Is a major defining characteristic required to make a nursing diagnosis?

[SeattleJess]

Help! I may have seriously missed something first quarter and now that I am in second quarter and tutoring first quarter students I need to be sure I'm not giving them the wrong information.

I understood that one MUST have at least one major defining characteristic in order to establish a nursing diagnosis. My first quarter students told me that they heard in lecture that as long as they had two minor defining characteristics, they could apply the nursing diagnosis.

So this means for example, that if you have verbal report of weakness and confusion, you can diagnose activity intolerance.

So what's the rule? Please help me, I'd rather blush and feel stupid than steer other students wrong.

Thank you!!!!

[la_chica_suerte85, BSN, RN]

I don't think we were ever taught the differences between minor and major defining characteristics. Can you give an example of a diagnosis that has both? Apparently a "major defining characteristic" clinically validates a diagnosis so I'm not sure that minor characteristics are sutable for validating the diagnosis.

[SeattleJess]

Hey, la_chica, thank you for responding to my question! I emailed my instructor from first quarter and she said that yes, at least one major defining characteristic is required for a nursing diagnosis but the instructors this quarter are encouraging students to "consider" a diagnosis if two minor characteristics are found.

Whether a characteristic is major or minor stuff is found in the NANDA-I definitions. For example, the nursing diagnosis of Ineffective Airway Clearance has the major defining characteristic of "inability to clear secretions or obstructions from the respiratory tract to maintain airway patency." It also has minor defining characteristics of "pallor" and "cyanosis."

...which, I think, you might observe in another nursing diagnosis that is more appropriate.

My takeaway is "let your assessment drive your diagnosis." Would love to hear from our experienced nurses about this. Maybe I'm making a tempest in a teapot. But it seems important to me not to focus on finding the minimum that would justify a nursing diagnosis before ceasing to access.

[la_chica_suerte85, BSN, RN]

I totally agree that it seems bizarre that with all the NANDA Dxs available, 2 minor characteristics are justification for determining one. I think maybe you could start the trend that major defining characteristics should be the gold standard for validating a Dx. Like you said, pallor and cyanosis can easily apply to so many other conditions and there is definitely something else going on (i.e. like with a Tet baby I took care of, Ineffective Airway Clearance was definitely not the reason she had pallor and cyanosis -- I could have used Ineffective Airway Clearance because she was in for bronchiolitis but the assessment required was more subtle. A Tetralogy of Fallot tends to present with pallor and cyanosis as a baseline so you need to assess where it's really actually bad and suction is required, like diaphoresis, suprasternal retractions, etc.).

[SeattleJess]

The 2015-2017 Nursing Diagnoses and Classifications 10th ed. doesn't subdivide defining characteristics into "major" or "minor" at all. See e.g. at p. 116. The only guidance I can find says, "'How many defining characteristics do I need to identify to diagnose a patient with a particular nursing diagnosis?' That is a difficult question, and it really depends on the diagnosis. For some diagnoses, one defining characteristic is all that is necessary; for example, with the health promotion diagnoses, a patient's expressed desire the enhance a particular facet of a human response is all that is required. Other diagnoses require a cluster of symptoms, probably three or four, to have accuracy in diagnosis." At p. 117/NANDA-I doesn't make any distinction between major and minor defining characteristics that I can see.

What's weird is that all my classes go strictly on Lynn Carpenito's books on nursing diagnosis. I wouldn't even HAVE the NANDA-I classifications if I hadn't bought it on my own out of personal interest. And Carpenito DOES distinguish between major and minor in her Nursing Diagnosis text; in her "Understanding the Nursing Process: Concept Mapping and Care Planning for Students" at p. 44 she says, ""Defining nursing diagnoses are separated as major or minor: Major - at least one must be present to validate it Minor -they provide supporting evidence but may not be present."

It's very confusing to a beginner.

[JustBeachyNurse, LPN]

The issue is there is ONE legitimate source for details on nursing diagnosis and related factors/defining characteristics and that is the current NANDA-I.

[SeattleJess]

The Carpenito books are also filled with lobbying for her point of view. Some persuasive arguments, I agree, but NOT NANDA-I improved.

The NANDA-I book is clear, easier (for me) to use and definitely easier to lug around! How funny that I'll be going rogue by using the official source!