Diagnosis is the science and art of identifying problems or conditions. The North American Nursing Diagnosis Association (NANDA) defines nursing diagnosis as a clinical judgment about individual, family, or community responses to actual and potential health problems/life processes, used as a basis for the selection of nursing interventions to achieve outcomes for which the nurse is accountable.

The purposes of nursing diagnosis are to communicate the health care needs of individuals and aggregates among members of the health care team and within the health care delivery system; to facilitate individualized care of the client, family, or community; and to empower the profession. Nursing diagnoses provide a standardized language that outlines areas amenable to nursing action. Along with the Nursing Interventions Classification (NIC) and the Nursing-Sensitive Outcomes Classification (NOC) developed at the University of Iowa, nursing diagnoses outline the contribution of nursing to health care.

Nursing diagnosis is not the same as medical diagnosis. The process is similar, since both are based on an assessment of the client and should be accompanied by expected clinical outcomes and intervention. Nursing diagnosis is used by a professional nurse to identify a client’s or aggregate’s actual, risk, wellness, or syndrome responses to a health state, problem, or condition. On the other hand, medical diagnoses are used by physicians to identify or determine a specific disease, condition, or pathologic state.

The philosophy of nursing is holistic, focusing on health promotion, disease prevention, comfort, and restoration of function. The medical model is restricted to curing disease and restoring health. The purpose of a nursing diagnosis is to focus on the human responses of the individual, family, or community to identified problems or conditions, including life processes. The purpose of medical diagnosis is to center on disease and pathology. Goals and interventions accompanying nursing diagnosis differ from medical goals and interventions.

Nursing diagnosis was first mentioned in the nursing literature in the 1950s. NANDA’s first national conference was held in 1973 for the purpose of identifying, developing, and classifying nursing diagnoses. NANDA adopted Taxonomy I, a means to classify nursing diagnosis into nine human response patterns, in 1986 and Taxonomy II in 2000. The American Nurses Association (ANA) incorporated nursing diagnosis into its Standards of Nursing Practice in 1973, Nursing: A Social Policy Statement in 1995, and Standards of Clinical Nursing Practice in 1998.

Three formats are used to write a nursing diagnosis statement. The first is a one-part statement, a simple problem statement or diagnostic label describing the client’s response to an actual, possible, and risk health problem or to a wellness condition. The second format is the two-part statement, used by NANDA and most experienced nurses because it is more precise. The first component is the problem statement or diagnostic label. The second component is the etiology statement that describes the related cause or contributor to the problem. The two parts are linked by the words related to. The third format for writing a nursing diagnosis is the three-part statement, including the problem statement or diagnostic label, the etiology statement, and the defining characteristic, or the “as evidenced by …” statement.

Nursing diagnoses are classified as actual, risk, and wellness statements. Actual diagnoses are problems identified by the nurse that are already in existence. Risk diagnoses are situations in which problems might occur but are not currently in existence. Wellness diagnoses identify the individual or aggregate condition or state that may be enhanced by health-promoting activities. The nursing diagnosis taxonomy is the type of classification under which the diagnostic label is grouped based on which human response the client is demonstrating. The NANDA nursing diagnosis taxonomy is based on nine patterns of human response: Exchanging, communicating, relating, valuing, choosing, moving, perceiving, knowing, and feeling.

The development of a nursing diagnosis is a systematic process, beginning with assessment. Assessment yields cues, small amounts of data that are applied to the decision-making process. Cues are validated, examined, and interpreted, then grouped into clusters, which are sets of data cues in which relationships between and among cues are established to identify a specific health state or condition. The nurse then consults the NANDA list of nursing diagnoses and determines an etiology. When using a three-part statement, the nurse would also point to evidence for the first two parts of the statement.

Errors when developing a nursing diagnosis include errors in data collection or interpretation and incorrect writing of the nursing diagnosis statement. Errors related to the data used to derive a diagnosis occur when the nurse uses incomplete or inaccurate data, misinterprets data, places data into inappropriate categories or clusters, neglects validating data, or records data incorrectly. Likewise, the client may provide inaccurate data to the nurse or be unable to provide information. Personal or cultural biases, as well as errors in physical assessment, observation, and interpretation of diagnostics, can also lead to missed or incorrect diagnoses.

Errors in writing a nursing diagnosis include using a symptom as a diagnosis, using a nursing or medical diagnosis as an etiology, or using a medical diagnosis rather than a nursing diagnosis. The latter is prevented by asking the question, “Is this a situation that is amenable to medical intervention or nursing intervention?” Nurses are accountable legally for inaccurate or incomplete nursing diagnoses or inappropriate or missing nursing actions.

Barriers to the use of nursing diagnoses are time constraints, the organization of health care according to medical diagnoses, the constantly evolving refinement of the nursing diagnosis language, and the availability of numerous approaches for the formulation and application of nursing diagnoses. These barriers can be overcome by agreeing on a common language, supporting colleagues’ use of nursing diagnoses, adopting a nonjudgmental attitude, and communicating with other nurses on national and international levels.