Time to call a duck a duck? - page 10

I remember having this debate with other students while I was in school. I have seen nothing during my time practicing nursing to change my mind about the issue. Now, with the recession bringing... Read More

  1. Visit  eriksoln profile page
    5
    O-B-1 can do the energy field assessment.

    "I feel a disturbance in the force, as if millions of voices cried out at once and then were suddenly silenced."
    LPNnowRN, KaroSnowQueen, SandraCVRN, and 2 others like this.
  2. Visit  wooh profile page
    12
    Quote from NocturneRN
    So we look for a cause or causes: is it ineffective airway clearance? Impaired ventilation/gas exchange? Or possibly a side issue, related to impaired tissue perfusion (cardiac) or anxiety or pain? Each of these conditions, of course, requires different interventions.

    So, when you're detecting and documenting a nursing diagnosis, you're indicating that you pursued the problem beyond the obvious (sticking the oxygen on the patient and walking away). You're showing that you followed a scientific method, rather than just going by the seat of your pants. And you're also providing criteria to evaluate the effectiveness of the interventions.

    Sure,it's cumbersome and it's a nuisance, when you're first learning to think in those terms. But it's also what causes you, as an experienced nurse, to do an EKG on your patient when he tells you he's having trouble breathing, or to question him a little more closely about his level of pain, instead of automatically assuming that trouble breathing = need for more oxygen.
    Well when a doctor walks in the room, they can figure out why a patient isn't breathing well, using medical diagnoses. And quite honestly, I don't determine if it's "ineffective breathing pattern vs. altered energy fields." I determine if it's, "CHF vs. asthma vs. pneumonia vs. just plain choking on something vs. cardiac ischemia."
    Yes, nursing diagnoses and care plans teach you to think through why you're doing what you do. And I would argue that nursing care plans, as much as I hated them, really were beneficial during nursing school in teaching me to think through what interventions to go through. But I also remember buying a little book, where I could look up the MEDICAL diagnosis and translate that into a nursing diagnosis. Because goodness gracious, it would be horrible of me to put the language of another profession on my NURSING care plan. But that extra step, translating it from a medical diagnosis to a nursing diagnosis IS STUPID and we only do it for the sake of calling ourselves a "profession" with our own "language" and our own "body of knowledge."
    I don't need a nursing diagnosis. I need the medical diagnosis. If I walk in a room, and someone has slurred speech and can't move one side of their body, I'm not going to call a doc and say they have "altered circulation" and we need to start the "altered circulation protocol." I'm going to call the doc and say, "They're having a stroke and we need to start the stroke protocol." Nobody cares about the nursing diagnosis except the people that desperately want this to be a "profession with their own language."
    Chin up, LPNnowRN, JacknSweetpea, and 9 others like this.
  3. Visit  ivanh3 profile page
    4
    Quote from eriksoln
    Eh, yeah. My point with Satyr was that............if we don't have (insert any of the qualifications of being a professional here) then we don't have it. Why we don't have (autonomy etc) is not important. We can make excuses for not fitting in on one or more qualification, but in the end we still don't have that qualification. Why we don't is not essential. A profession would have that qualification instead of excuses.


    Have to admit though, I can't argue the fact that I guess if you are splitting hairs..........you could say just about any profession lacks in one area or another.

    But, that doesn't change my mind that a more focused/pt. directed educational system and less fluff like nursing diagnosis would further our cause and make us better at what we do................help the patient.
    The flaw in your reasoning is that you are not looking at the big picture. First, I agree with you that nursing education should be improved. Without getting into what is "fluff" vs what is "relevant", I don't think anyone feels that nursing education has reached the point where there is nowhere else to go. However, what does that have to do with being/not being a profession? Do other "known" professions not also try to improve their education and training?

    Where you are losing sight of the big picture is that you have either forgotten or become acclimated to the enormous diversity of nursing. I will always believe that learning fosters more learning. So knowledge is always good. So the question is then what do you consider relevant? What would you include in your more "focused and directed" curriculum to prepare a new grad nurse to work in the ER, med-surge, psych unit, community health center, peds neurology clinic, sports clinic, neo-natal ICU, pediatric ICU, surgical ICU, cardiac step down, hem-onc, rehab, ambulatory surgery, substance abuse center, mobile primary care clinic, advice line, ob-gyn, labor and delivery, mother-baby, school nurse, jail nurse, occupational health, ortho floor, dialysis, LTC, ground/air transport, etc. Please factor in the modifiers of pediatric vs adult vs geriatrics, urban vs rural, and hospital vs free standing. That is going to be one hell of a curriculum.

    The fact is nurses are (and should be) taught what is minimally necessary to successfully complete a new grad program. New grad and transition programs are where the focused and directed training takes place.

    May the force be with you.

    Ivan
    CuriousMe, eriksoln, JacobK, and 1 other like this.
  4. Visit  ivanh3 profile page
    2
    Quote from wooh
    Well when a doctor walks in the room, they can figure out why a patient isn't breathing well, using medical diagnoses. And quite honestly, I don't determine if it's "ineffective breathing pattern vs. altered energy fields." I determine if it's, "CHF vs. asthma vs. pneumonia vs. just plain choking on something vs. cardiac ischemia."

    I don't need a nursing diagnosis. I need the medical diagnosis. (emphasis by ivanh3) If I walk in a room, and someone has slurred speech and can't move one side of their body, I'm not going to call a doc and say they have "altered circulation" and we need to start the "altered circulation protocol." I'm going to call the doc and say, "They're having a stroke and we need to start the stroke protocol." Nobody cares about the nursing diagnosis except the people that desperately want this to be a "profession with their own language."
    Then it is possible you have missed the point. Does it really matter initially if there is a medical DX or not? Patients can be in hospitals for hours to days without a medical DX. Does that mean they are not being treated? No. They most certainly are. Supportive care is initiated and much of that supportive care stems from (wait for it...) straight up nursing DXs! For example what if your "slurred speech" patient is a previous CVA with low blood sugar? CVA is a frequent misdiagnosis. So would we not be concerned about ABCs, effective breathing, clearance, risk for falls, safety, etc and initiate some type of care that would be common to both CVA and hypoglycemia?

    People get so caught up in nursing DX and how they relate to the written care plan. Nursing DXs and their components are more than that. They are what we do.

    More of my .02
    Ivan
    Last edit by ivanh3 on Jul 18, '10
    NocturneRN and JacobK like this.
  5. Visit  NocturneRN profile page
    2
    Quote from wooh
    Well when a doctor walks in the room, they can figure out why a patient isn't breathing well, using medical diagnoses. And quite honestly, I don't determine if it's "ineffective breathing pattern vs. altered energy fields." I determine if it's, "CHF vs. asthma vs. pneumonia vs. just plain choking on something vs. cardiac ischemia."
    Yes, nursing diagnoses and care plans teach you to think through why you're doing what you do. And I would argue that nursing care plans, as much as I hated them, really were beneficial during nursing school in teaching me to think through what interventions to go through. But I also remember buying a little book, where I could look up the MEDICAL diagnosis and translate that into a nursing diagnosis. Because goodness gracious, it would be horrible of me to put the language of another profession on my NURSING care plan. But that extra step, translating it from a medical diagnosis to a nursing diagnosis IS STUPID and we only do it for the sake of calling ourselves a "profession" with our own "language" and our own "body of knowledge."
    I don't need a nursing diagnosis. I need the medical diagnosis. If I walk in a room, and someone has slurred speech and can't move one side of their body, I'm not going to call a doc and say they have "altered circulation" and we need to start the "altered circulation protocol." I'm going to call the doc and say, "They're having a stroke and we need to start the stroke protocol." Nobody cares about the nursing diagnosis except the people that desperately want this to be a "profession with their own language."

    If you want to deal only with medical diagnoses, then what you're saying is that you want to leave all assessment and planning up to the doctors. The fact is, saying "The patient is having a stroke" is technically an observation, not a diagnosis----because (1) nurses who aren't advanced practitioners aren't qualified to diagnose CVAs, and (2) the diagnosis of CVA requires more than just observing symptoms.

    Even if you're dead certain that the patient is having a stroke, can you honestly say that you're not considering the problems or potential complications related to your findings? That, after all, is what nursing diagnoses are about, whether or not you choose to express them in the fancy sounding language that nursing textbook authors seem to favor.
    JacobK and pedicurn like this.
  6. Visit  NocturneRN profile page
    1
    Quote from ivanh3
    Then it is possible you have missed the point. Does it really matter initially if there is a medical DX or not? Patients can be in hospitals for hours to days without a medical DX. Does that mean they are not being treated? No. They most certainly are. Supportive care is initiated and much of that supportive care stems from (wait for it...) straight up nursing DXs! For example what if your "slurred speech" patient is a previous CVA with low blood sugar? CVA is a frequent misdiagnosis. So would we not be concerned about ABCs, effective breathing, clearance, risk for falls, safety, etc and initiate some type of care that would be common to both CVA and hypoglycemia?

    People get so caught up in nursing DX and how they relate to the written care plan. Nursing DXs and their components are more than that. They are what we do.

    More of my .02
    Ivan


    Thank you! That is exactly the point I was trying to make, but you stated it much more clearly than I did.
    ivanh3 likes this.
  7. Visit  SuesquatchRN profile page
    1
    Quote from eriksoln
    Right there is pretty much the jest of what I am trying to get at here. Eliminate all the walking in circles, creating labels for doing our job (nursing diagnosis, the nursing process, critical thinking........come on, trying way too hard to sound important is what I see it as) and focus on being better at our job. THEN, WE CAN TRULY HOLD OUR CHINS HIGH AS OUR FOCUS WILL ONCE AGAIN BE THE PATIENT.

    I am not saying nursing is a useless trade to practice, nor am I saying we are less than anyone else. What I am saying is, the immature inferiority complex that often drives nursing theory is failing us. Refocus schools on teaching nurses to obtain the best outcome for their pt., not on passing some exam that, in theory separates the "concrete thinkers" from people able to "think critically" but in reality is nothing more than a hit and miss lottery. I'll say this much: If the NCLEX were any good, don't you think it would have eliminated someone like me who completely disposes of most "nursing theory" from the get go? I passed first time.
    Stronly disagree that NCLEX is useless because it focuses on theory. I didn't get a single non-clinical question. Not a one.
    NocturneRN likes this.
  8. Visit  SuesquatchRN profile page
    1
    Quote from eriksoln
    I will borrow from one of my favorite philosophers, Satyr, here.

    "We are defined by what we do, not the reasons for what we do."
    Sartre, honey. A satyr is a woodland mythical creature. I'm not usually a correcter but I hadda.

    I disagree that anyone can be a good nurse. I agree that most people can master the physical skills of being a nurse.
    JacobK likes this.
  9. Visit  pedicurn profile page
    4
    Quote from wooh
    Well when a doctor walks in the room, they can figure out why a patient isn't breathing well, using medical diagnoses. And quite honestly, I don't determine if it's "ineffective breathing pattern vs. altered energy fields." I determine if it's, "CHF vs. asthma vs. pneumonia vs. just plain choking on something vs. cardiac ischemia."
    Yes, nursing diagnoses and care plans teach you to think through why you're doing what you do. And I would argue that nursing care plans, as much as I hated them, really were beneficial during nursing school in teaching me to think through what interventions to go through. But I also remember buying a little book, where I could look up the MEDICAL diagnosis and translate that into a nursing diagnosis. Because goodness gracious, it would be horrible of me to put the language of another profession on my NURSING care plan. But that extra step, translating it from a medical diagnosis to a nursing diagnosis IS STUPID and we only do it for the sake of calling ourselves a "profession" with our own "language" and our own "body of knowledge."
    I don't need a nursing diagnosis. I need the medical diagnosis. If I walk in a room, and someone has slurred speech and can't move one side of their body, I'm not going to call a doc and say they have "altered circulation" and we need to start the "altered circulation protocol." I'm going to call the doc and say, "They're having a stroke and we need to start the stroke protocol." Nobody cares about the nursing diagnosis except the people that desperately want this to be a "profession with their own language."
    Isn't that a fact ....sing it sister.
    Doctors use the medical model and it works pretty well for them.
    'If it aint broke....don't fix it'
  10. Visit  pedicurn profile page
    1
    Quote from NocturneRN
    If you want to deal only with medical diagnoses, then what you're saying is that you want to leave all assessment and planning up to the doctors. The fact is, saying "The patient is having a stroke" is technically an observation, not a diagnosis----because (1) nurses who aren't advanced practitioners aren't qualified to diagnose CVAs, and (2) the diagnosis of CVA requires more than just observing symptoms.

    Even if you're dead certain that the patient is having a stroke, can you honestly say that you're not considering the problems or potential complications related to your findings? That, after all, is what nursing diagnoses are about, whether or not you choose to express them in the fancy sounding language that nursing textbook authors seem to favor.
    I don't think we need nursing diagnoses to guide us here ....after all doctors manage quite well to know the things we know using medical diagnoses.
    A decent 'medical model' nurse should be able to identify potential issues relating to findings.
    Do we really need to 'dress up' the obvious with nursing jargonese... we need to know what the blood sugar is....we know there is a falls risk...we know we need to have swallowing assessed etc
    A good history and physical assessment plus a reasonable knowledge of differential diagnoses serve me pretty well when I initiate nursing care in the ED
    wooh likes this.
  11. Visit  NocturneRN profile page
    1
    Do we really need to 'dress up' the obvious with nursing jargonese... we need to know what the blood sugar is....we know there is a falls risk...we know we need to have swallowing assessed etc



    z----All of which are nursing diagnoses, even if you don't express them in "jargonese."

    Every time you make an observation and start to plan how you're going to address it, you're making a nursing diagnosis. If you relied exclusively on the medical model, you wouldn't be doing anything on your own---you'd simply be following doctor's orders.
    JacobK likes this.
  12. Visit  pedicurn profile page
    2
    Quote from NocturneRN
    Do we really need to 'dress up' the obvious with nursing jargonese... we need to know what the blood sugar is....we know there is a falls risk...we know we need to have swallowing assessed etc



    z----All of which are nursing diagnoses, even if you don't express them in "jargonese."

    Every time you make an observation and start to plan how you're going to address it, you're making a nursing diagnosis. If you relied exclusively on the medical model, you wouldn't be doing anything on your own---you'd simply be following doctor's orders.
    Well no ...I initiate that stuff on my own before the doctor sees the p't. I have taken their bloods, assessed neurvasc and airway, done a blood sugar, done a venous gas, decided if they meet criteria for stroke pathway,initiated falls precautions, maybe even done a CXR. The only thing I haven't done is requested a head CT (because I am not able to as an RN) ...however I have prepared the p't for one.
    CCL RN and wooh like this.
  13. Visit  jjjoy profile page
    3
    Quote from ivanh3
    Supportive care is initiated and much of that supportive care stems from (wait for it...) straight up nursing DXs! For example what if your "slurred speech" patient is a previous CVA with low blood sugar? CVA is a frequent misdiagnosis. So would we not be concerned about ABCs, effective breathing, clearance, risk for falls, safety, etc and initiate some type of care that would be common to both CVA and hypoglycemia?
    I think what you're talking about is knowledge of signs and symptoms and pathophys and various known medical conditions... and knowledge of how nurses can address the situation when they make those assesssments. Nurses DO need that knowledge. They just don't need to craft "diagnoses" to competently and professionally apply that knowledge. Problem-solving (the nursing process) works just fine without "diagnose": assess/plan/implement/evaluate

    Assessment: no milk in fridge --- Plan: go to store and buy more milk
    Assessment: pain at surgical site --- Plan: position for comfort, pain meds Q4 as needed
    Assessment: risk for falls --- Plan: ABC, XYZ, ...
    ------------------------------------
    Below are some NANDA diagnoses that sound more like assessments (observed signs and symptoms) than diagnoses to me.

    Fatigue
    Constipation
    Confusion
    Hyperthermia
    Pain
    Ineffective airway clearance
    Breating pattern, ineffective
    Risk for fall/poisoning/trauma
    Communication, impaired, verbal
    Memory, impaired
    Oral mucous membrane, altered
    Swallowing, impaired
    Physical mobility, impaired
    Last edit by jjjoy on Jul 18, '10


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