How To

Table of contents, what is a nursing diagnosis .

A nursing diagnosis is a clinical judgment and a statement about a patient’s response to actual or potential health conditions or needs. It serves as the basis for selecting nursing interventions and making appropriate clinical decisions. 

Making nursing diagnoses is the second step of the 5-step nursing process (ADPIE): 

• Assessment 
• Implementation
• Evaluation 

In this step, the nurse actually identifies their client’s problems and names them according to nursing diagnoses. 

Nursing diagnosis vs medical diagnosis

Medical diagnoses are made by physicians and identify a specific disease that a patient has. 

Nursing diagnoses, on the other hand, focus on the patient’s response to that disease or condition , guiding individualized care plans. Nursing diagnoses are standardized and often use frameworks like NANDA-I (North American Nursing Diagnosis Association International) for consistent terminology and categorization. 

How to write a nursing diagnosis

The goals of making nursing diagnoses are:

• Provide a concise definition of the patient’s response to a health condition
• Allows nurses to communicate in a common language
• Enables nurses to analyze assessment data 

How to make nursing diagnoses: 

• Activate critical reasoning skills.
• Observe for bodily changes.
• Determine strengths and unmet needs.
• Identify health risks.
• Cluster assessment data and match them with the NANDA nursing diagnoses.

What is the NANDA?

The NANDA-I (North American Nursing Diagnosis Association International) diagnostic manual is a compilation/list of nursing diagnoses originally recognized in 1973, with continued growth through nursing research.

Nursing diagnosis examples

Assessment data: Client has difficulty breathing when walking short distances and is wringing their hands during interaction. 

Nursing diagnosis: 

• Activity intolerance

Assessment data: Client has alteration in fluid volume due to dehydration, anemia, neurological impairment, and impaired memory related to dehydration. 

Fitting official NANDA nursing diagnoses for this assessment include Fluid volume deficit and impaired memory. 

Nursing diagnosis practice questions

Which nursing diagnosis would best apply to a child with allergic rhinitis .

A child with allergic rhinitis will experience increased mucus production, nasal congestion, and postnasal drip. These symptoms can lead to the child having difficulty maintaining a clear airway, which is correctly diagnosed with the nursing diagnosis of ineffective airway clearance. 

Which nursing diagnosis would best apply to a child with rheumatic fever? 

A child with rheumatic fever likely will experience joint pain and inflammation. Relevant nursing diagnoses would include acute pain related to inflammation and swelling , plus potentially impaired mobility and others. 

Which condition is most likely to have a nursing diagnosis of fluid volume deficit? 

The condition most likely to have a nursing diagnosis of fluid volume deficit is dehydration . Other conditions that may warrant this diagnosis include severe burns, hemorrhage, or conditions that cause polyuria like uncontrolled diabetes.

Why would a nursing diagnosis of a cough be incorrect? 

A nursing diagnosis of “a cough” would be incorrect because a cough is a symptom, not a nursing diagnosis.  Potential correct nursing diagnoses in a client suffering from a cough could be ineffective airway clearance, impaired gas exchange , or others depending on the assessment.

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Mastering the Art of Nursing Diagnosis: A Complete Guide

• Last Updated: July 20, 2023

A nursing diagnosis is a systematic method utilized by nurses to collect and analyze clinical-assessment data, which then informs the development of a tailored care plan to address the unique health needs and challenges faced by individual patients.

As a nursing student or a registered nurse, you might have come across the term “nursing diagnosis.” But what exactly does it mean, and why is it important? 

Well, diagnosis is an essential part of nursing that helps nurses provide adequate patient care. To fully comprehend the process, its purpose, and how to write a nursing diagnosis, you must know its three main components and the classifications made by The North American Nursing Diagnosis Association .

Table of contents

What is nursing diagnosis, what is the purpose of nursing diagnosis, examples of nursing diagnoses, nursing diagnosis vs. medical diagnosis vs. collaborative problems, nanda diagnosis, level 1: domains, level 2: classes, level 3: nursing diagnoses, the 5 types of nursing diagnoses, the 3 main components of a nursing diagnosis, how to write a nursing diagnosis.

Much like a roadmap, nursing diagnosis helps nurses navigate their patient’s health status as well as identify potential health problems. Its primary purpose is to guide nurses and other healthcare professionals on the best routes to follow while taking into account relevant factors related to their patient’s conditions. Like a map, the nursing diagnosis helps people reach their desired destination—good health.

Nursing diagnosis refers to a clinical judgment made by a nurse to identify their patient’s potential or actual health problems that can be managed independently by the nurse or collaboratively with other healthcare professionals. It provides the basis for selecting nursing interventions to achieve outcomes for which the nurse is accountable.

The primary purpose of a nursing diagnosis is to provide a framework for nurses to identify and prioritize patients’ health problems and address potential health concerns based on the data collected during the nursing assessment. So, nurse diagnosis guides the development of nursing care plans and interventions tailored to the patient’s needs.

Nursing diagnosis also serves as a channel for enhancing communication among healthcare professionals. The diagnosis helps share relevant data about the patient’s needs and potential problems with other healthcare personnel, including physicians, therapists, and social workers, through clear descriptions of the patient’s condition, interventions, and predicted results.

Based on the symptoms that the patient shows, nurses can conclude various nursing diagnoses, such as:

• Risk for Infection: A nurse may write such a diagnosis for a patient at risk of developing an infection due to a compromised immune system, surgical incisions, or indwelling catheters.
• Impaired Skin Integrity: A nurse may write such a diagnosis for a patient with an altered epidermis due to accidents, immobility, pressure ulcers, or surgical incisions.
• Impaired Mobility: A nurse may write such a diagnosis for a patient struggling with movement or activity due to an injury, stiffness, or chronic conditions such as arthritis.

Though they sound similar, nursing diagnosis, medical diagnosis, and collaborative problems differ in focus and scope. 

A nursing diagnosis is a clinical judgment made by a nurse in contrast to a medical diagnosis generally made by a physician. Then, nursing diagnoses identify concerns based on the data gathered during the initial assessment. So, they focus on the patient’s response rather than the disease or medical condition. 

On the other hand, medical diagnoses are based on results from medical tests and physical examinations. Thus, they serve to identify a specific disease or condition. Collaborative problems combine the two by involving nursing and medical diagnoses related to the patient’s medical condition and are a joint effort between various healthcare team members.

Lastly, nursing diagnoses help develop an individualized patient care plan, whereas medical diagnoses guide the medical treatment process, and collaborative problems integrate both practices.

The North American Nursing Diagnosis Association (NANDA) developed a standardized nursing diagnosis system that provides a framework for identifying, categorizing, and addressing patients’ health problems. The NANDA diagnosis involves several diagnosis types based on examination, analysis, and interpretation of patient data. Ultimately, it aims to ensure consistent nursing care across different healthcare settings.

Classification of Nursing Diagnoses 

Various classification systems may be used to categorize nursing diagnoses, such as the Clinical Care Classification (CCC) system or the International Classification for Nursing Practice (ICNP). However, one of the most widely used systems is the NANDA-I Taxonomy II.

According to the latest NANDA-I 2021-2023 edition, nursing diagnoses are organized and categorized based on their characteristics and related factors. This taxonomy consists of three levels.

This taxonomy includes 13 domains to categorize nursing diagnoses based on the patient’s health status or problem. These domains include:

• Health Promotion
• Elimination and Exchange
• Activity/Rest
• Perception/Cognition
• Self-Perception
• Role Relationships
• Coping/Stress Tolerance
• Life Principles
• Safety/Protection
• Growth/Development

Each domain contains several classes that further categorize nursing diagnoses. For example, the Perception/Cognition domain contains classes such as:

• Orientation
• Sensation/Perception
• Communication

This is the most specific level, where the actual nursing diagnoses are listed. Each nursing diagnosis is labeled with a unique code and includes a definition, related factors, and defining characteristics.

Generally, there are five types of nursing diagnoses. They differ based on the focus and purpose.

1. Problem-focused diagnosis

This type of nursing diagnosis focuses on a specific health problem that the patient is experiencing. Examples include:

• Impaired physical mobility related to a recent stroke
• Ineffective breathing pattern related to asthma exacerbation

2. Risk-nursing diagnosis

This type of nursing diagnosis identifies potential health problems that the patient is at risk of developing. Examples include:

• Risk for falls related to unsteady gait
• Risk for impaired skin integrity related to immobility

3. Health-promotion diagnosis

This type of nursing diagnosis focuses on promoting the patient’s health and preventing potential health problems. Examples include:

• Readiness for enhanced nutrition related to a desire for weight loss
• Readiness for enhanced exercise related to a desire to improve cardiovascular health

4. Syndrome diagnosis

This type of nursing diagnosis identifies a cluster of related problems that are present in the patient. Examples include:

• Post-trauma syndrome related to a motor vehicle accident
• Rape trauma syndrome related to sexual assault

5. Possible nursing diagnosis

This type of nursing diagnosis focuses on situations where the nurse suspects the presence of a health problem but requires further assessment to confirm the diagnosis. Examples include:

• Possible urinary incontinence related to frequent bathroom trips
• Possible ineffective airway clearance related to the presence of cough

PES is the initialism you must remember to understand the main components of a nursing diagnosis:

• P stands for Problem. This component refers to the patient’s health problem that the nurse has identified. It is the basis for the nursing diagnosis.
• E stands for Etiology. This component refers to the cause or contributing factors to the patient’s problem. It explains why the patient has whatever health problem the nurse has identified.
• S stands for Signs and Symptoms. This component represents the cues or manifestations that support the presence of the problem. They are the evidence that the patient has the identified health problem.

Writing a nursing diagnosis requires careful assessment and excessive knowledge of diagnosis types. You can write an adequate diagnosis by following these steps:

• Assess the patient: Begin by gathering information on the patient’s health status. You can use various methods, such as physical examinations, reviewing the patient’s medical history, and questioning.
• Identify health problems: Based on the gathered data, identify potential health problems and prioritize them in order of severity and impact on the patient’s overall health.
• Choose a diagnosis: Select a nursing diagnosis that best depicts the patient’s symptoms and is supported by the assessment data. Use the NANDA nursing diagnosis system to select an accurate diagnosis.
• Write the diagnosis: Use a standardized format to write the nursing diagnosis, including the problem statement and related factors.
• Validate the diagnosis: Lastly, review the nursing diagnosis with other healthcare team members to ensure that it accurately reflects the patient’s health status and guides appropriate nursing interventions.

Nursing diagnosis is an essential part of all patient’s healthcare journeys. In order to successfully complete the process of writing such a diagnosis, you must be well acquainted with its three main components, the five different types of nursing diagnosis, as well as the classifications made by relevant associations. Through nursing diagnosis, the goal is to understand the patient’s condition and know what path to take in order to help them.

Nurse Luke is a CRNA who specializes in Nursing content and still enjoys a very busy career with Locum, Per Diem and Travel nursing in the greater midwest. He has over 25 years of experience in the healthcare field and received his CRNA masters degree from the Mayo Clinic School of Healthcare. He is passionate about helping nurses explore the options of becoming a travel nurse as well as spending time with his Family. 

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Nursing Diagnosis Guide: All You Need to Know

The term “diagnosis” is defined as an agreed-upon clinical judgment. When we think of a diagnosis, it is often thought of as a medical diagnosis, such as high blood pressure. In its simplest form, a nursing diagnosis is determined by nurses based on their scope and clinical judgment to guide patient care. Nursing diagnoses encompass individuals, families, and communities and relate to health conditions and life processes. Nursing diagnoses reflect the knowledge that is fundamental to nursing practice. Nurses’ diagnoses also reflect the systematic and scientific method of nursing. 1

In this article:

• The Nursing Process
• Purpose of a Nursing Diagnosis
• Nursing Diagnoses vs. Medical Diagnoses

Purpose and Mission of NANDA-I

Related factors, defining characteristics, risk factors, problem focused, health promotion, risk focused, writing a problem-focused nursing diagnosis, writing a risk-focused diagnosis, writing a health promotion-based diagnosis, writing a syndrome diagnosis.

• List of Current Nursing Diagnoses and Domains
• List of Common Nursing Diagnoses

A nursing diagnosis cannot exist without the nursing process; the foundation of nursing practice. It includes five steps:

Assessment: The nurse collects subjective and objective data about the patient which may include their physical, emotional, and psychological health as well as lifestyle factors, socioeconomic status, and culture. Information obtained during the assessment phase may include vital signs, pain, medication use, medical history, and more.

Diagnosis: After the nurse collects and analyzes this data, they can begin to identify actual or potential health problems. This is where nursing diagnoses come into play. The nurse can create a clinical picture to understand possible causes and associations in the patient’s assessment which will become a part of the patient’s care plan.

Planning: The nurse can now develop a plan and interventions along with short and long-term goals that are individualized to the patient’s needs.

Implementation: The nurse puts their plan to action and carries out interventions set in the care plan. Actions are documented for continuity of care.

Evaluation: In the final step of the nursing process, the nurse evaluates the effectiveness of interventions. Goals may be met or may need to be modified. By going through the nursing process again, the care plan can be revised based on changes in the patient’s health.

Nursing diagnoses are the foundation of care plans. Nursing diagnoses drive actions and allow for continued assessment, prioritization, organization, and effective health outcomes.

Nursing diagnoses are used in all care settings and support high-quality, evidence-based care. Here are a few ways nursing diagnoses support nursing practice.

• Nursing diagnoses improve collaboration between team members. Nursing diagnoses improve consistency and clarity of communication between nurses and other members of the care team. Nursing diagnoses can be revised, added, or removed based on the patient’s outcomes.
• Nursing diagnoses are a teaching tool. For new graduate nurses, familiarity with nursing diagnoses helps to improve critical thinking and confidence in practice. Nursing diagnoses and supporting educational material can guide novice nurses to direct interventions and goals for their patients. Understanding how nursing diagnoses contribute to the nursing process allows new nurses to become familiar with possible interventions and care pathways for their patients.
• Nursing diagnoses may improve risk identification. Many nursing diagnoses include diagnoses that alert the care team to avoid a potential risk through intervention. For instance, the nursing diagnosis “risk for bleeding” alerts a nurse that the patient may be receiving an anticoagulant and to monitor for signs of bleeding.
• Nursing diagnoses can help establish care goals. Nursing diagnoses illuminate care priorities, including current issues, future risks, and health promotion opportunities. Once the nursing diagnosis is identified, priorities, interventions, and goals can be created in collaboration with the patient.
• Nursing diagnoses promote patient education. Many nursing diagnoses incorporate teaching and opportunities for learning. The nurse may identify knowledge deficits, including medication adherence, health management, nutrition, coping, etc. The nurse utilizes these nursing diagnoses to help patients reach their health and wellness goals.
• Nursing diagnoses serve as documentation. Documentation is crucial in healthcare. If nursing care is not documented, there is no proof it was completed. Documentation of interventions and outcomes provides continuity of care between staff and protects the nurse.

Nursing diagnoses are the foundation of nursing care plans . Nursing diagnoses drive actions and allow for continued assessment, prioritization, organization, and effective health outcomes.

Although there are some similarities between medical and nursing diagnoses, such as clinical judgment and shared terminology, they are distinct. 2 The most apparent difference between nursing and medical diagnoses is the healthcare practitioner deciding the diagnosis. All nursing designations share nursing diagnoses, while physicians create medical diagnoses. The exception is that nurse practitioners in most states can also determine medical diagnoses and prescribe medication. Therefore, a nurse practitioner could determine both nursing and medical diagnoses.

There are also differences in each type of diagnosis. For example, medical diagnoses focus on the disease or pathology that affects the patient. In contrast, nursing diagnoses concentrate on the patient’s response to the illness or life circumstance, which can be either a physiological or psychological response. By focusing on the client’s response, a nurse applies interventions to address or alter that response.

To clarify this distinction, here are two examples of how medical and nursing diagnoses can work together.

A patient with a medical diagnosis of cerebrovascular accident (stroke) may lead to the complementary nursing diagnosis of unilateral neglect. Without the medical diagnosis, the nurse would not know what was causing unilateral neglect. The nursing diagnosis is a jumping-off point to create goals to manage the deficit and improve patient safety and quality of life.

With the medical diagnosis of dehydration, the nurse knows that the patient is experiencing deficient fluid volume (nursing diagnosis). Therefore, the nurse may implement interventions such as administering IV fluids and recording intake and output for this patient.

Nursing and medical diagnoses are complementary and guide each other to create a holistic clinical story.

What is NANDA-I?

The name NANDA originated as the acronym for the North American Nursing Diagnosis Association. However, with the organization’s global expansion, they no longer use NANDA as an acronym but as a recognizable organizational name. If using the organization’s full name, the correct use is NANDA International, Inc. (no hyphen), and the abbreviation is NANDA-I (with a hyphen). The organization offers networking and education and holds task forces on topics such as diagnosis development, informatics, and nursing research.

NANDA International is an organization that supports the use and development of standardized nursing terminology throughout clinical settings. 3 The organization’s mission is to use nursing diagnoses to promote high-quality patient care through evidence-based research and consistent terminology. Standardized nursing diagnoses inform evidence-based terminology that improves clinical practice by providing clear guidelines for communication and documentation. NANDA International continually releases new editions with revised, added, or retired nursing diagnoses and updates to criteria and classifications.

• Components of a Nursing Diagnosis

Formulating a nursing diagnosis is the second step of the nursing process after assessment. 6 First, the nurse analyzes the assessment data they collect from the patient and through observation or diagnostic testing. The nurse will use that data and create clusters of pertinent information to form hypotheses about the appropriate nursing diagnoses. At this stage, the nurse will either write the nursing diagnosis or decide they need additional information to confirm or update their hypothesized diagnosis.

Related factors are the etiology or cause of the nursing diagnosis. 4 Related factors are used in problem-focused, syndrome, and sometimes health promotion nursing diagnoses. Related factors are the underlying or contributing conditions or circumstances associated with the patient’s health problem. While the cause may not always be known, the nurse aims to understand the root cause to develop appropriate interventions.

Characteristics and risk factors are the evidence behind the nursing diagnosis. 4 However, they should not be used interchangeably. Defining characteristics are observable characteristics that support a problem-focused health promotion diagnosis or syndrome. Defining characteristics are the signs or symptoms of clinical pathology.

Risk factors are used primarily for risk-focused nursing diagnoses. Risk factors replace the defining characteristics of problem-focused nursing diagnoses. Similarly, they provide supporting evidence for the nursing diagnosis. Unlike defining characteristics, risk factors describe why the patient has an increased chance of acquiring the undesirable health outcome identified by the nurse. Risk factors can be biological, psychological, family, or community-related. Patients may have one or multiple risk factors supporting a risk diagnosis.

• Types of Nursing Diagnoses

A problem-focused nursing diagnosis is a nursing diagnosis that addresses a current health challenge. 4 In contrast to other nursing diagnoses that address potential problems or opportunities for health improvement, a problem-focused diagnosis deals with a current, known health challenge. To make this type of diagnosis, the defining characteristics of the diagnosis must be present at the time of evaluation. The defining characteristics include signs, symptoms, and patient health history. Defining characteristics act as clues for the nurse and, when grouped together, form patterns that allow a diagnosis to be assigned. Related factors should also be described as part of a problem-focused nursing diagnosis.

Problem-focused nursing diagnosis example: The nurse notices that the patient has a negative balance between their fluid intake and output. The patient also has dry mucous membranes and weight loss. The nurse makes the problem-based nursing diagnosis of “deficient fluid volume.” The NANDA-I definition is “Decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone without change in sodium.” 5 Depending on the etiology and the patient’s health condition, the care plan and interventions will aim to increase fluid intake, identify the cause of the fluid deficit, and maintain evidence of normovolemia.

In contrast to problem-focused nursing diagnoses, health promotion diagnoses require that the individual/family/community is already functioning effectively in the health area, but there is an opportunity to increase well-being. Another requirement of a health promotion nursing diagnosis is that there is an expressed desire for improvement. This is often expressed at the beginning of the nursing diagnosis statement as “Readiness for enhanced…”. Therefore, the defining characteristic of a health promotion diagnosis is the client/family or community expressing a desire to improve or change health behaviors. There is some similarity to risk-focused nursing diagnoses; however, health promotion diagnoses are further upstream than risk-focused nursing diagnoses, as they aim to improve and actualize health potential instead of preventing an undesirable outcome.

Health promotion nursing diagnosis example: A patient expresses the desire to breastfeed exclusively during a prenatal screening visit with a nurse. The nurse recognizes the opportunity for health promotion with the nursing diagnosis of “Readiness for Enhanced Breastfeeding.” The NANDA-I definition is “A pattern of providing milk to an infant or young child directly from the breasts which may be strengthened.” 5 Based on this assessment, the nurse may refer the client to trusted online sources of information or refer them to group education sessions if available.

In a risk-based diagnosis, the nurse uses their clinical judgment to determine that the patient is at risk for health consequences if preventative measures are not implemented. Otherwise stated, the problem has not yet manifested for the client/family/community, but there is a vulnerability related to risk factors that the nurse identifies. Care plans will focus on preventing undesirable health outcomes.

Risk-focused nursing diagnosis example: In an inpatient surgical unit, a nurse is assigned to a patient postoperative day 3 for Whipple surgery. This nurse immediately recognizes that the patient meets the criteria for the nursing diagnosis of “Risk for Infection.” The NANDA-I definition is “At risk for being invaded by pathogenic organisms.” This patient is at risk due to their diagnosis of pancreatic cancer and recent surgery. One intervention the nurse may invoke is patient teaching on handwashing and providing the patient with alcohol-based antiseptic hand rub on their bedside table.

Nursing diagnosis syndromes are created when two or more concurrent nursing diagnoses are related and can be treated using similar interventions. Nursing syndrome diagnoses also cluster problem and risk-focused nursing diagnoses that often accompany specific health processes or life events.

Syndrome nursing diagnosis example: A patient shares that they recently witnessed a motor vehicle accident resulting in multiple injuries, including deaths. While not injured, they report difficulties sleeping, increased alcohol use, and irritability, which are now beginning to impact their ability to work. The nurse recognizes this cluster of symptoms as consistent with the nursing diagnosis of “post-trauma syndrome.” The NANDA-I definition of Post-Trauma Syndrome is “Sustained maladaptive response to a traumatic, overwhelming event.” 5 Other nursing diagnoses that may cluster to form this syndrome include nursing diagnoses related to sleep, anxiety, hope, depression, substance use, and relationships. The nurse discusses the goal of acknowledging the trauma and discusses options to connect the patient to support resources.

• How to Write a Nursing Diagnosis

Standardized methods of writing nursing diagnoses allow for clear communication of their purpose and driving factors. Writing a complete nursing diagnosis helps the nurse clarify their reasoning for potential interventions and care goals.

Problem-focused nursing diagnoses are three-part statements that include the problem, etiology, and symptoms (PES framework).

P roblem (Diagnostic Label) + E tiology (Cause or Related Factors) + S igns/Symptoms (Defining Characteristics)

[Diagnostic Label] + “related to” + [Etiology] + “as evidenced by” + [Defining Characteristics]

Examples of Problem-Focused Diagnosis:

Deficient Fluid Volume related to prolonged vomiting as evidenced by increased pulse rate and poor skin turgor.

Acute Confusion related to alcohol abuse as evidenced by hallucinations and increased agitation.

Problem (Nursing Diagnosis)

Nurses should use a NANDA-I label whenever possible to describe the identified problem to ensure consistency in diagnoses. However, if no NANDA-I label adequately represents the problem, the nurse needs to describe the problem in a clear, concise, and useful way to the care team. It is important to avoid judgmental language in the problem statement.

Etiology (Related Factors)

The second part of the problem-focused nursing diagnosis is the etiology or the underlying cause or causes of the nursing diagnosis. The etiology of the diagnosis is key to choosing appropriate interventions, so the nurse should describe the etiology as precisely as possible. For instance, what was the event’s timing, or how long has the client had the disease? When describing an etiology linked to a known pathophysiology or disease, the etiology should be stated as “secondary to.” Otherwise, the etiology should be stated as “related to” (R/T). “Related to” does not necessarily specify a direct cause-and-effect relationship, which is preferred because there may be other factors related to the nursing diagnosis that have not yet been identified.

When various factors contribute to a nursing diagnosis that cannot be summarized into a one-sentence statement, the etiology may be written as “related to complex factors.” This should not be used as a shortcut to finding the appropriate etiology, but when there is no clear primary etiology for the nursing diagnosis.

Signs/Symptoms (Defining Characteristics)

For a problem-focused nursing diagnosis, the described signs and symptoms are the defining characteristics of the nursing diagnosis. The nurse should link the etiology to the signs and symptoms by stating “as manifested by” (AMB) or “as evidenced by” (AEB).

The risk-focused diagnosis is a two-part statement that includes statements of the problem and risk factors.

Risk (Diagnostic Label) + Risk Factors

[Diagnostic Label] + “as evidenced by” + [Risk Factors]

Examples of Risk Diagnosis:

Risk for Infection as evidenced by a history of cancer and recent surgery.

Risk for Falls as evidenced by a history of falls, use of an assistive device, and visual difficulties.

Like a problem-focused diagnosis, the risk-focused statement should also use a NANDA-I approved diagnosis starting with “Risk for…”. If a NANDA-I nursing diagnosis does not adequately describe the vulnerability, the nurse should still begin their problem statement with “Risk for…”.

Rather than describing the etiology or related factors, risk-focused diagnoses are supported by describing the risk factors related to the diagnosis. The risk factor statement should follow the problem statement with the nurse describing the problem “as evidenced by” and then listing the risk factors.

Defining characteristics are not possible because they haven’t actually occurred yet.

A health promotion diagnosis is also described using a two-part statement.

Health Promotion (Diagnostic Label) + Signs & Symptoms (Defining Characteristics)

[Diagnostic Label] + “as evidenced by” + [Defining Characteristics]

Health Promotion-Based Diagnosis Examples:

Readiness for Enhanced Breastfeeding as evidenced by the patient stating their desire to exclusively breastfeed and requesting information on how to achieve this.

Readiness for Enhanced Coping as evidenced by the patient expressing a desire to enhance social support and spiritual resources.

Rather than identifying a health problem, the problem when following the PES framework here is an opportunity for health improvement. When possible, the nurse should use an approved NANDA-I health promotion diagnosis. If the nurse is formulating their own problem statement for a health promotion diagnosis, they should start the statement with “readiness for enhanced…”.

The signs and symptoms used to describe a health promotion diagnosis are related to the patient, family, or community expressing readiness or desire for health improvement. This may be a verbal expression, actions, or other cues that alert the nurse to readiness for health promotion.

The syndrome diagnosis is a group of related nursing diagnoses and should be written as a two-part statement. 7

Syndrome (Diagnostic Label) + 2 or more supporting Nursing Diagnoses

[Diagnostic Label] + “as evidenced by” + [Nursing Diagnosis] + [Nursing Diagnosis]

Syndrome Diagnosis Examples:

Post-Trauma Syndrome as evidenced by Disturbed Sleep Pattern and Hopelessness.

Frail elderly syndrome as evidenced by Social Isolation and Chronic Confusion.

The nurse should use a recognized NANDA-I syndrome to diagnose a nursing syndrome.

Etiology (Additional Nursing Diagnoses)

For a syndrome diagnosis, the etiology is described as two or more nursing diagnoses that form the evidence for the syndrome diagnosis. There should be a minimum of two diagnoses, with no maximum of nursing diagnoses to support a syndrome diagnosis. Each nursing diagnosis should be written in its complete, appropriate form, either including etiology, signs and symptoms, or risk factors.

In the 2020 to 2023 edition of NANDA-I, there are 13 domains of nursing diagnoses. Each domain has between three and six classes of nursing diagnoses that are then broken down into individual diagnoses. Here we list all 13 domains, related classes, and an example nursing diagnosis. Please see NANDA International- Nursing Diagnoses Definitions and Classification, 12th Edition, for the complete list of diagnoses.

Domain 1: Health Promotion Class 1: Health Awareness Class 2: Health Management  Diagnosis: Risk for frail elderly syndrome

Domain 2: Nutrition Class 1: Ingestion Class 2: Digestion Class 3: Absorption Class 4: Metabolism Class 5: Hydration Diagnosis: Risk for unstable blood glucose level

Domain 3: Elimination and exchange Class 1: Urinary function Class 2: Gastrointestinal function Class 3: Integumentary function Class 4: Respiratory function Diagnosis: Urinary retention

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 Diagnosis: Bathing self-care deficit

Domain 5: Perception/cognition Class 1: Attention Class 2: Orientation Class 3: Sensation/perception Class 4: Cognition Class 5: Communication Diagnosis: Impaired memory

Domain 6: Self-perception Class 1: Self-concept Class 2: Self-esteem Class 3: Body image Diagnosis: Chronic low self-esteem

Domain 7: Role relationship Class 1: Caregiving roles Class 2: Family relationships Class 3: Role performance Diagnosis: Impaired social interaction

Domain 8: Sexuality Class 1: Sexual identity Class 2: Sexual function Class 3: Reproduction Diagnosis: Risk for disturbed maternal-fetal dyad

Domain 9: Coping/stress tolerance Class 1: Post-trauma responses Class 2: Coping responses Class 3: Neurobehavioral stress Diagnosis: Risk for post-trauma syndrome

Domain 10: Life principles Class 1: Values Class 2: Beliefs Class 3: Value/belief/action congruence Diagnosis: Moral distress

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 Diagnosis: Risk of surgical site infection

Domain 12: Comfort Class 1: Physical comfort Class 2: Environmental comfort Class 3: Social comfort Diagnosis: Impaired comfort

Domain 13: Growth/development Class 1: Growth Class 2: Development Diagnosis: Delayed infant motor development

In this section, you will find common NANDA-I nursing diagnoses you can use to create care plans.

• Activity Intolerance
• Acute Confusion
• Chronic Pain
• Constipation
• Decreased Cardiac Output
• Disturbed Body Image
• Excess Fluid Volume
• Fluid Volume Deficit (Dehydration)
• Hopelessness
• Hyperthermia
• Imbalanced Nutrition
• Impaired Comfort
• Impaired Gas Exchange
• Impaired Physical Mobility
• Impaired Skin Integrity
• Impaired Urinary Elimination
• Impaired Verbal Communication
• Ineffective Airway Clearance
• Ineffective Breathing Pattern
• Ineffective Coping
• Ineffective Health Maintenance
• Ineffective Tissue Perfusion
• Knowledge Deficit
• Noncompliance (Ineffective Adherence)
• Risk For Aspiration
• Risk for Bleeding
• Risk for Electrolyte Imbalance
• Risk for Falls
• Risk for Infection
• Risk for Injury
• Risk For Unstable Blood Glucose
• Self-Care Deficit
• Social Isolation
• Stress Overload
• Urinary Retention
• Karaca T, Aslan S. Effect of ‘nursing terminologies and classifications’ course on nursing students’ perception of nursing diagnosis. Nurse education today. 2018;67(Journal Article):114-117. doi:10.1016/j.nedt.2018.05.011
• NANDA Internatioal. What is the difference between a medical diagnosis and a nursing diagnosis? Accessed January 7, 2023. http://nanda.host4kb.com/article/AA-00266/0/What-is-the-difference-between-a-medical-diagnosis-and-a-nursing-diagnosis-.html
• NANDA Internatioal. Our Story. Accessed January 7, 2023. https://nanda.org/who-we-are/our-story/
• NANDA Internatioal. Glossary of Terms. Accessed January 3, 2023. https://nanda.org/publications-resources/resources/glossary-of-terms/
• Carpenito LJ, Books@Ovid Purchased eBooks. Handbook of Nursing Diagnosis. 15th ed. Wolters Kluwer; 2017.
• Open Resources for Nursing. DIAGNOSIS. In: Nursing Fundamentals.
• NANDA Internatioal. The Structure and Development of Syndrome Diagnoses. Accessed January 7, 2023. https://nanda.org/publications-resources/resources/position-statement/

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Community Health Assessment Tools Adoptable in Nursing Practice: A Scoping Review

Chiara pazzaglia.

1 Bologna Local Health Trust, 40124 Bologna, Italy

Claudia Camedda

2 IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy

Nikita Valentina Ugenti

Andrea trentin.

3 Attorney at Law, 40138 Bologna, Italy

Sandra Scalorbi

4 Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy

Yari Longobucco

5 Department of Health Sciences, University of Florence, 50139 Florence, Italy

Associated Data

Not applicable.

The WHO European Region defined the role of a new central professional for primary care, the Family and Community Nurse (FCN). The introduction of an FCN in the framework of health policies highlights a key role of nurses in addressing the needs of families and communities. A scoping review was conducted in order to identify and describe the available tools which have been adopted for the assessment of community health needs by FCNs. A comprehensive literature review on the Embase, Cochrane Library, PubMed, CINAHL, Scopus and PsycInfo databases was conducted including all studies up to May 2021. A total of 1563 studies were identified and 36 of them were included. The literature review made it possible to identify studies employing twelve different community assessment tools or modalities. Referring to the WHO framework proposed in 2001, some common themes have been identified with an uneven distribution, such as profiling the population, deciding on priorities for action and public healthcare programs, implementing the planned activities, an evaluation of the health outcomes, multidisciplinary activity, flexibility and involving the community. To the best of our knowledge, this work is the first attempt to provide an overview of community assessment tools, keeping the guidance provided by the WHO as a reference.

1. Introduction

During 2020, the whole world had to face, and is still fighting, the consequences of the pandemic caused by COVID-19, which led to an unprecedented health crisis, not only due to the organic shortages of health professionals, procurement materials and personal protective equipment, but also due to the organization of Western health systems that are built around the concept of patient-centered care. The concept of patient-centered care does not allow for addressing the changes that an epidemic requires as an approach based on community-centered care [ 1 ].

These two care models do not express alternative concepts, but rather a cross planning and organizational approach; therefore, these are complementary concepts. Ideally, the patient-centered model responds more to the individualistic–paternalistic ethics, while the community-centered model responds to the ethics of public assistance systems, oriented to the fairest possible effort to meet the needs of the entire population, therefore of each person. This second model integrates more easily with the possible decision-making and organizational synergies between health, society and the environment.

The WHO has identified the development of community health systems as a health policy framework goal [ 2 ]. Primary healthcare (PHC) has been identified, starting from the 1978 Alma-Ata Declaration, as an integral part of the health system of each country that inextricably links health to the whole social and economic development of the community, based on equity, community participation, prevention, appropriate technology and intersectoral and integrated approaches to development [ 3 ]. Policies must ensure that activities and processes referring to the population derive from a careful assessment of local socio-health needs; evidence-based approaches must be applied to understand the inequalities in community health. The identification of a population’s unmet health needs, and the changes needed to meet them, are crucial elements for health professionals seeking to plan appropriate and effective programs to improve or initiate new services [ 4 ].

According to another approach, nursing care is carried out on the basis of how individuals, families and communities are conceptualized and of how nurses collaboratively work with them, taking into account organizational values and beliefs [ 5 ]. People are always members of their own families and communities, even when they are analyzed and assisted individually [ 6 ]. The health of individuals, families and communities influence each other [ 6 ]. The WHO [ 7 ] defined community by referring to its members, while respecting their group dimension and in relation to their specific identity connotations. In Italy, the nursing figure and professional profile are outlined in the Ministerial Decree n. 739, 14 September 1994. Article 1, paragraph 3, in particular, provides the following: “3. The nurse: (a) participates in the identification of persons’ and community’s health needs; (b) identifies the nursing care needs of individuals and community and formulates the related objectives; (c) plans, manages and evaluates the nursing intervention;…. (d) acts both individually and in collaboration with other health and social professionals”. The interpretation of the Decree lets emerge, first, the distinction between “individual and community health needs “ and “individual and community nursing care needs”. This difference, therefore, allows us to state that—with regards to the health needs—nurses act together with other professionals while—with regards to the nursing care needs—nurses are assigned an exclusive competence. Furthermore, from the Decree’s interpretation emerges that nurses “(c) plan, manage and evaluate the nursing care intervention” but not the public health programs and services.

The WHO European Region [ 8 ] defined the role of a new central professional for primary care, the Family and Community Nurse (FCN). The introduction of an FCN in the framework of health policies highlights a key role of nurses in addressing the needs of families and communities. These needs can affect the whole course of people’s lives from health to illness, with reference to the needs of the most vulnerable social groups, through a comprehensive understanding of the determinants of health, primary healthcare and public health principles. Community nursing therefore leads to a community care process, the activation of formal, informal and technological networks, enhances health professionals’ own area of competences and implements an approach aimed at enhancing individuals’, families’ and communities (relatives, friends, neighbors, volunteer groups, self-help, etc.) resources.

Therefore, through a comprehensive evaluation process which is as thorough and in-depth as possible for the context, nurses need to establish a broad knowledge of the community and its needs. This assessment is carried out regularly through a continuous process that allows the planning of not only the interventions but also the public health programs according to the phases described below [ 9 ].

• ○ Collection of relevant information that will inform the nurse about the health state and needs of the population;
• ○ Analysis of this information to identify the major health issues.
• − Deciding on priorities for action;
• − Planning public health and healthcare programs to address the priority issues;
• − Implementing the planned activities;
• − Evaluation of the health outcomes.

Family and community assessment involves data collection on what the community needs [ 9 ]. The objectives of the assessment process are:

• − To identify community strengths and areas for improvement;
• − To identify and understand the state of the community’s health needs;
• − To define areas for improvement to guide the community towards the implementation and support of policies, systems and environmental changes around healthy living strategies (e.g., physical activity, nutrition, tobacco and chronic disease management);
• − To help prioritize community needs and to consider the appropriate allocation of available resources.

The community needs assessment enables local stakeholders to work together in a collaborative process to analyze the community itself; offer suggestions and examples of change policies, systems and strategies; provide feedback to communities as they institute local changes for healthy living [ 9 ]; ensure resources allocation where there is the greatest health benefit; and adopting the principle of equity in practice [ 4 ].

Increasing healthcare demands, limited resources and growing health inequalities require governments across the European community to guarantee the right to health of all citizens [ 1 ], resulting in a paradigm shift away from historic “wait-and-see” healthcare in Europe and towards one already prevalent in other countries [ 10 ]. The issue of the assessment of community health needs, or rather socio-health needs, fits into this context, not only in European health services but in those around the world. The “health needs assessment” process plays, in fact, a central role: it allows professionals and policy-makers to identify priority health needs in the population and to ensure that social and health resources are used to maximize health and well-being; however, despite the centrality of this issue, there is not currently a standardized tool which reflects the framework proposed by the WHO in 2001 [ 9 ].

A scoping review was conducted in order to identify and describe the available tools which have been adopted for the assessment of community health needs by FCNs, without geographical restrictions.

2. Materials and Methods

The scoping review allows researchers to examine the extent and nature of research activities on a specific topic, to summarize and disseminate research findings and to identify research gaps in the existing literature [ 11 ].

A comprehensive literature review on the Embase, Cochrane Library, PubMed, CINAHL, Scopus and PsycInfo databases was conducted including all studies up to May 2021 in the English or Italian languages. The following inclusion criteria were adopted:

• − Primary and secondary studies, abstract and full text available;
• − Community, family and ethnic minorities’ needs assessment process;
• − Assessment/measurement tools (in particular validation studies);
• − Family and community nursing role;
• − Primary care context.

The search terms included were: “family nursing”, “community nursing”, “community health services”, “needs assessment”, “assessment tool”, “assets assessment” and “health needs”. These search terms were combined with each other through the use of Boolean operators and wildcard characters for the different databases, in order to obtain as many results as possible.

Four reviewers screened the title and abstracts and selected the eligible articles. All studies that discussed or applied community assessment tools or models were included.

The full text articles of all potentially eligible studies were retrieved and, after removing the duplicates, reviewed independently by four reviewers (CC, CP, NVU and YL). Any disagreement was resolved by a majority vote with the support of a tiebreaker (SS).

Data of the included studies were extracted and synthetized, in particular: authors, year, title, setting, study design and methods, purpose, sample and adopted tool and main findings. Any disagreement in the data extraction was resolved by a consensus of two experts (YL and SS). The study authors or investigators were contacted when additional information was necessary [ 12 ].

3.1. Study Selection and Charting the Data

After the removal of duplicates, articles were screened in order by titles, abstracts and then full text. A total of 1563 studies were identified and, after the removal of the duplicate studies, 610 abstract and 312 free-full-text studies were evaluated and then a total of 36 studies were identified ( Figure 1 ).

Study selection flow-chart.

3.2. Data Extraction

A total of 32 of the included studies are primary studies—USA (n = 16), UK (n = 3), Canada (n = 2), Japan (n = 2), Australia (n = 1), China (n = 1), Honduras (n = 1), Portugal (n = 1), Singapore (n = 1), South Korea (n = 1), Sweden (n = 1), Vietnam (n = 1)—and 4 are secondary studies.

The characteristics of primary studies are heterogeneous, also in the adopted design.

A synthesis of the results is reported in Table 1 .

Chronological overview of the studies.

The most widespread tool, although only officially recognized in the USA, is the Community Health Needs Assessment (CHNA), reported by Akintobi et al. [ 13 ]; Carlton and Singh [ 14 ]; Cain et al. [ 15 ]; Evans-Agnew et al. [ 16 ]; Pennel et al. [ 17 ]; Pennel et al. [ 18 ] (2015); Wilder et al. [ 19 ]; Kuehnert et al. [ 20 ]; and Sharma [ 21 ].

The CHNA is a systematic process involving the community to identify and analyze community health needs. The process provides a way for communities to prioritize health needs and to plan and act upon unmet community health needs.

Sharma [ 21 ] created a conceptual model for a community health assessment divided into eight steps: (1) know thyself , (2) know the community , (3) creating a participatory infrastructure , (4) developing a strategic plan , (5) establishing feedback mechanisms , (6) establishing priorities , (7) selecting interventions and (8) presentation of a joint report .

The Patient Protection and Affordable Care Act [ 22 ] has demanded that nonprofit hospitals must conduct a CHNA once every three years. The purposes are to adapt health services, implement strategies to address health priorities and improve population health.

Another tool, used in South Korea, is the Comprehensive Health and Social Needs Assessment (CHSNA) by Park et al. [ 23 ]. This validated system is characterized by user-friendly images and can be used by healthcare professionals, social workers and community residents to evaluate the reasoning underlying health and social needs, to facilitate the identification of more appropriate healthcare plans and to guide community residents to receive the best healthcare services. In detail, the assessment covers three areas: a basic health assessment, a life and activity assessment and an in-depth health assessment.

Through the literature research, another measurement method has been identified, such as the Community-Based Collaborative Action Research (CBCAR) by Van Gelderen et al. [ 24 ] and Krumwiede et al. [ 25 ]. This tool seems to facilitate community engagement and promote critical dialogue.

The Community-Based Participatory Research (CBPR) [ 13 ] is a partnership approach to research that equitably involves community members, organizations and researchers in all aspects of the research process. All partners shared expertise, decision-making and ownership. The aim of this tool is to increase the knowledge and understanding of a given phenomenon and to integrate the knowledge gained with interventions for policy or social change benefiting the community members.

The Precede–Proceed Model [ 26 ] is a cost–benefit evaluation framework proposed in 1974 by Green that could help health program planners, policy makers and other evaluators to analyze situations and design health programs efficiently. It provides a comprehensive structure for assessing health and quality of life needs, and for designing, implementing and evaluating health promotion and other public health programs to meet those needs.

The Participatory Rural Appraisal (PRA) [ 27 ] is an approach used by nongovernmental organizations (NGOs) and other agencies involved in international development that incorporates the knowledge and opinions of rural people in the planning and management of projects and programs.

Other tools, specific for certain categories of the population or patients, are used; for example, the Carer Support Needs Assessment Tool (CSNAT), used by Horseman et al. [ 28 ], Alvariza et al. [ 29 ], Ewing et al. [ 30 ] and Aoun et al. [ 31 ] is an evidence-based tool that enables the comprehensive assessment of carers’ support needs, facilitating tailored support for the family members and friends of adults with long-term, life-limiting conditions (palliative care, motor neuron disease, etc.). It comprises 14 areas of need in which carers commonly request support. Carers may use this tool to state what they need both to allow them to care for their family member or friend and to preserve their own health and well-being within the caregiving role.

The Questionnaire for Assessing Community Health Nurses’ Learning Needs [ 32 ] is destined for community health nurses.

The EASY-care [ 33 ], is a comprehensive geriatric assessments (CGA) instrument designed for assessing the physical, mental and social functioning and unmet health and social needs of older people in community settings or primary care.

The SPICE assessment tool [ 34 ], a shorter version of the Camberwell Assessment of Need for the Elderly, has been developed for routine use in primary care, focusing on five domains: Senses, Physical ability, Incontinence, Cognition, and Emotional distress (SPICE).

The University of Kansas Community Tool Box and the HRSA Compliance Manual have been used by Burns et al. [ 35 ] to conduct a needs assessment aimed at enhancing the service delivery of African-American adolescents and young adults at an urban federally qualified health center.

Finally, a modified version of the Patient Centered Medical Home Assessment (PCMH-A) has been developed by Kimble et al. [ 36 ] to assess primary care nurses’ perceptions of their practice.

Some other tools reported in literature are: the Community Health Assessment toolkit [ 37 ], Mobilizing for Action through Planning and Partnerships (MAPP) [ 38 ], State Health Improvement Planning (SHIP) Guidance and Resources [ 39 ], Community Health Assessment and Group Evaluation (CHANGE) [ 40 ], Needs Assessment, Resource Guide [ 41 ], Healthy People 2030 and MAP-IT [ 42 ].

Moreover, some data collection methods expressed in the literature are: the triangulation of data, methods and researchers [ 13 , 26 ], surveys [ 43 ] and public database consultation [ 19 ], focus groups [ 13 , 30 , 44 , 45 , 46 , 47 ], questionnaires [ 13 , 27 , 47 , 48 ], semi-structured interviews in person, by post or telephone [ 13 , 15 , 27 , 43 , 45 , 49 , 50 ] and, in particular, to a community’s key members [ 13 , 19 ] and technological tools such as visual tools [ 27 ], video clips [ 15 ] and applications for smartphones, tablets and PC [ 46 ].

Among these methods, those that deserve further exploration for their flexibility, innovativeness, effectiveness in identifying a community’s needs and for the involvement and empowerment of citizens are listed below.

• − The elaboration, with the help of a local artist, of a “visual tool” [ 27 ], similar to a board game, submitted to citizens in order to identify and quantify the different needs of the population.
• − The creation of a short video [ 15 ] in which some citizens are interviewed with the purpose to “give voice” to the minorities of the community. These videos have been used not only as a source of data for the assessment but also as a proposal to integrate the point of view of the community to the CHNA process through their direct participation.
• − The use of applications and technological devices for community needs assessments [ 46 ].
• − The planning of tools for needs assessments of people with low literacy skills [ 46 ].

Another important source of information which requires dedicated deepening, with transversal value at the international level, is the Community Health Needs Assessment—An introductory guide for the family health nurse in Europe [ 9 ]. It is a tool designed for services planning at the level of families, communities and populations, highlighting the importance of the nurses’ contribution in the process. It describes how the evaluation of needs can identify priorities, directing resources to address inequalities and to activate a mechanism of involvement and participation of the local population.

The first part of the tool provides practical and user-friendly guidance to nurses through some general definitions and more specific advice regarding the needs assessment, dividing the process into three sections: profiling of the population , how do you find out and what to do with the information . The second part is a training pack written for trainers involved in nursing education about community health needs assessments.

Lastly, ‘A Framework for Community Health Nursing Education’ is a document produced by WHO [ 51 ] representing a possible approach to analyzing the community context through a participatory process between the reference stakeholders of the territory.

An overview of the common aspects of these tools with the WHO framework is reported in Table 2 .

Comparison of the tools identified through the literature review with the WHO “Community Health Needs Assessment” (2001).

4. Discussion

Community health assessments are the basis to defining, implementing and evaluating the services and educational programs necessary to reach public health, through the definition of the main health problems and the factors influencing them, the identification of the community’s resources, the development potential and the involvement and empowerment of the people belonging to the community [ 9 ].

By identifying research using various community assessment tools, this review was able to find several recurring themes.

4.1. Education and Skills of the Family and Community Nurse

The relevance of education to improving how community health is assessed has been highlighted in numerous papers [ 19 , 24 , 25 , 44 , 47 , 49 ]. Education should be advanced [ 43 , 52 ] and specific to some professional fields, such as palliative care [ 53 , 54 ].

Evans-Agnew et al. [ 16 ] stated that the assessments of community health needs through academic and practical partnerships offer new opportunities for skills development, not only for professionals, but also for nursing students.

For education planning, it is necessary to determine the areas of competence development of family and community nurses through the assessment of learning needs [ 16 , 25 , 32 , 36 , 50 ].

4.2. Shared Decision Making and Nursing Role

The assessment process is defined as a core competence for the community/public health nurse (C/PHN) [ 9 ]. Nevertheless, among the selected studies, there is a limited number of those that refer to nurses, both as responsible for the assessment and as a processes member with other professionals [ 16 , 27 , 29 , 32 , 33 , 47 , 49 , 50 , 52 ].

In Cho et al.’s [ 47 ] work, it is argued that nurses play a key role in identifying the needs of the population and in reducing health inequalities.

Running et al. [ 27 ] consider nurses as professionals who can establish a real trust relationship with community members, the main actors in the assessment process [ 16 , 29 , 32 , 33 , 50 ].

Wilder et al. [ 19 ] offers a different point of view: the assessment process is carried out exclusively by doctors. Their work states that conducting a CHNA in a primary care training program can helps the next generation of family physicians become culturally competent and community-focused.

Yoshioka-Maeda et al. [ 50 ] found that providing support from PHNs to citizens considered as “difficult clients” was the starting point for identifying community health problems and the need for new services in their daily practice. The results showed that PHNs first took care of their “difficult clients” and, after, gradually identified the existence of community health problems. This is different from a traditional community assessment, in which the identification of community health problems is considered the first step in the development of a new service or action and is necessary to gather sufficient information to understand the community and to clarify its specific health problems.

In addition, community/public health nurses (C/PHN) during their daily practice make choices based on their responsibility and professional authority, determining if the different needs identified and/or problems may be addressed independently or in teams or, in general, with other professionals on an interdisciplinary level [ 47 , 50 ].

This perspective recognizes the usefulness of teamwork in assessment and planning: shared decision making (SDM) is an interpersonal and interdependent process in which the healthcare provider, the person and his or her family members relate to and influence each other, collaborating in healthcare decisions.

The SDM focuses on the evidence-based experiences of healthcare professionals and the unique attributes of the “patient” and her/his family [ 57 ]. This allows people to improve their knowledge of available options and clarify which ones are more important, taking into account your own values.

4.3. Community Engagement and Empowerment

The data produced by community assessments are as important as the process itself, because it allows a population’s engagement to be activated which leads to the empowerment of the individual and the community. The assessment process, therefore, depends on the underpinning methodological and theoretical orientation. Sharma [ 21 ] examined two possible types with different outcomes. The first has been described as a directive assessment, characterized by goals and subject matters defined by the professional, service delivery-focused, centralized decision-making, a focused task definition, a community as an object and with an expert practitioner that sees him/herself as having whole knowledge of the problem and whole responsibility for results. The second has been defined as a nondirective assessment where community members are involved in the decision-making process and play a vital role in defining their priority health needs and in taking action to meet them, with decentralized decision-making, open-ended task definitions, community as the subject and with a reflective practitioner that spends more time studying the problem and engaging the community in a dialogue regarding problems and their possible solutions.

Community engagement has a positive impact on health, particularly if supported by strong organizational and community processes [ 55 ].

The systematic review by Haldane et al. [ 55 ] argues that community participation is a key element of an equitable, rights-based approach to health that has been shown to be effective in optimizing the health interventions for positive public health outcomes in a wide range of health areas and on multiple levels: organizational, community and individual.

Indeed, engagement makes it possible to establish trusting partnerships, to collect human and financial resources, to enhance communication processes and to improve health outcomes [ 24 ].

A theme closely related to engagement is empowerment; in fact, the participation of community members in decisions about their health reflects the process of empowerment itself [ 27 ] and is considered, along with the establishment of trusting relationships between citizens and professionals, to be a key element of health.

Furthermore, the citizens themselves express their willingness to be actively involved by health organizations [ 15 ]. Nevertheless, CHNAs often use quantitative data, revisions of the public data in databases and rarely incorporate directly the “voices” of the local community members. Then, what emerges is only an average of the data and not the specific, actual needs of the community, leading to an increasing risk to not identify and/or to underestimate the needs of some minority groups, such as ethnic minorities [ 15 ], or to not recognize the needs at the family/individual level, keeping in too-general terms.

4.4. “Culturally Competent” Approach

Among the examined studies, Running et al. [ 27 ] grounds its theoretical foundations on Leininger’s theories of transcultural nursing and the process of community involvement of Hildebrandt’s model of health empowerment. Several studies show the importance of using an approach and tools for the assessment that at the same time involve the general population [ 15 , 27 , 54 ] and the specific community considered, keeping a high sensitivity to the local community and minorities’ culture [ 15 , 27 , 31 , 35 , 45 , 46 , 48 , 54 ].

The population itself [ 15 ] asks that social health organizations treat culture as a useful resource for health.

4.5. Development of Social Policies

Conducting a health needs assessment can guide policies and systems, approaches to environmental change, community-administered grants and job creation [ 13 ]. Furthermore, it improves hospital community continuity [ 14 ] and reshapes the path of care of elderly or end-of-life patients [ 56 ]. All of the above requires attention to community stakeholder involvement in collaborative assessment and planning, an understanding of the etiology of diseases, identification and intervention on the broader determinants of health, adopting a public health assessment and planning model and, finally, emphasis on improving population health [ 18 ].

4.6. Flexibility and Local Adaptability of Tools

The CHNA may be conducted by a variety of organizations thanks to its adaptability and the possibility to customize. Every community and hospital is different in terms of resources, demographic data, health issues, partners, history and other contextual factors that contribute to the manner in which organizations and community members work together, make decisions, identify and address problems and resources. Therefore, although the tool refers to the American context, thanks to these features, it could also be applied in other countries.

However, without more specific guidance or evaluation criteria, the usefulness, the applicability and the potential improvement of community outcomes are difficult to identify [ 17 ]. For this reason, Pennel [ 18 ] gives some recommendations to improve assessments and outcomes on a population’s health.

In addition, organizations may carry out the CHNA using different methodologies, producing results that cannot be compared effectively. In fact, many authors have demonstrated information gaps [ 14 , 17 , 20 ].

The WHO [ 9 ] suggested that for several contexts, the tools can be adapted, up to the use of different tools combined each other, in order to create one that is effective and suitable for the considered community, the social and health characteristics of the citizens and for the network of services present.

The tool and the adopted approach need to be multidisciplinary and allow community engagement and empowerment [ 9 , 15 , 23 , 46 ].

To the best of our knowledge, this scoping review is the first attempt to provide an overview of community assessment tools, keeping the guidance provided by the WHO as a reference.

4.7. Limitations

This study has some limitations. First, this article does not perform a critical assessment of the literature included. However, as a scoping review, the aim of this study was not to synthetize evidence, but to pool together elements and core concepts from a various body of knowledge. The literature review was performed until May 2021, exposing this work to a publication bias. Nevertheless, the COVID-19 pandemic may also have led to differences in perspectives among studies conducted from 2020 onward compared with those from previous years.

5. Conclusions

Community assessments are a core competence for nurses but their role must be better defined, both as an autonomous and a collaborative one. According to Friedman [ 5 ], nurses work with individuals, families and communities at different levels and degrees.

From the literature review and the analysis of regulatory references emerges a multi-professional approach, both in assessing the health needs of the community and in the treatment of identified needs. It means that the global assessment of the community and the definition of programs and services are carried out by a multi-professional team, with the equal participation of the community members.

When nurses work with families and communities, their goal is to guide them in the identification of problems and strengths, supporting analysis and decision-making. Community health can, in fact, be defined as the satisfaction of the collective needs of its members through the identification of problems and the management of interactions within the community [ 58 ].

The multidisciplinary approach in “individuals’ and communities’ health needs identification” must not, however, leave behind the fundamental and widespread role of every nurse involved in the everyday care of individuals, as: a source for activity data collection, which will then be aggregated; indirect community health promotion, supporting the individual health; the reinforcement of the social responsibility of each citizen, through health education.

Funding Statement

This research received no external funding.

Author Contributions

C.P., S.S. and Y.L. conceived the study. S.S. and Y.L. designed the methodology and coordinated the activity planning. C.P., C.C., N.V.U., Y.L. and S.S. independently reviewed the papers and disagreements were resolved by a consensus. C.P., C.C. and N.V.U. drafted the manuscript. A.T., S.S. and Y.L. revised the manuscript and contributed with intellectual ideas. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

Informed consent statement, data availability statement, conflicts of interest.

All authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

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The Ultimate Guide to Nursing Diagnosis

Posted on: Feb 27, 2022;

A nursing diagnosis is a fundamental part of the nursing process. It’s an essential tool for nurses and subsequently for the entire healthcare field.  

In this complete guide to nursing diagnosis, you will find out everything there is to know about this vital instrument. What a nursing diagnosis is and its place in the nursing process; what types and classifications of diagnosis are out there; how to write and use a nursing diagnosis – these are just some things that we will put under a microscope in our article. 

Let’s start exploring.

What Is The Nursing Process? 

We can’t talk of nursing diagnosis before first explaining what the nursing process is and how the diagnosis fits into the grander scheme of things. 

The nursing process consists of five steps, of which diagnosis is the second. 

Assessment – The first step of the nursing process relates to thorough patient evaluation. Collecting data, such as vital signs, health history, psychological or socioeconomic evaluations, is an integral part of this step. 

Diagnosis – After the assessment has been completed, the nurse can form a nursing diagnosis based on the collected data. The nursing diagnosis instructs the specific nursing care that the patient shall receive. 

Outcomes and Planning – In this third step of the nursing process, the nurse develops a care plan drawing on information from the nursing diagnosis. The planning needs to be measurable and goal-oriented. 

Implementation – This is the part of the nursing process in which the care plan is put into action. It takes place throughout the duration of the hospitalization up until the discharge of the patient

Evaluation – The final step of the nursing process involves evaluating the care plan based on the initial goals and desired outcomes. Should the results not align, the care plan can be adjusted based on the patient’s needs. 

What is Nursing Diagnosis? 

As we have already established, a nursing diagnosis is an important step in the nursing process. It is a concrete and evidence-based way for nurses to communicate their professional judgments to patients, fellow nursing professionals, members of other medical areas, and the public. The nursing diagnosis is developed based on information gathered in the assessment phase. Further, once a nursing diagnosis is elaborated, the nurse can move ahead and create a care plan, which can be used to measure outcomes of a patient’s care at a later phase.

NANDA International also referred to as NANDA-I, is the international organization in charge of defining, distributing, and integrating the process of standardized nursing diagnosis worldwide. According to the organization, the official definition of a nursing diagnosis is:

“A nursing diagnosis is a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group or community. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.”

What Are the Differences Between a Nursing Diagnosis and Other Types of Diagnosis?

Nursing diagnosis is not the only diagnosis one might come across in the process of care. That’s why it’s important to know the difference between different types of diagnosis. The three main ones to consider are nursing diagnosis, medical diagnosis, and collaborative diagnosis. 

A nursing diagnosis refers to the process and, subsequently, the label nurses use to assign meaning to patient data collected in the Assessment phase. The data is labeled with NANDA-I approved nursing diagnosis. For instance, while assessing a patient, the nurse may notice that the patient coughs prior to swallowing any food, displays inadequate laryngeal elevation, and repeatedly reports “something stuck” in their throat. The nurse can conclude a nursing diagnosis based on these symptoms: impaired swallowing . 

Examples of nursing diagnosis : risk for impaired liver function; urinary retention; disturbed sleep pattern; decreased cardiac output. 

On the other hand, a medical diagnosis is made by a doctor or advanced health care practitioner. This type of diagnosis focuses on the patient’s disease, medical condition, or pathologic state – determining which falls into the expertise of advanced medical practitioners. While the nursing diagnosis can be subject to change, the medical diagnosis generally doesn’t change. It remains imprinted on the patient’s medical history forever. 

Examples of medical diagnosis : atrial fibrillation; hepatitis; chronic kidney disease; hypertension.

Collaborative diagnoses are the ones that require both nursing and medical interventions. For the most part, these imply teamwork: RNs keep an eye on the health problems while the medical professionals prescribe drugs and more diagnostic tests. 

Examples of collaborative diagnosis : respiratory insufficiency.

Nursing Diagnosis Classification

In order to easily keep track of nursing diagnoses, they need to be organized in an unambiguous and orderly fashion. NANDA-I has listed, arranged, and classified the nursing diagnoses in a register known as Taxonomy II, which has been in use for more than two decades. Taxonomy II is split into three levels: 13 domains, 47 classes, and 267 nursing diagnoses. 

Currently, there are the following domains and classes:

• 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

What Are the Categories of Nursing Diagnosis?

NANDA-I recognizes four categories of nursing diagnoses: problem focused diagnosis, risk diagnosis, health promotion diagnosis, and syndrome. 

Problem focused diagnoses , also known as actual diagnoses, are patient issues or problems that are present and observable during the assessment phase. They are based on the presence of certain signs or symptoms. A problem focused nursing diagnosis comprises three components: the diagnosis itself, related factors, and defining characteristics. 

Risk diagnosis refers to clinical judgments concerning a patient’s vulnerability to developing undesirable health conditions unless the nurse intervenes. Essentially, a risk diagnosis says that a problem does not yet exist, but there are risk factors that could potentially lead to a problem emerging. Thus, nurses will offer care to avoid it. There are two components nurses have to account for with this type of diagnosis: a risk diagnostic label and risk factors. 

Health promotion diagnosis , or wellness diagnosis, are the clinical judgments about the motivation and desire to increase well-being and reach one’s health potential. These judgments express a patient’s readiness to improve specific health behaviors. Health promotion diagnosis can exist at an individual, family, group, or community level. 

Syndromes are the least present diagnosis in the NANDA-I taxonomy. They concern the clinical judgments that relate to a cluster of nursing diagnoses that occur together and are dealt with through similar interventions. 

Below, you will find examples of each type of diagnosis from NANDA-I definitive guide to nursing diagnoses, Nursing Diagnosis: Definitions and Classifications, 2021-2023. 

What Are the Components of a Nursing Diagnosis?

When writing a nursing diagnosis, certain components should be included. The components may differ depending on the diagnosis type. Below, you’ll find an overview of all the features of a nursing diagnosis:

Diagnosis label – It is a name that reflects the diagnostic focus and the nursing judgements. 

Examples : ineffective health self-management; acute pain; impaired skin integrity.

Definition – This component delivers a clear, exact diagnosis description, making it easier to differentiate from similar diagnoses. 

Example : for an imbalanced nutrition nursing diagnosis, the definition is: “intake of nutrients insufficient to meet metabolic needs.”

Defining characteristics – These refer to the observable details that pinpoint the existence of a problem focused, health promotion diagnosis or syndrome. It includes things that the nurse can see and things that can be heard, touched or smelled, or information coming from the patient or the family. 

Example : for an impaired gas exchange nursing diagnosis, some of the defining characteristics might be: abnormal arterial blood gasses; abnormal skin color (e.g., pale, dusky, cyanosis); and headache upon awakening.

Risk factors – Risk factors can fall into one of several categories: environmental, physiological, psychological, genetic, or chemical elements that increase a patient’s vulnerability to an unhealthy event. Bear in mind that risk factors are only applicable to risk diagnosis. 

Example : a risk for infection diagnosis may have one (or more) of these risk factors: chronic illness, like diabetes; inadequate vaccination; invasive procedure; malnutrition. 

Related factors : These are the factors that in some way present a connection to the nursing diagnosis. They may have been existent before the diagnosis; they may be associated with it; they may contribute or abet a particular diagnosis. Related factors only occur in the case of problem focused nursing diagnosis and syndromes. Rarely, health promotion diagnosis may have related factors. 

For an ​​ineffective peripheral tissue perfusion diagnosis, hypertension is one of the potentially related factors. Others are diabetes mellitus, smoking, or a sedentary lifestyle. 

How to Write a Nursing Diagnostic?

First, you need to carefully analyze all the data and identify the patient’s health problems, health risks, and strengths. Once you have all the information, you can formulate the diagnosis statement. NANDA International strongly recommends that diagnosis follow a specific template. This allows for accurate, precise, and valid diagnoses that nurses and other healthcare team members can easily understand and follow. 

Each type of nursing diagnosis needs to contain certain information. Below, you will find the outline of how to write nursing diagnoses, including examples. 

Impaired bed mobility related to musculoskeletal impairment as evidenced by impaired ability to reposition self in bed.  

Constipation related to inadequate toileting habits as evidenced by change in bowel pattern .

• Risk Diagnosis: 

Risk for decreased cardiac output as evidenced by alteration in heart rhythm.

Risk for adult pressure injury as evidenced by Inadequate adherence to incontinence treatment regimen.

• Health Promotion Diagnosis:

Sedentary lifestyle as evidenced by insufficient motivation for physical activity .

Ineffective family health self-management as evidenced by difficulty with the prescribed regimen . 

• Syndrome Diagnosis:

Post-trauma syndrome;

Chronic pain syndrome.

More Nursing Diagnosis to Help You Elaborate Your Care Plans:

As we have mentioned before, with 267 inputs, the NANDA-I nursing diagnosis list is comprehensive and an excellent tool for nurses used worldwide. We have used several nursing diagnosis examples throughout this guide, all collected from the NANDA-I 2021-2023 complete handbook. This section will provide you with additional nursing diagnosis examples that you can use to formulate and implement future nursing care plans. 

• Decreased activity tolerance
• Risk for surgical site infection
• Deficient knowledge
• Decreased cardiac output
• Deficient fluid volume
• Ineffective coping
• Ineffective thermoregulation
• Ineffective breathing pattern
• Risk for electrolyte imbalance
• Bathing/dressing/feeding self-care deficit
• Risk for ineffective childbearing process
• Risk for injury
• Impaired physical mobility
• Ineffective airway clearance
• Readiness for enhanced communication
• Impaired comfort
• Risk for metabolic syndrome
• Disturbed body image
• Deficient community health
• Neonatal hypothermia
• Risk for bleeding
• Risk for vascular trauma

Are You Ready to Master This Critical Component of Care?

Nursing diagnoses are a useful tool which aids nurses in providing safe, quality, and evidence-based care. They are a critical aspect of patient healthcare that every nurse should know how to use, formulate, and write.  

Nursing Diagnosis Guide

• What Is Nursing Diagnosis?
• Nursing Diagnosis vs. Medical Diagnosis
• Categories of Nursing Diagnoses
• Classification

How to Perform a Nursing Diagnosis

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In 1982, NANDA-I, then known as the North American Nursing Diagnosis Association (NANDA), created official nursing diagnosis classifications to help document the many clinical decisions nurses make on behalf of their patients.

Creating and implementing a nursing diagnosis improves communication and patient care outcomes. Nursing diagnoses and processes help ensure and promote evidence-based, safe practices.

Learn about nursing diagnosis, its importance, and how to write one.

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What Is a Nursing Diagnosis?

NANDA-I defines the nursing diagnosis as communicating “the professional judgments that nurses make every day to our patients, colleagues, members of other disciplines and the public.”

A nursing diagnosis generally has three components:

• A diagnosis approved by NANDA-I
• A “related to” statement that defines the cause of the NANDA-I diagnosis
• An “as evidenced by” statement that uses specific patient data to provide a reason for the diagnosis.

Risk-related nursing diagnoses are used when patients are at risk for developing certain conditions. In this case, nurses use “risk for” and “as evidenced by” statements.

The nursing diagnosis involves nurses’ clinical decisions and expands the nursing process, which includes five core steps.

Assessment is a thorough and holistic evaluation of a patient. It includes the collection of both subjective and objective patient data such as vital signs, a health history, head-to-toe physical, and a psychological, socioeconomic, and spiritual evaluation.

The nurse forms the diagnosis based on the data collected during the assessment. The nursing diagnosis directs nursing-specific patient care.

In this step, the nurse forms a diagnosis based on the patient’s specific medical and/or social needs. The diagnosis leads to the creation of goals with measurable outcomes.

Outcomes and Planning

Outcome and planning involve developing a nursing care plan based on the nursing diagnosis. Planning should be measurable and goal-oriented for the patient and/or their family.

Implementation

Implementation is when nurses initiate the care plan and put it into action. This step provides the continuation of care during hospitalization until discharge.

Evaluation is the final step of the nursing process. A patient care plan is evaluated based on specific goals and desired outcomes and may be adjusted based on the patient’s needs.

How Does a Nurse’s Diagnosis Differ From a Doctor’s Diagnosis?

A nurse initiates a nurse’s diagnosis. The nursing diagnosis focuses on the patient’s needs and outcomes holistically.

A nursing diagnosis aims to incorporate every part of the nursing practice and clinical judgment into accurate documentation.

A doctor’s diagnosis focuses on assessing the patient’s signs and symptoms, identifying the condition, and constructing a medical diagnosis. In many states, advanced practice registered nurses (APRNs) have full practice authority , so they can diagnose patients independently of a physician.

Nursing Diagnosis

• Based on the patient’s immediate situation
• Initiated to resolve a health problem
• Improves communication among the healthcare teams
• A holistic approach to caring for patients

Example: Ineffective breathing pattern related to impaired inhalation and exhalation as evidenced by the use of accessory muscles

Medical Diagnosis

• Initiated by a medical doctor or specialist
• Defines a medical condition, disease, or injury
• Explains the signs and symptoms of the disease

Example: Asthma

4 Categories of Nursing Diagnoses

NANDA-I divides nursing diagnosis into four main categories.

1 | Problem-focused Diagnosis

A problem-focused nursing diagnosis is related to a patient’s problem. It can be used throughout the patient’s hospitalization or resolved by the shift’s end.

Example: Anxiety related to situational crises and stress (related factors) as evidenced by restlessness, insomnia, anguish, and anorexia (defining characteristics)

2 | Risk Diagnosis

A risk nursing diagnosis identifies when the patient is at risk for developing a problem. NANDA-I describes it as a vulnerability the patient has encountered.

Example: Risk for infection as evidenced by inadequate vaccination and immunosuppression (risk factors)

3 | Health Promotion Diagnosis

A health promotion diagnosis identifies how to improve a patient’s health. A health promotion diagnosis includes the patient and their family/community members.

Example: Readiness for enhanced self-care as evidenced by expressed desire to enhance self-care

4 | Syndrome Diagnosis

A syndrome nursing diagnosis identifies a cluster of diagnoses for a patient. These nursing diagnoses are best described together. The patient may be experiencing several health problems forming a pattern.

Example: Chronic pain syndrome

Nursing Diagnosis Classification

NANDA-I created Taxonomy II after collaborating with the National Library of Medicine. Taxonomy, defined as “a system of naming, describing, and classifying related things,” was created to standardize care. There are three levels: nursing diagnosis, domains, and classes.

The NANDA-I Taxonomy II currently has over 200 nursing diagnoses, 47 classes, and 13 domains of nursing practice. The domains are:

• Health promotion
• Elimination and exchange
• Activity/rest
• Perception/cognition
• Self-perception
• Role relationships
• Coping/stress tolerance
• Life principles
• Safety/protection
• Growth/development

Each domain is associated with specific classes.

Nurses complete five steps to carry out a strong, accurate nursing diagnosis. Nurses should follow the five nursing processes:

Nursing Science

Understanding nursing science and theory provides a strong foundation for patient care. It is also the first step in initiating a holistic, patient-centered nursing diagnosis and care plan.

During the health assessment , nurses gather medical, surgical, and social history and perform a physical on the patient.Nurses then ask themselves: What is the current and priority health problem(s) the patient is experiencing? This information is applied to creating a nursing diagnosis.

Identifying Potential Diagnoses

Once the health problem or human response(s) is identified, nurses ask another question: What important information is relevant to the health problem and what’s unrelated?

The answer to this question helps create a potential nursing diagnosis. Nurses will then:

• Determine the category of the nursing diagnosis
• Confirm and rule out other diagnoses
• Create new diagnoses

The nursing diagnosis must be validated and critically thought out. NANDA-I advises using an in-depth assessment. This will confirm or rule out a diagnosis.

Implementing a Care Plan

A nursing diagnosis determines the care plan . Nurses create measurable, achievable goals and related interventions. They then take action, administering the planned interventions.

Nurses constantly evaluate their patients. They often evaluate a nursing diagnosis to ensure the care plan works. If the nursing diagnosis doesn’t fit the situation, nurses must consider what else can be done to improve the patient’s health.

Nurses and nursing students must become members of NANDA-I or purchase the NANDA-I Taxonomy II book to obtain the complete list of nursing diagnoses.

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How to write a diagnostic statement for a care plan.

Problem-Focused Diagnosis Example: Anxiety related to situational crises and stress (related factors) as evidenced by restlessness, insomnia, anguish and anorexia (defining characteristics).

Risk Diagnosis Example: Risk for infection as evidenced by inadequate vaccination and immunosuppression (risk factors).

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How to Write a NANDA Nursing Diagnosis

NANDA International standardizes nursing terminology, specifically nursing diagnoses. Nurses use collected patient data to formulate nursing diagnoses or determine health problems better managed by physicians (medical diagnoses) or collectively with other health care professionals (collaborative problems).

Nursing diagnoses are made up of three components: problem statement, the etiology/related factors, and defining characteristics/risk factors. The problem statement pertains to the patient’s current health problem and needed nursing interventions.

Nursing diagnoses are made up of three components: problem statement, the etiology/related factors, risk factors, and defining characteristics. The etiology, or related factors, identifies probable causes of the health problem, and/or the conditions involved in the development of the problem.

Defining characteristics are the groups of signs and symptoms that indicate the presence of a particular diagnostic label. An example of a written nursing diagnosis using all three components is as follows: “Ineffective airway clearance (problem statement) related to bronchial airway inflammation (etiology/related factor) as evidenced by coarse rhonchi to bilateral apices heard on auscultation (defining characteristics).” Risk factors can be used in place of defining characteristics and encompass the patient’s vulnerability toward their health problem. An example would be something such as, “Risk for infection as evidenced impaired skin integrity.”

A problem-focused diagnosis is the patient's problem that is present at the time of the nursing assessment. This nursing diagnosis is based on the signs and symptoms present in this assessment. Examples are decreased cardiac output and impaired gas exchange. Problem-focused nursing diagnoses include three components: (1) nursing diagnosis, (2) related factors, and (3) defining characteristics.

This nursing diagnosis identifies interventions needed to decrease the risk related to a patient’s problem. There are no etiological factors (related factors) for risk diagnoses. The components of a risk nursing diagnosis include (1) risk diagnostic label and (2) risk factors. An example of a risk diagnosis would be “Risk for infection as evidenced by a suppressed inflammatory response.”

The purpose of this kind of nursing diagnosis is to improve individual patient, family, or community health and well-being. Examples include readiness for enhanced family coping. Components of a health promotion diagnosis generally include only the diagnostic label or a one-part statement. An example would be something such as Readiness for Enhanced Family Coping.

These diagnoses are used when the patient is experiencing multiple health problems forming a pattern that are responsive to similar nursing interventions. Syndrome Diagnoses are written as a one-part statement requiring only the diagnostic label. Examples include decreased cardiac output or decreased tissue perfusion.

To write a problem-focused diagnostic statement, use the problem-etiology-symptom (PES) method. Start with the diagnosis itself, followed by the etiologic factors (related factors in an actual diagnosis), then identify the major signs/symptoms (defining characteristics) that are appearing in the patient. This is for an actual diagnosis, not a risk diagnosis. An example would be: (Impaired physical mobility) related to (decreased muscle control) as evidenced by (the inability to control lower extremities).

For risk diagnoses, there are no related factors (etiological factors) as you are identifying a vulnerability in a patient for a potential problem; the problem is not yet present. Therefore, you identify the risk factors that predispose the individual to a potential problem. An example would be “Risk for (infection) as evidenced by (suppressed inflammatory response).”

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