so frustrated with nursing diagnoses

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    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.

    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.

    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?

    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?

    Even my Iggy text relates all sorts of diabetes n.d's to "diabetic neuropathy." Hey, Iggy, that's a medical diagnosis. We have to say "sensory nerve dysfunction" but that's just a less precise way of saying diabetic neuropathy.

    ***

    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.

    The End of a long vent. Sigh.
  2. 16 Comments so far...

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    The NANDA list was not intended to be the "every-day" language of nursing conversation. It was meant as a taxonomy to organize and express knowledge and thus promote consistency in terminology for academic purposes. Trying to use it in every-day conversation is an abomination -- yet another example of nurses taking something that was originally a good idea and twisting it into something ridiculous.

    Unfortunately, we do that a lot in nursing.
    Last edit by llg on Nov 18, '07
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    Your preaching to the choir here sister!! What a waste of valuable educational time....I think they are just another hurdle jumping exercise designed to weed out those who cannot comply to an idiotic system.

    I am now 10 years into nursing, and nursing diagnosis have NEVER helped me in my care of a patient and I give GREAT care.

    But that being said, those "in power" in nursing think you need to know it, so learn it, spit it back to them, and then forget it like the rest of us.
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    amen, I feel the same way. When I reported the n.d to a duty nurse she looked at me like I was from MARS. Like DeeDawntee says , learn it and spit it out to them its only for a short time.The real world is at the end of the tunnel
    deeDawntee likes this.
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    Quote from laura11
    amen, I feel the same way. When I reported the n.d to a duty nurse she looked at me like I was from MARS. Like DeeDawntee says , learn it and spit it out to them its only for a short time.The real world is at the end of the tunnel
    ditto
    for some people who can't think, or prioritize well, n.d. can help a little. Otherwise, worthless piece of s***
    deeDawntee likes this.
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    NANDA Dx's are such hokey it's not even funny. NO ONE USES THEM OUTSIDE THE ******* CLASSROOM!!!!!!!!!!! It's just more useless fluff to sell textbooks and give something profs can use to recharge their egos. Most nurses use DARP or narrative, so right there NDX's are rendered moot.

    Not being able to use medical Dx's to support an NDx just makes it look even less credible. I mean, wow, do I really feel dumbed down when I have to make these things for a care plan. I wouldn't even think of saying an NDx to a doctor; the last thing I need is a doctor looking at me like, "oh, how cute, trying to play doctor are we?"

    I know my boundaries in practice. I wish the "academics" would take their heads outta their glutes and remember where they came from.
    Last edit by SN2bExpAt on Nov 18, '07
    deeDawntee likes this.
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    They are absolutely pointless. Thankfully the hospital I work at has a pre-printed book for nursing diagnosis -- so when you are admitting a patient, you open the book up to the appropriate admitting medical diagnosis and copy it in to the initial plan of care.

    I agree with the other posters -- it is yet another hoop for us nursing students to jump through.

    Even though I think they are pointless, they do allow professors to guage how students are thinking. There are students in my class who prioritize pain before ineffective airway -- those are the students professors can really focus on and help them out.
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    I remember when I first started nursing college and nursing diagnosis were discussed... I laughed at first. I thought it was a joke. Then I learned the rules and all that stuff and can't help but think it is word play and quite frankly I have better things to do, like... oh I don't know... be with the patient!! What is so hard to understand that if we as nurses got rid of half the paper crap, we would then be able to actually spend time with the patients.

    I have spent too much time on these n.d., just like many of you and for what... I can make appropriate nd and careplans and then the next nurse coming on doesn't necessarily agree with mine and feels that they should do something different. I have said this before... you can have 5 nurses looking at ONE patient and come up with 5 different n.d.'s.

    I really believe that n.d. were created so that we can feel like we have a special dialogue just like physicians. I hate how some nurses struggle to be something we are not.

    I understand that we want to have autonomy, but keep it simple people. And lets remember that in order to help our patients, we actually need to be with them and not spending a major portion of our time and energy on a piece of paper.

    Whew! I feel better!
    deeDawntee and MikeyJ like this.
  10. 2
    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.
    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.
    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.
    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. . .
    1. 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.
    2. 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.
    Last edit by Daytonite on Nov 19, '07
    4jen and Hellllllo Nurse like this.
  11. 0
    IMO, NDX and writing care plans are very important learning tools for student nurses. It's not the completed careplan itself that has value- it is the processes the student goes through in writing it which are invaluable.

    When I was in RN school, struggling through yet another long, tedious care plan- it suddenly hit me like a smack in the head- The problem solving and critical thinking utilized in writing the care plan are what's important for students- not the care plan itself.

    The NDX is not the thing- it's what you do and how you are challenged to think in determining your NDX which are important.

    for example- I did a humungous care plan on a S/P CVA pt. Because of doing that care plan waaay back in the day- I learned what to do- what interventions to take to prevent complications and sequelae, and to promote recovery in such a pt.
    Even if all I know about the pt is "S/P CVA"- I don't know his labs, his co-morbidies, or anything else, I will still know many things that I will need to watch for and actions I need to take w/ this pt.

    S/P CVA tells me-

    The pt may have difficulty swallowing- high risk for aspiration pneumonia- I need to see it the pt needs thickened liquids, a soft or pureed diet, keep his HOB elevated,
    He may have sensory/motor deficits on one side of his body- I need to be aware of what side of his body is affected, and be sure to keep his call light, liquids and telephone on that side, approach him from that side-

    He may have trouble speaking- I'll need to ask yes or no questions. Big fall risk, side rails up, fall precautions, risk for skin break down, keep him turned, repositioned, attend to sweating in body creases, keep his skin free of urine and stool, risk for contractures, foot drop. He will be a lot less active than he was before- skin breakdown and contractures, again. Risk for DVT, muscle wasting, bone demineralization. If he can't reach for his water himself, or has lost sensation of thirst from the CVA, he's at increased risk for dehydration, UTI, constipation, hypotension. He may be depressed- I'm sure the CVA altered his roles and his views of himself, and on and on and on.

    The reason these things just automatically pop into my head when I hear CVA is because of all those "meaningless" care plans I did back in school.

    As nurses, we don't need to use the language of careplans in our work, and the care plans we write for work are likely just cursory, and there only for The State.

    But- what our educational careplans have taught us needs to be in our heads, and incorprated into our way of thinking- it is through writing those tedious careplans that we learn to think like nurses.
    Last edit by Hellllllo Nurse on Nov 19, '07


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