so frustrated with nursing diagnoses

[birdgardner]

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.

[Hellllllo Nurse, BSN, RN]

Yes! That's how I learned that liver pts often need to have diarrhea- because of their ammonia levels. That's why they get Lactulose. I know not to hold the Lactulose and to not to give Immodium- thanks to care plans!

[Virgo_RN, BSN, RN]

Most of my instructors have expressed that the purpose of writing care plans is to get us thinking about what is going on with the patient, what nursing interventions we need to be focusing on, and very importantly, the rationale for each intervention. They're not really strict about sticking to NANDA (or Nanda-ese, as one instructor put it), so much as that we're understanding what it is that we, as nurses, need to be doing, and why. They think it's important that we're not just doing things because it says so on the chart, but that we understand why it is we're doing those things.

[ange26s]

I too used to get frustrated with nursing Dx just because it did not click to me at first. I do understand that the point of ADPIE is to help us learn to care for the patient, to organize our assesssments. It did not click to me unitl my instructor one day said, " if a patient is having difficult breathing and their vitals signs change you need to do ADPIE on the spot!!!" I had been thinking it was something you had to sit for ever going over and complete all this paperwork like in school, but its not always like that. They are trying to condition our minds to start thinking like nurses and not students. And for the person who said they were offended because they felt like their profession was being bashed, I do not think that is the case. As NS we like to vent, and things dont always make sense to us.It is a learning process.And just to clarify something, you said the AEB is the etiology and S&S. The R/T is the etiology and the AEB is the S&S. I think we are entitled to our opinions, just as long as we have the patients wellbeing as our priority.

[MB37]

Hellooo Nurse,

You pretty much made my points for me. Our lead instructor got up in front of the class and said that she basically believes that the taxonomy is a crock of you know what. She told us to learn it, that we'll get tested on it, and that it will be on the NCLEX - and then we can forget all the nursing diagnoses that we want, unless we come back and teach. We don't don't use NIC or NOC, and my school is anti-concept maps. However, she said that she strongly supports writing care plans, that it really gives the instructors a window into how we're thinking (critically hopefully) and that it's a formalized version of all the steps we'll likely do in our heads once we're working nurses. We'll be doing more and more of those each semester, and they'll get more in depth as we progress. That makes sense to me, and at least having the diagnoses to choose from for now gives us a way to look up plans of care before this all starts to become second nature.

[trepinCT]

Daytonite..kudos to you!! My understanding is that the NADA made it so that there is a STANDARD in place to be able to provide the best possible care to our patients and although the hospitals I have worked in do not always used the NADA language exactly the care plans I have seen are formatted similar and many nurses actually have the NADA pocket guide and use it.RNs work hard to get where they are and they need to show that they are educated, intelligent people..we stopped working under the Doctors supervision a long time ago..the Dr Dx isint going to help us as much as a nursing dx..I was taught that a nursing dx involves situations that we , as nurses, can control, ease or change( At risk for fall r/t immobility secondary to right AKA)..the immobility is something we can change, the amputation is not..Our job as nurses is to do more than just give out pain med as ordered, we need a plan of care because there is so much more to a patient than a Dr diagnosis...even grief can be a nursing DX for an amputation..think the doctor cares enough about patients sense of loss to actually implement a plan of care to help them heal mentally?? Hell no..its why its a nursing DX...Daytonite, any other advice or helpful hints for us nursing students will be welcomed..thanks!!!!!