Wellness nursing diagnoses focus on the patient's progress or potential progress towards healthier behaviors rather than on a problem. They were created to remedy a situation in which only negative issues were addressed, leaving out diagnoses for patients in a healthy setting. A wellness diagnosis indicates a readiness to advance from the current level of health to a higher level. There are two prerequisites for a wellness diagnosis—a desire to advance and an ability to do so.
The first requirement for a wellness diagnosis is a desire to attain a higher level of well-being. The patient must express emotional readiness to engage in interventions that will help him reach that next level. For example, a patient recently had knee replacement surgery and the doctor feels he is ready to start ambulating with assistance. The patient tells you he just doesn't feel up to it, he's too tired and he thinks it's just going to be too hard. At this point, the patient is not expressing a readiness to enhance his well-being and a wellness diagnosis cannot be written.
Status and Function
The second prerequisite for a wellness diagnosis is the presence of status or function required to perform tasks related to the diagnosis. Your knee replacement patient expresses an emotional readiness to begin doing exercises that will enable him to regain optimum function in his knee. However he has recently developed a clot in his leg from his immobility and the doctor doesn't want him ambulating until it dissolves. Although the patient is emotionally ready to begin taking charge of his health, he is not physically able to perform the interventions.
Assessing a patient's readiness to respond to a wellness diagnosis involves patient interviews and interaction. For example, you are doing home visits with a new mother who has displayed a risk for impaired parenting in the past. She refused to hold her baby and expressed feelings of hopelessness about being a good parent. On your most recent visit, you notice she is cuddling her newborn. She tells you she finally feels like she knows what she's doing and is much more confident. Based on your observations, you may write a “readiness for enhanced parenting” diagnosis.
Writing the Diagnosis
While most nursing diagnoses require at least two parts, the diagnosis and the “related to” factors, wellness diagnoses are written a little different. They are started with the word “readiness” followed by the action or health-seeking behavior that will be enhanced. For example, “readiness for enhanced nutrition” indicates that the patient has expressed a desire and ability to learn more about proper nutrition as it relates to his condition.
“Readiness for enhanced management of therapeutic regimen” describes a patient who is willing and able to participate in her own treatment by following recommendations and helping set new goals for herself. A patient who has expressed a desire to come to terms with his illness and requests help with this is displaying “readiness for enhanced coping.” “Readiness for enhanced religiosity” can be applied to a patient who previously stated she no longer believed in her religion but later states that she wants to get back in touch with her spiritual side.