The Foundational Three-Part Nursing Diagnosis (PES)
In the nursing profession, formulating a clear and accurate nursing diagnosis is a cornerstone of patient care planning. The P.E.S. format—Problem, Etiology, and Symptoms—provides a structured framework for this process, ensuring that the diagnosis is specific, accurate, and actionable. The phrases “related to” and “as evidenced by” are the linguistic linchpins of this structure, connecting each part of the statement logically.
Deconstructing the 'Related To' Component
The "related to" (or R/T) portion of the nursing diagnosis statement is crucial because it identifies the probable cause or contributing factors of the patient's health problem. This is not a guess but a reasoned clinical judgment based on the nurse's assessment. It pinpoints the underlying conditions or circumstances that are causing or maintaining the patient's issue.
Here are some examples of 'related to' statements:
- Acute Pain related to a surgical incision.
- Ineffective Airway Clearance related to retained secretions.
- Anxiety related to an upcoming surgical procedure.
It is important to remember that the 'related to' is focused on factors within the scope of nursing practice. For instance, a nursing diagnosis would not use a medical diagnosis like 'related to appendicitis,' but rather 'related to abdominal inflammation and pain.'
The Role of 'As Evidenced By'
Following the 'related to' component, the "as evidenced by" (or AEB) provides the factual, patient-specific data that supports the diagnostic label. This data, also known as defining characteristics, can include subjective information (patient statements) and objective data (what the nurse observes or measures). It is the concrete evidence that justifies the nurse's clinical judgment.
Examples of 'as evidenced by' statements include:
- Ineffective Airway Clearance... as evidenced by thick, tenacious sputum, and diminished breath sounds.
- Anxiety... as evidenced by a patient's report of nervousness, increased heart rate, and restlessness.
- Acute Pain... as evidenced by a patient's report of a pain level of 8/10 on the pain scale and guarding behavior over the painful area.
Bringing it all together: The Complete P.E.S. Statement
The power of the three-part nursing diagnosis lies in its clarity and completeness. By linking the three components—Problem, Etiology, and Symptoms—the nurse creates a robust statement that can guide the entire care plan.
Here is how to write a full P.E.S. statement step-by-step:
- Identify the Problem: Start with the NANDA-I diagnostic label that best describes the patient's human response to a health condition. For example, Impaired Physical Mobility.
- Determine the Etiology: Ask, "What is causing or contributing to this problem?" Connect it with "related to." For example, Impaired Physical Mobility related to surgical incision pain.
- Provide the Evidence: Gather the signs and symptoms observed during your assessment. Link this to the statement using "as evidenced by." For example, Impaired Physical Mobility related to surgical incision pain as evidenced by patient's grimacing during movement and inability to ambulate without assistance.
Nursing Diagnosis vs. Medical Diagnosis
Understanding the distinction between a nursing and a medical diagnosis is fundamental for effective care planning. While both are critical, they serve different purposes and focus on different aspects of a patient's health.
| Aspect | Nursing Diagnosis | Medical Diagnosis |
|---|---|---|
| Focus | Patient's human responses to health conditions or life processes (e.g., pain, anxiety, impaired mobility). | Identification of a disease, disorder, or condition based on signs, symptoms, and diagnostic tests (e.g., appendicitis, COPD, congestive heart failure). |
| Purpose | To guide holistic, patient-centered care and nursing interventions. It directs how the nurse will help the patient cope with and respond to their health problems. | To guide medical treatment, therapies, and surgical interventions. It directs the medical management of the patient's illness. |
| Changeability | Can change frequently as the patient's condition and responses evolve. A patient might move from having 'Acute Pain' to 'Readiness for Enhanced Self-Care'. | Remains consistent throughout the patient's illness, although its severity or stage may change. A diagnosis of 'appendicitis' remains consistent until treated. |
The Critical Importance of Evidence-Based Statements
The phrase "as evidenced by" ensures that the nursing diagnosis is not based on assumption but on verifiable patient data. This evidence-based approach is vital for several reasons:
- Accountability: It holds the nurse accountable for their clinical judgment by demonstrating the data that led to the diagnosis.
- Clarity in Communication: It allows other healthcare professionals to understand the rationale behind the care plan, fostering better communication and continuity of care.
- Justification for Intervention: The evidence provides the justification for the specific nursing interventions chosen. If the diagnosis is Anxiety AEB restlessness, the intervention might be relaxation techniques. If it were based on guesswork, the interventions might be inappropriate.
- Standardization: Using standard diagnostic language (like NANDA-I) and an evidence-based structure ensures consistency and a higher quality of care across different settings and nurses. To learn more about standard nursing diagnostics, review the official Nurseslabs Nursing Diagnosis Guide.
Common Pitfalls to Avoid
Even experienced nurses can fall into common traps when writing nursing diagnoses. Recognizing these can improve the quality of your care plans:
- Writing a Medical Diagnosis: Never use a medical diagnosis or a diagnostic test result as the Problem or the Etiology. For example, instead of Ineffective Airway Clearance related to Asthma, use Ineffective Airway Clearance related to bronchospasm.
- Causality vs. Correlation: Ensure the 'related to' factor is a direct cause or contributing factor, not just a related event. Avoid statements like Anxiety related to being in the hospital and instead focus on specifics, such as Anxiety related to unfamiliar hospital environment.
- Using Non-Specific Evidence: The 'as evidenced by' data should be as specific as possible. Instead of Poor Skin Integrity as evidenced by skin is bad, state Impaired Skin Integrity as evidenced by non-blanching erythema on sacrum.
- Lack of Specificity in the Problem: Diagnostic labels can sometimes be too broad. For instance, Pain is less specific than Acute Pain or Chronic Pain.
Conclusion: The Backbone of Patient-Centered Care
Understanding what is a nursing diagnosis related to as evidenced by? is more than an academic exercise; it's the core skill for creating patient-centered, effective, and evidence-based care plans. By accurately identifying the problem, its cause, and the evidence, nurses create a roadmap for interventions that truly address the patient's individual needs. This structured approach not only improves patient outcomes but also elevates the quality of nursing documentation and professional communication. Mastery of the P.E.S. format is a hallmark of an expert nurse.
