Many books use the PES format to talk about the possible parts of a Nursing Diagnosis.
PES stands for Problem, Etiology and Symptoms.
In this video I am going to define each of these components as well as show you how
to add in other components that are used in three and four part nursing diagnoses.
The Problem should be identified using a NANDA label whenever possible. The “problem”
is what the client needs, which with some types of nursing diagnoses may not be problem
focused. The problem statement needs to clearly and concisely indicate what the client’s
response to their health status is. Standardised language is used for many reasons that we
covered in another video. By looking at the problem statement nurses can anticipate what
the client’s goals may be. However, be sure to discuss these goals with the client when
a care plan is created.
Sometimes the NANDA label will be general and ask you to add a more specific description
of the problem to this section. Remember to include qualifiers to the general diagnostic
concept as appropriate. For examples please see the book provided in the links attached
to this video.
Be careful when writing your problem statement that judgemental language is not included.
The problem statement should sound neutral to avoid offending clients or influencing
treatment decisions.
The Problem and Etiology are connected by the phrase “Related to”, which is typically
abbreviated as r/t. This phrase is always used because it does not imply a direct cause
and effect relationship, which would be practically impossible to prove for most nursing diagnoses.
Nursing diagnoses are worded this way to leave open the possibility that there may be factors
contributing to the problem that have not yet been identified.
The Etiology identifies the factors that are causing the problem. For actual nursing diagnoses
the etiology identifies the main contributing factors. With potential diagnoses risk factors
are used as the etiology. This etiology should help to individualise care for your client.
The Etiology needs to be as specific and precise as possible. Do not write this section vaguely
hoping that the symptoms section will explain what is going on with the patient. Write your
Problem and Etiology as specific as possible before adding the signs and symptoms to the
end.
“Secondary to” is used to make a statement more precise and clarify the etiology. Use
secondary to to specify a pathophysiology or disease that is contributing to the problem.
Keep in mind that it is not always necessary to use the “secondary to” phrase. You
want to keep your diagnoses as clear and concise as possible.
If a client has the defining characteristics of a nursing diagnosis but you do not know
the cause or contributing factors you can say there is an “unknown etiology.” Make
sure you have completed your assessment and used critical thinking to be sure you are
not jumping to conclusions when making your diagnosis. Writing “unknown etiology”
is not a trick to get your homework done faster!
If you are unsure of the etiology you can say that a problem is possibly related to
an etiology until you have collected enough data to confirm your inference. Once you have
more data to confirm the etiology you will need to go back and re-write the nursing diagnosis.
In very few cases the etiology may be so complex that you cannot include it in a nursing diagnosis
concisely. This situation occurs when there are too many factors causing the problem to
state. In these rare circumstances the phrase “complex etiology” may replace the etiology.
Please note that in my experience students do not use the phrases “Unknown Etiology”
or “Complex Etiology” in their assignments or on exams. Since you are just learning professors
generally keep it simple enough that an etiology can be identified.
Symptoms are then listed at the end of your diagnosis following the clause “as manifested
by” which is abbreviated. Even though the S in PES stands for Symptoms, signs and symptoms
are listed here. These signs and symptoms are very helpful for planning interventions
so they need to be made accessible - either in the nursing diagnosis or somewhere else
in the patient’s chart. As a student you will most likely be asked to list your signs
and symptoms at the end of your nursing diagnosis. If there are many signs and symptoms you may
be able to list subjective and objective data separately just below the diagnosis - just
check with your teacher to see how they want it done.
Thank you for watching. I am continuing work on this series to help you through the nursing
process. Don’t forget to subscribe to be notified when new videos are released. In
the meantime please comment below with any questions you have about nursing diagnoses.
Links to helpful resources are provided below. You may also want to check out my related
videos.