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INTRODUCTION:
Creating nursing diagnoses requires the application of detailed
assessment skills, critical thinking, and decision making. The
formulation of nursing diagnoses is related to competency in diagnostic
reasoning which students begin in their first year.
DEFINITIONS:
A diagnosis is a statement that synthesizes (brings together) assessment
data. It is a label that describes a situation (or state) and implies an
etiology (reason) and gives evidence to support the inference.
The North American Nursing Diagnosis Association (NANDA) defines
nursing diagnosis as a clinical judgment about individual, community or
family responses to community to actual or potential health problems or
life processes. All types of diagnoses are similar.
A nursing diagnosis limits the diagnostic process to those
diagnoses that represent individual responses to actual or potential
health problems that nurses are licensed to treat. Outcomes are usually
noticeable within a designated time frame.
A family nursing diagnosis is an extension of a nursing
diagnosis to the family system and/or subsystems and is the outcome of
family assessment. It includes actual or potential health problems that
nurses are capable and licensed to treat by virtue of their education and
experience.
A community diagnosis differs in that it is focused on an
aggregate or a community (rather than an individual). It requires a
multidisciplinary action to address or treat, and multiple determinants
must be considered when planning interventions. Outcomes of an action
may not be visible for a long time.
A wellness diagnosis describes human responses to levels
of wellness in an individual, family or community that have the
COMMUNITY DIAGNOSIS:
There are four parts to a community diagnosis;
1. a description of the problem, response, or state (risk, concern,
issue, potential or actual),
2. a statement of the aggregate, population, community, or focus
(boundaries). THIS DIFFERS FROM THE NURSING
DIAGNOSIS, the focus is added
3. an identification of factors etiologically related to the problem
( factors), and
4. those signs and symptoms (manifestations) that are
characteristic of the problem.
EXAMPLE: a risk of low birth rate among pregnant adolescents in
the downtown area related to inadequate income and use of
tobacco as evidenced by insecure housing, use of the food bank,
unemployment rates, and smoking rates among pregnant teens.
NOTE: The italicized area indicates the focus portion of the
diagnosis (for teaching purposes only).
COMMUNITY WELLNESS DIAGNOSIS:
a. Characteristics:
Sometimes called positive or health oriented diagnoses.
Focus is on a community or aggregate.
Require multidisciplinary action to address or enhance.
Multiple determinants must be considered when planning
interventions.
Outcomes/ actions may not be visible in the short term.
There is usually a desire for a higher level of wellness.
Sometimes an effective program or status is present and there is a
desire to improve the functioning.
Focus is on existing or potential community strengths.
REFERENCES:
Freidman, M.M., Bowden, V.R., & Jones, E.G. (2003). Family nursing:
Research, theory, and practice. (5th ed.). New Jersey: Prentice Hall.
Sparks, S.M., & Taylor, C.M. (2001). Nursing diagnosis reference
manual. (5th ed.). Pennsylvania: Springhouse.
Stammler, L.L. & Yiu, L. (Eds.). (2008). Community health nursing: A
Canadian perspective. (2nd.ed.). Toronto: Pearson.
Stolte, K.M. (1996). Wellness: Nursing diagnosis for health promotion.
Philadelphia: J.B. Lippincott.
Vollman, A.R., Anderson, E.T. & McFarlane, J. (2004). Canadian
community as partner: Theory and practice in nursing. Philadelphia:
Lippincott Williams & Wilkins.