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.
WHAT 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.
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?
NANDA-I 2012 Conference: May 23-26, 2012
NANDA-I Nursing Diagnoses: Definitions and Classifcation 2012-2014
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