Does anyone think nursing diagnoses are just plain silly?

[marie-francoise]

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 profession that we resort to such silly, "uniquely nursing" language? I think it was a waste of energy to have devoted so much time to developing this "uniquely nursing" language.

That energy could have been so much more constructively applied in, say, lobbying Congress to improve nursing working conditions and, say, public service announcements showing the public why nursing IS a profession & one that should be respected!

I mean, why can't we just use the same language as docs? We're all grown-ups with a pretty good grip on health sciences terminology - after all, we went to school in the subject! A pulmonary embolism is a pulmonary embolism. Constipation is constipation. I know the NDs give us "cues" as to what nurses can specifically & autonomously treat, but c'mon....

Do we really expect docs to read over such silly "diagnostic" language?

Some cases in point from my nursing textbook are provided below, with real-world translations. (Feel free to contribute others, either fictional or actual!)

Forgive me if I seem overly facetious or sarcastic. But these are nursing dx's really suggested by my textbook, and I found them not a little ridiculous:

NURSING DIAGNOSIS-ESE: "Impaired gas exchange related to interference with the diffusion of oxygen and carbon dioxide between the capillaries and cells secondary to excess fluid volume." (DUH!! That's how the lungs work!)

TRANSLATION: Patient has pulmonary edema.

NURSING DIAGNOSIS-ESE: "Constipation related to inadequate amount of fluid to provide volume for stool formation." (Ah! Didn't know constipation involved dry poos.)

TRANSLATION: Patient is dehydrated and constipated.

NURSING DIAGNOSIS-ESE: "Impaired gas exchange related to decreased volume of blood available to transport respiratory gases secondary to deficient fluid volume" (Yes! The blood DOES carry oxygen and CO2!)

TRANSLATION: Pulmonary problems related to hypovolemia.

NURSING DIAGNOSIS-ESE: "Fatigue related to altered cellular metabolism secondary to deficient fluid" (Yes! Cellular metabolism does affect the body!)

TRANSLATON: Fatigue related to hypovolemia.

[Spidey's mom, ADN, BSN, RN]

I too, used to think that nursing diagnoses and elaborate care plans were silly. Until I started teaching nursing students.

Then the lightbulb turned on.....

They teach you how to think like a nurse.

I agree . . . even though I hated them in school. And I don't use them at all now.

It is a learning tool.

steph

[MIA-RN]

no one outside of nursing can understand them or the reason for them, they just don't fit and make you sound like you are guessing at what the problem is. it certainty does not do what is was suppose to do,

quote " are we trying so hard to legitimize nursing as a profession that we resort to such silly, "uniquely nursing" language? i think it was a waste of energy to have devoted so much time to developing this "uniquely nursing" language. " it actually just makes us seem like morons, waisting or time. and for jacho to make them mandatory just makes them also seem like a just another waist full government bureaucracy. jeff

mandatory???

[Shantas]

They are absolutely absurd!!! After we got audited by JACHO our hospital established an audit protocol where they audit each and every chart to make sure we are doing those "nursing diagnosis" and "problem goal list" and charting the "teaching".....

We are so busy with cleaning poo, turning pts and dealing with unhappy pt and family all day, we simply fill in the blank to make the management happy and JACHO happy.

[onlyhope]

i don't think i could ever teach nursing because all i would want to do the whole time is tell my students the truth about how pointless the nursing dx are

[marie-francoise]

I agree that nursing dx's can be good learning tools - they can make you really think about a client's condition - what the related factors are, and how one aspect of the condition might relate to another.

BUT.... BUT.... BUT.... that's where they should stay: in the academic arena. (And, yes, as a teacher I would have a tough time "selling" them, esp. with a straight face.)

As language that nurses would actually use in the REAL world - nursing dx are JUST PLAIN LAUGHABLE! Nursing dx language makes us seem ridiculous & fatuous &, well, bordering on the moronic.

Nursing dx's also make nurses seem THAT MUCH MORE separated from the medical world - as if we were clueless about medical issues and the real names for medical diagnoses and processes.

And NANDA - my guess is that many of them are academics not quite married to reality, with the misguided idea that the grand & lofty "Nursing Diagnosis" will give nurses the increased professional stature they need & deserve.

I hope students can see through the silliness of Nursing Diagnoses, while recognizing that, yes, they can serve as a learning tool. But that should be the extent of their utility (please!).

JCAHO requiring them? Ugh!

[lovingtheunloved, ASN, RN]

In Nursing School Land, they are critical to the care of your patient. In Real Life Nursing Land, nobody gives a crap, your common sense and ability to utilize your knowledge is critical to the care of your patient. I learned early on in NS how to play the game...

[S.T.A.C.E.Y, LPN]

I was in college for a post-graduate specialty course, and the teacher was doing scenarios with the class and ended with expected nursing diagnoses. We all refused to answer. Why? she asked. Cause they're useless we replied. She started form her defence, but we held our ground. We're already nurses, and have been though that crap. We told her we were willing to learn the important take-home points from the scenario, but we rufused to waste our time on nursing diagnoses. I think the teacher had been teaching for alittle too long as she still felt knowing the nursing diagnosis was important to everyday nursing practice.

[Daytonite, BSN, RN]

marie-francoise. . .i don't think you would get much support for your position on the student forums. if you did post on the student forums you would know that i answer questions about the nursing process, nursing care plans and nursing diagnoses, in particular, all the time. why is it you don't post on the student forums?

a nursing diagnosis is nothing more than a label, a title, a tag, that is placed on a nursing problem that a patient has. that's all it is. nurses have been determining the nursing problems of patients since there have been nurses. that's what we nurses do. determining patient problems is part of the nursing process. we used to say on a care plan that a patient was "dehydrated" and list our nursing interventions; now we say "deficient fluid volume" and list the same nursing interventions. the nursing process is nothing more than a problem solving process. we've all been engaged in the problem solving process all of our lives even before we went to nursing school. nursing just put a name on the process and added some fancy instructions to the process. and, i don't think that any of the experienced rns who are reading this and who are working will dispute that most of our working life involves solving patient problems. learning the nursing process (problem solving) is the most important thing we all had to learn in nursing school.

in the 1070's nanda was born and came up with the idea of these nursing diagnosis labels for nursing problems. part of the reason for this had to do with the advanced practice nurses who had to bill for the services they were performing. they needed to have a uniform and consistent way to bill for what they were doing that was going to be accepted by the computers of the insurance companies, medicare and medicaid. the nanda taxonomy (the arrangement of the nursing diagnoses into a logical grouping) was a godsend for these professionals. the nanda nursing diagnoses are also used by independent physical therapy and respiratory therapy businesses as well to do their billing functions. did you know that?

however, it wasn't long before nursing educators saw what nanda was doing and decided that nursing diagnosis fit in well with the nursing process. specifically, it fits in with step #2, problem determination, of the nursing process. for one thing the taxonomy listed the symptoms of these problems. can you spout off the symptoms of dehydration, cardiac preload and afterload, depression? they are listed in the nanda taxonomy under the nursing diagnoses that they belong with. when you first use nursing diagnoses you need to also have a reference of some sort to help you with classifying them. even medical students who are learning medical diagnosing have references to help them correctly diagnose the medical conditions of their patients. why would a nursing student blindly go about picking nursing diagnoses for patients without consulting nursing diagnosis references? that would be crazy and irresponsible!

i would recommend that you take the energy that it took to write your post trashing nursing diagnoses and spend it actually reading some of the nanda information in the care plan books you use for writing your care plans (if you have one). it's not that complicated or lengthy. i doubt that many of you have even taken the time to look at it. so, how can you sit there and trash it? the nanda taxonomy has provided for every nursing diagnosis

1. a definition of the diagnosis
   
2. the etiologies or underlying causes of the problem (related factors)
   
3. the symptoms (defining characteristics)

those are the three elements you students need to create a three part nursing diagnostic statement for your school care plans. most of this information for each nursing diagnosis fits on one 5 x 7 inch page. if you don't have a book where you can see some of these for free online, you can link into 75 of the most commonly used ones on post #109 of this thread https://allnurses.com/forums/f205/desperately-need-help-careplans-170689.html on the nursing student assistance forum. i posted them there to help students out.

nursing diagnosis is only one small, small, part of writing a care plan, i.e. problem solving. it follows the comprehensive assessment of the patient. determining outcomes and nursing interventions, the remainder of the care plan, have nothing to do with the nursing diagnosis and everything to do with the symptoms that were determined as a result of the patient assessment. some students don't get that part of the nursing process because they want to stay hung up on the nursing diagnosis because of the hatred that so many nurses in our profession want to perpetuate about them. we, like the doctors, treat the causes of our patient's problems and their responses to these problems as well as the symptoms they are having. if people are getting this worked up over one small piece of this process, the nursing diagnostic label, then i have got to wonder where their heads are when it comes to being practitioners. if you are going to get enraged about the label on my nursing problem instead of treating my problem then i don't want you as my nurse.

fyi. . .a written care plan is a required element in every acute hospital and nursing home patient chart. this is mandated by federal law (title 42, sections 482 and 483 in case you want to verify this for yourself), not by jcaho. most facilities have tried to make the care plan writing process as easy as possible for their nurses because they know it is a tedious and time consuming process. canned care plans or skeletal care plans are something that nursing diagnoses easily adapt to. let me be crystal clear, however. care plans are the documentation of our problem solving efforts of our patient's problems. like them or not, they are here to stay because the federal government says so and since they are the biggest payer of health care--they win. if you want to fight washington be my guest, but you won't win. nursing diagnosis has given us uniformity and consistency in documenting patient problems. before them, you sometimes sat there trying to figure out what to write on the care plan in the column where it said "problem". believe me, i know. i was working back then.

[cpnegrad07]

Boy, you hit it on the head with every point. Sorry you are still a student, because you have to put up with this crap for a while.

A friend took the creative route: since he had to do this stuff, he managed to use every single, stupid Carpenito NANDA that there is during his 2 years. He made his prof furious with some of it, but "if it is in Carpenito, it is accepted." So have some

fun and throw it in their faces!

I studied on my own, so when i came up against this i was like "Can this be real? Am i reading this wrong?" I mean, talk about contrived, contorted, a solution looking for a problem... .

Again, as you said, a waste of time for people smart enough to have figured out "the nursing process". (for the rest of you, the process is the rational one you use to solve any real-world problem, something you probably did the first time you built a fort on your own. It ain't a big mystery.)

[marie-francoise]

I posted this to the general forum since I want to know how real nurses feel about nursing dx's, and also since only a relatively few people read the students' forum.

And, yes, I independently purchased the Nursing Diagnoses text, and still hold to my opinion - about the dx language itself. The book's descriptions of the INTERVENTIONS, though, were genuinely useful. The book itself is a useful read. Forcing nurses to use the dx language in real life, though... different story. The language is way out in academic left field (not politically, but figuratively).

And I hear what you're saying, but still think that Nursing Diagnoses need to be seriously revisited, esp in this day and age where nurses are being asked to do WAY too many things in a limited about of time, as it is.

Docs don't have to recite and chart each and every bodily process underlying/associated with a medical problem. Forcing already time-strapped nurses to do that, and using such hyper-literal language while they're at it, just adds more time away from patients. And the hyper-literal descriptions required in the ND's are just ridiculous.

And some of the language DOES appear to be the product of 1970s ethos - e.g., "Readiness for enhanced family processes". Sorry, but it just doesn't ring right. We need to get real.

[Daytonite, BSN, RN]

Here is a copy of NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008. I work with that every day too trying to explain it to students in the simplest way I can make it.

[marie-francoise]

Yes - the "nursing process" is assessment, diagnosis, planning (goal-setting), interventions, and evaluation (how much were those goals met?).

And it's not a specifically nursing process. It's the mental process one applies to ANY problem, as CPNEgrad07 observes.

And, yes, I have gone through the Nursing Dx book. Please see my post above.

I have an advanced degree in the health field, and I know how to write an "A" care plan - so, I'm not blindly "trashing" the Nursing Dx's. I really think they seriously need to be revisited.