Writing "readiness for enhanced" diagnoses...Help!

[sarabellum1]

What is the correct way of writing this type of diagnosis? I've always avoided these because I couldn't figure out how to write them, but now I'm on a postpartum floor and most everything seems to warrant a "readiness for enhanced..."

My pt. had a c-section after an unsuccessful vag. delivery.

Here's what I'm working with:

Readiness for enhanced comfort (in relation to pain at her incision site)

FYI: We are not allowed to use acute pain since everyone is in pain after delivering

Readiness for enhanced immunization status (in relation to her tDAP vaccine)

Any help is appreciated!! Thanks!!

[nurseprnRN, BSN, RN]

The correct way to write all nursing diagnoses is to quote them exactly from the NANDA-I 2012-2014. If it's not in there, it's not an actual nursing diagnosis and you can't use it for one.

Most nursing diagnosis statements follow this pattern:

(Nursing diagnosis) related to (related factor(s)) as evidenced by (defining characteristics).

A lot of times the only way people can understand diagnosis in general is to give them a medical example. I hate that, because nursing diagnoses are not subservient to or dependent on medical diagnoses, but the analogy is sometimes helpful.

"Anemia r/t lower GI bleed as evidenced by Hct 26 and hematochezia x 3 days." (this is a medical diagnostic statement for a particular patient with anemia)

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________."

"Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological."

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic." Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2012-2014 (current edition). $29 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!

If you do not have the NANDA-I 2012-2014, you are cheating yourself out of the best reference for this you could have. I don’t care if your faculty forgot to put it on the reading list. Get it now. Free 2-day shipping for students from Amazon. When you get it out of the box, first put little sticky tabs on the sections:

1, health promotion (teaching, immunization....)

2, nutrition (ingestion, metabolism, hydration....)

3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...)

4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...)

5, perception and cognition (attention, orientation, cognition, communication...)

6, self-perception (hopelessness, loneliness, self-esteem, body image...)

7, role (family relationships, parenting, social interaction...)

8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...)

9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...)

10, life principles (hope, spiritual, decisional conflict, nonadherence...)

11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilization...)

12, comfort (physical, environmental, social...)

13, growth and development (disproportionate, delayed...)

Now, if you are ever tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... there's a match. If not... keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with THE reference for the professional nurse.

The definition and defining characteristics for "readiness for enhanced comfort" are found on page 475 :

Domain 12: Comfort, Class 1, physical comfort; class 2, environmental comfort; class 3, social comfort

Definition: A pattern of ease, relief, and transcendence in physical, psychospiritual, environmental, and/or social dimensions that is sufficient for well being and can be strengthened.

Defining Characteristics:

• Expresses desire to enhance comfort
• Expresses desire to enhance feeling of contentment
• Expresses desire to enhance relaxation
• Expresses desire to enhance resolution of complaints

Not all nursing diagnoses have or require a "related-to," but you have to know if the one you diagnose after your patient assessment is one of the ones that does/doesn't. Get the book.

[duckyluck111]

Obviously you already turned this paper since I'm responding a year later in but just in case anybody else is looking for information on this topic, according to Lynda Carpenito, Nursing Diagnosis Application to Clinical Practice 14th edition p. 15 "Health-promotion nursing diagnoses do not contain related factors" in other words, you just say Readiness for Enhanced Comfort. You have related goals that "give direction for interventions".

[nurseprnRN, BSN, RN]

duckyluck111 said:

Obviously you already turned this paper since I'm responding a year later in but just in case anybody else is looking for information on this topic, according to Lynda Carpenito, Nursing Diagnosis Application to Clinical Practice 14th edition p. 15 "Health-promotion nursing diagnoses do not contain related factors" in other words, you just say Readiness for Enhanced Comfort. You have related goals that "give direction for interventions".

I am looking in the NANDA-I 2012-2014 to check this. As a matter of fact, all of the health promotion (Domain 1) nursing diagnoses have related (causative) factors, except the two "readiness for..." diagnoses.

I'm going to recommend two more books to you that will save your bacon all the way through nursing school, starting now. The first is NANDA, NOC, and NIC Linkages: Nursing Diagnoses, Outcomes, and Interventions. This is a wonderful synopsis of major nursing interventions, suggested interventions, and optional interventions related to nursing diagnoses. For example, on pages 113-115 you will find Confusion, Chronic. You will find a host of potential outcomes, the possibility of achieving of which you can determine based on your personal assessment of this patient. Major, suggested, and optional interventions are listed, too; you get to choose which you think you can realistically do, and how you will evaluate how they work if you do choose them.It is important to realize that you cannot just copy all of them down; you have to pick the ones that apply to your individual patient. Also available at Amazon. Check the publication date-- the 2006 edition does not include many current nursing diagnoses and includes several that have been withdrawn for lack of evidence.

The 2nd book is Nursing Interventions Classification (NIC) is in its 6th edition, 2013, edited by Bulechek, Butcher, Dochterman, and Wagner. Mine came from Amazon. It gives a really good explanation of why the interventions are based on evidence, and every intervention is clearly defined and includes references if you would like to know (or if you need to give) the basis for the nursing (as opposed to medical) interventions you may prescribe. Another beauty of a reference. Don't think you have to think it all up yourself-- stand on the shoulders of giants.

Let this also be your introduction to the idea that just because it wasn't on your bookstore list doesn't mean you can’t get it and use it. All of us have supplemented our libraries from the git-go. These three books will give you a real head-start above your classmates who don't have them.

[nalie2, ADN, BSN, MSN, RN, NP]

To whoever comes across this post like I have...I couldn't find how to write this diagnosis and finally just asked my instructor for help. She confirmed like duckyluck mentioned...wellness diagnoses do not have related factors. It is just "Readiness for knowledge."