Nursing Care Plans: NANDA-I, PES, and ADPIE

A nursing care plan is only as strong as its diagnosis statement — a vague or poorly structured diagnosis undermines every intervention that follows it. Here's how the three pieces (NANDA-I, PES, ADPIE) fit together.

ADPIE: the overall process

• Assessment — subjective and objective data collection.
• Diagnosis — a NANDA-I nursing diagnosis, structured in PES format.
• Planning — measurable, patient-specific goals and expected outcomes.
• Implementation — the nursing interventions actually carried out.
• Evaluation — whether the goals were met, partially met, or not met, and why.

NANDA-I: choosing the right diagnosis

NANDA-International maintains the standardized list of nursing diagnoses used across care plans — each with a specific definition, defining characteristics, and related factors. Picking a diagnosis that doesn't match your actual assessment data is one of the most common reasons care plans lose points: the diagnosis has to be supported by evidence you actually documented in your assessment, not by what seems clinically likely.

PES: structuring the diagnosis statement

PES format states the diagnosis in three connected parts:

• Problem — the NANDA-I diagnosis label (e.g., "Impaired Skin Integrity").
• Etiology — the related factor(s), connected with "related to."
• Signs/Symptoms — the defining characteristics you actually assessed, connected with "as evidenced by."

Worked example: "Impaired Skin Integrity related to prolonged immobility as evidenced by a Stage II pressure injury on the sacrum."

Note that "risk for" diagnoses (used when a problem hasn't occurred yet but risk factors are present) drop the "as evidenced by" clause, since there are no signs/symptoms yet to cite.

Common mistakes

• A diagnosis not actually supported by the assessment data presented.
• Goals that aren't measurable ("patient will feel better" instead of "patient will report pain ≤3/10 within 24 hours").
• Interventions that don't clearly connect back to the stated etiology.