Nursing Diagnoses and Theories

Nursing diagnoses are diagnoses that the nurses can make and act upon. The difference between that and a medical diagnosis is that the nurse cannot act independently on the medical diagnosis. Say the nurse suspects that a patient has a urinary tract infection. The nurse may not independently order a urinalysis without receiving an order from the physician. Nor can the nurse prescribe an antibiotic to treat said infection. However, the nurse can make a nursing diagnosis of altered urinary elimination and can independently perform nursing interventions based upon that diagnosis, i.e encourage the patient to drink plenty of fluids, administer the antibiotic as ordered, educate the patient about the medication, etc.

As for nursing theory, it is essentially a way to describe what nurses do. There are some big names theorists out there (Florence Nightingale is considered the 1st, but then there's Henderson, Neuman, Sister Calista Roy, the list goes on...). Some schools will base their teaching on a particular theorist, others will present different ones. Some theories are more applicable to particular areas of nursing (i.e. community health or mental health). This site provides an overview of nursing theories.

In my program we have had the difference between the medical model and the nursing model alluded to, but it has not been discussed in great detail.

I know I'll be learning this very soon, but wanted some info anyway beforehand. What are nursing diagnoses and how are they different from medical diagnoses? And in a broad sense what are nursing theories and what are some of the basic ones? From my limited understanding, nursing theories are just models used in caring for the patient, based on success in past use.

Also, in school, do they fully discuss the differences between the medical model and the nursing model?

Ahh yes. ADPIE. Goodtimes.

Nursing/Medical Approaches are roughly the same. Physicians/Nurses use ADPIE:
Assess
Diagnose
Plan
Implement
Evaluate

But that's where the similarities end. Physicians treat the disease, whereas we are responsible for treating the person as a whole.
Nurses help diagnose how having said disease affects a person's life, and we implement nursing interventions to help, or collaborate with the physicians as a team to help the person get better.

We can diagnose and intervene in such things as:
Fatigue
Risk for Falls
Powerlessness
Ineffective Role Performance
When Oxygen Therapy should be applied, and how much --

and MANY more things.

Physicians concentrate on the disease and we help to concentrate on the patient and their family and their problems associated with the disease (the rest).

That's nursing in a nutshell. Once you learn how to write a good progress note in nursing, keep it up in your practice. It's kind of seems to be a lost art these days, even though it's a responsibility that goes with having the "letters" after your name.

J. . .a diagnosis in it's most simple definition, and you can verify this in any dictionary, is a decision or opinion that results from an examination or investigation. This examination or investigation usually takes on some sort of process or act. Diagnoses of conditions are made by professionals in all different types of jobs: car mechanics, beauticians, plumbers, etc. Doctors diagnose using the medical decision making process. Nurses diagnose using the nursing process. When you take your car in to a certified mechanic they use a process that they have been taught to diagnose the problem with your car. Nursing diagnoses differ from medical diagnoses, car diagnoses or plumbers diagnoses in that each diagnosis has a different set of criteria that classify and describe them. The signs and symptoms of a flat tire are unique just are the signs and symptoms of Unilateral Neglect (one of the nursing diagnoses) are unique. In other words, in order for a condition to be labeled a specific nursing diagnosis it must meet and satisfy certain criteria. For nursing, this criteria, in general, has been determined by NANDA, the North American Nursing Diagnosis Association. There are currently 188 approved nursing diagnoses and you can see the official criteria for them in this NANDA work: NANDA-I Nursing Diagnoses: Definitions & Classification 2007-2008 published by NANDA International. The information in this book is re-printed in many of the current care plan and nursing diagnosis books that are published today along with other tidbits that the various authors have added (usually nursing interventions, outcomes and assessment information). Many care plan books are organized by medical diagnosis which makes things confusing to new nurses who are struggling to understand the difference between a nursing diagnosis and a medical diagnosis. The two are NOT the same. You will be taught the nursing process in nursing school. If your program wants you to learn about nursing diagnosis you will learn that too.

Again, a theory in its most simple definition is an idea of the way, or the principles of the way, to do something. The Big Bang Theory is a way some people believe the Earth came into existence. A number of different nurses over the years have proposed nursing theories and applied them to the practice of nursing. As stated, they are a way to do nursing when you are following that particular theorist is all. If you want to read about the basic nursing theories, get a copy of Taber's Cyclopedic Medical Dictionary. You should be able to find one in a library if you don't already have your own copy. There is a description of all the major nursing theories in the appendix.

In nursing school you will be taught the nursing model your school wants you to follow while you are a student there. When I was in my BSN program we had to take a 10-week course in which we were taught the nursing process, nursing diagnosis and the theoretical foundation we were to incorporate in our practice as students of that nursing program. Many bachelor programs of nursing do this. I never forgot it even though it was 23 years ago. The theoretical foundation we were to use was not one nursing theorist but the combination of two other scientists: Hans Selye's stress theory and Aaron Antonovsky's theory of the general resources of resistance. We had to assess each of our patients for Seyle's physical and psychosocial stressors and Antonovsky's general resistance resources and incorporate that data into our nursing care plans. Never forgot the stuff and can still list it for you.