Understanding the Three Parts of a Nursing Diagnosis
NANDA International (NANDA-I) provides a standardized language for nurses to articulate a patient's actual or potential health problems. For an actual or problem-focused nursing diagnosis, the standardized statement typically consists of three components, often referred to as the PES format: Problem, Etiology, and Symptoms. This structure answers the question, "What is the Nanda nursing diagnosis related to as evidenced by?", by systematically outlining the patient's condition, its contributing factors, and the clinical proof that supports it.
The Problem Statement: The Diagnostic Label
The first part of the PES format is the problem statement, or the diagnostic label. This is a concise phrase from the official NANDA-I taxonomy that describes the patient's health problem. It is a judgment based on a comprehensive nursing assessment and not a medical diagnosis. For example, a medical diagnosis might be 'Congestive Heart Failure,' but the corresponding nursing diagnosis could be 'Decreased Cardiac Output' or 'Excess Fluid Volume'. This distinction is crucial as the nursing diagnosis focuses on the patient's response to the health issue, which is what nurses are accountable for addressing through their interventions.
The Etiology: The 'Related To' (r/t) Component
The second part is the etiology, or the 'related to' (r/t) component, which identifies the probable cause or contributing factors for the problem. The 'related to' phrase connects the diagnostic label to its underlying cause. This cause should be something the nurse can address through interventions. For instance, a patient's 'Ineffective Breathing Pattern' might be 'related to' pain from a surgical incision, rather than the surgery itself.
- Key aspects of the 'related to' statement:
- It guides the selection of nursing interventions.
- It should not be a medical diagnosis.
- It describes the underlying cause or a contributing factor that the nurse can influence.
- If the etiology is linked to a known pathophysiology, it may be phrased as 'secondary to'.
- For complex situations, the etiology can be written as 'related to complex factors'.
The Signs and Symptoms: The 'As Evidenced By' (aeb) Component
The third and final part for an actual diagnosis is the 'as evidenced by' (aeb) or 'as manifested by' (amb) statement. This provides the evidence—the specific subjective and objective signs and symptoms gathered during the nursing assessment—that validates the chosen diagnosis. It is the clinical proof that the problem actually exists.
- Elements of the 'as evidenced by' statement:
- Subjective Data: What the patient states. For example, a patient reporting, "My chest hurts so much when I try to walk," could be evidence for 'Activity Intolerance'.
- Objective Data: What the nurse observes or measures. This includes physical assessment findings like vital signs, lab results, and observed behaviors. For instance, an oxygen saturation of 88% on room air is objective evidence for 'Impaired Gas Exchange'.
Putting It All Together: A Complete PES Statement
A complete and well-structured problem-focused nursing diagnosis statement combines these three parts into a single sentence, creating a clear and focused direction for nursing care.
- Problem: Ineffective Airway Clearance...
- Etiology ('related to'): ...related to increased mucus production...
- Symptoms ('as evidenced by'): ...as evidenced by coarse rhonchi on auscultation, persistent coughing, and oxygen saturation of 90%.
Nursing Diagnosis vs. Medical Diagnosis: A Crucial Distinction
Understanding the difference between a nursing and medical diagnosis is foundational for proper care planning and for answering the question, what is a Nanda nursing diagnosis related to as evidenced by. A medical diagnosis focuses on the disease process, while a nursing diagnosis focuses on the patient's human response to that condition.
| Aspect | Medical Diagnosis | Nursing Diagnosis |
|---|---|---|
| Focus | Identifying and treating a specific disease, illness, or medical condition. | Identifying and addressing a patient's response to health issues and life processes. |
| Made By | Physician, Nurse Practitioner, or other advanced provider. | Registered Nurse (RN) as an independent clinical judgment. |
| Scope | Pathological state and medical treatment plan. | Patient's holistic care needs, including physical, emotional, and psychosocial aspects. |
| Example | Congestive Heart Failure | Decreased Cardiac Output or Excess Fluid Volume. |
| Persistence | Generally permanent; remains part of the patient's health history. | Dynamic and can change or resolve based on the patient's current condition. |
| Interventions | Prescribed treatments, medications, or surgeries. | Independent nursing interventions that address the identified problem. |
The Role of Risk and Health Promotion Diagnoses
While the PES format is specific to problem-focused diagnoses, NANDA-I also recognizes other types that utilize the 'as evidenced by' structure differently.
Risk Diagnoses
Risk diagnoses identify potential problems that a patient is vulnerable to developing. These do not have an 'as evidenced by' statement tied to symptoms because the problem has not yet occurred. Instead, the 'as evidenced by' phrase validates the diagnosis by linking to the existing risk factors. For example: 'Risk for Infection as evidenced by impaired skin integrity'.
Health Promotion Diagnoses
These diagnoses focus on the patient's motivation and desire to improve their well-being, such as 'Readiness for Enhanced Self-Care'. They typically do not use 'related to' or 'as evidenced by' phrases in the same way as problem-focused diagnoses.
How the PES Format Enhances Patient Care
The PES format standardizes the documentation of patient care, ensuring consistency and clarity among healthcare professionals. It forces the nurse to justify their clinical judgment by backing up the diagnosis with concrete patient data. This systematic approach ensures that interventions are targeted and effective, and that patient outcomes are measurable. For further exploration of NANDA's role in care, see NANDA International's website.
Conclusion
The structure of a NANDA nursing diagnosis with 'related to' and 'as evidenced by' components is the bedrock of patient-centered nursing care. It is more than a standardized phrase; it is a critical thinking tool that guides nurses from identifying a patient's problem to implementing targeted, evidence-based interventions. By clearly defining the problem, its cause, and the supporting evidence, nurses ensure the care plan is logical, comprehensive, and focused on the patient's individual responses to their health journey.
