Know the concepts behind writing NANDA nursing diagnosis (NDx) in this ultimate tutorial and list. Learn what is a nursing diagnosis, the nursing process, the different types, and how to write NANDA nursing diagnoses correctly. Included also in this guide are tips on how you can formulate better nursing diagnosis plus a list of NANDA-I diagnoses that you can use in creating your nursing care plans (NCP).
What is a nursing diagnosis?
A nursing diagnosis (NDx) may be part of the nursing process and is a clinical judgment concerning 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 the selection of nursing interventions to achieve outcomes for which the nurse has accountability. Nursing diagnoses are developed based on data obtained during the nursing assessment and enable the nurse to develop the care plan.
Purposes of Nursing Diagnosis
The purpose of the nursing diagnosis is as follows:
- Helps identify nursing priorities and help direct nursing interventions based on identified priorities.
- Helps the formulation of expected outcomes for quality assurance requirements of third-party payers.
- Nursing diagnoses help identify how a client or group responds to actual or potential health and life processes and knowing their available resources of strengths that can be drawn upon to prevent or resolve problems.
- Provides a common language and forms a basis for communication and understanding between nursing professionals and the healthcare team.
- Provides a basis of evaluation to determine if nursing care was beneficial to the client and cost-effective.
- For nursing students, nursing diagnoses are an effective teaching tool to help sharpen their problem-solving and critical thinking skills.
Difference between Medical and Nursing Diagnoses
The term nursing diagnosis is associated with three different concepts. It may refer to the distinct second step in the nursing process, diagnosis. Also, nursing diagnosis applies to the label when nurses assign meaning to collected data appropriately labeled with NANDA-I-approved nursing diagnosis. For example, during the assessment, the nurse may recognize that the client is feeling anxious, fearful, and finds it difficult to sleep. It is those problems which are labeled with nursing diagnoses: respectively, Anxiety, Fear, and Disturbed Sleep Pattern. Lastly, a nursing diagnosis refers to one of many diagnoses in the classification system established and approved by NANDA. In this context, a nursing diagnosis is based upon the response of the patient to the medical condition. It is called a ‘nursing diagnosis’ because these are matters that hold a distinct and precise action that is associated with what nurses have autonomy to take action about with a specific disease or condition. This includes anything that is a physical, mental, and spiritual type of response. Hence, a nursing diagnosis is focused on care.
A medical diagnosis, on the other hand, is made by the physician or advance health care practitioner that deals more with the disease, medical condition, or pathological state only a practitioner can treat. Moreover, through experience and know-how, the specific and precise clinical entity that might be the possible cause of the illness will then be undertaken by the doctor, therefore, providing the proper medication that would cure the illness. Examples of medical diagnoses are Diabetes Mellitus, Tuberculosis, Amputation, Hepatitis, and Chronic Kidney Disease. The medical diagnosis normally does not change. Nurses are required to follow the physician’s orders and carry out prescribed treatments and therapies.
As explained above, now it is easier to distinguish nursing diagnosis from that of a medical diagnosis. Nursing diagnosis is directed towards the patient and his physiological and psychological response. A medical diagnosis, on the other hand, is particular with the disease or medical condition. Its center is on the illness.
NANDA International (NANDA-I)
NANDA–International earlier known as the North American Nursing Diagnosis Association (NANDA) is the principal organization for defining, distribution and integration of standardized nursing diagnoses worldwide.
The term nursing diagnosis was first mentioned in the nursing literature in the 1950s. Two faculty members of Saint Louis University, Kristine Gebbie and Mary Ann Lavin, recognized the need to identify nurses’ role in an ambulatory care setting. In 1973, NANDA’s first national conference was held to formally identify, develop, and classify nursing diagnoses. Subsequent national conferences occurred in 1975, in 1980, and every two years thereafter. In recognition of the participation of nurses in the United States and Canada, in 1982 the group accepted the name North American Nursing Diagnosis Association (NANDA).
The first taxonomy of nursing diagnoses was alphabetical which was considered unscientific by some. In 1982, NANDA adopted the “nine patterns of unitary man” based on the nursing models of Sr. Calista Roy and Martha Rogers as an organizing principle. In 2002, Taxonomy II was adopted, which was adapted from the Functional Health Patterns assessment framework of Dr. Maryjoy Gordon. Taxonomy II has three levels: domain, classes, and nursing diagnoses. Nursing diagnoses are no longer grouped by Gordon’s patterns but coded according to seven axes: diagnostic concept, time, unit of care, age, health status, descriptor, and topology. In addition, diagnoses are now listed alphabetically by its concept, not by the first word.
The American Nurses Association (ANA) incorporated nursing diagnosis into its Standards of Practice in 1973, Nursing: A Social Policy Statement in 1995, and Standards of Clinical Practice in 1998.
In 2002, NANDA became NANDA International (NANDA-I) in response to its significant growth in membership outside of North America. The acronym NANDA was retained in the name because of its recognition.
Review, refinement, and research of diagnostic labels continue as new and modified labels are discussed at each biannual conference. Nurses can submit diagnoses to the Diagnostic Review Committee for review. The NANDA-I board of directors give the final approval for incorporation of the diagnosis into the official list of labels. As of 2019, NANDA-I has approved 244 diagnoses for clinical use, testing, and refinement.
The five stages of the nursing process are assessment, diagnosing, planning, implementation, and evaluation. In the diagnostic process, the nurse is required to have critical thinking. Apart from the understanding of nursing diagnoses and their definitions, the nurse promotes awareness of defining characteristics and behaviors of the diagnoses, related factors to the selected nursing diagnoses, and the interventions suited for treating the diagnoses.
What data is collected? The first step of the nursing process is called assessment. When the nurse first encounters a patient, the former is expected to perform an assessment to identify the patient’s health problems as well as the physiological, psychological, and emotional state. The most common approach to gathering important information is through an interview. Physical examinations, referencing a patient’s health history, obtaining a patient’s family history, and general observation can also be used to collect assessment data.
What is the problem? Once the assessment is completed, the second step of the nursing process is where the nurse will take all the gathered information into consideration and diagnose the patient’s condition and medical needs. Diagnosing involves a nurse making an educated judgment about a potential or actual health problem with a patient. More than one diagnoses are sometimes made for a single patient.
How to manage the problem? When the nurse, any supervising medical staff, and the patient agree on the diagnosis, the nurse will plan a course of treatment that takes into account short- and long-term goals. Each problem is committed to a clear, measurable goal for the expected beneficial outcome. The planning step of the nursing process is discussed in detail in Nursing Care Plans (NCP): Ultimate Guide and Database.
Putting the plan into action. The implementing phase of the nursing process is when the nurse put the treatment plan into effect. This typically begins with the medical staff conducting any needed medical interventions. Interventions should be specific to each patient and focus on achievable outcomes. Actions associated in a nursing care plan include monitoring the patient for signs of change or improvement, directly caring for the patient or conducting important medical tasks, educating and guiding the patient about further health management, and referring or contacting the patient for a follow-up.
Did the plan work? Once all nursing intervention actions have taken place, the team now learns what works and what doesn’t by evaluating what was done beforehand. The possible patient outcomes are generally explained under three terms: the patient’s condition improved, the patient’s condition stabilized, and the patient’s condition worsened. Accordingly, evaluation is the last, but if goals were not sufficed, the nursing process begins again from the first step.
Types of Nursing Diagnoses
The four types of NANDA nursing diagnosis are Actual (Problem-Focused), Risk, Health promotion, and Syndrome. Here are the four categories of nursing diagnosis provided by the NANDA-I system.
Problem-Focused Nursing Diagnosis
A problem-focused diagnosis (also known as actual diagnosis) is a client problem that is present at the time of the nursing assessment. These diagnoses are based on the presence of associated signs and symptoms. Actual nursing diagnoses should not be viewed as more important than risk diagnoses. There are many instances where a risk diagnosis can be the diagnosis with the highest priority for a patient.
Problem-focused nursing diagnoses have three components: (1) nursing diagnosis, (2) related factors, and (3) defining characteristics. Examples of actual nursing diagnosis are:
Risk Nursing Diagnosis
The second type of nursing diagnosis is called risk nursing diagnosis. These are clinical judgment that a problem does not exist, but the presence of risk factors indicates that a problem is likely to develop unless nurses intervene. The individual (or group) is more susceptible to develop the problem than others in the same or a similar situation because of risk factors. For example, an elderly client with diabetes and vertigo has difficulty walking refuses to ask for assistance during ambulation may be appropriately diagnosed with Risk for Injury.
Components of a risk nursing diagnosis include: (1) risk diagnostic label, and (2) risk factors. Examples are:
- Risk for Falls
- Risk for Injury
Health Promotion Diagnosis
Health promotion diagnosis (also known as wellness diagnosis) is a clinical judgment about motivation and desire to increase well-being. Health promotion diagnosis is concerned in the individual, family, or community transition from a specific level of wellness to a higher level of wellness.
Components of a health promotion diagnosis generally include only the diagnostic label or a one-part-statement. Examples are:
- Readiness for Enhanced Spiritual Well Being
- Readiness for Enhanced Family Coping
- Readiness for Enhanced Parenting
A syndrome diagnosis is a clinical judgment concerning with a cluster of problem or risk nursing diagnoses that are predicted to present because of a certain situation or event.
They, too, are written as a one-part statement requiring only the diagnostic label. Examples of a syndrome nursing diagnosis are:
- Chronic Pain Syndrome
- Post-trauma Syndrome
- Frail Elderly Syndrome
Possible Nursing Diagnosis
A possible nursing diagnosis is not a type of diagnosis as are actual, risk, health promotion, and syndrome. Possible nursing diagnoses are statements describing a suspected problem for which additional data are needed to confirm or rule out the suspected problem. It provides the nurse with the ability to communicate with other nurses that a diagnosis may be present but additional data collection is indicated to rule out or confirm the diagnosis.
- 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.
Problem and Definition
The problem statement, or the diagnostic label, describes the client’s health problem or response for which nursing therapy is given as concisely as possible. A diagnostic label usually has two parts: qualifier and focus of the diagnosis. Qualifiers (also called modifiers) are words that have been added to some diagnostic labels to give additional meaning, limit or specify the diagnostic statement. Exempted in this rule are one-word nursing diagnoses (e.g., Anxiety, Fatigue, Nausea) where their qualifier and focus are inherent in the one term.
|Qualifier||Focus of the Diagnosis|
|Imbalanced||Nutrition: Less Than Body Requirements|
The etiology, or related factors and risk factors, component of a nursing diagnosis label identifies one or more probable causes of the health problem, are the conditions involved in the development of the problem, gives direction to the required nursing therapy, and enables the nurse to individualize the client’s care. Nursing interventions should be aimed at etiological factors in order to remove the underlying cause of the nursing diagnosis. Etiology is linked with the problem statement with the phrase “as related to”.
Defining characteristics are the clusters of signs and symptoms that indicate the presence of a particular diagnostic label. In actual nursing diagnoses, the defining characteristics are the identified signs and symptoms of the client. For risk nursing diagnosis, no signs and symptoms are present therefore the factors that cause the client to be more susceptible to the problem form the etiology of a risk nursing diagnosis. Defining characteristics are written “as evidenced by” or “as manifested by” in the diagnostic statement.
How to Write a Nursing Diagnosis?
In writing nursing diagnostic statements, describe the health status of an individual and the factors that have contributed to the status. You do not need to include all types of diagnostic indicators. Diagnostic statements can be one-part, two-part, or three-part statements. A common format used when writing or formulating nursing diagnosis is the PES format.
One-Part Nursing Diagnosis Statement
Health promotion nursing diagnoses are usually written as one-part statements because related factors are always the same: motivated to achieve a higher level of wellness though related factors may be used to improve the of the chosen diagnosis. Syndrome diagnoses also have no related factors. Examples of one-part nursing diagnosis statement include:
Two-Part Nursing Diagnosis Statement
Risk and possible nursing diagnoses have two-part statements: the first part is the diagnostic label and the second is the validation for a risk nursing diagnosis or the presence of risk factors. It’s not possible to have a third part for risk or possible diagnoses because signs and symptoms do not exist. Examples of two-part nursing diagnosis statement include:
- Risk for Infection related to compromised host defenses
- Risk for Injury related to abnormal blood profile
- Possible Social Isolation related to unknown etiology
Three-part Nursing Diagnosis Statement
An actual or problem nursing diagnosis have three-part statements: diagnostic label, contributing factor (“related to”), and signs and symptoms (“as evidenced by”). Three-part nursing diagnosis statement is also called the PES format which includes the Problem, Etiology, and Signs and Symptoms. Examples of three-part nursing diagnosis statement include:
- Impaired Physical Mobility related to decreased muscle control as evidenced by inability to control lower extremities.
- Acute Pain related to tissue ischemia as evidenced by statement of “I feel severe pain on my chest!”
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 diseases 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 to the general response or NANDA label to make it more precise. For example, Impaired Skin Integrity (Right Anterior Chest) related to disruption of skin surface secondary to burn injury.
Nursing Diagnosis List
In this section is the list or database of NANDA nursing diagnoses examples with their definitions that you can read to learn more about them or use them in developing your nursing care plans. Click on the links to visit the complete guide.
- Activity Intolerance: Insufficient physiologic or psychological energy to endure or complete required or desired daily activities.
- Acute Confusion: Abrupt onset of a cluster of global, transient changes and disturbances in attention, cognition, psychomotor activity, level of consciousness, or the sleep/wake cycle.
- Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months.
- Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.
- Bowel Incontinence: Change in normal bowel habits characterized by involuntary passage of stool.
- Caregiver Role Strain: Difficulty in performing family caregiver role.
- Chronic Confusion: An irreversible, long-standing, and/or progressive deterioration of intellect and personality characterized by decreased ability to interpret environmental stimuli, decreased capacity for intellectual thought processes, and manifested by disturbances of memory, orientation, and behavior.
- Chronic Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage…a duration of greater than 6 months.
- Constipation: Decrease in normal frequency of defecation accompanied by difficult or incomplete passage of stool and/or passage of excessively hard, dry stool.
- Decreased Cardiac Output: Inadequate blood pumped by the heart to meet the metabolic demands of the body.
- Deficient Fluid Volume: Decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone without change in sodium.
- Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
- Diarrhea: This nursing diagnosis is defined as passage of loose, unformed stools.
- Disturbed Body Image: Confusion in mental picture of one’s physical self.
- Disturbed Thought Processes: The state in which an individual experiences a disruption in such mental activities as conscious thought, reality orientation, problem solving, judgment, and comprehension related to coping, personality, and/or mental disorder.
- Excess Fluid Volume: Increased isotonic fluid retention.
- Fatigue: An overwhelming sustained sense of exhaustion and decreased capacity for physical and mental work at usual level.
- Fear: Response to perceived threat that is consciously recognized as danger.
- Grieving: A normal complex process that includes emotional, physical, spiritual, social, and intellectual responses and behaviors by which individuals, families, and communities incorporate an actual, anticipated, or perceived loss into their daily lives.
- Hopelessness: Subjective state in which an individual sees limited or no alternatives or personal choices available and is unable to mobilize energy on own behalf.
- Hyperthermia: Body temperature elevated above normal range.
- Hypothermia: Body temperature below normal range.
- Imbalanced Nutrition: Less Than Body Requirements: Intake of nutrients insufficient to meet metabolic needs.
- Imbalanced Nutrition: More Than Body Requirements: Intake of nutrients that exceeds metabolic needs.
- Impaired Gas Exchange: Excess or deficit in oxygenation and/or carbon dioxide elimination at the alveolar-capillary membrane.
- Impaired Oral Mucous Membrane: Disruption of the lips and/or soft tissue of the oral cavity.
- Impaired Physical Mobility: Limitation in independent, purposeful physical movement of the body or of one or more extremities.
- Impaired Swallowing: Abnormal functioning of the swallowing mechanism associated with deficits in oral, pharyngeal, or esophageal structure or function.
- Impaired Tissue (Skin) Integrity: Damage to mucous membrane, corneal, integumentary, or subcutaneous tissues.
- Impaired Urinary Elimination: Dysfunction in urinary elimination.
- Insomnia: A disruption in amount and quality of sleep that impairs functioning.
- Impaired Verbal Communication: Decreased, reduced, delayed, or absent ability to receive, process, transmit, and use a system of symbols.
- Ineffective Airway Clearance: Inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.
- Ineffective Breathing Pattern: Inspiration and/or expiration that does not provide adequate ventilation.
- Ineffective Coping: Inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources.
- Ineffective Therapeutic Regimen Management: Pattern of regulating and integrating into daily living a program for treatment of illness and the sequelae of illness that is unsatisfactory for meeting specific health goals.
- Ineffective Tissue Perfusion: Decrease in oxygen, resulting in failure to nourish tissues at capillary level.
- Insomnia: A disruption in amount and quality of sleep that impairs functioning.
- Latex Allergy Response: A hypertensive reaction to natural latex rubber products.
- Nausea: An unpleasant, wavelike sensation in the back of the throat, epigastrium, or throughout the abdomen that may or may not lead to vomiting.
- Powerlessness: Perception that one’s own action will not significantly affect an outcome; a perceived lack of control over a current situation or immediate happening.
- Rape Trauma Syndrome: Sustained maladaptive response, violent sexual penetration against the victim’s will and consent.
- Risk for Aspiration: At risk for entry of gastrointestinal secretions, oropharyngeal secretion, solids, or fluids into tracheobronchial passages.
- Risk for Bleeding: At risk for a decrease in blood volume that may compromise health.
- Risk for Electrolyte Imbalance: At risk for change in serum electrolyte levels that may compromise health.
- Risk for Falls: Increased susceptibility to falling that may cause physical harm.
- Risk for Impaired Skin Integrity: At risk for skin being adversely altered.
- Risk for Infection: At increased risk for being invaded by pathogen organisms.
- Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.
- Risk for Suicide: At risk for self-inflicted, life-threatening injury.
- Risk for Unstable Blood Glucose Level: Risk for variation of blood glucose/sugar levels from the normal range.
- Self-Care Deficit: Impaired ability to perform or complete activities of daily living for oneself, such as feeding, dressing, bathing, toileting.
- Situational Low Self Esteem: Development of a negative perception of self-worth in response to current situation.
- Urinary Incontinence, Functional: Inability of usually continent person to reach toilet in time to avoid unintentional loss of urine.
- Urinary Incontinence, Reflex: Involuntary loss of urine at somewhat predictable intervals when a specific bladder volume is reached.
- Urinary Incontinence, Stress: Sudden leakage of urine with activities that increase intraabdominal pressure.
- Urinary Incontinence, Urge: Involuntary passage of urine occurring soon after a strong sense of urgency to void.
- Urinary Retention: Incomplete emptying of the bladder.
References and Sources
References for this Nursing Diagnosis guide and recommended resources:
- Ackley, B. J., & Ladwig, G. B. (2010). Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care. Elsevier Health Sciences. [Link]
- Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s Fundamentals of Nursing: Concepts, process and practice. Boston, MA: Pearson. [Link]
- For the Complete List of NANDA-I Nursing Diagnosis: Herdman, H. T., & Kamitsuru, S. (Eds.). (2017). NANDA International Nursing Diagnoses: Definitions & Classification 2018-2020. Thieme. [Link]
- NANDA. International. (2014). Nursing Diagnoses 2012-14: Definitions and Classification. Wiley.