Getting worried: this sounds like some mumbo jumbo

[vivasmom]

So, 3 weeks into nursing school and my jaw is on the ground re: nursing diagnosis.

The diagnosis sounds like grasping at straws mumbo jumbo. am I going to grow to appreciate the nursing diagnosis?

I nearly roll my eyes each time i come across one in a care plan (which I haven't had to write yet) that I've read.

Sorry if this ticks off people, as i said I'm just 3 weeks into it

[Daytonite, BSN, RN]

A nursing diagnosis, as you are referring to it, is a label for a problem that the patient has. The true nursing problem is actually the definition of the nursing diagnosis label. You can find them in NANDA references. All nursing diagnoses are based upon the symptoms a patient has. Each nursing diagnosis has a list of symptoms (NANDA calls them defining characteristics) and a patient must have at least one of more of them in order to be labeled with that diagnosis. You will learn to appreciate nursing diagnosis by working with them. As with any skill, you start out slowly, not knowing how it works and you develop mastery over time and by working with them.

If you are having problems assigning or understanding a nursing diagnosis, please ask. I will help you.

[Jilaweez, BSN, MSN, RN]

I do think sometimes they sound a little silly, why can't we get straight to the point, right? But I'm assuming they have a greater purpose than we can imagine at this early stage in the game. It is a good starting off point for a new nurse, even though many of the interventions are just obvious things you would do without really thinking about it, some are pretty creative.

[Roseyposey]

Careplans, right now, seem foreign and mystical. In a while they will seem like an exercise in futility. However, as a nurse you will use them. You use them every day with every patient whether you're actually writing a formal careplan or not. Identifying what is going on with your patient and using the correct interventions - be it giving a med, repositioning, ambulating, calling the doctor, etc., are part of the nurse's day. You will find people on this site very helpful in helping you if you get stuck when writing them - use the help you have been offered.

[prmenrs, RN]

Care plans give you a scenario in which you can put all the pieces together. Basic science principles (normal body function), social science (psych, soc, development as it influences this pt and this illness), pathophysiology (what's not working right), treatment and pharmacology (what are we going to do about it). Nursing diagnoses are another piece, and they can be very illuminating in how to respond to the pt's symptoms.

All of that helps you understand how you're going to take care of the pt, why the docs are ordering what they're ordering, and what the patient/family need to know to return the patient to optimal functioning. Why did they order those labs/tests, how these meds are going to help. What social supports are needed? What kind of diet will help? Are OT, PT, Speech going to help?

When you are out there in the "real world", having done care plans will enable you to see the big picture--the pt as a whole. And, believe me, having a good nurse who can put the puzzle together can make a huge difference in the outcome!

[carolinapooh, BSN, RN]

At the risk of getting verbally battered, I'm going to go out on a limb here and say I completely "get" what the OP is saying.

Come on, folks - "altered energy field"? Does that REALLY advance us as professionals? That one REALLY embarrasses me, and in my opinion should NEVER have been put into print. (While I don't doubt the effects of therapeutic touch, I still say we could have done WITHOUT that one.)

I have felt like the OP so many times - as did many of my classmates. The only place I see RN Dx's at my hospital is on the one page, unit-specific POC found at the front of the patient's chart, and sometimes in the paper charting as the location for the required nurse's note.

When I was in the Air Force, the aircraft maintenance personnel were distanced from the pilots by many things - education, experience, rank. Yet the pilot knew he/she couldn't fly without the maintenance and support crew members. They speak the same language - the pilot knows how the plane works, and can make suggestions to the maintenance crew - but it's the maintenance crew who "nurses" the plane.

It's the crew chief's name on the side of cargo aircraft, not the pilot's like it is on fighters.

My point is, we have a language - the language of medicine. Why are we so "embarrassed", for lack of a better word, to use it to explain "the patient is at a risk of developing pressure ulcers, so we're turning him q 2 hours" instead of "risk for altered skin integrity"? I get frustrated with not being able to "say what I mean".

Sorry - I got the whole care plan thing as a teaching tool, and I did them - and actually picked my patients carefully so they'd be interesting and more educational for me. I always scored in the high 90s on them. But discussing nursing diagnoses makes me as nervous as the OP sounds.

Just my , folks - just one lady's opinion.

[jackson145]

Our instructors actually said basically the same thing the OP did. They told us to consider it a learning tool and that one day we'd probably never think about it again.

I've worked at the hospital for almost 10 yrs and I've never seen a nurse using a nursing diagnosis. When they discuss a patient they use the same language that the docs use.

I don't have any LTC experience but my husband does and he says he hasn't seen a nursing diagnosis since school. He also said that he isn't doing anything at his job as a LPN that nursing school trained him for. According to him, most of what was pounded into their heads is completely useless in the real world.

Our hospital wants our nurses to be intimate with ICD-9 codes because that is what gets the insurance claim paid (& our checks signed).

[GMUNurse2B]

I understand too!

But it's important to remember that Nursing Diagnoses are the effect of the disease/illness on the individual. They serve as a guide to help us with our care. I know most of them are common sense but if you right down 5 Dx for a pt then it will trigger you to remember that detail about the pt. If you keep up with all your interventions then that will greatly improve your pt outcome.

I do get what you're saying though- you're not alone my dear!

[stiltarget]

ill jump on the band wagon. as a paramedic switching over it seems as though for every medical dx theres 39 nursing dx's that are all correct. i am three weeks in also and i am having a hard time getting used to these nursing rationales for dx's, i am told in time it will come...lolololol

[melisgood]

I am in the second semester of a four semester program and I feel this way sometimes also...especially when doing a 12 hour shift and being so exhausted and I feel like I have common sense and from class I know what should be done (check v/s Q12h, etc.). Honestly though, it's a way of thinking and once it's drilled into your head you do your own nursing diagnoses in your head.....I'm just starting to think that way and it kinda makes sense why they have us write down every little obvious step....it becomes drilled into our brains.

[melisgood]

LOL....actually v/s would be like Q4h....but whatever...you get the point...i'm tired....lol =P

[Chaya, ASN, RN]

Yep definitely a large heap of Bull (well, ok, they can be marginally useful on occasion in a very round-about way). Think of mastering Nursing Diagnoses as another meaningless challenge in the Reality Show called Nursing School where passing this challenge gets you closer to your goal of being the one left standing at the end after other contenders have been eliminated-at least they don't make you eat bugs...