The PES statement is a standardized, structured sentence used by nutrition professionals to articulate a patient’s specific nutritional diagnosis. It is the second step in the Nutrition Care Process (NCP), a systematic framework used by dietitians to provide high-quality care. The acronym PES represents the three components of the diagnosis: Problem, Etiology, and Signs/Symptoms. This format ensures clear, consistent communication among healthcare providers about the patient’s nutrition-related issue.
Breaking Down the Three Components (P, E, S)
The three parts of the PES statement define the patient’s nutritional status. The Problem (P) identifies the specific nutrition-related diagnosis the dietitian is responsible for treating. These problems are selected from standardized terms, such as “Inadequate energy intake” or “Excessive sodium intake.”
The Etiology (E) describes the root cause or contributing factors leading to the identified problem. This component pinpoints the underlying reason for the nutrition issue that the intervention will aim to resolve or improve. The Etiology is typically a free-text description, allowing flexibility to capture the patient’s unique situation, such as a lack of knowledge or a physical restriction.
The Signs and Symptoms (S) provide the objective and subjective data that serve as evidence for the Problem and the Etiology. Signs are measurable indicators, like lab values or weight loss figures. Symptoms include subjective reports from the patient, such as statements about appetite or physical discomfort.
The Standardized PES Statement Formula
The Problem, Etiology, and Signs/Symptoms are connected using a specific, required syntax to form a cohesive sentence. The formula is structured as: “Problem related to Etiology as evidenced by Signs and Symptoms.” This standard format ensures the logic connecting the diagnosis, its cause, and the supporting data is clear.
The phrase “related to” establishes a cause-and-effect relationship, linking the nutritional diagnosis (P) to its root cause (E). The phrase “as evidenced by” introduces the specific, verifiable data (S) that confirms the diagnosis and supports the Etiology. Dietitians must use this exact structure to document the nutritional diagnosis.
Practical Steps for Constructing a Statement
Constructing a PES statement begins with assessing the patient’s nutritional status to identify the most urgent nutritional problem a dietitian can address. This must be distinguished from a medical diagnosis; for example, “Diabetes” is medical, but “Inconsistent carbohydrate intake” is a specific nutritional problem (P) a dietitian can treat. The problem must be selected from the standardized terminology list.
Once the problem is identified, the next step is determining the Etiology (E), which should be the root cause targetable by an intervention. If the root cause is a medical condition, the Etiology should focus on the impact of that condition that a nutrition intervention can improve. For example, instead of listing the medical diagnosis, the Etiology might be “difficulty swallowing due to stroke,” which can be addressed through modified food textures.
Finally, the Signs/Symptoms (S) must be selected to provide concrete proof for the diagnosis and the claimed cause. A well-written statement includes quantifiable data that can be re-measured to track progress. A complete example is: “Inadequate fiber intake related to limited consumption of high-fiber foods as evidenced by food diary records showing an average of less than two servings of fruits and vegetables daily and patient report of chronic constipation.”
The Role of the PES Statement in Nutrition Care
The PES statement connects the initial patient assessment to the creation of a targeted care plan. The Etiology (E) component directly dictates the Nutrition Intervention (I), which is the action plan to solve the problem. For instance, if the Etiology is “lack of knowledge,” the intervention focuses on nutrition education and counseling.
The Signs and Symptoms (S) component establishes the parameters for Monitoring and Evaluation (M/E), the final step of the NCP. The specific data points listed in the Signs/Symptoms—such as a lab value or a reported weight change—become the outcomes measured to determine if the intervention successfully resolved the Problem. A precise PES statement ensures care is targeted and measurable, allowing the dietitian to track progress.