Nurses don't diagnose! (wanna fight about it?!)

  1. 2 OKay I needed a catchy title... let me be more specific now, my argument is two-fold as spelled out below. I appreciate respectful feedback on these thoughts. I don't really want to fight!

    #1 Professional nursing care is the professional assessment and management of a patient's (or community's) health conditions/status/indicators. This may or may not include providing medical diagnoses and making medical/surgical treatment decisions.

    #2 "Nursing diagnoses" is a confusing misnomer. "Professional nursing assessments" might better reflect the function of these labels.
    ---------------
    With a license, the nurse has the right to make "professional nursing assessments". Thinking of nursing this way, nursing diagnoses actually make sense (except for calling them 'diagnoses'). It's not that only someone with a nursing license can recognize and identify "diarrhea" or "insomnia", it's that only someone with a nursing license is allowed to apply those labels in professional documentation and communication.

    A lay person can often correctly conclude if someone has impaired mobility or confusion or the like. A nursing assistant can - and should - recognize many conditions that professional nursing assessment addresses such as confusion and risk for falls. What the lay person and assistant *can't* do is offer "professional nursing assessment" of the condition. In the same way, nurses can - and should - recognize and identify medical conditions even though they may not be qualified to give professional medical diagnoses.

    In fact, lay people often assess and manage their own nursing and medical needs. Many lay people diagnose their own medical conditions and implement treatment plans, but if they want a professional opinion, they go to a doctor/NP/PA. Similary, lay people often assess and manage their own nursing needs, but if they want professional assessment and management, then they need a professional nurse!

    (I was inspired to elaborate on this after reading NANDA's FAQs about nursing diagnoses.
    NANDA International Nursing Diagnosis Frequently Asked Questions
    )
  2. Enjoy this?

    Join thousands and get our weekly Nursing Insights newsletter with the hottest, discussions, articles, and toons.

  3. Visit  jjjoy} profile page

    About jjjoy

    Joined Jul '03; Posts: 2,938; Likes: 2,340.

    44 Comments so far...

  4. Visit  HamsterRN} profile page
    2
    If I'm understanding you correctly, I agree. I'm not sure where the rumor got started that Nurses aren't allowed to diagnose, we're actually expected to diagnose of you read most states' standards of practice and the ANA standards, this includes diagnosing medical conditions.
    When we have a patient who recently had an MI, and they start to have difficulty breathing and their lungs start to sound wet, we're expected to recognize the beginnings of flash pulmonary edema due to decompensated heart failure, that's how we know how to focus our assessment and what to ask the doc for, or even to act independently of the Doc using ACLS .

    It's unfortunate that the term "Nursing Diagnosis" has gotten such a bad ring to it that we have to invent pseudonyms for the name, hopefully someday we'll be able to re-define the term.

    The only limit to a nurses ability to diagnose, is that medicare and insurer billing based on a diagnosis usually needs to come from a licensed independent practitioner. Other than that, diagnose to your heart's content.
  5. Visit  Asystole RN} profile page
    1
    I think many times people do not understand that we are not the Doctor's assistants and we do not practice medicine.

    MDs treat disease, Nurses treat people. Hence the difference in the diagnosis. MD diagnosis are disease centered, Nursing diagnosis are patient centered.

    Doc says you have xxx disease, Nurse says you are reacting to the disease in xxx way.

    I do not like the term "Professional nursing assessments" because it mixes what an assessment is and what a Nursing diagnosis is.

    A Nursing diagnosis is the end conclusion of the Nursing assessment. You would be squishing the A and D together in ADPIE.
    sigel55 likes this.
  6. Visit  Blackheartednurse} profile page
    1
    In my mind I always diagnose,only in my mind though.I always label 80-90 something patients with a slight dementia and a heart failure regardless of MD diagnosis
    SunnyAndrsn likes this.
  7. Visit  jjjoy} profile page
    1
    I do think the terminology "nursing diagnoses" confuses matters, plus tends to make nurses look, well, kinda dumb. Establishing that a patient has diarrhea, pain, impaired mobility, decreased cardiac output, increased risk for falls is an important step in identifying nursing needs and developing a plan of care. It takes clinical assessment skills and knowledge to thoroughly evaluate nursing needs. But it doesn't take the diagnostic process.

    On the other hand, nurses DO use the diagnostic process when evaluating nursing needs, just not to determine 'nursing diagnoses'... eg a patient's foot turns cold after a peripheral vascular intervention. The nurse will use the diagnostic process to conclude that the patient may be experiencing acute arterial thrombosis. The nurse may not officially make that diagnosis, but their nursing assessment and plans will be instructed by their knowledge of the condition. On the other hand, for the nurse to conclude "altered tissue perfusion" does not require the diagnostic process. It's a description of the condition.

    Food for thought...

    "In the case of nursing, four major components were originally described: assessment, planning, implementation, evaluation. ...nurses at some point are expected to identify a person's actual and/or potential needs for nursing... This has increasingly been identified as a phase of the nursing process in its own right, referred to as the nursing diagnosis."
    Wiley InterScience :: Session Cookies

    "The effort to create a meaningful distinction between "observing" and "diagnosing" is impossible. No physician realistically expects a nurse to report everything observed as if the nurse were a video camera. What the physician expects is for the nurse to observe and report only the patterns and isolated facts which would lead the physician to a diagnosis. An understanding of human nature would suggest that the ability to observe the facts which would lead to a diagnosis of a disease requires the equivalent of the ability to diagnose the disease."
    AANA - Legal Briefs -- 12/93 -- Baptists Medical Center Montclair v. Wilson
    kaliRN likes this.
  8. Visit  jjjoy} profile page
    0
    Quote from Asystole RN
    A Nursing diagnosis is the end conclusion of the Nursing assessment. You would be squishing the A and D together in ADPIE.
    Exactly. I don't think "D" is a necessary part of the nursing process.
  9. Visit  CNL2B} profile page
    3
    Quote from jjjoy
    #1 Professional nursing care is the professional assessment and management of a patient's (or community's) health conditions/status/indicators. This may or may not include providing medical diagnoses and making medical/surgical treatment decisions.
    Completely and totally disagree with this. I do not diagnose, am not responsible for diagnostics, and do not want to be held liable or responsible for diagnosing disease. This is not within the scope of practice of an RN. I practice in critical care, which stretches my skills, knowledge, and ability within my license to it's max capacity. I know full well I am not qualified to make a medical diagnosis.

    Nearly all medical problems have cluster symptoms. As nurses, we are educated to know what these symptoms are and to help manage the course of illness, but that doesn't mean we can necessarily differentiate subtle differences in patient condition that would change the differential. We aren't trained to that degree, period, no matter how rigorous or prestigious your nursing program was. Sometimes we can beat the official written diagnosis to the chart in our heads, and sometimes we can't. Either way, it doesn't really matter, because we can't formulate a medical plan of care, so in my mind, it's a mute point.

    Physicians and mid-level providers go to school a minimum of two years beyond a Bachelor's degree (obviously much more for physician specialties) to be specifically trained in pathophysiology, diagnostics, and physical assessment. If you think for two minutes you have that level of education and licensure to back you up, you are sorely mistaken. Sorry, I'll stick with the hated NANDA "constipation" as opposed to SBO, and "impaired gas exchange", as opposed to "klebsiella pneumonia."

    Doesn't mean nurses are stupid, or they should be disrespected. Just sayin.
    kaliRN, elkpark, and leslie :-D like this.
  10. Visit  jjjoy} profile page
    1
    #1 Professional nursing care is the professional assessment and management of a patient's (or community's) health conditions/status/indicators. This may or may not include providing medical diagnoses and making medical/surgical treatment decisions.
    I included the bolded sentence so as not to exclude what nurse practitioners do from the definition of 'professional nursing care'.
    kaliRN likes this.
  11. Visit  llg} profile page
    2
    Quote from jjjoy
    Exactly. I don't think "D" is a necessary part of the nursing process.
    I agree. I was not taught ADPIE as an undergraduate. We were taught APIE as the correct definition of the nursing process. Actually, "assessment" means to both gather data and to draw conclusions from that data (i.e. "diagnose.") Therefore, the "D" is conceptually redundant.

    When I have taught assessment, I have always emphasized that it is not just data gathering. A lot of people (e.g. nursing assistants) can gather data. However, it is the professional nurse who can organize, analyze, and draw conclusions from that data. That's why nurse practice acts, nursing standards, etc. say that only RN's can officially assess the patients -- and that LPN's, CNA's, etc. need that RN involvement to finalize admission assessment, plans of care, etc.

    I also agree that using the word "diagnosis," while technically correct has gotten us into more trouble than its worth as most people don't take the trouble to really sort out and understand the distinctions between the roles well enough to be comfortable with the use of the same word to refer to many different types of diagnoses. I just hate to think that nurses should abandon this correct term only because "the physicians got there first" and cornered the market on the use of this word.
    Last edit by llg on Jul 21, '10
    elkpark and nursemike like this.
  12. Visit  Asystole RN} profile page
    0
    Quote from llg
    I agree. I was not taught ADPIE as an undergraduate. We were taught APIE as the correct definition of the nursing process. Actually, "assessment" means to both gather data and to draw conclusions from that data (i.e. "diagnose.") Therefore, the "D" is conceptually redundant.
    There IS a difference between Assessment and Nursing Diagnosis. Yes you do draw conclusions in assessments but Nursing Diagnosis are a certain set of predetermined diagnosis set forth by NANDA. Assessments aid the RN to develop Nursing Diagnosis, Nursing Diagnosis develop and define the Care Plan.

    As defined by NANDA

    "A nursing diagnosis is used to determine the appropriate plan of care for the patient. The nursing diagnosis drives interventions and patient outcomes, enabling the nurse to develop the patient care plan. Nursing diagnoses also provide a standard nomenclature for use in the Electronic Health Record, enabling clear communication among care team members and the collection of data for continuous improvement in patient care"

    Not to be offensive but some posters resumes may be longer.... NANDA was only founded in 82' and Nursing Diagnosis were developed there after to further improve patient outcomes and develop professional Nursing.

    Every single professional Nursing organization I have come across recognizes ADPIE as the official Nursing Process. Remember that the profession of Nursing is ever changing as a result of evidence based practice.

    Quote from llg
    When I have taught assessment, I have always emphasized that it is not just data gathering. A lot of people (e.g. nursing assistants) can gather data. However, it is the professional nurse who can organize, analyze, and draw conclusions from that data. That's why nurse practice acts, nursing standards, etc. say that only RN's can officially assess the patients -- and that LPN's, CNA's, etc. need that RN involvement to finalize admission assessment, plans of care, etc.

    I also agree that using the word "diagnosis," while technically correct has gotten us into more trouble than its worth as most people don't take the trouble to really sort out and understand the distinctions between the roles well enough to be comfortable with the use of the same word to refer to many different types of diagnoses. I just hate to think that nurses should abandon this correct term only because "the physicians got their first" and cornered the market on the use of this word.
    The only reason we have gotten into trouble over the term is due to a "Knowledge Deficit" of Nurses and the public at large. Sounds like a great basis for a care plan
  13. Visit  jjjoy} profile page
    0
    Okay, I just looked up how the words 'diagnose' and 'diagnosis' are defined. Clearly nursing diagnoses don't fit definition 1 below. Definition 2? Nurses must use critical thinking while doing assessments (pull together what they know about anatomy, physiology, psychology, etc and apply it to each individual situation), but to emphasize that "critical analysis" is required to reach the conclusion that a patient has pain, impaired mobility, or impaired tissue integrity I think kind of makes nurses look dumb. Definition 3 isn't widely known or used. I copied this use of the term "diagnosis" in context and it is essentially a description as opposed to a conclusion or even identification.

    di-ag-no-sis

    1. Medicine a. The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data. b. The opinion derived from such an evaluation.
    2. a. A critical analysis of the nature of something. b. The conclusion reached by such analysis.
    3. Biology A brief description of the distinguishing characteristics of an organism, as for taxonomic classification.

    "Diagnosis: Colonies membranous, disc-shaped. Gastrovascular cavities extend to base of colony, separated from substrate by thin layer of coenenchyme. Polyps monomorphic, fully retractile, calyces absent. Anthocodial armature absent; sclerites in coenenchyme mostly irregular forms with tuberculate sculpture; some crosses also present. Lacking algal symbionts."

    di-ag-nose

    To distinguish or identify (a disease, for example) by diagnosis.
    To identify (a person) as having a particular disease or condition by means of a diagnosis.
    To analyze the nature or cause of: diagnose the reasons for an economic downturn.
    Last edit by jjjoy on Jul 21, '10
  14. Visit  Asystole RN} profile page
    0
    Quote from jjjoy
    Okay, I just looked up how the words 'diagnose' and 'diagnosis' are defined. Clearly nursing diagnoses don't fit definition 1 below. Definition 2? Nurses must use critical thinking while doing assessments (pull together what they know about anatomy, physiology, psychology, etc and apply it to each individual situation), but to emphasize that "critical analysis" is required to reach the conclusion that a patient has pain, impaired mobility, or impaired tissue integrity I think kind of makes nurses look dumb. Definition 3 isn't widely known or used. I copied this use of the term "diagnosis" in context and it is essentially a description as opposed to a conclusion or even identification.
    HA! Tell your professor that. Tell us if you still believe that statement when your working for awhile. Yes some of the diagnosis are pretty straightforward but there is an underestimated complexity to Nursing Diagnosis.

    Critical analysis IS required to make a Nursing Diagnosis, no matter how simple that diagnosis is.

    It's like saying MDs should not use the term diagnosis because the diagnosis of dermatitis is too simple...

    You're splitting hairs here, so should they change the name of "Football" because "foot" and "ball" are emphasized when in reality it should be "carry or pass" and "ovoid?"
  15. Visit  llg} profile page
    2
    Quote from Asystole RN
    There IS a difference between Assessment and Nursing Diagnosis. Yes you do draw conclusions in assessments but Nursing Diagnosis are a certain set of predetermined diagnosis set forth by NANDA. Assessments aid the RN to develop Nursing Diagnosis, Nursing Diagnosis develop and define the Care Plan.

    As defined by NANDA

    "A nursing diagnosis is used to determine the appropriate plan of care for the patient. The nursing diagnosis drives interventions and patient outcomes, enabling the nurse to develop the patient care plan. Nursing diagnoses also provide a standard nomenclature for use in the Electronic Health Record, enabling clear communication among care team members and the collection of data for continuous improvement in patient care"

    Not to be offensive but some posters resumes may be longer.... NANDA was only founded in 82' and Nursing Diagnosis were developed there after to further improve patient outcomes and develop professional Nursing.

    Every single professional Nursing organization I have come across recognizes ADPIE as the official Nursing Process. Remember that the profession of Nursing is ever changing as a result of evidence based practice.



    The only reason we have gotten into trouble over the term is due to a "Knowledge Deficit" of Nurses and the public at large. Sounds like a great basis for a care plan
    I'm not offended ... and I certainly don't want to start a fight ... but I can't let your implication that I am "an old fogey who has not kept up with contempory nursing" go without comment.

    I am well aware that ADPIE is the predominant acronym these days. I just don't agree with it. Just because NANDA says something, doesn't make it right. You need to keep in mind that the NANDA folks have built their careers (and personal financial livelihoods) on the NANDA diagnosis schema. They are not an unbiased source of information on these matters. Reading their pronouncements is like reading articles about medications put out by pharmaceutical companies.

    A sign of a healthy discipline is the presence of open discussion among its members. I am an experienced nurse scholar who happens to questions some of the work being done by NANDA. That doesn't make me old and out-of-date. It makes me an independent thinker who has not fallen for some of the more dogmatic aspects of the nursing diagnosis movement.
    elkpark and leslie :-D like this.


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

Top