Nursing diagnoses can also serve as a focus for quality improvement (Gordon, 1994).

Quality improvement is the monitoring and evaluation of process and outcomes in health care or any other business to identify opportunities for improvement. The nursing diagnosis is a method of identifying the focus of nursing activity. When focusing on the nursing diagnosis, the reviewer can determine whether nursing care was correct and delivered according to standards of practice. The benefits of nursing diagnoses for the profession are also important for the client and family. Better communication among health care professionals helps eliminate potential problems in giving care and maintains a focus on meeting the client's health care goals. Similarly, the ultimate reason for improvement and peer review is to ensure that high-quality care is given to clients and families. Furthermore, the client benefits from the individualization of nursing care resulting from appropriate goal setting, correct selection of priorities, selection of appropriate interventions, and establishment of outcome criteria. Limitations of Nursing Diagnoses Nursing diagnoses have limitations, and the beginning practitioner should be aware of their existence. Because of the continuous evolution of the terms and use of nursing diagnoses, the language can occasionally be verbose and contain jargon. This may limit the use of nursing diagnoses to only nursing professionals and result in confusion among other members of the health care team (Seahill, 1991; Carpenito, 1995). Imprecise language of the diagnosis may incorrectly "label" a client. One such diagnostic label is noncompliance. The term is value laden and incomplete (Stantis and Ryan, 1982; Edel, 1985). In addition, the evolution of a standardized terminology in the form of a taxonomy has resulted in confusion about the language of the diagnostic label (Lunney, 1986; Porter, 1986). The 1986 National Conference for the Classification of Nursing Diagnosis first proposed a taxonomic structure for an organizational framework of current and future diagnostic labels (McLane, 1987). To date, the revised taxonomic structure serves as a classification system for nursing diagnosis (Carpenito, 1995). The evolving taxonomy can limit nursing practice. Nursing diagnoses, developed by the Task Force of the National Group for the Classification of Nursing

Diagnoses, are only the beginning of a total classification system. Through formulation and use of other nursing diagnoses, the taxonomy will grow and expand the focus of professional nursing.

KEY CONCEPTS The diagnostic process includes critical analysis and interpretation of data, identification of client problems and formulation of nursing diagnoses. The interpretation of data requires the nurse to validate and cluster data. Nursing diagnoses state the actual or potential problems of the client's health status. Nursing diagnoses are written for the physical, developmental, intellectual, emotional, social, and spiritual dimensions of the client. Nursing diagnoses are necessary to develop a plan of care that will help the client and family adapt to changes resulting from an illness or change in lifestyle. Nursing diagnostic errors can occur by errors in data collection, interpretation and analysis of data, clustering of data, or in the diagnostic statement. Nursing diagnoses improve communication between nurses and other health professionals. Nursing diagnoses can serve as a focus for quality assurance and improvement and peer review. KEY TERMS Actual health problem, p. 128 At risk health problem, p. 128 Client-centered problems, p. 125 Critical thinking, p. 125 Defining characteristics, p. 128 Diagnostic process, p. 127 Etiology, p. 129 Medical diagnosis, p. 131 North American Nursing Diagnosis Association (NANDA), p. 125 Nursing diagnosis, p. 125

CRITICAL THINKING EXERCISES 1. Your client's nursing Kardex contains a care plan for bathing/hygiene and toileting self-care deficit related to decreased mobility of right arm. What data do you need from the assessment data base to determine whether the nursing diagnosis is relevant? 2. Using a client's assessment cluster data from the history and physical examination components, identify which trends are fully supported by data and which trends need more data. (Using multicolored highlighters can assist with this exercise.) 3. How do you organize assessment data to derive nursing diagnoses that reflect client response to illness, hospitalization, and lifestyle changes?

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Carpenito LJ: Nursing diagnoses: application to clinical practice, ed 5, Philadelphia, 1993, JB Lippincott. Carpenito- LJ: Nursing diagnoses: application to clinical practice, ed 6, Philadelphia, 1995, JB Lippincott. Edel MK: Noncompliance: an appropriate nursing diagnosis? Nurs Outlook 33:183, 1985. Fry VS: The creative approach to nursing, Am / Nurs 53:301, 1953. Gordon M: Nursing diagnoses: process and practice, New York, 1982, McGraw-Hill. Gordon M: Nursing diagnosis: process and application, ed 3, St Louis, 1994, Mosby. Hickey P: Nursing process handbook, St Louis, 1990, Mosby. Hurley ME: Classification of nursing diagnoses, St Louis, 1986, Mosby. Iowa Intervention Project, 1992. Nursing interventions classification (NIC), ed 2, St Louis, 1996, Mosby. Kim MJ, McFarland GK, McLane AM, editors: Classification of nursing diagnoses: proceedings of the Fifth Conference (NANDA), St Louis, 1984, Mosby. Kim MJ, McFarland GK, McLane AM: Pocket guide to nursing diagnoses, ed 6, St Louis, 1995, Mosby. Lunney M: Nursing diagnoses: refining the system, Am / Nurs 82:456, 1986. McCloskey JC, Bulechek GM: Nursing interventions classification (NIC), ed 2, St Louis, 1996, Mosby. McFarland GK, McFarlane EA: Nursing diagnosis and intervention: planning for patient care, St Louis, 1989, Mosby. McLane AM, editor: Classification of nursing diagnoses: proceedings from the Seventh Conference (NANDA), St Louis, 1987, Mosby. Nightingale F: Notes on nursing: what it is and is not, London, 1860, Harrison & Sons. North American Nursing Diagnosis Association: Proceedings of the ninth national conference, Orlando, Fla, March 17-21, 1990. Porter EJ: Critical analysis of NANDA nursing diagnoses taxonomy. I, Image / Nurs Sch 18:137,1986. Seahill L: Nursing diagnosis vs. goal-oriented treatment planning in child psychiatry, Image / Nurs Sch 23:95, 1991.

Soares O'Hearn CA: Nursing diagnosis: a phenomenological structural description and multidimensional taxonomy or typological redefinition. In Chaska N: The nursing profession: turning points, St Louis, 1990, Mosby. Stantis MA, Ryan ]: Noncompliance, an unacceptable diagnosis, Am I Nurs 82:941, 1982.

ADDITIONAL READINGS Benner P, Tanner C: How expert nurses use intuition, Am I Nurs 87:23, 1987. Carpeni'o LJ: Nursing diagnoses: application to clinical practice, ed 2, Philad ihia, 1987, JB Lippincott. Dalto i: A descriptive study: defining characteristics of the nursir ignosis: cardiac output, alterations in, decreased, Image / Nurs> 7:113, 1985. Feh , RJ: Validating diagnostic labels: standardized methodology, h . iurley M, editor: Classification of nursing diagnoses: proceeding's of the Sixth Conference (NANDA), St Louis, 1986, Mosby. Gebbie KM, l.avin MA: Classifying nursing diagnoses, Am 1 Nurs 74:250, 1974. Gleit CJ, Tatro S: Nursing diagnoses for healthy individuals, Nurs Health Care 8:456, 1981. Gordon M: Nursing diagnoses and the diagnostic process. Am / Nurs 76:1298, 1976. Gordon M: The concept of nursing diagnoses, Nurs Cliti North Am 1 -487, 1979. J,. >y MK: The dilemma of physiological problems: eliminating the < ;)le standard, Am / Nurs 85:281, 1985. Ki: (J: Nursing diagnoses in critical care, Dimens Crit Care Nurs 2:5, 1 >'. Kii. H: Without collaboration, what's left? Am ) Nurs 85:281, 1985. MarteiiS K: Let's diagnose strengths, not just problems, Am I Nurs 86:192, 1986. Miller K: Critical thinking and nursing process, 1996, St Louis. Mosby. Nettle C et al: Community nursing diagnosis, / ('.(immunity Health 6(3):135, 1989. Popkess SA; Diagnosing your patient's strengths, Nurs SI 1 1:34, 1981. Shamansky SL, Yanni CR: In opposition to nursing diagnosis: a minority opinion, Image / Nurs Sch 17:47, 1985.

Shoemaker JK: Essential features of a nursing diagnosis. In Kini MJ et al, editors: Classification of nursing diagnoses: proceedings of the Fifth Conference (NANDA), St Louis, 1984, Mosby. Walker L: Nursing diagnoses and interventions: new tools to define nursing's unique role, Nurs Health Care 7(6):323, 1986.