# Situation: The nurse on a psychiatric unit reviews admission records. Each record lists the client's diagnosis under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and nursing diagnoses written with NANDA International (NANDA-I) 2024–2026 labels. A student asks how a nursing diagnosis differs from the diagnosis made with the psychiatric manual on the same chart. Which explanation is accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630093  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: The nurse on a psychiatric unit reviews admission records. Each record lists the client's diagnosis under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and nursing diagnoses written with NANDA International (NANDA-I) 2024–2026 labels.

A student asks how a nursing diagnosis differs from the diagnosis made with the psychiatric manual on the same chart. Which explanation is accurate?

## 보기

1. It restates the disorder in nursing terms and stays the same until discharge
2. It becomes valid only after the psychiatrist has confirmed the medical diagnosis
3. It describes a response nurses treat and changes as the response changes **✔ 정답**
4. It ranks the diagnostic criteria the client meets from the most to least severe

**정답: 3**

## 해설

A nursing diagnosis is a clinical judgment about the client's human response to a health problem, which nurses can treat independently, and it changes as the response changes. A medical or psychiatric diagnosis names the disease and stays the same while the disease is present.

## 심화 해설

A nursing diagnosis and a psychiatric diagnosis serve different purposes on the same chart, even though both appear in the admission record. The psychiatric diagnosis, classified under the DSM-5-TR, identifies the disease process itself—for example, major depressive disorder or schizophrenia. It is made by a psychiatrist or other qualified clinician and remains the same as long as the disorder is present. The nursing diagnosis, written with NANDA-I labels, is not a restatement of that disease. It is a clinical judgment about the client’s human response to the health problem or life process.

The distinction rests on what each diagnosis describes and who acts on it. A medical or psychiatric diagnosis names the pathology. A nursing diagnosis describes a response that nurses can treat independently—such as ineffective coping, social isolation, or risk for self-directed violence. These responses are not fixed. They shift as the client’s condition, coping resources, environment, and treatment progress change. The nursing diagnosis is therefore dynamic: it is revised, resolved, or replaced as the client’s response changes. In contrast, the DSM-5-TR diagnosis remains stable while the underlying disorder persists.

This dynamic quality is central to the nursing process. A client admitted with schizophrenia may initially have the nursing diagnosis of disturbed sensory perception related to hallucinations. As antipsychotic medication takes effect and hallucinations subside, that response changes. The nursing diagnosis may then shift to impaired social interaction or ineffective health maintenance. The psychiatric diagnosis of schizophrenia, however, does not change simply because the hallucinations improved—it remains until the disorder is in remission or resolved by clinical judgment.

The NANDA-I definition has been refined over time to emphasize this response-based, nurse-treatable focus. Early discussions within the Diagnosis Development Committee highlighted that proposed “physiologic” or “surveillance” diagnoses sometimes did not fit the core definition because they described conditions rather than human responses [1]. A nursing diagnosis must capture something the nurse can address through independent interventions—teaching, counseling, environmental management, symptom monitoring, or supportive care. It is not contingent on the psychiatrist’s confirmation to become valid. The nursing diagnosis stands on its own as a judgment about the client’s response, made from nursing assessment data. It does not rank DSM-5-TR criteria by severity; that is a function of diagnostic assessment, not nursing diagnosis.

| Characteristic | Nursing diagnosis (NANDA-I) | Psychiatric diagnosis (DSM-5-TR) |
| --- | --- | --- |
| Focus | Human response to a health problem | Disease or disorder itself |
| Made by | Nurse, from nursing assessment | Psychiatrist or qualified clinician |
| Stability | Changes as the response changes | Stable while the disorder is present |
| Treatment basis | Independent nursing interventions | Medical or psychiatric treatment |
| Example | Ineffective coping, social isolation | Major depressive disorder, schizophrenia |

Watch out! A common error is thinking the nursing diagnosis is simply the medical diagnosis translated into nursing words. It is not. The nursing diagnosis identifies a separate phenomenon—the client’s response—that nurses are licensed and competent to treat. Key point! The nursing diagnosis changes when the response changes, while the psychiatric diagnosis remains stable as long as the disorder is present. This distinction explains why a client’s chart may show the same DSM-5-TR diagnosis from admission to discharge, but a series of different nursing diagnoses over the same period.References (research sources)

- [1]Nursing diagnosis: is it time for a new definition?Research articleHerdman TH (2008) · DOI: 10.1111/j.1744-618X.2007.00073.x

## 임상 시나리오

Differentiating Nursing and Psychiatric DiagnosesUnderstanding the dynamic nature of nursing care
A psychiatric diagnosis (DSM-5-TR) names the disease process and remains stable while the disorder is present.

A nursing diagnosis (NANDA-I) is a clinical judgment about the client's human response to that problem, which nurses treat independently.

Nursing diagnoses are dynamic; they are revised, resolved, or replaced as the client's response changes over time.

CautionDo not simply restate the medical diagnosis in nursing terms. Focus on the client's response, such as ineffective coping or risk for self-harm, which is the target of nursing interventions.

## 핵심 개념

- **Nursing Diagnosis** — A clinical judgment about a client's human response to a health problem or life process that nurses can treat independently.
- **DSM-5-TR** — The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision; used to classify psychiatric disease processes.
- **NANDA-I** — NANDA International; provides standardized terminology and labels for nursing diagnoses.
- **Human Response** — The client's individual reaction to a health problem, such as ineffective coping or social isolation, which is the focus of nursing care.
- **Clinical Judgment** — The interpretation or conclusion made by a nurse about a client's needs, concerns, or health problems, leading to a decision to take action.

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