Understanding the PES Framework
To begin writing a PES statement, you must first master its three core components: the Problem, the Etiology, and the Signs & Symptoms. This framework provides a standardized language for nurses to communicate a patient's health status and needs effectively.
The Problem (P)
The 'P' in PES refers to the nursing diagnosis, which is a clinical judgment about an individual's, family's, or community's response to actual or potential health problems or life processes. It is essential to distinguish a nursing diagnosis from a medical diagnosis. A medical diagnosis, such as 'diabetes mellitus,' is made by a physician, while a nursing diagnosis, like 'Unstable Blood Glucose Level,' describes a human response that a nurse can address independently. The Problem component should be chosen from the official NANDA-I nursing diagnosis list to ensure standardization and clarity. For example, instead of focusing on the medical condition, you would state the patient's specific response to that condition, such as 'Impaired Skin Integrity' or 'Risk for Falls.'
The Etiology (E)
The 'E' stands for Etiology, which is the root cause or contributing factor of the nursing diagnosis. This part of the statement identifies what is causing or maintaining the problem. The etiology helps guide the nursing intervention, as addressing the cause is the most effective way to resolve the problem. The Problem and Etiology are linked by the phrase 'related to.' The etiology should be a condition that the nurse can influence through interventions. For example, 'Ineffective Airway Clearance related to increased mucous production' directly points to an intervention aimed at decreasing the patient's mucous. If the etiology is something beyond nursing control, it might not be the most appropriate focus for the care plan.
The Signs & Symptoms (S)
The 'S' in PES represents the Signs and Symptoms, which are the objective and subjective data gathered during the nursing assessment that provide evidence for the chosen nursing diagnosis. These are the defining characteristics that justify your problem statement. Objective signs are observable and measurable, such as vital signs, lab results, and physical examination findings. Subjective symptoms are what the patient reports, such as pain, fatigue, or feelings of anxiety. The Etiology and Signs & Symptoms are linked by the phrase 'as evidenced by.' The signs and symptoms should be specific, measurable, and relevant to the patient's condition. For instance, for 'Unstable Blood Glucose Level,' the signs might be 'blood glucose levels consistently above 200 mg/dL' and 'patient reports feeling shaky and lightheaded.'
The Step-by-Step Process for Writing a PES Statement
Follow these steps to construct a clear and actionable PES statement for your patient's care plan:
- Conduct a Comprehensive Assessment: Gather both subjective and objective data from your patient. This includes physical examination findings, patient interviews, review of their medical history, and lab results. This data is the foundation of your entire care plan.
- Identify the Nursing Diagnosis: Based on your assessment data, identify a potential nursing diagnosis from the NANDA-I approved list that accurately reflects the patient's health issue. Choose the most specific and accurate diagnosis possible.
- Determine the Etiology: Pinpoint the underlying cause of the identified nursing diagnosis. Ask yourself, 'What is contributing to this problem?' The etiology should be an area where nursing interventions can make a difference.
- Connect the Problem and Etiology: Use the phrase 'related to' to link the nursing diagnosis with its cause. For example: 'Acute Pain related to surgical incision.'
- Identify Supporting Evidence: Review your assessment data to find the specific signs and symptoms that validate your problem and etiology. Look for both objective (e.g., grimacing, guarding, elevated heart rate) and subjective (e.g., patient reports pain score of 8/10) evidence.
- Complete the Statement: Link the Etiology and Signs & Symptoms using the phrase 'as evidenced by.' The full statement might be: 'Acute Pain related to surgical incision as evidenced by patient report of pain score 8/10, grimacing, and guarding at the incision site.'
Nursing vs. Medical Diagnosis
It is critical for nurses to understand the difference between their role and the physician's role in diagnosing health issues. A clear distinction is key to professional autonomy and effective care.
| Feature | Nursing Diagnosis | Medical Diagnosis |
|---|---|---|
| Focus | Patient's response to a health condition. | The disease or medical condition itself. |
| Example | Impaired Physical Mobility | Fractured Femur |
| Scope | Identifies problems nurses can treat independently. | Identifies problems physicians are licensed to treat. |
| Longevity | Changes as the patient's condition and responses change. | Remains the same as long as the disease is present. |
| Goal | Guides nursing interventions for patient response. | Guides medical treatment for the disease. |
Pro-Tips for Perfecting Your PES Statements
- Be Specific: Vague language leads to vague interventions. Instead of 'pain,' specify 'acute pain in the right knee.' Instead of 'poor diet,' describe 'Imbalanced Nutrition: Less Than Body Requirements.'
- Prioritize: You may identify multiple nursing diagnoses. Prioritize the most critical issues using frameworks like Maslow's Hierarchy of Needs or the ABCs (Airway, Breathing, Circulation).
- Use NANDA-I Language: Stick to the official NANDA-I terminology for nursing diagnoses to ensure professional consistency and clear communication. You can access the official list on the NANDA International website.
- Ensure Measurability: The 'Signs and Symptoms' section should include data that you can monitor to evaluate the effectiveness of your interventions. This allows you to track progress or modify the care plan if needed.
- Tailor to the Patient: Always individualize the statement to reflect the specific patient's circumstances. Avoid generic or templated statements that do not accurately represent their unique needs.
Conclusion
Writing a clear and effective PES statement is a foundational skill for every nurse. It is the bridge that connects the thorough assessment process with the targeted interventions of the care plan. By following the Problem, Etiology, and Signs & Symptoms framework, and by practicing the step-by-step process outlined here, you can produce flawless documentation that improves patient outcomes and demonstrates your clinical reasoning. Consistent practice will build your confidence and make this critical skill second nature.
