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What is Nursing Diagnosis - And Why Should I Care?
One of the most frequent questions we get goes something like this….”My patient has Congestive Heart Failure. What is the highest priority/most likely nursing diagnosis?”

There is no right answer, because it’s the wrong question! Assigning a nursing diagnosis based on a medical diagnosis skips several steps essential to optimal and safe patient care. A medical diagnosis is only one piece of the puzzle; it does not by itself, provide the depth of information necessary to make an accurate nursing diagnosis.

NANDA International Nursing Diagnosis BlogWHAT IS A NURSING DIAGNOSIS?
Maybe the easiest thing is to start with what a nursing diagnosis is NOT.

A nursing diagnosis is NOT:

  • Merely a label that you make up that “sounds like” it explains what you are seeing in your patient.
  • Another way of explaining the medical diagnosis, or of renaming a medical condition.
  • Something that “goes with a particular medical diagnosis”.

Nursing diagnosis is defined as “a clinical judgment about individual, family, or community experiences/responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.” (Herdman, 2012, p. 515). 

In other words, a nursing diagnosis is a judgment based on a comprehensive nursing assessment. The medical diagnosis provides one important piece of data, but it does not provide anywhere near the depth of information necessary for making an accurate nursing diagnosis.

WHY SHOULD YOU CARE?

Because an accurate nursing diagnosis based on a thorough assessment results in more effective and safer patient care. Period.

Let’s take a look at an example:

A man is admitted through the Emergency Department with a medical diagnosis of Viral Pneumonia with the following profile:

  • Age 78;
  • Dyspneic and demonstrating very shallow breathing;
  • Pulse oximeter is showing 90% on 4L of O2;
  • History of COPD.
What is the primary nursing diagnosis? Did you think of impaired gas exchange? Seems obvious, doesn’t it, considering the data and medical diagnosis? However, the question the nurse should ask is this: “What is causing the low SpO2?”

After completing a thorough assessment, the nurse discusses her findings with the patient, including the very shallow breathing. She learns the patient is breathing shallowly because he’s in pain. He’s suffering from posthepatic neuralgia as a result of a very painful course of shingles. In this example, the assessment-based, primary nursing diagnosis is chronic pain.

Consider these two scenarios:

Nursing Diagnosis Linked to the Medical Diagnosis
A care plan is developed to address the nursing diagnosis of impaired gas exchange, based on the medical diagnosis of Viral Pneumonia. The posthepatic neuralgia as a cause for shallow breathing is not identified and overlooked in treatment.

OR

Nursing Diagnosis Linked to Nursing Assessment and Critical Thinking
A care plan is developed to address the nursing diagnosis of chronic pain, with treatment designed to resolve this as the primary cause of the shallow breathing, and to prevent recurrence.

Which scenario provides the best patient care and outcome? What do you think the relationship is – or is not – between medical diagnosis and nursing diagnosis?

Dr. T. Heather Herdman, PhD, RN
Executive Director
NANDA International, Inc.
Comments
Mago legal
7/6/2013
Hi! this my first time on that site and I am trying to copy the NANDA list of nursing and cannot may help
NANDA-I
7/8/2013
Hello Mago: we do not provide a list of terms, as to do so defeats the purpose of a standardized language. Please read our FAQ on this subject: http://kb.nanda.org/article/AA-00232. Here is a link for more information about NANDA-I publications: http://www.nanda.org/nanda-international-publications.html.
Denise Kruszynski
9/14/2013
Good afternoon, this is my first time visiting this site also! I'm taking a class on nursing informatics, and well, one thing led to the other; here I am. Dr. Herdman's comment as to the distinction between the nursing diagnosis & medical diagnosis, or a symbiotic mesh of the two intrigued me. Honestly, I have never given it a second thought. The benefits of widely applied standardized nursing terminology now makes a lot more sense. While considering the medical diagnosis, the wise nurse looks past the diagnosis to the patient in a way that meshes clinical information and intuitive wisdom in a singular fashion. What we do is so different from medicine that it really does require a unique language to represent it. Thank you for your example, now I understand. Back to the basics, nurses always ask, "why?" Denise Kruszynski, RN
T. Heather Herdman
9/16/2013
Exactly, Denise! We have to look at and recognize the medical diagnosis, but as you put it, we have to "look past the diagnosis to the patient" - that's a great way of saying, look at the human responses!
Dawn L.
10/6/2013
Good afternoon! I'm researching NANDA for my graduate Nursing Informatics course and in doing so am trying to confirm whether or not NANDA is the only professional organization that provides nursing diagnosis classifications? I have not been able to find a "competing" standard in CINAHL or through Google. However, I did locate an article in OJIN (albeit from 1998) stating your classification system is the only one with a formal review process. My guess is that your system is the best (hence International adoption) and therefore competition is virtually non-existent. Would you be able to speak to this? Thank you so much for your time!
Kelly S.
10/22/2013
What is post-hepatic neuralgia?
NANDA International
10/24/2013
Hi Kelly - click here to read more about postheptic neuralgia.
NANDA International
10/28/2013
Hi Dawn: thank you for your interest in NANDA-I. You are correct, NANDA-I is the original, most comprehensive, and most widely-used official classification of nursing diagnoses. NANDA-I is recognized by the American Nurses Association and has been systematically updated since the late 1970s. Our taxonomy currently includes 216 diagnoses.

Dr. Gail Keenan
Chair, NANDA International Informatics Committee
A. Davis RN
11/21/2013
post-hepatic neuralgia is a medical diagnosis?
NANDA International
11/23/2013
Hello A. Davis: Yes,post-hepatic neuralgia is a medical diagnosis. However, it is not the focus of the nursing care. Rather, the focus is chronic pain, and the post-hepatic neuralgia is a related factor.
Sabtuyah Selet
11/28/2013
Show me the nursing diagnosis for end stage renal failure sample. Pre and post hemodialysis
NANDA International
12/6/2013
Hello Sabtuyah - nursing diagnoses cannot be based solely on medical diagnoses. Click here to read our FAQ on this subject.
Kamal Arain
1/3/2014
Hi I want to copy a nursing assessment list but i could`nt got it.What should i do?
lindalemarkele
1/29/2014
thanks very much
sharif
2/12/2014
Nurse supervisor
sharif
2/12/2014
Hat
6/24/2014
This shit is silly and you know it. It only exists in academia. Nursing, in real practice, is a trade.
Kunal
8/16/2014
hi, i m writing a client assessment of a patient with osteoarthritis. what are the nursing diagnosis i can use to help develop a care plan. any suggestions?
Nicolet Johnson
11/17/2014
can you post to the web site some secenario so that as student we can practice writing nursing diagnosis
Tony cortes
3/31/2015
Under "Why should I care," the nursing diagnosis listed is posthepatic neuralgia. Shouldn't this read postherpatic vs. posthepatic? Your thoughts
nafaha ahmed hassan
4/14/2015
hello I am nafaha I need to know difference between nursing diagnosis and medical diagnosis
Banu
5/5/2015
hi this is my first time visit though I have heard a lot about NANDA in the class. I'm looking for potential nursing diagnostic for acute abdominal pain and discomfort with past medical history of small intestine resection? please help me.
pat
5/17/2015
can a nurse give a family member her medical opinion
mbwila
5/28/2015
Hi! It's my first time to visit NANDA. I would like to know how I can get access of nanda contents.
Ayodeji Abdulganiyu Bilewu
6/24/2015
Nanda i
Nashwa
8/17/2015
its my first time to visit the web site ,In my hospital there's great confusion in writing nursing care plan ,as nursing educator I need to clarify for the staff about writing meanful nursing diagnosis ,please advice me where to start .
J Cruz
9/8/2015
The level of some of the input in this conversation is worrying of the lack of understanding of the basic tenets of nursing diagnosis, and therefore of the profession in general. I am concerned about that the current state of nursing education has not focused on the nursing process, including diagnosis, as well as nursing theory.
Newbie
9/12/2015
I believe you mean post-herpetic neuralgia, which is pain that persists after shingles lesions have resolved.
Dr. G
11/5/2015
On the web site you stat "A medical diagnosis may be a related (or etiologic) factor for a nursing diagnosis, but you must identify defining characteristics of a nursing diagnosis during your assessment; it is impossible to make an accurate nursing diagnosis strictly from a medical diagnosis" I mostly agree, but I disagree that the Medical Dx can be a related factor; the related factors should almost always be (physical, social, psychological or even spiritual) pathophysiology. The segment of the related to statement might include the medical Dx in the secondary to clause; but, I find it is otherwise inappropriate as part of the related to phrase.
Teri Hill
11/21/2015
I agree with Dr. G. I have taught nursing students for over 15 years and placing that medical diagnosis anywhere near the R/T causes the student to revert to the medical model. To me, it is also outside of my scope of practice. For example, while my scope allows me to diagnosis Impaired Gas Exchange it does not allow me to diagnosis Pneumonia. The student and the nurse needs to look deeper than just that 'medical diagnosis' to the true patho, why does the patient have trouble maintaining gas exchange? Is it weakness? Position? etc. The nurse needs to find what they can independently treat -- in order to stay in their legal scope of practice.
jawad ahmed
4/6/2016
i read first time.my concept clear.
Melanie
5/22/2016
I am a student nurse studying care planning at the moment. I thought the article was clear and I could relate it to my work easily. I do have a question about the difference between a systematic nursing diagnosis and a medical diagnosis though. I am working on an assignment about a child who has come into hospital with abdominal pain. She is overweight, has poor diet and has constipation. Obviously the nursing care plan would address the pain, lack of exercise and diet, however my understanding of what my teacher said, is that the nurse would diagnose constipation and treat this too. Is this correct as I thought this was a medical diagnosis? However, It could just be my misunderstanding, she could have meant that constipation was a medical diagnosis and we would treat this to relieve other symptoms i.e. pain. Any thoughts?
Kit
7/5/2016
hi, I am a nursing student. I would like to ask about the legal and ethical issues connected with nursing care plan. I mean is there any issues with regard to wrong nursing care plan? your thoughts are appreciated. many thanks!
Arsenic T. Manlangit
8/1/2016
hi, I am a registered nurse and is currently working in saudi arabia. i would like to know of you are conducting trainings/workshops on Nursing care plans? i would like to lear =n more about the correct way of creating a nursing care plan. Thanks
Regina Lawrence
8/9/2016
http://www.drbriffa.com/2014/01/31/statins-associated-with-increased-risk-of-death-in-those-with-heart-failure/#comment-337813
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