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
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
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.
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."
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