Understanding the Etiology: The “Related To” Component
In nursing, a diagnostic statement is more than just a label; it is a clinical judgment that guides the entire care process. The term "related to" (R/T) is the critical link that connects the nursing diagnostic label to its underlying cause or contributing factors. This component, also known as the etiology, is the reason the patient is experiencing the specific health problem and is the target for nursing interventions. The goal is to identify a factor that is within the nurse's scope of practice to treat, manage, or change, rather than a medical diagnosis.
The PES Format: Problem, Etiology, and Symptoms
Most nursing schools and clinical settings teach the PES format for constructing a nursing diagnosis. This three-part statement is a comprehensive tool for documentation and care planning.
- P (Problem): This is the approved NANDA-I diagnostic label, such as Impaired Physical Mobility or Acute Pain.
- E (Etiology): This is the "related to" component, which describes the cause of the problem, like generalized weakness or tissue ischemia.
- S (Symptoms): These are the defining characteristics, or the signs and symptoms, that provide evidence for the diagnosis. They are connected to the statement with "as evidenced by" (AEB) or "as manifested by" (AMB).
Distinguishing Between "Related to" and "Secondary to"
While sometimes used interchangeably, it is important to understand the nuance. A related to factor is the direct, treatable cause of the nursing problem, whereas secondary to can be used to link the nursing problem to a specific medical diagnosis or condition. For example, a nursing diagnosis might be Impaired Physical Mobility related to pain secondary to osteoarthritis. In this case, the nurse addresses the pain (a nursing focus), which is a direct cause of the mobility issue, rather than trying to cure the osteoarthritis (a medical focus). It's crucial for the related to factor to be something a nurse can directly intervene upon.
How to Identify Appropriate Related Factors
Identifying the correct related factor is the product of a thorough and critical nursing assessment. This involves clustering subjective and objective data to reveal patterns that point to an underlying cause.
Sifting Through Assessment Data
To pinpoint the correct etiology, a nurse must analyze all available patient information, including:
- Subjective Data: What the patient tells you, such as "I'm too weak to move" or "My pain is an 8 out of 10".
- Objective Data: Measurable and observable findings, such as decreased range of motion, guarding behavior, or a high respiratory rate.
- Patient History: Reviewing the patient's medical history for relevant background information.
- Lab and Diagnostic Results: Any findings that support a physiological cause.
By comparing these clustered signs and symptoms to the official NANDA-I defining characteristics, the nurse can confirm the most appropriate nursing diagnosis and, subsequently, the correct related factor.
Common Categories of Related Factors
Related factors can stem from various aspects of a patient's health and environment. Common categories include:
- Physiological: Factors like decreased muscle control, increased metabolic rate, or decreased cardiac output.
- Situational: Causes related to specific events, such as surgical incision, environmental hazards, or unfamiliar surroundings.
- Psychological: Etiologies linked to emotional and mental states, such as anxiety, grieving, or ineffective coping.
- Treatment-Related: Factors that are a result of medical procedures, like prolonged immobility, medication side effects, or complex therapeutic regimens.
Examples: What to Put in "Related To"
Consider a patient recovering from surgery. The nurse must differentiate between a medical diagnosis (the surgical procedure itself) and the nursing-relevant etiology (the physical and psychological consequences).
| Appropriate Related Factor | Inappropriate Related Factor | Reasoning |
|---|---|---|
| related to surgical incision | related to appendectomy | The surgical incision is the specific cause of the pain/risk that the nurse addresses. The appendectomy is a medical procedure. |
| related to decreased muscle strength | related to stroke | Weakness is the direct nursing concern. The stroke is the underlying medical diagnosis. |
| related to immobility | related to knee replacement surgery | Immobility is the direct problem the nurse plans interventions for (e.g., exercises). The surgery is the medical cause of the immobility. |
| related to lack of knowledge regarding disease process | related to chronic obstructive pulmonary disease (COPD) | The patient's knowledge deficit is a problem the nurse can directly address with education. COPD is a medical condition. |
The Importance of Accurate Related Factors
Using accurate and specific related factors is fundamental to the nursing process. It serves several crucial functions:
- Individualizes Care: It ensures that interventions are tailored to the specific cause of a patient's problem, rather than a generic approach.
- Guides Interventions: The etiology directly informs what interventions a nurse will implement. For example, if the etiology of Impaired Physical Mobility is pain, the interventions will focus on pain management. If the etiology is decreased muscle strength, interventions will focus on range-of-motion exercises and strengthening.
- Facilitates Communication: The clear, concise statement improves communication among healthcare team members, ensuring everyone understands the focus of nursing care.
- Improves Outcomes: By targeting the root cause of the nursing diagnosis, care plans are more effective, leading to better patient outcomes and the resolution of the health problem.
Conclusion: The Final Word on Etiology
Mastering what to put in related to in nursing diagnosis statements is a cornerstone of effective nursing practice. By correctly identifying the etiology, or the treatable cause of a patient's health problem, nurses can create individualized, targeted, and highly effective care plans. The key is to shift focus from the medical diagnosis to the specific, nursing-manageable factors that are contributing to the patient's current condition. A thorough assessment and clear thinking are the most vital tools for making an accurate and meaningful diagnostic statement, ultimately leading to improved patient health and well-being. For further guidance on nursing care plans, refer to resources like the comprehensive guide on Nurseslabs.
