Nursing Diagnosis...the sacred cow that needs to go.

[Idaho4me]

i've been an adn for 16 years. recently, i finished my bsn and now am through my first year of a dnp program. like most students, i struggled with learning to understand a nursing diagnosis during my adn schooling. since that time the term has cropped up in various situations but usually as a passing comment. it has in no way benefitted my practice as a nurse. in fact, when i bring up the subject with colleagues i often get a smirk or an eye-roll!

the subject of nursing diagnoses happened to come up in one of my grad school classes the other day. i decided to take a stab at this sacred cow and suggest that maybe they are burdensome and irrelevant to a working nurse that they simply aren't utilized. my professor's response was a textbook explanation that i've only heard repeated on a college campus. "if you say your patient has pneumonia, you are using a medical diagnosis which is outside your scope of nursing practice. you must have a nursing diagnosis to be able to implement and evaluate your interventions." i may be wrong, but i'm pretty sure i've been able to implement and evaluate my nursing interventions without needing a nursing diagnosis.

personally, i believe the idea for a nursing diagnosis comes from the ongoing and hard-won independence from the thumb of the medical community. i am all for the continued growth of nursing science. however, on this point we overshot the mark. there is simply no justifiable rationale for calling pneumonia something like

"impaired gas exchange related to effects of alveolar-capillary membrane changes. or

ineffective airway clearance related to effects of infection, excessive tracheobronchial secretions, fatigue and decreased energy, chest discomfort and muscle weakness. "

why not just say the patient has pneumonia? because it a medical diagnosis and we don't practice medicine? baloney! its a pathologic condition. call it what it is. we dont need to reinvent the wheel.

why do we hang on to this? we need to eject it from nursing and maybe realize we don't use it like we thought we would. a lot of time and energy is wasted on this topic in nursing programs that could be better spent elsewhere.

what say you?

[canned_bread]

That being said, nursing care plans are useful, espceially for the nurses that aren't so good and don't know what to do/give. It gives them direction and makes sure things aren't forgotten.

[nurseprnRN, BSN, RN]

I've been one of the more vocal advocates of the "nursing dx are a waste of time" theory. But since I've been assigned a caseload of monthly summaries at my LTC facility, I have come to appreciate them a little more.

They really help to organize and clarify what would otherwise be an unfocused, rambling mess. I format my summaries by addressing each "problem" (ie nursing dx) on the care plan and by stating the goal for said dx. I then evaluate if the goal has been met this month or not. This helps the RN case manager (as a LPN, I can't actually alter the care plan) decide if the current care plan is working, or if it needs to be changed.

All this would be much more difficult without everything neatly compartmentalized into nursing diagnoses.

And I've come to realize that many of my resident's biggest issues aren't really medical in nature at all. For many of them, there's no real medical reason for their "potential self care deficit". They just, well, don't take good care of themselves and have poor personal hygiene. It's still something that needs to be addressed with a plan of action. It's more of a "nursing" thing than a "medical" thing.

I still don't think nursing dx has much of a place in day to day care, but they're not worthless. If nothing else, they can help to organize thoughts and to form a nursing plan of care (which I can now better appreciate is separate from the medical plan of care).

Having gone through a number of excellent reasons why nursing plans of care are great (I just love experiential learning, it's the best kind), you then say nursing dx isn't of much use? Reread that and think again. Now you see exactly why it is of excellent use.

[nursel56]

Having gone through a number of excellent reasons why nursing plans of care are great (I just love experiential learning, it's the best kind), you then say nursing dx isn't of much use? Reread that and think again. Now you see exactly why it is of excellent use.

I think there has been a lack of follow-through and commitment from nurse managers to incorporate the care plan into their unique units and that more nurses would see their value as they actually work with them. I remember the days of the Kardex that sat right out on the table accessible to all. I know the Kardex care plans weren't part of the whole system the nursing diagnoses represent, but they were dynamic, and incorporated into our daily tasks.

I just lay it mostly at the feet of managers as I don't think most staff nurses make a big fuss over how the nursing dx care plans are underutilized. The end result being many nurses who say they are useless.

[NJ2008]

I heard that schools are moving away from teaching nursing diagnosis. I for one agree with those who think it is useless.