Problem with Assessment Data

There is an underlying assumption that nurses have adequate

assessment skills and are knowledgeable about what
data need to be collected. When assessment data are missing,
regardless of the cause, the end result is either an omission
of nursing diagnoses, inaccurate diagnoses, or incorrect
qualifying statements about the diagnoses

Incomplete Collection
of Assessment Data
Incomplete collection can occur when the nurse has neither
had nor taken the time to appropriately address all
subjective and objective data. a nurse is
interrupted during the data collection and fails to return
to finish the admission process at the end of the shift.

Restricted Data Collection

Restricted data collection occurs when a client is unable
or unwilling to provide the necessary data..

Failure to Validate Data

Failure to validate occurs when the nurse does not confirm
previously collected data. A follow-up blood pressure may
have revealed a transient elevation due to the stress of the admission process.

Misinterpretation of Data
Misinterpretation can occur when the meaning
attached to the data is incorrect.
THINK ABOUT I T
Errors in Data Interpretation
Your client, a 35-year-old married man with two children,
has been discharged home following an appendectomy.
During your first two visits to assess the healing of the
incision, you notice that the client seems reluctant to leave
his bed and expresses minimal interest in topics other
than the television programs he has been watching. If you were to
determine on your third visit that the client has refrained
from these kinds of activities because of his fear of
reopening the incision, how would you reconcile the
discrepancy between the assessment data gathered and
the nursing diagnosis that was developed? Do you think
that your values relating to this client’s conduct may have
played a role in the misinterpretation of the data and the
resulting nursing diagnosis?

presents with several signs and symptoms, including a

reported 4-pound weight gain that month. Further
investigation indicates this finding is not related to
increased adipose tissue but, rather, is associated with
fluid retention that accompanies an edematous state.
Inappropriate Data Clustering
Associated with Lack of Clinical
Knowledge
Inappropriate data clustering may occur when the nurse
lacks sufficient theoretical and clinical expertise and
knowledge to appropriately cluster data cues. The nurse attributes the vomiting to the
influenza, but further analysis indicates that, in addition
to this condition, this client is actually manifesting symptoms
of a toxic reaction to prescribed drug therapy that
is causing the vomiting.

Incorrect Writing of theNursing Diagnosis Statement

Incorrect writing of the statement can occur when the
nurse does not follow the guidelines for formulating a
two- or three-part statement. . In conclusion, when the nurse makes premature
conclusions without allowing sufficient time for analysis
and interpretation of data, the subsequent care plan
may be inappropriate for the client (Dobrzyn, 1995).
The Nursing Checklist provides selected questions that
nurses can ask themselves in order to avoid making mistakes
when developing nursing diagnoses.

In addition,
nurses may disagree with or refuse to use diagnoses such
as noncompliance or knowledge deficit (Carpenito,
1995). In this instance, the nurse then has the choice
and the right to not use these specific diagnoses.
Novice nurses need to know nursing diagnosis and
nursing process in order to understand how the discipline
of nursing intersects with the other health care
providers. Common “client problems”
listed on a critical pathway are written as nursing
diagnoses such as risk for infection or risk for injury.
Nurses are accountable for
their actions and must document their interventions. If
a nursing diagnosis is inappropriate or a nursing diagnosis
list is incomplete and, as a result, the interventions
are inappropriate or lacking, the nurse is liable for these
errors in clinical judgment. These errors can be avoided
by collecting comprehensive assessment data and by
critically analyzing these data.

LIMITATIONS OF
NURSING DIAGNOSIS
There are a number of limitations and professional
concerns associated with nursing diagnosis.

OVERCOMING BARRIERS
TO NURSING DIAGNOSIS
According to Iyer, Taptich, and Bernocchi-Losey (1994),
objections to using nursing diagnoses include: (1) nurses
are more overworked than ever and have less time to
spend with clients; (2) care is still organized around the
medical diagnosis and nurses are involved in the completion
of tasks based on this focus; (3) nurses are afraid
they may be ridiculed for using nursing diagnoses; and
(4) the nursing diagnosis list does not always fit the
client situation.