Does anyone think nursing diagnoses are just plain silly? - page 10

Does anyone think nursing diagnoses are just plain silly - overly literal and laughably complex? (please see examples at end of this post) Are we trying so hard to legitimize nursing as a... Read More

  1. by   Daytonite
    Quote from oldiebutgoodie
    A question:

    Are you saying that an APN can submit a bill to Medicare with a diagnosis of "Impaired Tissue Perfusion" and get paid? My (albeit) uneducated understanding is that Medicare pays for ICD-9 diagnoses and CPT procedures.
    I have a second career as a coder and HIM professional which is why I know so much about this stuff. Providers, particularly Medicare and Medicaid DO NOT PAY when the diagnosis is a symptom. The diagnosis must be a diagnosis which is another reason why NANDA worked to get a list of nursing diagnoses together. I am quite familiar with ICD-9 and CPT codes. There is a whole chapter in ICD-9 of symptoms and I can tell you from my coding days that claims with symptoms as primary diagnoses can often get denied payment.
  2. by   Daytonite
    Quote from marie-francoise
    NURSING DIAGNOSIS-ESE: "Impaired Skin Integrity and Impaired Tissue Integrity related to surgical incision"
    TRANSLATION: Patient has a surgical incision.
    • Early 1070s and before (I was there and we did it this way): Surgical Incision on ____
    • Now: Impaired Skin Integrity R/T surgical intervention
      • Meaning: patient was cut into by a doctor
    Time progresses forward and the way we do things DOES change. Telephones now have push buttons instead of cranks and dials. No one complains about this.

    Where's my explanation of hyper-literal language and hyper-literal descriptions that I asked for? I think if someone is going to use these terms that ought to at least be able to explain to people what they mean by them in the simple language that they are saying they are a proponent of.
  3. by   SuesquatchRN
    "Surgical incision on x" is a far better description than the others.

    Daytonite, I really value your knowledge and your willingness to teach and share that knowledge. But it strikes me that you are getting really frustrated because some of us don't like the the way it has been mandated that nurses do this particular task.

    Let us not like it!

  4. by   Diary/Dairy
    I sooo do not miss nursing diagnoses - and I think my objection echoes some of the others, they are just sooo awkward. It's almost a waste of ink to write some of them down. I would be more open to using them if they flowed a little better!
  5. by   ERRNTraveler
    Hyper Literal = OVERLY or EXCESSIVELY literal. Example: referring to a "surgical incision" as "impaired skin integrity secondary to surgical site"... excessive verbiage.....

    There's a definition for you, happy???
  6. by   oldiebutgoodie
    Quote from Daytonite
    I have a second career as a coder and HIM professional which is why I know so much about this stuff. Providers, particularly Medicare and Medicaid DO NOT PAY when the diagnosis is a symptom. The diagnosis must be a diagnosis which is another reason why NANDA worked to get a list of nursing diagnoses together. I am quite familiar with ICD-9 and CPT codes. There is a whole chapter in ICD-9 of symptoms and I can tell you from my coding days that claims with symptoms as primary diagnoses can often get denied payment.


    I'm afraid I'm not following you. The issue we are debating, I think, is the value of the NANDA nursing diagnoses.

    To submit to medicare, you submit the diagnosis, such as 707.03, Decubitus Ulcer of lower back. This is a medical diagnosis. The NANDA diagnosis would probably be "Impaired Skin Integrity". My Medicare book tells me that the CMS 1500 form must be filled out with the ICD-9 diagnosis code, not a NANDA code.

    So, whether Medicare rejects a symptom-related ICD-9 code is not, I think, pertinent to the argument. The argument is the value of NANDA diagnoses.

    As you wisely pointed out previously, perhaps they have been shoved down our throats. But more importantly, they are ignored by MDs, not discussed in APN graduate school, and dismissed by most nurses. So where is the value?

    Just because a taxonomy was created, and mapped to SNOMED, doesn't mean it is necessarily the best solution. I suppose it is good that this initial work is done, but as one of the primary tools in nursing school to teach critical thinking? I think not. I assume I will teach nursing students someday (when I get this MSN in 2010), but I certainly am not going to obsess over wording like some of my instructors did.

    Regards,
    Oldiebutgoodie
  7. by   Daytonite
    Quote from suesquatch
    daytonite, i really value your knowledge and your willingness to teach and share that knowledge. but it strikes me that you are getting really frustrated because some of us don't like the the way it has been mandated that nurses do this particular task.
    i am frustrated that many don't see the simplicity in it. care plans are just another documentation that we have to do. nursing diagnoses are nothing but labels placed on the same old nursing problems we have been assessing patients for for years. it's an argument over the language, the words, we are using to describe these problems. i think that is what is the silliness here. when you are educated, there are all kinds of words that you can use that mean the same thing. that's the fun of using language. but, for a reason, for this particular task, we have to be uniform and consistent. the coders who work with icd-9 can tell you that coding medical diagnoses from doctor's dictations can be a nightmare because a doctor can write a medical diagnosis a number of different ways. the coders have to turn it into an icd-9 code which is a uniform, consistent and acceptable diagnosis so everyone is clear and on the same page. if you've ever seen an icd-9 code manual, it gives a definition of each medical diagnosis along with it's assigned 3-, 4-, or 5-digit code number.

    i work with nursing diagnoses all the time in writing care plans. i use my little (current) copy of nanda-i nursing diagnoses: definitions & classification 2007-2008 which is the bare bones of the taxonomy. it's loaded with all kinds of little notations that i have added to various pages. each time i get my updated copy i re-copy all these notations into the new updated copy. when you use it all the time, you get comfortable using this "nursing language". if one doesn't use it enough or use the references in the first place when they are first learning them to become familiar with it then i can understand why there is so much hatred and distaste against them. the place to start learning the nursing diagnoses is in school. how can one learn this in school if one is not open to it? if one is working in any specific unit of a facility there are only going to be, perhaps, 25+ nursing diagnoses one is going to use repeatedly out of the current 188 that exist. even i haven't used all 188 of them, but i know how to read and interpret my reference on them to help guide me which i suspect is part of the real problem for most.

    somehow, i think many educators have neglected to educate students to the actual nanda taxonomy and how it should be used as a reference, like one would refer to an encyclopedia or a dictionary to help them. i suspect it is because some of the educators themselves have never looked at the taxonomy or know how it works. yet, they attempt to teach it to nursing students. isn't that like the blind leading the blind? and, that, i think, is where a lot of the confusion and bad feelings over this issue might stem from, not from the wording of the nursing diagnoses themselves.

    i feel that i am pretty certain about this because of the same questions that are always asked by students on the student forums about nursing diagnoses. they are so hung up on them that they can't seem to see all the other good information they already have to proceed with their care plans. how this impasse seems to be such a common occurrence is really an outstanding problem that i see. question after question after question about it on the student forums. what are some of the educators doing to cause this kind of confusion? and, why does the confusion continue after school to the point that not too many others seem to be able to help these poor lost lambs? i've only seen two or three of the members who have posted to this thread assisting any of the students with their care plan questions on allnurses. believe me, i check for these questions every day.

    i don't think it is totally nanda's fault. i think it is the way the nanda was introduced and is taught. maybe i see it differently because i was writing care plans way back in the days before nanda. i really don't see the difference except that the nandas are just a label we use to replace the problem statement we used to have to make up in our heads as we wrote the care plan.

    a good part of what the op is referring to has to do with the critical thinking part of what her instructors require. working, employed nurses don't have to include that information in their nursing diagnosis statements as it's assumed they already know it. as i see it, the op is another lost lamb who is struggling to understand critical thinking and the nursing process and mistakenly using nursing diagnosis as the scapegoat because it's convenient and because it already has a bad reputation in the nursing community. i am also frustrated and bothered that a tenderoni not even out of school has already made a judgment about an issue without giving it a fair trial. nonjudgmentality is something that was drummed into my nursing class from day 1.
  8. by   marie-francoise
    Quote from daytonite
    as i see it, the op is another lost lamb who is struggling to understand critical thinking and the nursing process and mistakenly using nursing diagnosis as the scapegoat because it's convenient and because it already has a bad reputation in the nursing community. i am also frustrated and bothered that a tenderoni not even out of school has already made a judgment about an issue without giving it a fair trial.
    could i please ask that the personal comments about me stop?

    who i am or what my character is really has no bearing on the fact that, even on face value, the language used in the nanda's is overly complex and literal and does nothing to increase respect for nursing from other professions (in fact, likely does the opposite).

    but - to indulge the personal aspect of this debate just for a very short minute - i'm not a "little lost lamb" or a "tenderoni" who is a stranger to "critical thinking" (otherwise known as using one's brain).

    i'm a grown woman in my mid-thirties, am coming back to school for a second career, have an advanced degree in the health field, and was genuinely surprised by this nursing dx language when i encountered it. i've coordinated and worked with docs for years, and have generally dwelt in the adult world for several years now...

    anyway, please stop these personal comments. they do nothing to advance the debate, unless you want to discredit me as the op. but you can't discredit me by calling me a "little lost lamb" when you do not even know me.

    so, to return to the debate - to abolish the nanda's, i would think the accrediting bodies for nursing schools, nln, ana, textbook writers, and any regulatory body that requires this language should be approached.

    getting rid of nursing dx's might actually be one of the steps in increasing the respect for the nursing profession that is so needed right now to enact systemic changes. it will make us seem more credible in the eyes of other professions, by making us seem less silly & fatuous. (and, again, i know that is not what nurses are - but the nursing dx language gives this perception.)

    in fact, the textbooks would be marvelously reduced in size were the nursing dx's removed from them...

    and i'll speak from the perspective of someone from another profession, since i come from one: the nursing dx's don't do anything to elevate the nursing profession in the eyes of other professions. in fact, i think they demote it because it makes nurses seem as if they are straining for respect by adopting their "own" pseudo-technical language, when in fact, their own, no-nonsense language would suffice just fine.

    and when, in fact, they should be respected for the very work they do and the considerable knowledge they have.

    and when, in fact, such odd language does nothing to enhance communication among the health care team.

    for example, a break in the skin is not some esoteric disease that only we can describe properly through phrases such as "impaired skin integrity and impaired tissue integrity".

    pulmonary edema shouldn't be described as "impaired gas exchange due to .... " oh, boy, i can't even remember the rest of it, it was so complex... something about how not enough respiratory gases can get into the bloodstream due to "excess fluid volume".

    any lay person with a bit of knowledge about the health field can see through what the nursing dx's are trying to do - i.e., elevating even the most basic bodily process to some highly technical thing to make a profession feel more "special" about itself. (again, i know most nurses don't embrace this language - i'm just talking about the perception one gets when reading the nursing dx's...). docs, nurses, respiratory therapists, etc., etc., should be using a common language, not each adopting their own "cult" language.

    i don't want to seem like an uppity student and i do apologize for my long-windedness... but i'm daily confronted by these nursing dx, am asked to use them, and i find myself increasingly resistant to them.
  9. by   Altra
    Quote from marie-francoise
    I don't want to seem like an uppity student and I do apologize for my long-windedness... But I'm daily confronted by these nursing dx, am asked to use them, and I find myself increasingly resistant to them.
    Excellent post, marie-francoise. As many of us have said on this thread ... try your best not to sweat it. Do your best to ascertain exactly what each individual instructor wants on a care plan, put it on there, and don't worry about it.

    After nursing school, everyone you communicate with every day: other nurses, MDs, respiratory, PT, case managers, etc. etc. etc. ... will all speak in terms of symptoms and medical diagnoses. You'll all be on the same page, and it won't be the NANDA page.

    Nursing dx may help students understand the multi-faceted care of individual disease processes. But the excessive verbiage ... well, we've already covered that.

    Good luck to you.
  10. by   jackson145
    A person can't expect everyone to think like them and appreciate all the things that they do. Everyone does not have to be converted to a particular point of view to validate it. If something makes sense to you, great! Be thankful for it. Everyone else will find a way that works for them. I think the world is an ugly place when we try to force the natives to adopt our religion because we are threatened by them having their own, different one.
  11. by   FireStarterRN
    Quote from MLOS
    Excellent post, marie-francoise. As many of us have said on this thread ... try your best not to sweat it. Do your best to ascertain exactly what each individual instructor wants on a care plan, put it on there, and don't worry about it.

    After nursing school, everyone you communicate with every day: other nurses, MDs, respiratory, PT, case managers, etc. etc. etc. ... will all speak in terms of symptoms and medical diagnoses. You'll all be on the same page, and it won't be the NANDA page.

    Nursing dx may help students understand the multi-faceted care of individual disease processes. But the excessive verbiage ... well, we've already covered that.

    Good luck to you.
    This just about sums it up. No one, other than nursing students, actually uses these. I always was under the impression that they were a teaching tool, I didn't ever see that they had any practical clinical application after school was over.
  12. by   MiaKeaRN
    Let's get out of the DARK AGES of nursing, and start moving forward.

    There are no right or wrong answers/posts here, and everyone is entitled to their opinion, but it is 2007 and I think nursing needs to catch up with current times....not the way things were taught 40 years ago, 30 years ago, or even 10 years ago.

    I look forward to graduating and not having to deal with the tedious, time-wasting task of writing out nursing diagnoses. Yes, I feel it is a waste of my time......give me more of a hands-on approach, teach me more clinical SKILLS, but stop giving me writer's cramp. The 100 or so hours wasted on writing out ND's could be put to much better use on patient care.
  13. by   Weeping Willow
    I agree it's an insult to our intelligence. God forbid we should just say, "He's having an asthma attack."

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