The nurse writes a nursing diagnosis according to guidelines from The North American Nursing Diagnosis Associations (NANDA). The nurse's diagnosis is distinct from the physician's medical diagnosis. NANDA explains the difference stating, "A medical diagnosis deals with disease or medical condition. A nursing diagnosis deals with human response to actual or potential health problems and life processes."
The explanation continues with an example of "a medical diagnosis of Cerebrovascular Attack (CVA or Stroke)." The companion nursing diagnosis is "Impaired verbal communication, risk for falls, interrupted family processes and powerlessness." The nursing diagnosis focuses on the client's physical response, risks of health problems, and the family's reaction to the client's condition.
Nurses Controlled by Physicians
Some nursing students may wonder why the patient receives two separate diagnoses. An age-old conflict between nurses and physicians is the explanation. In the earliest days of nursing, the nurse was literally a handmaiden to the doctor.
M. Berghs, B. Casterle, and C. Gastmans describe the public's poor perception of nurses in 2006 Journal of Medical Ethics article, "Nursing, Obedience, and Complicity with Eugenics: a Contextual Interpretation of Nursing Morality at the Turn of the Twentieth Century." The authors write, "Before Florence Nightingale's Notes on Nursing, nursing as a profession was not held in high esteem: a physician of the time described nurses as: '...dull, unobservant, untaught women; of the best it could be said that they were kindly and careful and attentive in doing what they were told.' "
The authors add that "The dominant public perception of nurses during Nightingale's time was that they were either drunks or prostitutes, for a “refined woman” would never be allowed to work outside of the home." In the early 20th century, the nurse worked for the physician and commanded little power, authority or respect.
Nurses and College Degrees
But in 2010 Laura Stokowski protested the assertion "Physicians are nurses' superiors in the hospital hierarchy - nurses 'work for' physicians." Stokowski wrote in the Medscape article, "A Letter to Hollywood: Nurses are not Handmaidens" that it is "Not true" that nurses work for physicians. She adds that "Nursing is a separate, autonomous profession. We work with, not for physicians. We have our own leaders, and we regulate, license, and manage ourselves. Nurses decide what nurses do, not physicians." Establishing a separate diagnosis is a part of maintaining separation of the two practices.
The nursing diagnosis is also a response to individuals like Minette Marrin, author of November 2009 Sunday Times article, "Oh Nurse, Your Degree is a Symptom of Equality Disease." Marrin complains that "Nurses — or rather those who claim to represent them — want to have the status of professionals, on a level with doctors." Writes Marrin, "part of being a professional is having a degree. So nurses must have degrees."
Nurses Fighting for Respect
Marrin opposes a mandate for degreed nursing and complains, "All sorts of people who might make excellent nurses will be put off, and lost to nursing: anyone who is not particularly academic; anyone who — frankly — is not particularly bright; anyone who has a vocation to care for patients without wishing for the most high-tech training; anyone who is unable to take on a mass of student debt on a nurse’s poor pay; any late entrants — and this at a time when the NHS (National Health Service on Britain) is desperately short of nurses."
The counter-argument is that without high-tech training, a nurse in the 21st century cannot provide competent care. She/he must understand the medical technologies and life-support systems that sustain her client. Nurses require advanced knowledge and medical training to save patient's lives and respond to medical emergencies.
Writing a Nursing Diagnosis Statement
Returning to the subject of writing the nursing diagnosis, it has three main parts: health problem, a "related to" (r/t) phrase (etiology) and the "as evidenced by" phrase.
1. Find a list of NANDA-approved diagnoses. You can use reference books that list medical diagnoses alongside their most common companion nursing diagnoses to save time. But NANDA protests that "if nurses only use a 'list' of nursing diagnoses with a particular medical diagnosis, they are missing the uniqueness of the patient for whom they are providing care."
2. After choosing a NANDA diagnosis, follow it with "related to" and the associated factors. The related factors are the physiological processes that cause the symptoms. The Mendicino College Powerpoint "The Nursing Diagnosis Statement" uses the example of, "poor blood flow due to congested veins and arteries and cellular damage in tissues," as the related to statement for ineffective tissue perfusion.
3. Write the "As evidence by" statement followed by the sign and symptoms you observed during the assessment.
Tips for Writing the Nursing Diagnosis Statement
Begin your statement with a NANDA-approved nursing diagnosis; otherwise, no matter how well reasoned the diagnosis, the instructor is likely to disapprove. The Mendocino College Powerpoint presentation " The Nursing Diagnosis Statement," contrasts an incorrect diagnosis of "poor sleep patterns" with the NANDA approved diagnosis "sleep pattern, disturbed."
R/T - Related to - List factors that are related to the condition after this phrase. These factors basically define the medical diagnosis. They describe how the body processes are affected by the disease or condition. An example is "poor blood flow due to congested veins and arteries and cellular damage in tissues." Gualnick et al. lists related factors that could follow the diagnosis disturbed sleeping patterns.
AEB - As evidenced by - List signs and symptoms following this phrase.
Secondary to - Write the medical diagnosis after this statement. Some instructors prefer no mention of medical diagnoses in the statement.
Search the Internet for helpful websites
Nurses struggle for recognition among healthcare professionals and the public. Although the nursing diagnosis may seem redundant, it is part of this struggle, and a required subject in nursing schools. Student nurses who master the basic principles of writing the nursing diagnosis statement will appreciate the benefits to their school work.
Sources
- Lyer, Patricia. Nursing Malpractice. Tucson, Arizona: Lawyers and Judges. 2001
- Mendicino College Powerpoint. " The Nursing Diagnosis Statement."
- Stokowski, Laura. "A Letter to Hollywood: Nurses are not Handmaidens." Medscape. 2010.
- Kansas State University. The Nursing Process.
- Porterville College. Nursing Process, Nursing Fundamentals.
- NANDA. Nursing Diagnosis Frequently Asked Questions.
Marian Henderson - I was in the Marine Corps for 12 years, and after completing my last four-year enlistment, I became a Merchant Marine. I worked aboard ...
Join the Conversation