At my wife's school Nursing diagnoses are handled...

[Roland]

in a particularly vexing manner. The students are told that they are NOT to list any nursing diagnosis that they are not able to DO something about. Thus, if you had a person with advanced CJD (as my wife recently did) she could not list constipation secondary to neurological impairment. Rather, she was compelled to list constipation resulting from inactivity (which in theory could be addressed by more activity if not in practice). My point is that if the school is going to deviate from accepted protocals in applying nursing diagnoses that the LEAST they should do is to clarify the standards that they expect to be used to do less is to reduce the whole matter to subjective opinion. It would be like a medical school advising students that they could not apply any medical diagnosis for any disease where an effective treatment did not exist! There are many times that she cannot provide a nursing diagnosis since not exist that are open to her effective influence How can nurses communicate logically, and hopefully develop more effective interventions if consistent definitions of conditions are not utilized? Maybe, for instance nurses at John Hopkins (or someplace else) have discovered effective ways for ameliiorating constitpation in CJD patients that would never be shared, if nurses in Indianapolis are looking for ways to combat inactivity (rather than the actual condition).

[LeesieBug]

All I can say is that this is how our school runs the show also. They basically explained to us that the point of the nursing diagnosis is to lead into a plan of action for care of the patient. It is NOTHING like a medical diagnosis.

Whether that's the norm, right, or wrong, I have no clue!:chuckle

P.S. Our textbooks provide a similar explanation for the purpose of Nursing Diagnoses. The diagnoses include ONLY those nurses are educated and licensed to treat....they are used to generate and complete a nursing care plan.

[PJMommy]

Yep...our rule of thumb was: never use a medical diagnosis as the "secondary to". We could use it for the "tertiary to". This would have been accepted at my school:

Constipation secondary to immobility tertiary to CJD.

In other words, CJD caused the immobility and immobility caused the constipation.

[PJMommy]

I was thinking about this some more and thought I'd pass along. I think the idea here is that your nursing dx shows the cause for which you, as the nurse, can intervene. Take, for example, this dx: Pain (say from a broken arm)

The diagnosis would be something like: Pain secondary to inflammation and prostaglandin release tertiary to tissue trauma.

The nurse can't do much for the tissue trauma (broken arm) -- that's the medical world. But the nurse, in planning his/her interventions, can give as ordered prostaglandin inhibitors and/or analgesics.

Hope this helps.

[Roland]

doesn't allow even NANDA nursing diagnosises UNLESS that particular nursing diagnosis can lead to a particular intervention on their SPECIFIC patient. It's giving many of the students headaches because it's not at all like there NURSING textbooks explain. Her prof's explain that they are deviating from NANDA, but dont explain how exactly they are REPLACING those guidelines.

[palesarah]

I don't see how your wife's school is deviating from any protocols . I agree with the above posters- nurses use "care plans" to actually plan our care. We choose nursing dx's that apply to our patient, and interventions that are within the nurses' scope of practice to perform. It's not enough to state that a problem exists, you have to look at why it exists and what you, as a nurse, can actually do about it.

[colleen10]

Could the school's rationale be that they do not want their students spending time on care plans listing a bunch of nursing diagnoses for which they cannot provde good interventions or plan of care,

when they could be spending their time (and practicing) creating diagnoses that will give them many interventions to utilize?

Kind of making the students do more work on their care plans so that they can practice more, rather than taking "an easy way out" and briefly listing things that they cannot do anything about?

Edited to say

I guess I can't understand why anyone would list a Diagnosis that you can't do anything about. It seems that there are very few out there. There is almost always something that can be done to reduce a problem.

[U_South_Al_RN2B]

Our school does it the same way. We can't use a medical dx. They told us that they are trying to teach us how to care for the patient. Its not, at this point, in her scope of practice to do anything independently about the CJD.....but she can damn sure do something about immobility. They are trying to promote critical thinking.

[chris_at_lucas_RN, RN]

I can't believe that if the patient's condition warrants a particular nursing diagnosis, but the student can't actually do anything about it, they don't use that diagnosis.

Maybe it is that the students are supposed to implement the interventions according to their plans? Only then does this make sense.

If the diagnosis is there, it is there, whether the student (or an RN--real nurse!--or whoever) can do something for it or not.

Also no secondary to and certainly not tertiary to! {identified problem from the NANDA list} related to {the physiological issue that was seen as causing the ID'd problme} as evidenced by {and list the S/S you saw that made you think, oh, this patient has impaired skin integrity, or whatever.

Hope this helps. On that other business, Roland, I am never surprised to find out another weirdness that comes out of nursing school.... :chuckle

[LeesieBug]

Roland, I am understanding what you are saying perfectly.

The POINT of students writing up nursing diagnoses, in my understanding, is to plan for care and complete interventions. If a student writes up a diagnosis they can do NOTHING with, it is pointless. It's not like a medical diagnosis, where you are simply stating what is wrong with the patient. You are using the diagnosis as a point of origin to provide nursing care.

If you look in a nursing diagnosis handbook, every diagnosis has potential nursing interventions that accompany it. If we write a diagnosis that we cannot provide any interventions for, I would not call it a valid NURSING diagnosis for that particular patient.

I am not sure how her textbooks are explaining it, but that is how mine are explaining it.

I have no idea if that clarifies anything. Sorry if this is proving to be a frustrating subject to you.

[TweetiePieRN]

Good post!