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Unit 1
Contemporary concepts in nursing
development of autonomy and accountability in nursing and
have helped to delineate the scope of practice.
Choosing a nursing diagnosis
When choosing the nursing diagnoses for a particular patient,
the nurse must first identify the commonalities among the
assessment data collected. These common features lead to the
categorisation of related data that reveal the existence of a
problem and the need for nursing intervention. The patient’s
identified problems are then defined in terms of nursing diag-
noses. It is important to remember that nursing diagnoses
are not medical diagnoses; they are not medical treatments
prescribed by the doctor; and they are not diagnostic studies.
Nursing diagnoses are not the equipment used to implement
medical therapy, and they are not the problems that the nurse
experiences while caring for the patient. They are the patient’s
actual or potential health problems that independent nursing
actions can address. Nursing diagnoses that are succinctly
stated in terms of the specific problems of the patient will guide
the nurse in the development of the nursing plan of care.
To give additional meaning to the diagnosis, the charac-
teristics and the aetiology of the problem must be identified
and included as part of the diagnosis. For example, the nursing
diagnoses and their defining characteristics and aetiology for a
patient who has rheumatoid arthritis may include:
•
Impaired physical mobility related to pain and stiffness
with joint movement
•
Self-care deficits (bathing/hygiene, dressing/grooming,
feeding, toileting) related to fatigue and joint stiffness.
•
Low self-esteem (chronic, situational, risk for situational)
related to loss of independence.
•
Imbalanced nutrition (less than body’s requirements),
related to fatigue and inadequate food intake.
Collaborative problems
In addition to nursing diagnoses and their related nursing
interventions, nursing practice involves certain situations and
interventions that do not fall within the definition of nursing
diagnoses. These activities pertain to potential problems or
complications that are medical in origin and require collab-
orative interventions with the doctor and other members of
the healthcare team. The term
collaborative problem
is used to
identify these situations.
Collaborative problems are certain physiological compli-
cations that nurses monitor to detect changes in status or
onset of complications. Nurses manage collaborative problems
using doctor-prescribed and nursing-prescribed interventions to
minimise complications (Carpenito, 2012). A primary focus of
the nurse when treating collaborative problems is monitoring the
patient for the onset of complications or changes in the status of
existing complications. The complications are usually related to
the patient’s disease process, treatments, medications, or diagnos-
tic studies. The nurse prescribes nursing interventions that are
appropriate for managing the complications and implements the
treatments prescribed by the doctor. Figure 2-5 depicts the dif-
ferences between nursing diagnoses and collaborative problems.
After the nursing diagnoses and collaborative problems have
been identified, they are recorded on the plan of nursing care.
Planning
Once the nursing diagnoses have been identified, the planning
component of the nursing process begins. This phase entails
the following:
1. Assigning priorities to the nursing diagnoses and
collaborative problems.
2. Specifying expected outcomes.
3. Specifying the immediate, medium-term, and long-term
goals of nursing action.
4. Identifying specific nursing interventions appropriate for
achieving the outcomes.
5. Identifying interdependent interventions.
6. Documenting the nursing diagnoses, collaborative
problems, expected outcomes, nursing goals, and nursing
interventions on the plan of nursing care.
7. Communicating to appropriate personnel any assessment
data that point to health needs that can best be met by
other members of the healthcare team.
Situation identified
(health status, problem)
Can the nurse legally order the primary
interventions to achieve a goal?
Nursing diagnosis
Prescribe and execute
the interventions that
are definitive for
prevention, treatment
or health promotion
Discharged from
nursing care
Collaborative problems
Monitor and
evaluate
condition
Implement the
prescriptive orders
Prescribe and
implement
interventions that
are in the domain
of nursing
Are medical and nursing
interventions needed to
achieve the patient goal?
Yes
No
Yes
No
Figure 2-5
Differentiating nursing diagnoses and collaborative
problems
(Redrawn from Carpenito, L.J. (2012). Nursing diagnosis: Application to
clinical practice (14th ed.). Philadelphia: Lippincott Williams & Wilkins.)
