FOCUS CHARTING OR

F-DAR CHARTING
It is intended to make the client
and client concerns and
strengths the focus of care. It is a
method of organizing health
information in an individual’s
record. It is also a systematic
approach to documentation.
 FOCUS CHARTING PARTS
Three columns are usually used in Focus Charting for documentation:

 Date/Hour
 Focus
 Progress Notes

The Progress Notes are organized into (D) data, (A) action, and (R)
response, which is referred to DAR as third column.
 DATE FOCUS DATA, ACTION &
/SHIFT/TIME RESPONSE
03/03/2019 D > __________________________
7AM-7PM __________________________
__________________________
9:00AM ___________________________
 THE PROGRESS NOTES
FOCUS
The focus might be a nursing
diagnosis, patient’s problem,
change in patient's condition, or
any significant event.
 Nursing Diagnosis
 It is a clinical judgment about individual, family, or community
experiences/responses to actual or potential health
problems/life processes.
 It is developed based on data obtained during the nursing
assessment, it is the “label” when nurses assign meaning to
collected data appropriately labeled with NANDA-approved
nursing diagnosis.
 refers to one of many diagnoses in the classification system
established and approved by NANDA.
 It is based upon the response of the patient to the medical
condition. It is called a ‘nursing diagnosis’ because these
are matters that hold a distinct and precise action that is
associated with what nurses have autonomy to take action
about with a specific disease or condition. This includes
anything that is a physical, mental, and spiritual type of
response. Hence, a nursing diagnosis is focused on care.
 Comparison between Medical and
Nursing Diagnosis
 Medical diagnosis is made by the physician or advance
health care practitioner that deals more with the disease,
medical condition, or pathological state only a
practitioner can treat. Moreover, through experience and
know-how, the specific and precise clinical entity that
might be the possible cause of the illness will then be
undertaken by the doctor, therefore, providing the proper
medication that would cure the illness.
 The medical diagnosis normally does not change. Nurses
are required to follow the physician’s orders and carry out
prescribed treatments and therapies.
TYPES OF NURSING
DIAGNOSIS
 Problem Nursing Diagnosis
A problem diagnosis (or also called actual
diagnosis) is a client problem that is present at the
time of the nursing assessment. These diagnoses are
based on the presence of associated signs and
symptoms. Examples: Ineffective Breathing Pattern
and Anxiety, Acute Pain, and Impaired Skin Integrity
.
 Risk Nursing Diagnosis
A risk nursing diagnosis is a clinical judgment that a
problem does not exist, but the presence of risk factors
indicates that a problem is likely to develop unless nurses
intervene. For example, all people admitted to a hospital
have some possibility of acquiring an infection; however, a
client with diabetes or a compromised immune system is at
higher risk than others. Therefore, the nurse would
appropriately use the label Risk for Infection to describe
the client’s health status.
 Wellness Diagnosis
Wellness Diagnoses (or also called health
promotion diagnosis) describe human responses to
levels of wellness in an individual, family or
community that have a readiness for enhancement.
Examples of wellness diagnosis would be Readiness
for Enhanced Spiritual Well Being or Readiness for
Enhanced Family Coping.
 SYNDROME DIAGNOSIS
A syndrome diagnosis is associated with a cluster
of problem or risk nursing diagnoses that are
predicted to present because of a certain situation
or event. An example is Rape Trauma Syndrome.
 POSSIBLE NURSING
DIAGNOSIS
Are statements describing a suspected problem for
which additional data are needed to confirm or rule
out the suspected problem. A possible nursing
diagnosis also provides the nurse with the ability to
communicate with other nurses that a diagnosis may
be present but additional data collection is indicated
to rule out or confirm the diagnosis. Examples
include Possible Chronic Low Self-Esteem, Possible
Social Isolation.
How to Write a Nursing
Diagnosis?
Nursing diagnostic statements describe the
health status of an individual and the
factors that have contributed to the status.
Diagnostic statements can be one-
part, two-part, or three-part statements.
One-Part Nursing Diagnosis Statement

Wellness nursing diagnoses are written as one-part

statements because related factors are always the same:
motivated to achieve a higher level of wellness.
Syndrome diagnoses also have no related factors.
Examples include:
 Readiness for Enhance Breastfeeding
 Readiness for Enhanced Coping 
 Rape Trauma Syndrome
Two-Part Nursing Diagnosis Statement

Risk and possible nursing diagnoses have two-part statements: the

first part is the diagnostic label and the second is the validation for a
risk nursing diagnosis or the presence of risk factors. It’s not possible
to have a third part for risk or possible diagnoses because signs and
symptoms do not exist. Examples include:

 Risk for Infection related to compromised host defenses

 Risk for Injury related to abnormal blood profile
 Possible Social Isolation related to unknown etiology
Three-part Nursing Diagnosis Statement

An actual or problem nursing diagnosis have three-part statements:

diagnostic label, contributing factor (“related to”), and signs and
symptoms (“as evidenced by”). Three-part nursing diagnosis
statement is also called the PES format which includes
the Problem, Etiology, and Signs and Symptoms. Examples include:
 Impaired Physical Mobility related to decreased muscle control as
evidenced by inability to control lower extremities.
 Acute Pain related to tissue ischemia as evidenced by statement
of “I feel severe pain on my chest!”