Needs and Organizers: Formulating Nursing Diagnoses
This is the basis for teaching and learning the concepts of health problems and illness in the JAC Nursing Program. Nursing diagnoses should be stated in terms of these “unmet needs” of the client, “due to” one or more of the factors identified under “organizers”.
July 2014
NEED
ORGANIZER
Comfort
A condition of physical and psychological ease that enables the client to have a sense of control and readiness for action
Pain
Anxiety
Hygiene (inability to complete independently)
Temperature
Body alignment
Sensory deprivation
Sensory overload
Effects of illness and hospitalization
Rest
Rest: physical relaxation and freedom from mental stress
Lack of meaningful or purposeful activity
Changes in comfort which may interfere with rest
Sleep
Sleep: a natural and periodic suspension of consciousness during which the body is restored
Changes in quality and/or quantity of sleep
Changes in comfort which may interfere with sleep
Safety
Freedom from exposure to injury or infection
(client may be unsafe and have an actual unmet need for safety, or there may be a potential unmet need for safety due to risks in the environment, altered body structure or function)
Due to (risk of) infection or injury
1. related to the environment
-mechanical
-thermal
-electrical
-chemical
-biological
2. related to an altered body structure and function
-musculoskeletal function
-neurological function
-perceptual
-cognitive
-motor
-integument
-immune response
-cellular function
3. related to developmental abilities
Activity
A state of physical body action or movement, including exercise or mobility
Increased mobility
Decreased mobility
Decreased activity tolerance
Nutrition
A process that leads to nutrient and energy balance in the body through intake, absorption and metabolism of fluids and nutrients
Altered ability to
ingest
digest
absorb
Altered – nutritional requirement
– metabolism
– fluid and electrolyte balance
Elimination
A process that regulates essential body functions including acid-base balance and waste elimination.
Altered
fluid output
-urine production/excretion
-gastric losses
• bowel excretion
-diarrhea/constipation
Oxygenation
A process by which oxygen is provided to all cells for the production of energy, including ventilation and tissue perfusion
Altered
ventilation
-ineffective airway clearance
-ineffective breathing pattern
-impaired gas exchange
tissue perfusion
-blood vessel changes
-blood pressure abnormalities
-decreased cardiac output
-decreased oxygen carrying capacity of
blood
Self Esteem
A positive evaluation of self; includes a sense of value and adequacy, a feeling of self-reliance and goal achievement
Altered
self worth
identity
body image
role
Social Interaction
The process by which one interacts with individuals or groups to obtain love, acceptance, approval and a sense of belonging
Altered
communication
patterns of interaction
sexuality
valuing and goal of life
Although not one of the basic needs, each individual may have learning needs related to any of the basic needs above.
Learning Needs
This may arise from a knowledge deficit identified by the nurse or client, client directed health seeking behaviors or a problem with adherence because of intervening factors.
Statement of nursing diagnoses associated with learning needs would include:
“Knowledge deficit” a phrase used to indicate
that the patient doesn’t know enough about an
issue thus creating a potential unmet need. Or
that the patient has a concern of his own that is
related to an unmet need
“Health seeking behaviour” related to any
need, or an issue such as parenting, or coping
with illness.
“Non-adherence because of”- should always be
specified as unable or unwilling to be involved
for whatever reason, rather than the client is
non-compliant. The goal would not be
for the client to comply, but to participate, or to
become more involved, or to adhere to the plan
The plan and interventions following should involve the nursing abilities of Teaching, Communication, and Collaboration (with the client and/or family)
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