1. Tips for Teaching Nursing Diagnosis and the Use of NANDA International Terminology

2. Nursing Diagnosis: Definition
The NANDA-I definition of a nursing diagnosis was adapted from a national, Delphi study by Dr. Joyce Shoemaker (1984)
Nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable (NANDA, 1997).

3. The Diagnoses
206 NANDA-approved nursing diagnoses will be present in the Definitions & Classifications book for
Level of Evidence (LOE) Criteria Established for All New and Revised Diagnoses
Entry into the Taxonomy requires various levels of clinical evidence

4. Clinical Decision Making
Health care professionals face complex decisions daily regarding patient care— and must do so with decreased resources
What is the area of concern that nurses can treat/prevent/monitor? (Diagnosis)
What is an appropriate goal for this patient? (Outcome)
What treatment is most effective? (Intervention)

5. Critical Thinking
Nurses need knowledge of diagnoses, definitions and defining characteristics, especially those common to the populations with which they work and the diagnostic processes that are used to interpret patient data
Skills of analyzing, logical reasoning, and applying standards are thinking processes required for accurate diagnosis in nursing
These skills are developed through:
Discussions of how data should be clustered to generate accurate diagnoses
Relation of data clusters to diagnoses
Comparisons of existing data to expected data based on research findings.
Lunney (2009)

6. Diagnosis Requires Assessment
Identifying human responses that are related to medical diagnosis without a complete assessment to determine the presence of defining characteristics
Lack of instruction on clustering assessment data to derive a list of potential diagnoses
Lack of hypothesis testing to determine best diagnoses for each patient

7. Nurses Are Diagnosticians
Diagnosticians interpret data within their fields of expertise in order to provide needed services
A key element of data interpretations is that they are subject to error.
A good diagnostician must realize that there are always risks to the accuracy of data interpretations
Becoming a nurse diagnostician requires development of professional and personal skills and characteristics
Competencies in intellectual, interpersonal, and technical domains
Personal strengths of tolerance for ambiguity and use of reflective practice

8. Teaching Methods
Review proper method to complete patient assessment to determine the presence of defining characteristics
Clustering of defining characteristics is often misunderstood : presence of one defining characteristic does not necessarily require a diagnosis
All nursing interventions do not require a nursing diagnosis
Medication administration for a condition that is not a primary focus of nursing care is related more to a medical diagnosis
Need to test hypotheses
Need to evaluate success of plan of care and reassess continually

9. Diagnostic Process Assessment Cluster cues / defining characteristics
Collect additional data to narrow list of potential diagnoses
Generate list of potential diagnoses
Implement plan of care based on identified diagnoses
Evaluate success of plan of care
Determine diagnosis/diagnoses to be treated

10. Cue Generation and Nursing Diagnosis
Cues are analyzed in relation to possible diagnoses
Existing cues are matched with the expected cues for the diagnoses being considered
During the evaluation of cues and related diagnoses, nurses may decide that there are not enough data to make a diagnostic decision or that there is enough evidence for one or more likely diagnoses
If there are not enough data to make a diagnosis, then the next step involves a focused search for additional cues
If there is enough supporting evidence, a diagnosis is made and then validated

11. Quality Nursing Care Accurate Assessment and Diagnosis
Defining characteristics
Related factors
Risk factors
Identify Attainable Patient Outcomes
Efficiency
Utilize Proven Interventions
Effective
Least resource-intensive

12. Quality Nursing Care Accurate Assessment and Diagnosis
Defining characteristics
Related factors
Risk factors
Identify Attainable Patient Outcomes
Efficiency
Utilize Proven Interventions
Effective
Least resource-intensive

13. Incorrect Diagnostic Process
Cluster cues / defining characteristics
Collect additional data to narrow list of potential diagnoses
Generate list of potential diagnoses
Implement plan of care based on identified diagnoses
Evaluate success of plan of care
Assessment OR Identify Medical Diagnosis
Determine nursing diagnosis/diagnoses to be treated

14. Teaching Methods
Requiring students to develop and detail care plans with “every possible diagnosis” creates resistance
Sets up situation that is not realistic
Cannot address every possible diagnosis in a short hospital stay
Becomes a “thing to do” rather than truly understanding and applying diagnostic reasoning and differential diagnosis
Students learn to “just pick a diagnosis” rather than making decisions about the best explanation(s) for patient responses

15. Teaching Methods
Use of case studies can assist students in identifying cues in patient situations that may be defining characteristics of one or more nursing diagnoses
Hypothesis generation and differential diagnosis skills can be developed through case studies, clinical conference discussions and in skills lab scenarios

16. “The List”
Automating the electronic record to populate the plan of care with nursing diagnoses when a particular medical diagnosis is used
Becomes a documentation tool rather than an individualized plan of care to direct nursing interventions to meet important patient outcomes
Puts patients at risk / Negligence
May ignore or miss important diagnoses for patients
Plan of care does not address critical outcomes for patients

17. Reportable Quality Measures: Where is Nursing?
Management of diabetes:
Percent of adults with diabetes who had a foot examination in past year
Percent of adults with diabetes who had an influenza immunization in past year
Percent of adults with diagnosed diabetes with HbA1c level > 9.0% (poor control); < 7.0% (optimal)
Hospital admissions for short-term complications of diabetes per 100,000 population
Nursing diagnoses represent the phenomena of concern to the nursing profession. The consistent utilization of standardized nursing terminologies such as NANDA-I’s nursing diagnoses within electronic health records is necessary to enable collection and analysis of nursing data and nurse-sensitive outcomes. Without this ability, nursing remains relatively invisible to patients, and hospital administrators are more likely to consider nurses solely as the single largest line item in terms of hospital expenses. A true analysis of nursing’s impact, enabled by the accurate and consistent use of standardized nursing languages, will enable linkage of nursing care to patient outcomes – demonstrating the invaluable impact of nurses on patient/family/community well-being.

18. The Role of Nursing in Patient Quality
Percent of adults with diagnosed diabetes with HbA1c < 7.0% (optimal)
Readiness for enhanced family coping
Health-seeking behaviors
Readiness for Enhanced Self Health Management

19. The Role of Nursing in Patient Quality
Management of diabetes:
Hospital admissions for short-term complications of diabetes per 100,000 population
Anxiety
Ineffective coping
Ineffective health maintenance
Risk for injury
Deficient knowledge
Ineffective Self Health Management

20. Diagnostic Difficulties
Significant overlap of cues (Defining Characteristics) to diagnoses
Contextual factors such as culture can change the perspective on diagnosis
Many studies have verified that interpretations of clinical cases have the potential to be less accurate than indicated by the data
(Lunney, 2007).