birdgardner. . .so, i'm guessing you're not getting "a's" on your care plans, are you?
1) nursing diagnoses do not "facilitate communications between nurses." no nurse has ever given me a n.d. during report in clinicals, and if one did say, "reduced cardiac output", the coming on duty nurse would need to know why - she'd need the medical diagnosis.
nursing diagnoses are labels
that that describe patient problems. nanda (north american nursing diagnosis association) has merely created an entire taxonomy (that is a word that means a classification or arrangement or ordering of the nursing diagnoses into logical groupings) that all of nursing could use. before nanda we had to think up and write the patient problems on our care plans in our own words. this sometimes took up a lot of time. nanda has given us the taxonomy to help us save time. if you take the time to learn how to use the taxonomy along with the nursing process writing care plans will be much easier. a nursing diagnosis only represents one small part of the care plan, or nursing process. why people make such a big deal about it is a mystery to me. i believe it's because they don't understand the bigger process involved--the nursing process in the first place. nursing diagnosing is only step #2 of 5 steps of the nursing process.
so what? just because some doctors happen to be disrespectful of the nursing profession doesn't make it right for nurses to jump on the same bandwagon and side with them. the criteria (rules, standards) for the formation of nursing diagnoses is different from the criteria for the formation of medical diagnoses. the way a doctor arrives at a medical diagnosis and the way a nurse arrives at a nursing diagnoses are slightly different. doctors aren't trained in how to determine a nursing diagnosis and nurses aren't trained in how to determine a medical diagnosis. your job as student nurses is to learn how to assess your patients and determine their nursing diagnoses. keep your eye on the ball here.
2) doctors think they're foolishness. one told me, "just between us (nurses and doctors) you can use the medical diagnosis." i'd never tell a doctor a patient had a knowledge deficit, i'd say the pt. did not understand or was worried about the disease or the procedure.
3) one of my texts says that saying "the patient is unhappy and worried about health" is not scientific, but "ineffective coping r/t knowledge deficit regarding disease treatment" is scientific. now suppose the patient's been diagnosed with cancer, is coping as effectively as anyone could, understands the treatment, but is still naturally worried and unhappy?
how could something totally inaccurate be more scientific than something accurate? jargon doesn't make science.
your text is referring to "nursing language" or the wording that nanda uses in it's taxonomy when it refers to "ineffective coping r/t knowledge deficit. the formation of a diagnostic statement like that involves scientific reasoning. that particular statement contains two elements of scientific reasoning: (1) the patient's problem, and (2) the etiology of the problem. please look at post #106 on this thread (http://allnurses.com/forums/f205/des...ns-170689.html
) for an explanation of pes, the construction of nursing diagnostic statements. if the "jargon" doesn't make sense to you, then you need to sit down with a care plan book that contains the nanda taxonomy or nanda-i nursing diagnoses: definitions & classification 2007-2008 published by nanda international
and study it until it does. this is your chosen profession and this "jargon" is part of it. if you don't want to learn this information then what are you doing in nursing school?
4) we're not supposed to relate the n.d. to a medical diagnosis. so i can't say reduced cardiac output r/t to congestive heart failure. but according to rodgers's care plan book i can say r/t decreased myocardial contractility. isn't that pretty much the definition of heart failure?
and the reason you can say "decreased myocardial contractility" is because if you look at the related factors in the nanda taxonomy "altered contractility" is listed. that related factor is the underlying etiology of the patient's problem and is often though not always
based in the pathophysiology that is going on not on a medical diagnosis. the medical diagnosis, by the way, is also based upon the pathophysiology that is going on as well.
what if i want to relate to increased afterload? if bp was high, i could aeb bp but what if bp is normal because of meds? can i aeb the meds?
your aebs must be
symptoms that you found during your assessment that support the problem and/or etiology of the the problem. a normal b/p is not a symptom. by definition, a symptom (or defining characteristic) is a manifestation of an actual illness or health state
. a normal blood pressure is not a symptom of any illness of health state other than a wellness health state. you can aeb any side effects caused by the meds the patient is getting if those side effects are causing or contributing to the nursing problem or etiology of the nursing problem.
as far as i'm concerned, nursing diagnoses are nothing more than the carving out of fiefdoms by academic and political hacks. how the h-e-double toothpicks did they take over a profession which by its nature sensible and practical? nurses don't have any reason to make pointless hoops to jump through - they've got too much to deal with already.
you have a great misunderstanding of what nursing diagnoses are. that you have allowed a small portion of the nursing process to possess your learning of a very important concept (the nursing process) is going to impede your learning and understanding. let me point out, again, that a nursing diagnosis is a clinical judgment that you make about a patient that is based upon their response to what is happening to them (step 2 of the nursing process). it is based upon that assessment you have made (step 1 of the nursing process). from that abnormal data you obtained during your assessment you then have a basis for selecting goals/outcomes and nursing interventions (step 3 of the nursing process). there is logic in how this works. being a professional rn is all about making clinical judgments, not handing out pills and fluffing pillows.
let me make two points very clear to you. . .
- the nursing process, or problem solving, (you can also refer to it as critical thinking) is something that you must learn by the time you have completed your nursing school education because you will be expected to be able to do it on the job. that is what rns are primarily being hired to do--problem solve using the nursing process. you have already performed the nursing process in other areas of your life countless times before you even got to nursing school. nursing school has just taken the process and tweaked it, specified it and streamlined it to fit in with nursing. they added some jargon to it and you freaked out. i'm saying it's not as hard as it seems to be. underneath the jargon is a very simple method going on here that you need to try to see. there is help to learn the jargon.
- care plans are nothing more than the written documentation of the nursing process and a care plan is required to be documented and made a part of every inpatient chart. this is a federal law. so, you are going to be required to write care plans if you get a job in an acute hospital or a nursing home. now, many facilities have done their best to make the care plan writing as easy as possible for nurses because they are aware that it is time-consuming. however, as students you are going to be required to do the whole 9 yards because care plans are a good learning tool and help you to learn to think critically.
i understand that you wanted to vent, but you need to understand that from my vantage point you were spitting on my profession and i didn't like it. i have to wonder why someone who wants to be a nurse would be so resistive and opinionated to what they are being taught instead of being open to the learning. i understand that these concepts are not easy to learn. i spend a great deal of my time trying to find easier ways to help students understand them on the nursing student assistance forum. why? because i know what you are going to face when you graduate and go out into the working world because i already have gone through all of this. there is a great deal more about the nursing process and care planning, both the thinking of it and the writing of it, that you have to learn. i want you to print out this entire thread, put it away, and take it out and re-read it after you have graduated and have worked at a nursing job for about a year and see if you still have the same thoughts.