Do I have to use "as manifested by" or "as evidenced by" and "related to" for documenting a nursing diagnosis?
NANDA International







No.

While this is a good way of teaching the diagnostic reasoning process, it is not required by NANDA-I. It is sufficient to provide the nursing diagnosis label (e.g., Anxiety), and in fact, many computer systems do not allow the “related to…as evidenced by” model. However, it is important that nurses communicate the assessment data to support the diagnosis they make, so that others caring for the patient know why a diagnosis was selected.

Please see the NANDA-I Position Statement #2: The Structure of the Nursing Diagnosis Statement When Included in a Care Plan. Documentation rules vary among hospitals, sites and schools. In some settings, the wording of a nursing diagnosis may require these terms. This format is required by some organizations in order to substantiate the accuracy of the diagnostic statement.  An example might be the following:
 
Impaired Mobility related to decreased muscle control, neuromuscular impairment and sensoriperceptual impairments (related or etiologic factors) , as manifested / evidenced by gait changes, uncoordinated movements and postural instability (defining characteristics). Because patients usually have more than one related factor and/or defining characteristic, many sites replaced the wording "as manifested/as evidenced" and "related to" with a list of  the defining characteristics and related factors following the diagnostic statement . This list is based on the individual patient situation and by using standardized NANDA-I terms.

 Impaired Mobility
Related factors:
- decreased muscle control
- neuromuscular impairment
- sensoriperceptual impairments

Defining characteristics:
- Gait changes
- Uncoordinated movements
- Postural instability

This format is helpful for scientific evaluations of accuracy of nursing diagnoses, however nursing documentation requirements vary among settings and countries. In some countries/settings it is a requirement to document the defining characteristics and related factors with the diagnostic statement; in others the assessment data (defining characteristics and related factors) are contained solely within the assessment documentation section of the information system. Regardless of the requirements for documentation, it is important to remember that for safe patient care in clinical areas, it is crucial to survey or assess defining characteristics (manifestations of diagnoses), and related factors (or causes) of nursing diagnoses. Choosing effective interventions is based on related factors and defining characteristics.

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