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Beginning nursing students often struggle to identify patient problems based on their assessments that link a North American Nursing Diagnosis Association (NANDA) label to them. To help students, we developed a list of common problem concepts, such as oxygenation, perfusion, and fluid/electrolytes, and paired them with appropriate assessment and NANDA labels that fit the problem concept. This tool is named the Problem Concept/Assessment/Diagnosis (PCAD) tool (see Table, Supplemental Digital Content 1, While using the nursing process and completing head-to-toe assessments, students are able to utilize the tool to identify which concept is a problem for patients and quickly identify missing assessment data. The PCAD then assists students to identify appropriate NANDA labels correlated to assessment data and the patient's priority problems.


The tool is also helpful for clinical instructors, especially those who are new to teaching. Clinical instructors are able to use the tool to guide students in prioritizing problems, encourage the student to do a more thorough assessment, and link NANDA labels that fit the patient's condition. The PCAD also reminds new clinical instructors of how novice nursing students work through the nursing process and make early clinical judgements.


By Alyssa Backes, MS, RN, CLC, and Sara Berger MSN, RN-BC, CNE Assistant Professors of Practice, North Dakota State University Nursing, Sanford Health, Bismarck, ND,;