Nurse's Pocket Guide

could be used by nurses throughout the world. They called the
labels nursing diagnoses, which represent clinical judgments
about an individual’s, family’s, or community’s responses to
actual or potential health problems/life processes. Therefore, a
nursing diagnosis (ND) is a decision about a need/problem that
requires nursing intervention and management. The need may
be anything that interferes with the quality of life the client is
used to and/or desires. It includes concerns of the client, SOs,
and/or nurse. The ND focuses attention on a physical or behavioral
response, either a current need or a problem at risk for
developing.
The identification of client needs and selection of an ND label
involve the use of experience, expertise, and intuition. A six-step
diagnostic reasoning/critical thinking process facilitates an accurate
analysis of the client assessment data to determine specific
client needs. First, data are reviewed to identify cues (signs and
symptoms) reflecting client needs that can be described by ND
labels. This is called problem-sensing. Next, alternative explanations
are considered for the identified cues to determine which
ND label may be the most appropriate. As the relationships
among data are compared, etiological factors are identified based
on the nurse’s understanding of the biological, physical, and
behavioral sciences, and the possible ND choices are ruled out
until the most appropriate label remains. Next, a comprehensive
picture of the client’s past, present, and future health status is
synthesized, and the suggested nursing diagnosis label is combined
with the identified related (or risk) factors and cues to create
a hypothesis. Confirming the hypothesis is done by reviewing
the NANDA definition, defining characteristics (cues), and
determining related factors (etiology) for the chosen ND to
ensure the accuracy and objectivity in this diagnostic process.
Now, based on the synthesis of the data (step 3) and evaluation
of the hypothesis (step 4), the client’s needs are listed and the correct
ND label is combined with the assessed etiology and
signs/symptoms to finalize the client diagnostic statement. Once
all the NDs are identified, the problem list is re-evaluated, assessment
data are reviewed again, and the client is consulted to
ensure that all areas of concern have been addressed.
When the ND label is combined with the individual’s specific
related/risk factors and defining characteristics (as appropriate),
the resulting client diagnostic statement provides direction for
nursing care. It is important to remember that the affective tone
of the ND can shape expectations of the client’s response and/or
influence the nurse’s behavior toward the client.
The development and classification of NDs have continued
through the years on a regular basis spurred on by the need to
describe what nursing does in conjunction with changes in
APPLICATION OF THE NURSING PROCESS 13