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

Stcroix, ASN, PhD, RN · Jun 10, 2011

Amen! I am a humble student suffering through the agony of care plans now. I have thought what you have stated so eloquently on many occasions. If the patient has pneumonia, we know (are learning) the interventions for that disease, we don't need to veil it in some other self-imposed diagnosis. Thank you for your clear and considered opinion. Now, maybe in 20 years the nursing schools........

tothepointeLVN, LVN · Jun 10, 2011

I'm still a pretty new nurse with only 2 years experience but I felt that the nursing diagnoses and the associated careplans helped me learn clusters of interventions that later proved useful to be. Could I have adequately cared for my patient using just the medical diagnosis absolutely so I think the usefulness comes from the intervention side not just the nursing diagnosis itself.

whichone'spink, BSN, RN · Jun 10, 2011

I found the diagnoses somewhat helpful in my sophmore year because it clustered together necessary interventions. But by junior year, I got sick of it. I really wish I did not have to deal with it next year.

Idaho4me · Jun 10, 2011

TothepointeLVN-

I absolutely agree to the value of learning nursing interventions. That's the fundamental skill set of nursing. The nursing care plan is useful also to a certain degree, but I think that could use some revision. The argument is often made that the nursing diagnosis helps the beginning student understand the nursing process. However, in the two years since you graduated, have you written a nursing diagnosis for a patient? Have you ever seen one stated anywhere in any patient chart? I have yet to see them utilized in any nursing journal or reference text intended for the working nurse. That's my point. It seems to me that the natural habitat for nursing diagnoses is only in the world of nursing academia.

jjjoy, LPN · Jun 10, 2011

I've made the comparison to an auto tech not being allowed to say "flat tire" because he's not a certified mechanic. Problem? Impaired mobility (of the vehicle) due to lack of pressure in rubber tubing (tire) on wheel rim related to puncture in rubber tubing as evidenced by rubber tubing in contact with ground conforming to shape of ground (flat). And what about the associated problem of the risk of damage to the wheel rim when there's a flat tire? Let's come up with another convoluted statement!

I definitely see the benefit of nursing care plans and demonstrating understanding of the relationship bewteen physiologic/pathologic conditions and nursing needs, but the wording of traditional nursing diagnoses just confuses things.

Have you looked up previous threads on this? You'll find lots of company!

nurse2033, MSN, RN · Jun 10, 2011

Your points are well taken. I think your instructor's point is valid in the absence of a physician, let's say at a clinic in the Congo. But once a physician pronounces pneumonia we move on from there, which is what we do. I think if we took a vote we could get rid of them by later today, but the thought processes that they follow are valuable. I'm sure we could learn those processes in other ways however.

AgentBeast, BSN, RN · Jun 10, 2011

It's more of an educational tool than anything else.

bsnanat2 · Jun 10, 2011

i have to agree 100%! when i first saw a nursing dx in school, i thought it was a joke. turns out it really is a joke, and a sad one at that. can you imagine the looks you would get from other professionals (pt, pharm, physicians) if you actually spoke this garbage on the floor? if we really want to kill this albatross, any nurse called into court should speak only in terms of nursing dx when testifying. a judge will 'outlaw that crap real quick.'

attorney: what was the patient's condition?

nurse: i'm not a physician, so as a nurse i'd have to say it was "impaired gas exchange related to effects of alveolar-capillary membrane changes."

judge: just answer the question.

nursing dx = the emperor's new clothes.

kool-aide, RN · Jun 10, 2011

When I report potential pt problems to my nurses, I usually follow up with "and that's my CNA Dx." hahahaha Usually gets a good laugh!

Asystole RN · Jun 10, 2011

I am confused, is it that you do not like care plans or you do not like NANDA?

Whatever we use we must be able to describe what nursing actions we have taken in order to clarify what nursing really is. Nursing is one of the very few fields in health care that is poorly defined and almost impossible to bill for. We have to be able to prove to the world that we touched this patient, we formed a plan, we acted on that plan, and we are worth the cost.

It seems common sense to us that we are the cornerstone of health care but those outside, and even those within who sit behind desks, do not truely understand what we do. We must be able to communicate in writing that we provide a service and that service can be billed for. This is a cornerstone issue for nursing informatics.

Why do we not use medical terms? There lays the foundation of the difference between medicine and nursing.

Docs treat disease, nurses treat people. To clarify this, we are concerned with the patient's reaction to the illness, not necessarilly the illness. It may become difficult to see this from the floor where we get caught up in tasks but in all reality this is our "motto."

glutton4punishment · Jun 10, 2011

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?

great post, well said, and i totally aggree.

i'm just not sure how i would have formatted that 50 page paper without the nursing diagnosis:smokin: