Nursing Diagnosis Guide: All You Need to Know

The term “diagnosis” is defined as an agreed-upon clinical judgment. When we think of a diagnosis, it is often thought of as a medical diagnosis, such as high blood pressure. In its simplest form, a nursing diagnosis is a diagnosis that nurses make based on their scope and clinical judgment to guide patient care. Nursing diagnoses encompass individuals, families, and communities and relate to health conditions and life processes. Nursing diagnoses reflect the knowledge that is fundamental to nursing practice. Nurses’ diagnoses also reflect the systematic and scientific method of nursing.¹

In this article:

• Purpose of a Nursing Diagnosis
• Nursing Diagnoses vs. Medical Diagnoses
• Purpose and Mission of NANDA-I
• Components of a Nursing Diagnosis
  • Diagnosis
  • Defining Characteristics
  • Risk Factors
  • Related Factors
• Types of Nursing Diagnoses
  • Problem Focused
  • Health Promotion
  • Risk Focused
  • Syndrome
• How to Write a Nursing Diagnosis
  • Writing a Problem-Focused Nursing Diagnosis
  • Writing a Risk-Focused Diagnosis
  • Writing a Health Promotion-Based Diagnosis
  • Writing a Syndrome Diagnosis
• List of Current Nursing Diagnoses and Domains
• List of Common Nursing Diagnoses
• References

Purpose of a Nursing Diagnosis

Nursing diagnoses are used in all care settings and support high quality, evidence-based care. Here are a few ways nursing diagnoses support nursing practice.

• Nursing diagnoses improve collaboration between team members. Nursing diagnoses improve consistency and clarity of communication between nurses and other members of the patient’s care team. Nursing diagnoses can be revised, added, or removed based on the patient’s outcomes.
• Nursing diagnoses are used as a teaching tool. For new graduate nurses, familiarity with nursing diagnoses helps to improve critical thinking confidence in practice. Nursing diagnoses and supporting educational material can guide novice nurses to direct interventions and goals for their patients. Understanding how nursing diagnoses contribute to the nursing process allows new nurses to become familiar with possible interventions and care pathways for their patients.
• Nursing diagnoses may improve risk identification. Many nursing diagnoses include diagnoses that alert the care team to avoid a potential risk through intervention. For instance, the nursing diagnosis “risk for bleeding” alerts a nurse that the patient may be receiving an anticoagulant and to monitor for signs of bleeding.
• Nursing diagnoses can help establish care goals. Nursing diagnoses illuminate care priorities, including current issues, future risks, and health promotion opportunities. Once the nursing diagnosis is identified, priorities, interventions, and goals can be created in collaboration with the patient.

Nursing diagnoses are the foundation of care plans. Nursing diagnoses drive actions and allow for continued assessment, prioritization, organization, and effective health outcomes.

Nursing Diagnoses vs. Medical Diagnoses

Although there are some similarities between medical and nursing diagnoses, such as clinical judgment and shared terminology, they are distinct.² The most apparent difference between nursing and medical diagnoses is the healthcare practitioner deciding the diagnosis. Nursing diagnoses are shared by all nursing designations, while physicians create medical diagnoses. The exception is that nurse practitioners in most states can also determine medical diagnoses and prescribe medication. Therefore, a nurse practitioner could provide both nursing and medical diagnoses.

There are also differences in each type of diagnosis. For example, medical diagnoses focus on the disease or pathology that affects the patient. In contrast, nursing diagnoses concentrate on the patient’s response to the illness or life circumstance, which can be either a physiological or psychological response. By focusing on the client’s response, a nurse applies interventions to address or alter that response.

To clarify this distinction, here are two examples of how medical and nursing diagnoses can work together.

Example 1:

A patient with a medical diagnosis of cerebrovascular accident (stroke) may lead to the complementary nursing diagnosis of unilateral neglect. Without the medical diagnosis, the nurse would not know what was causing unilateral neglect. The nursing diagnosis is a jumping-off point to create goals to manage the deficit and improve patient safety and quality of life.

Example 2:

With the medical diagnosis of dehydration, the nurse knows that the patient is experiencing deficient fluid volume (nursing diagnosis). Therefore, the nurse may implement the interventions of administering IV fluids and recording intake and output for this patient.

Nursing and medical diagnoses are complementary and guide each other to create a holistic clinical story.

Purpose and Mission of NANDA-I

NANDA International is an organization that supports the use and development of standardized nursing terminology throughout clinical settings.³ This organization’s mission is to use nursing diagnoses to promote high-quality patient care through evidence-based care and consistent terminology. Standardized nursing diagnoses inform evidence-based terminology that improves clinical practice by providing clear guidelines for communication and documentation. NANDA International continually releases new editions with revised, added, or retired nursing diagnoses with updates to criteria and classifications.

The name NANDA originated as the acronym for the North American Nursing Diagnosis Association. However, with the organization’s global expansion, they no longer use NANDA as an acronym but as a recognizable organizational name. If using the organization’s full name, the correct use is NANDA International, Inc. (no hyphen), and the abbreviation is NANDA-I (with a hyphen). The organization offers networking and education and holds task forces on topics such as diagnosis development, informatics, and nursing research.

Components of a Nursing Diagnosis

Diagnosis

Nursing diagnosis is the second step of the nursing process after assessment.6 First, the nurse analyzes the assessment data they collect, including quantitative and qualitative data. The nurse uses critical thinking and understanding of the client’s context to perform data analysis to determine what is expected or abnormal and what information is relevant to the clinical picture. The nurse will use that data and create clusters of pertinent information to form hypotheses about the appropriate nursing diagnoses. At this stage, the nurse will either write the nursing diagnosis or decide that they need additional information to confirm or update their hypothesized diagnosis.

Defining Characteristics

Characteristics and risk factors are the evidence behind the nursing diagnosis.⁴ However, they should not be used interchangeably. Defining characteristics are observable characteristics to support a problem-focused health promotion diagnosis or syndrome. Defining characteristics are the signs or symptoms of clinical pathology.

Risk Factors

Risk factors are used primarily for risk-focused nursing diagnoses. Risk factors replace the defining characteristics of problem-focused nursing diagnoses. Similarly, they provide supporting evidence for the nursing diagnosis. Unlike defining characteristics, risk factors describe why the patient has increased chances of the undesirable health outcome identified by the nurse. Risk factors can be biological, psychological, family, or community-related. Patients may have one or multiple risk factors supporting a risk diagnosis.

Related Factors

Related factors are described as the etiology of the nursing diagnosis.⁴ Related factors are used in problem-focused, syndrome, and sometimes health promotion nursing diagnoses. If the etiology of the nursing diagnosis is known, it should be included in the diagnosis. The nurse must then determine if other assessments are required to understand the underlying etiology to form an accurate care plan to address the issue. For example, a nurse may conclude the nursing diagnosis of ineffective tissue perfusion. The nurse may conduct a further respiratory assessment to find the patient hypoxic. Further investigation would be required to find the clinical etiology of the ineffective tissue perfusion if there is not a known cause in the patient’s medical history.

Types of Nursing Diagnoses

Problem Focused

A problem-focused nursing diagnosis is a nursing diagnosis that addresses a current health challenge.⁴ In contrast to other nursing diagnoses that address potential problems or opportunities for health improvement, a problem-focused diagnosis deals with a current, known health challenge. To make this type of diagnosis, the defining characteristics of the diagnosis must be present at the time of evaluation. The defining characteristics include signs, symptoms, and patient health history. Defining characteristics act as clues for the nurse and, when grouped together, form patterns that allow a diagnosis to be assigned. Related factors, also known as etiology, should also be described as part of a problem-focused nursing diagnosis.

Problem-focused nursing diagnosis example: The nurse notices that the patient has a negative balance between their fluid intake and output. The patient also has dry mucous membranes and weight loss. The nurse makes the problem-based nursing diagnosis of “deficient fluid volume.” The NANDA-I definition is “Decreased intravascular, interstitial, and/or intracellular fluid. This refers to dehydration, water loss alone without change in sodium.”⁵ Depending on the etiology and the patient’s health condition, the care plan and interventions will aim to increase fluid intake, identify the cause of the fluid deficit, and maintain evidence of normovolemia.

Health Promotion

In contrast to problem-focused nursing diagnoses, health promotion diagnoses require that the individual/family/community is already functioning effectively in the health area, but there is an opportunity to increase well-being. Another requirement of a health promotion nursing diagnosis is that there is an expressed desire for improvement. This is often expressed at the beginning of the nursing diagnosis statement as “Readiness for enhanced…”. Therefore, the defining characteristic of a health promotion diagnosis is the client/family or community expressing a desire to improve or change health behaviors. There is some similarity to risk-focused nursing diagnoses; however, health promotion diagnoses are further upstream than risk-focused nursing diagnoses, as they aim to improve and actualize health potential in contrast to preventing an undesirable outcome.

Health promotion nursing diagnosis example: At a prenatal screening visit with a nurse, a patient expresses the desire to breastfeed exclusively. The nurse recognizes the opportunity for health promotion with the nursing diagnosis of “Readiness for Enhanced Breastfeeding.” The NANDA-I definition is “A pattern of providing milk to an infant or young child directly from the breasts which may be strengthened.”⁵ Based on this assessment, the nurse may refer the client to trusted online sources of information or refer them to group education sessions if available.

Risk Focused

As stated previously, a risk-based nursing diagnosis falls between a problem-based nursing diagnosis and a health promotion nursing diagnosis. In a risk-based diagnosis, the nurse uses their clinical judgment to determine that the patient is at risk for health consequences if preventative measures are not implemented. Otherwise stated, the problem has not yet manifested for the client/family/community, but there is a vulnerability related to risk factors that the nurse identifies. Care plans will focus on preventing undesirable health outcomes.

Risk-focused nursing diagnosis example: In an inpatient surgical unit, a nurse is assigned to a patient postoperative day 3 for Whipple surgery. This nurse immediately recognizes that the patient meets the criteria for the nursing diagnosis of “Risk for Infection.” The NANDA-I definition is “At risk for being invaded by pathogenic organisms.” This patient is at risk due to their diagnosis of pancreatic cancer and recent surgery. For this reason, the nurse provides patient teaching on handwashing and provides the patient with alcohol-based antiseptic hand rub on their bedside table.

Syndrome

Nursing diagnosis syndromes are created when two or more concurrent nursing diagnoses are related and can be treated using similar interventions. Nursing syndrome diagnoses also cluster problem and risk-focused nursing diagnoses that often accompany specific health processes or life events.

Syndrome nursing diagnosis example: A patient shares that they recently witnessed a motor vehicle accident resulting in multiple injuries, including deaths. While not injured, they report difficulties sleeping, increased alcohol use, and irritability, which are now beginning to impact their ability to work. The nurse recognizes this cluster of symptoms as consistent with the nursing diagnosis of “post-trauma syndrome.” The NANDA-I definition of post-trauma syndrome is “Sustained maladaptive response to a traumatic, overwhelming event.” ⁵ Other nursing diagnoses that may cluster to form this syndrome include nursing diagnoses related to sleep, anxiety, hope, depression, substance use, and relationships. The nurse discusses the goal of acknowledging the trauma and discusses options to connect the patient to support resources.

How to Write a Nursing Diagnosis

Standardized methods of writing nursing diagnoses allow for clear communication of a nursing diagnosis’s purpose and driving factors. Writing a complete nursing diagnosis helps the nurse clarify their reasoning for potential interventions and care goals.

Writing a Problem-Focused Nursing Diagnosis

Problem-focused nursing diagnoses are three-part statements that include the problem, etiology, and symptoms (PES framework).

Problem

Nurses should use a NANDA-I label whenever possible to describe the identified problem to ensure consistency in diagnoses. However, if no NANDA-I label adequately represents the problem, the nurse needs to describe the problem in a clear, concise, and useful way to the care team. It is important to avoid judgmental language in the problem statement.

Etiology

The second part of the problem-focused nursing diagnosis is the etiology or the underlying cause or causes of the nursing diagnosis. The etiology of the diagnosis is key to choosing appropriate interventions, so the nurse should describe the etiology as precisely as possible. For instance, what was the event’s timing, or how long has the client had the disease? When describing an etiology linked to a known pathophysiology or disease, the etiology should be stated as “secondary to.” Otherwise, the etiology should be stated as “related to” (R/T). “Related to” does not necessarily specify a direct cause-and-effect relationship, which is preferred because there may be other factors related to the nursing diagnosis that have not yet been identified.

When various factors contribute to a nursing diagnosis that cannot be summarized into a one-sentence statement, the etiology may be written as “related to complex factors.” This should not be used as a shortcut to finding the appropriate etiology but can be used when there is not a clear primary etiology for the nursing diagnosis.

Signs/Symptoms

For a problem-focused nursing diagnosis, the described signs and symptoms are the defining characteristics of the nursing diagnosis. The nurse should link the etiology to the signs and symptoms by stating “as manifested by” (AMB).

3-Part Nursing Diagnosis (P-E-S Format)

Problem (Label) + Etiology (Cause or Related Factors) + Signs/Symptoms (Defining Characteristics)

Problem-Focused Diagnosis label ____________ related to ____________ (Etiology or Related Factors) as evidenced by ____________ (Defining Characteristics).

Example: Deficient fluid volume related to prolonged vomiting as evidenced by increased pulse rate, increased urine concentration, and poor skin turgor.

Writing a Risk-Focused Diagnosis

The risk-focused diagnosis is a two-part statement that includes statements of the problem and risk factors. In this case, a vulnerability rather than a present health problem.

Problem

Like a problem-focused diagnosis, the risk-focused statement should also, if possible, use a NANDA-I approved diagnosis starting with “Risk for…”. If a NANDA-I nursing diagnosis does not adequately describe the vulnerability, the nurse should still begin their problem statement with “Risk for…”.

Risk Factors

Rather than describing the etiology or related factors, risk-focused diagnoses are supported by describing the risk factors related to the diagnosis. The risk factor statement should follow the problem statement with the nurse describing the problem “as evidenced by” and then listing the risk factors.

2-Part Nursing Diagnoses

2-Part Nursing Diagnoses = Label + Risk Factors

Risk focused diagnosis label ____________ as evidenced by ____________ (Risk Factors).

Defining characteristics are not possible because the problem isn’t “actual” yet.

Examples:

• Risk for infection as evidenced by a history of cancer and recent surgery.
• Risk for falls as evidenced by a history of falls, use of an assistive device, and visual difficulties.

Writing a Health Promotion-Based Diagnosis

A health promotion diagnosis is also described using a two-part statement.

Problem

Rather than identifying a health problem, the problem when following the PES framework here is an opportunity for health improvement. When possible, the nurse should use an approved NANDA-I health promotion diagnosis. If the nurse is formulating their own problem statement for a health promotion diagnosis, they should start the statement with “readiness for enhanced…”.

Signs/Symptoms

The signs and symptoms used to describe a health promotion diagnosis are related to the patient, family, or community expressing readiness or desire for health improvement. This may be a verbal expression, actions, or other cues that alert the nurse to readiness for health promotion.

2-Part Nursing Diagnoses

2-Part Nursing Diagnosis = Label + Defining Characteristics

Health promotion label ____________ as evidenced by ____________ (Defining characteristics).

Examples:

• Readiness for enhanced breastfeeding as evidenced by the patient stating their desire to exclusively breastfeed and requesting information on how to achieve this.

Writing a Syndrome Diagnosis

The syndrome diagnosis is a group of related nursing diagnoses and should be written as a two-part statement.⁷

Problem

The nurse should use a recognized NANDA-I syndrome to diagnose a nursing syndrome.

Etiology

For a syndrome diagnosis, the etiology is described as two or more nursing diagnoses that form the evidence for the syndrome diagnosis. There should be a minimum of two diagnoses, with no maximum of nursing diagnoses to support a syndrome diagnosis. Each nursing diagnosis should be written in its complete, appropriate form, either including etiology, signs and symptoms, or risk factors.

2-Part Nursing Diagnoses

2-Part Statement = Label + Nursing Diagnoses that make up the syndrome

Syndrome diagnosis label ____________ as evidenced by ____________ (2 or more nursing diagnoses that support the syndrome diagnosis).

Examples:

• Post-trauma syndrome as evidenced by disturbed sleep pattern and ineffective relationship functioning.
• Post-trauma syndrome as evidenced by insomnia and risk for suicide.

List of Current Nursing Diagnoses and Domains

In the 2020 to 2023 edition of NANDA-I, there are 13 domains of nursing diagnoses. Each domain has between three and six classes of nursing diagnoses, that are then broken down into individual diagnoses. Here we will list all 13 domains, related classes, and an example nursing diagnosis. Please see NANDA International- Nursing Diagnoses Definitions and Classification,  12th Edition, for the complete list of diagnoses.

List of Common Nursing Diagnoses

In this section you will find common NANDA nursing diagnoses you can use to create care plans.

• Activity Intolerance
• Acute Confusion
• Acute Pain
• Anxiety
• Chronic Pain
• Constipation
• Decreased Cardiac Output
• Diarrhea
• Disturbed Body Image
• Excess Fluid Volume
• Fatigue
• Fluid Volume Deficit (Dehydration)
• Hopelessness
• Hyperthermia
• Imbalanced Nutrition
• Impaired Comfort
• Impaired Gas Exchange
• Impaired Physical Mobility
• Impaired Skin Integrity
• Impaired Urinary Elimination
• Impaired Verbal Communication
• Ineffective Airway Clearance
• Ineffective Breathing Pattern
• Ineffective Coping
• Ineffective Health Maintenance
• Ineffective Tissue Perfusion
• Insomnia
• Knowledge Deficit
• Noncompliance (Ineffective Adherence)
• Risk For Aspiration
• Risk for Bleeding
• Risk for Electrolyte Imbalance
• Risk for Falls
• Risk for Infection
• Risk for Injury
• Risk For Unstable Blood Glucose
• Self-Care Deficit
• Social Isolation
• Stress Overload
• Urinary Retention

References

1. Karaca T, Aslan S. Effect of ‘nursing terminologies and classifications’ course on nursing students’ perception of nursing diagnosis. Nurse education today. 2018;67(Journal Article):114-117. doi:10.1016/j.nedt.2018.05.011
2. NANDA Internatioal. What is the difference between a medical diagnosis and a nursing diagnosis? Accessed January 7, 2023. http://nanda.host4kb.com/article/AA-00266/0/What-is-the-difference-between-a-medical-diagnosis-and-a-nursing-diagnosis-.html
3. NANDA Internatioal. Our Story. Accessed January 7, 2023. https://nanda.org/who-we-are/our-story/
4. NANDA Internatioal. Glossary of Terms. Accessed January 3, 2023. https://nanda.org/publications-resources/resources/glossary-of-terms/
5. Carpenito LJ, [email protected] Purchased eBooks. Handbook of Nursing Diagnosis. 15th ed. Wolters Kluwer; 2017.
6. Open Resources for Nursing. DIAGNOSIS. In: Nursing Fundamentals.
7. NANDA Internatioal. The Structure and Development of Syndrome Diagnoses. Accessed January 7, 2023. https://nanda.org/publications-resources/resources/position-statement/