RISK FOR diagnosis

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Specializes in ER / Critical Care.

My clinical instructor and I are not seeing eye to eye regarding how to write a nursing diagnosis.... I know that she is the one that grades me, and she is the MSN-RN, and I'm just a student....so I should just do as she says; right?

Well, she is my 4th clinical instructor thus far and the only one to say:

(her exact text, i copy/pasted)

"You need to write out the nursing diagnosis in a standardized way. the format should follow as this: related to as evidenced by; risk factors are not the correct way to write a care plan as you have it written here. "

These are my RISK FOR diagnoses: (copy/pasted from care plan)

  1. Risk for ineffective tissue perfusion. Risk Factors: ↓BP, ↓saO2%.
  2. Risk for falls. Risk Factors: unsteady gait, ↓BP, generalized weakness.
  3. Risk for impaired skin integrity. Risk Factors: bed rest, bowel incontinence.
  4. Risk for infection. Risk Factors: Indwelling urinary catheter, IV, hospital admission.

I realize that my diagnoses are far from being perfect, BUT is she correct in stating that "Risk for" diagnoses are to be documented "Risk for...... R/T..... AEB....." ??

I use the NANDA International 2012-2014 book as a reference and that is where I learned to list risk factors for the Risk for dx rather than the way she wants it done.

What are your thoughts? I would REALLY appreciate if any nursing instructors could give me a little feedback ? THANKS SO MUCH!!

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I am a LVN instructor and RT and AEB are the right way to do it. When doing risk for I don't usually have them write the AEB but it would the correct way, further more, I think your instructor wants to know why you are having the patient be at risk for.

I have many colleagues who don't have them wrote it that way but it is because they have been out of school so long they don't remember the new way. I recently took an educator course and this is the bee correct way of writing a nursing dx. Now in the real world they are not done that way.

Sent from my iPhone using allnurses.com

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According to NANDA there are no RT in a risk for diagnosis. There are AEB (which are what the risk factors are). Now would I debate the teacher?? No probably not a smart decision. From the email I think she wants you to write out the diagnosis in a sentence format. I might be totally wrong but maybe asking if this is what she meant may be a good place to start.

EX. Risk for ineffective tissue perfusion. Risk Factors: ↓BP, ↓saO2%. Instead write Risk for ineffective tissue perfusion aeb decreased blood pressure (72/50) and decreased oxygen saturation (92%).

If you should decide to push that rt are not needed for the risk for diagnosis here is a clip from the NANDA website. I know that my diagnosis book also state that rt are not needed for that type of diagnosis.

"For risk diagnoses, there are no related factors (etiological factors), since we are identifying a vulnerability in a patient for a potential problem; the problem is not yet present. Therefore we identify the risk factors that predispose the individual to a potential problem.

The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).

Risk Diagnosis Example: Risk for infection as evidenced by inadequate vaccination and immunosuppression (risk factors)."

found on NANDA site here:

How do I write a diagnostic statement for risk, actual and health promotion diagnoses? | NANDA International Knowledgebase

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Specializes in ER / Critical Care.
Quote
I am a LVN instructor and RT and AEB are the right way to do it. When doing risk for I don't usually have them write the AEB but it would the correct way, further more, I think your instructor wants to know why you are having the patient be at risk for.

I have many colleagues who don't have them wrote it that way but it is because they have been out of school so long they don't remember the new way. I recently took an educator course and this is the bee correct way of writing a nursing dx. Now in the real world they are not done that way.

Sent from my iPhone using allnurses.com

Thank you for responding.

For nursing d/x I do put "dx, R/T, AEB" but for the "risk for" dx, I didn't because that's not how it's laid out in the NANDA book.

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Specializes in ER / Critical Care.
Quote
According to NANDA there are no RT in a risk for diagnosis. There are AEB (which are what the risk factors are). Now would I debate the teacher?? No probably not a smart decision. From the email I think she wants you to write out the diagnosis in a sentence format. I might be totally wrong but maybe asking if this is what she meant may be a good place to start.

EX. Risk for ineffective tissue perfusion. Risk Factors: ↓BP, ↓saO2%. Instead write Risk for ineffective tissue perfusion aeb decreased blood pressure (72/50) and decreased oxygen saturation (92%).

If you should decide to push that rt are not needed for the risk for diagnosis here is a clip from the NANDA website. I know that my diagnosis book also state that rt are not needed for that type of diagnosis.

"For risk diagnoses, there are no related factors (etiological factors), since we are identifying a vulnerability in a patient for a potential problem; the problem is not yet present. Therefore we identify the risk factors that predispose the individual to a potential problem.

The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).

Risk Diagnosis Example: Risk for infection as evidenced by inadequate vaccination and immunosuppression (risk factors)."

found on NANDA site here:

How do I write a diagnostic statement for risk, actual and health promotion diagnoses? | NANDA International Knowledgebase

Thank you for responding.

I think I'll email her that link ?

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Specializes in Critical Care, Capacity/Bed Management.

I understand where you are coming from but the LVN instructor has a point, you want to know why your patient is at risk for something. for example let's suppose you have a patient with angioedema, they will most definitely have a risk for airway obstruction; but why? the related to will help the professor evaluate you in terms of appropriate nursing diagnosis and interventions.

Honestly this is not a battle worth fighting for as when you graduate nursing care plans are very different. Just accept that this professor likes it done a certain way and move forward.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Quote
"You need to write out the nursing diagnosis in a standardized way. the format should follow as this: related to as evidenced by; risk factors are not the correct way to write a care plan as you have it written here. "

These are my RISK FOR diagnoses: (copy/pasted from care plan)

  1. Risk for ineffective tissue perfusion. Risk Factors: ↓BP, ↓saO2%.
  2. Risk for falls. Risk Factors: unsteady gait, ↓BP, generalized weakness.
  3. Risk for impaired skin integrity. Risk Factors: bed rest, bowel incontinence.
  4. Risk for infection. Risk Factors: Indwelling urinary catheter, IV, hospital admission.

Uhmmmmm.......This is exactly what your instructor said....

Quote
the format should follow as this: related to as evidenced by

...I guess you and argue that she wants the related to wording....which is not correct by NANDA.

The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).

Quote
Risk Diagnosis Example: Risk for infection as evidenced by inadequate vaccination and immunosuppression (risk factors)."

found on NANDA site here:

How do I write a diagnostic statement for risk, actual and health promotion diagnoses? | NANDA International Knowledgebase

But she was correct that the way you had them was not correct.

Quote
  1. Risk for ineffective tissue perfusion. Risk Factors: ↓BP, ↓saO2%.
  2. Risk for falls. Risk Factors: unsteady gait, ↓BP, generalized weakness.
  3. Risk for impaired skin integrity. Risk Factors: bed rest, bowel incontinence.
  4. Risk for infection. Risk Factors: Indwelling urinary catheter, IV, hospital admission.

It should be......

  1. Risk for ineffective tissue perfusion as evidenced by....... Risk Factors: ↓BP, ↓saO2%.
  2. Risk for falls as evidenced by........Risk Factors: unsteady gait, ↓BP, generalized weakness.
  3. Risk for impaired skin integrity as evidenced by..... Risk Factors: bed rest, bowel incontinence.
  4. Risk for infection as evidenced by......Risk Factors: Indwelling urinary catheter, IV, hospital admission.
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Specializes in ER / Critical Care.

It should be...... [*]Risk for ineffective tissue perfusion as evidenced by....... Risk Factors: ↓BP, ↓saO2%. [*]Risk for falls as evidenced by........Risk Factors: unsteady gait, ↓BP, generalized weakness. [*]Risk for impaired skin integrity as evidenced by..... Risk Factors: bed rest, bowel incontinence. [*]Risk for infection as evidenced by......Risk Factors: Indwelling urinary catheter, IV, hospital admission.

Ok thank you. So I'd actually put "risk factors:"?

After reading up on it more I thought the correct way was:

Risk for falls as evidenced by unsteady gait, BP 90/60, and generalized weakness.

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RED1984 said:
It should be......
  • Risk for ineffective tissue perfusion as evidenced by....... Risk Factors: ↓BP, ↓saO2%.
  • Risk for falls as evidenced by........Risk Factors: unsteady gait, ↓BP, generalized weakness.
  • [*]Risk for impaired skin integrity as evidenced by..... Risk Factors: bed rest, bowel incontinence.
  • Risk for infection as evidenced by......Risk Factors: Indwelling urinary catheter, IV, hospital admission.

Ok thank you. So I'd actually put "risk factors:"?

After reading up on it more I thought the correct way was:

Risk for falls as evidenced by unsteady gait, BP 90/60, and generalized weakness.

While all the above information is very good, I think you'll have better luck discussing this with your instructor. you should sit down with her (endless emails don't resolve things well) and present your information, "I've done some research and this is the information I've found (present NANDA info). I want to make sure I'm on the right track and am just confused about how it should be" -- or something to that effect.

You're going to be much more successful in nursing school AND as a nurse if you can present information clearly and concisely and have it be evidence based.

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For what it's worth, when you share your copy of the NANDA-I 2012-2014 and the print-out from the link helpfully provided by babsy28 :anpom: with your instructor at that sit-down, you can also tell her that a former instructor and current NANDA-I member (me) has told you that members have recently voted on several new diagnoses and the idea of rewording most "risk for..." diagnoses to "Vulnerable to ..." to clarify the thinking and rationales for these safety diagnoses.

You do NOT have to tell her that the main reason this change has been proposed is that too many nursing instructors think that if you don't have related to (causative factors) AND "as evidenced by" that you don't have a real nursing diagnosis (we see this here a lot). Totally not true, and you can look it up. Oh, you already did. Good on ya.

I think you are definitely on the right track and concur with the idea of using the exact NANDA-I language to make your case stronger.

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Specializes in ER / Critical Care.

Well. She marked my "risk for" nursing diagnoses as "incorrect".

She INSISTS that I state Risk for.... R/T.... AEB.

I showed her where I'm getting my information from (NANDA-I book) and she won't change the mark.

I'm bringing this issue up to the clinical course coordinator and to the director of the program. This isn't the only issue I've had with this instructor and I'm not going to risk failing the course because of her ignorance.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
:no:./...this drives me crazy ....however she is the one grading
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