Truth about Nursing diagnosis

Dixielee, BSN, RN · Oct 7, 2004

Nursing diagnosis is one of the silliest things I have seen come down the pike. They were invented by nurses who had worked themselves "up the ladder" so far, they had nothing to do but invent more work for those of us who are taking care of patients. They must justify their own jobs by creating paperwork for caregivers. These are the folks that usually end up being JCAHO surveyers!

In other words, they are completely useless. :rotfl:

steff_rn1 · Oct 7, 2004

UTRN2005 said:

I'm a student and I was just wondering how much you actually use written 3-part nursing diagnoses and pt goals and nursing interventions and evaluations in the real world. Our program seems to stress them a lot more than what I've actually seen them used in clinicals. Thanks.

I have been out of school for 2 1/2 years, and have never actually used nursing care plans the way we learned to write them in school. I have, though, used the knowledge I gained from doing care plans to plan care for my patients. Goals and interventions are used to guide care. Rationales are not written in "the real world". I think care plans are used in school to develop critical thinking, which is a very important part of being a nurse. When you are working as a nurse, it will be important that you guide your care and decisions based on the ability to think (to yourself) why you are doing what is best for the patient. To me, this is the same as taking math, algebra, etc in high school. You do need it, although in a different way, in the real world.

UTRN2005 · Oct 7, 2004

Dixielee said:

Nursing diagnosis is one of the silliest things I have seen come down the pike. They were invented by nurses who had worked themselves "up the ladder" so far, they had nothing to do but invent more work for those of us who are taking care of patients. They must justify their own jobs by creating paperwork for caregivers. These are the folks that usually end up being JCAHO surveyers!
In other words, they are completely useless. :rotfl:

Can you tell I was working on my diagnosis for my clinicals at the time I wrote this post? I hate those things.

UTRN2005 · Oct 7, 2004

steff_rn1 said:

I have been out of school for 2 1/2 years, and have never actually used nursing care plans the way we learned to write them in school. I have, though, used the knowledge I gained from doing care plans to plan care for my patients. Goals and interventions are used to guide care. Rationales are not written in "the real world". I think care plans are used in school to develop critical thinking, which is a very important part of being a nurse. When you are working as a nurse, it will be important that you guide your care and decisions based on the ability to think (to yourself) why you are doing what is best for the patient. To me, this is the same as taking math, algebra, etc in high school. You do need it, although in a different way, in the real world.

I understand that this information will be used to plan pt care...I'm just sick of writing out a half- to full-page diagnosis of this r/t that AEB x,y, and z. Just venting I guess. Glad to know how applicable this all is :rotfl:

Dixielee, BSN, RN · Oct 7, 2004

I had a little time on my hands so I did a Google search for nursing diagnosis, then examples of nursing diagnosis. In the first search, all I found on the entire first page were people selling books on ND, and how to interpret them. The second search for examples was equally fruitless. They even have an international organization for these people! This was one from the search.

"NANDA is an association that focuses on new developments in nursing diagnosis, nursing language, classification, nursing journals and books........"

After 5 minutes, my eyes glazed over and I fell asleep. Guess I will go watch TV!! Good luck in school. Glad I am not going thru that again! Next time I take a class it will be on quilting, pottery, gardening.....

IMustBeCrazy · Oct 7, 2004

All I know is..

The texts they recommend to nursing students on writing nursing diagnoses are about the most convoluted ridiculous non-helpful things I have ever had the misfortune to read. And I have lots of experience in Technical Writing!

We were told to purchase a textbook by Lynda Juall Carpenito, who is supposedly the best of the pack in this area. Biggest waste of money EVER on any textbook. I agree with Dixielee, it's very evident that the people that came up with this so-called system really weren't about having people easily USE it, seems like more of a liner note on their curriculum vitae.

Roland · Oct 7, 2004

My wife was told by her ASN instructors that Nursing Diagnoses were intended to provide a way to achieve independent nursing interventions that are independent of MD's. Indeed, she was told that such independent interventions were importent because without them there would be no need for nurses!!

To me this attitude is part of the problem. Nurses should be recognized for what they are, essential members of the health care team who's over all goal should be the best possible patient care. Furthermore, a key role of nurses as a "check and balance" upon physician error is seldom acknowledged. Of course independence from Dr's may be nice, but it shouldn't be achieved via convoluted methods that detract from the primary health care mission.

Can someone give the real "straight dope" on the origins of ND's, their history, purported usefulness ect. Also, what was done before ND's existed (to achieve the objectives that ND's now purport to fill)? Have they done anything to improve patient/client outcomes?

IMustBeCrazy · Oct 7, 2004

One more thing that chaps my behind.

The only way you can access this 'list' of NANDA diagnoses is 1) spend serious cash on one of the aforementioned convoluted texts, or 2) have some type of subscription service with NANDA.

This bothers me. If these diagnoses are so essential to the nursing process, why is it that this information is hidden? You would think that it would be a plus to have this information easily accessible in many formats. What this suggests is academia at its worst. I.E. Let's hide critical information that helps others do their jobs and not explain it very well so that it makes a few of us look smarter.

/rant off

Thunderwolf, MSN, RN · Oct 7, 2004

Nursing diagnoses.....Ahhh. Nursing diagnoses and care plans have their place, but truely...honestly, they are best for students in nursing in assisting them in their critical thinking skills, organization of care, and case management. The truth about nursing school is "we do it this way, but in THE REAL WORLD" as one of my old instructors used to say is very true. It helps you THINK like a nurse. So, in nursing school (learning the trade), I believe they are necessary. Now, in the real world...many institutions have preprinted (canned) nursing care plans/care paths already available to use where all you have to do is tweek it to individualize the care. Nursing diagnosis or terms of observation regarding a patients identified difficulties are again good for the nursing student...but again, in the real world...I can't say that they are honestly being used in any meaningful way. There is great truth that Nursing as a field has tried to make itself "independent" from the doc. This is also true regarding attempts to separate and further define its role away from other professions, such as social work. Much of this push began in the 1980's (am I dating myself?) when the field was tugging at itself from all sides. For example, there has been pushes in different locales to phase out the LPN/LVN. Fool hearty, but hospitals did release a lot of them in the 1980's because they were not an RN (trying to go to an all RN facility). Many of these hospitals had to rehire back these same LPNs because there were not enough RNs. We all have heard about the back and forth push to have all RNs become BSNs, but this failed too because of the same reason. The push you hear now is encouraging nurses to be advanced practiced (which does imply much more independence if you want to call it that). However, in advanced practice, care remains pretty much "supervised" under the doc. Nursing as a field has always had an identity crisis. So, to make a long story short, Nursing diagnosis has been ONE tool of many to help define who we are. Is it practical in the real world? Probably not.

P_RN, ADN, RN · Oct 7, 2004

I hate writing them also. I'm very good at it, but I still hate it. However, they do make you focus on the 1-2-3 of caring for your patient. 1. what you notice 2. why it made you notice it and 3. what you will do to resolve or better it.

The NANDA list used to be in the back of Taber's Dictionary. Our place gave everyone a clipboard with the list printed on the back. And there is a NIC and a NOC too....right?Those came along after my exposure to ND.

mitchsmom · Oct 7, 2004

The NANDA list seems to be in most of my textbooks.

And yes, it's in Taber's 19th edition starting on pg. 2529.

Truth about Nursing diagnosis

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