Using Nanda- Approved Nursing Diagnoses PDF

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USING NANDA-APPROVED NURSING DIAGNOSES

After the data have been organized into clusters, the nurse needs to consult the NANDA-approved diagnoses, carefully reviewing the definitions, defining characteristics, and risk or related factors. The clustered data are then matched with a particular NANDA diagnosis. It is important that the nurse review the actual definitions and defining characteristics to ensure that the diagnosis being made is accurate; reliance on only the diagnostic statement can lead to inaccuracies in diagnosis. STATEMENT The nursing diagnosis selected from NANDA-approved diagnoses becomes the diagnostic label, the first part of the diagnosis statement. Etiologies can be identified using the related factors listed with each nursing diagnosis. The appropriate etiology is selected and joined to the first part of the statement with the ‘‘related to’’ phrase. Because the NANDA list of nursing diagnoses is constantly evolving, there may be times when no etiology is provided. In such cases, the nurse should attempt to describe likely contributing factors to the client’s condition. NURSING DIAGNOSES Following is a discussion of common errors that may occur in the process of developing nursing diagnoses. ASSESSMENT ERRORS There is an underlying assumption that nurses have adequate assessment skills and are knowledgeable about what data need to be collected. However, this is not always the case. The novice nurse may have only rudimentary assessment skills and limited clinical experience. Experienced nurses are challenged to keep current and sometimes are ill equipped to collect appropriate assessment data. Errors may be made when writing a nursing diagnosis due to an incomplete database or inappropriately collected assessment data. Incomplete Assessment Data Incomplete collection can occur when the nurse has neither had nor taken

the time to appropriately address all subjective and objective data. For example, during admission of a new client to a health care facility, a nurse is interrupted during the data collection and fails to return to finish the admission process. Restricted data collection occurs when a client is unable or unwilling to provide the necessary data. Validation Errors Failure to validate occurs when the nurse does not confirm previously collected data. An example would be failure by the nurse to recheck an admission blood pressure that was elevated. Misinterpreting Data Misinterpretation can occur when the meaning attached to the data is incorrect. An example would be a client who comes to the ambulatory care clinic and presents with several signs and symptoms, including a reported 4pound weight gain that month. DIAGNOSTIC ERRORS Errors can also occur in the nursing diagnostic process during the clustering, interpretation, and statement of the diagnosis. Inappropriate Data Clustering Inappropriate data clustering may occur when the nurse lacks sufficient theoretical knowledge and clinical expertise in order to appropriately cluster data cues. An example would be the client who visits an industrial clinic with complaints of flulike symptoms, stomach cramps, and vomiting. The nurse attributes the vomiting to the influenza, but further analysis indicates that this client is actually manifesting symptoms of a toxic reaction to a prescribed drug that is causing the vomiting.

Diagnosis Statement RT renal disease. Renal disease is a medical diagnosis, and, according to the guidelines, the etiology must be a human response that the nurse is licensed and competent to treat. This diagnosis would be better stated as imbalanced nutrition: less than body requirements RT inadequate intake of an appropriate renal diet.

Values play an important role in interpretation of data, clustering of data, and ultimately the development of the diagnosis. Nurses must be cognizant of personal biases, being careful not to impose their value systems on clients. Personal prejudices should be avoided in the diagnostic statement. The Nursing Checklist provides selected questions that nurses can ask themselves in order to avoid making mistakes when developing nursing diagnoses.

LIMITATIONS OF NURSING NANDA-approved nursing diagnosis list. Criticisms about the list include disagreement over specific labels in the classification system and the perception that the list is confining, incomplete, illness and disease oriented, and confusing. Many nurses are not familiar with the NANDA list and do not know how to use it or feel ‘‘it doesn’t have the diagnosis’’ they need. It should be noted that this list is not meant to be inclusive. Development and refinement of diagnoses continue to be a focus of NANDA conferences. In addition, nurses may disagree with or refuse to use diagnoses such as noncompliance or knowledge deficit . In these instances, the nurse then has the choice and the right to not use these specific diagnoses. Novice nurses need to know nursing diagnosis and nursing process in order to understand how the discipline of nursing intersects with the other health care providers. NANDA-I recognizes that health care continues to move toward an interdisciplinary, client-focused care environment that requires standardization of languages across disciplines. Many acute care facilities use an interdisciplinary care plan such as care maps or critical pathways to monitor client outcomes. All health care providers use the same care plan to document the client’s response to specific interventions. Common ‘‘client problems’’ listed on a critical pathway are written as nursing diagnoses such as risk for infection or risk for injury.

LIMITATIONS TO NURSING NANDA’s language is relatively new compared to medical language that has existed for several hundred years. Some nurses would rather wait until the NANDA listing is complete before they use it.

‘‘completed’’ list of nursing or medical diagnoses for this very reason. The ever-changing health care scene dictates that nurses participate in evolving methods to communicate within the health care industry. Another barrier to the use of nursing diagnoses is the numerous approaches for application that are found in the nursing literature. Due to these various methods, it may be difficult for nurses to choose one method with which they feel comfortable. Nurses may also be unable and unwilling to use nursing diagnoses because of incomplete knowledge about the process and disagreements about wording. After identifying the existence of barriers to the use of nursing diagnoses, it is possible to design strategies to overcome them. One strategy is to develop a common nursing language that is globally used throughout the profession. Nursing diagnostic terminology serves this purpose. Familiarity with this language empowers the nurse to communicate more effectively with other nurses and health care team members. Effective communication, in turn, improves the accuracy in nursing diagnoses. Ultimately, the quality of care should improve, and the costs associated with that care should decrease. Due to the fact that many health care facilities are asking nurses to do more with fewer resources, nurses are challenged to learn more efficient ways of performing their duties. Nurses’ time is spent more efficiently if less time is spent deciphering meanings of words. The move toward electronic health records is making it more important than ever to have standardized nursing languages. As health care settings are required to communicate with other organizations to improve client management, it will be important to have standardized languages within those electronic systems so that different information systems are able to ‘‘talk to’’ one another by sending and receiving data that diverse systems can readily understand. The current method of ‘‘free text charting’’ will become a thing of the past, and standardized nursing languages representing nursing diagnoses, interventions, and outcomes will be critical to the success of these information systems. See the Nursing Process Highlight on page 121 in order to practice developing a diagnostic statement. The accompanying Uncovering the Evidence display on page 121 describes how education can improve the use and documentation of nursing diagnoses. When a nurse encounters client situations that do not readily fit the nursing diagnosis language, every attempt should be made to describe the phenomena. The nurse may be on the threshold of documenting the need for a new, asyet-undiscovered nursing diagnosis....