I HATE NANDA!!!! - page 2

I believe a nursing diagnosis should drive the nursing process. You collect data (assessment), then define the patient's likely problem(s) (diagnosis), determine where the patient needs to be (goals) then design care to get them... Read More

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    Yes, it does make things confusing for students, and it's so nice to see a prof acknowledge that. I guess I don't see SBAR as static- situation is now, background is the past pertinent stuff leading up to now, and the R is what we hope will happen in the future.
    To me, it acknowledges the reality of nursing practice much better than the NANDA, without speaking a different language than our non-nursing colleagues.

    I can see your point and yes, I think you could use SBAR to teach clinical reasoning. I just want to students to understand the nursing process. SBAR could work. NANDA cannot.
    SHGR likes this.

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  2. 1
    Quote from Cr8zyamy
    Oh where were you when I was writing my care plans? I so detested NANDA. I wish there was something anything better out there. SBAR does make sense and is easily understood by support staff as well as nurses and doctors. We have a point and click care plan builder that we use and under a tab labeled psych/social is: Risk for postpartum depression. Nothing follows this statement and so many of my coworkers just click on it. Why is the patient at risk for PPD? How is a patient that has not even delivered yet at risk for it? Care plans just frustrate me to no end. I always add to that risk factor by stating R/T preterm infant in NICU, or hx of depression, hx of anxiety, r/t mulitparity and the like.
    I completely agree with you. First, as you suggest, the NANDA syntax (R/T and AEB) is fine. Adds clarity. Second I think people have misunderstood the purpose of care plans.

    WRITTEN CARE PLANS ARE FOR STUDENTS!!! They are written because faculty members can't read minds, we have to have a product. Second, if a student can't write out a nursing care plan (and mine are minimalist) then when they graduate, they will be unable to do the necessary sequential thinking in their heads!

    Cr8zyamy, don't get me started on EMR "care plans". My keyboard will melt.
    mappers likes this.
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    Someone's making a nice living off NANDA...

    And only when every nursing instructor petitions to drop this obtuse nonsense will things change.

    Everywhere you look, nursing organizations are gleefully embracing the future of nursing, new responsibilities, the new healthcare environment. And yet we simply can't seem to dissuade this profession from the notion that we must have our own terminology in order to be legitimate.

    Why do we burden students with this artificial nonsense? It teaches them nothing except that nursing is powerless and afraid to speak truth to power.

    There is only one diagnosis...and it's a medical one.

    A duck is a duck, and pneumonia is pneumonia.
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    i agree with you, (and i totally sympathize with you) but not for the reason you think. i think that students do not learn the full ramifications of assessment. doh, yeah, i know, they're students. but in my opinion, the patient in your example doesn't have a ventilation problem. as you note, he has a gas exchange and oxygen delivery problem and a vq imbalance. so why do students think this is just an air-in, air-out problem? somebody neglected to teach them physiology and nursing assessment to make nursing diagnosis, that's why. thus:

    activity intolerance: (insufficient physiological or psychological energy to endure complete required or desired daily activities (domain 4 activity/rest, class 4: cardiovascular/pulmonary responses)) related to hypoxemia due to intrapulmonary shunt (secondary to pneumonia) aeb %sat 89 on room air, respiratory rate of 28, tachycardia and fever" and probably increased sob with minimal activity. that will lead the student into ways of thinking how this can be addressed from a nursing standpoint in a addition to applying the medical plan of care. can we teach this higher order thinking? gawd, i hope so. else all we get is "iv antibiotics and treatments as ordered, continue to monitor." that's when i start looking around for the sharp sticks.

    "this "diagnosis" (ineffective breathing pattern) is equally suitable for the dying patient with cheyne-stokes respirations, the 18 year old trauma victim with a c3 cord transection, a 10 year old asthmatic who is ready to crash and burn, or an 80 year old post belly-surgery patient who won't use the incentive spirometer and is getting atelectasis."

    might be, depending on what is going on. (i know you know all this stuff, i'm just summarizing for those who don't)
    the cheyne-stokes, ok, not an effective breathing pattern...but also not much of a problem in the infinite scheme of things; more important stuff going on.
    the 18-yr-old, maybe not an effective breathing pattern due to neuro loss, but might be tied with ineffective airway clearance: inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway (domain 11: safety/protection, class 2: physical injury) to do a decent job of planning nursing care.
    the 10-yr-old, his breathing is ineffective, alright, and what's the matter with knowing why (airway constriction) and what's to be done about it (bronchodilators, sedate/paralyze/vent, whatever that all leads you to)
    the 80-yr-old, that is an ineffective breathing pattern-- he won't deep breathe and he's getting atelectasis as a result. nursing can surely figure out what to do to help him with that.

    as an analogy from the medical side, this is why we have differential diagnosis. you have to look at lots of things before you can develop a treatment plan. and even though some people may have the same findings, say, a hypoxic left toe, there are all sorts of reasons this could be happening and different ways to treat it depending on what it is. (e.g., femoral clot, chf, copd, co poisoning, cyanide, vsd with r>l shunt, sepsis, massive vasoconstriction...)

    i agree that seeing "ineffective breathing pattern" all day long does induce the introduce-sharp-sticks-to-bilateral-foveas response. and just how far can a nursing program go to teach students how to do it better than that? how far are they willing to go?
    VivaLasViejas, VickyRN, nursel56, and 1 other like this.
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    Grntea, the way you describe the NANDA diagnoses, they make sense and seem to have value. The way they were taught to us in undergrad was not like that. They were more like, a platform for delineating nursing tasks. We didn't get to that higher-level process, that meta-level of thinking- that wasn't even presented as a possibility.
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    Oh I agree that care plans are a valuable learning tool. So much of it does not fit reality though. And the fact that they still use them in real work situations really irks me. So much more can be put across in simple terms:

    Dyspnea related to Exacerbation of COPD or even just Exacerbation of COPD

    Nursing Interventions:
    Elevate the HOB
    Allow rest periods
    Check Lung sounds q shift

    Etc, etc, etc. That is all you need.

    I agree we are not SUPPOSED to use medical diagnosis but it is more sensible and useful to formulate a care plan around a medical diagnosis. Weeping Edema, Poison Ivy, Decubitus, etc. So much easier than Alteration in Skin Integrity, or whatever the current NANDA term is. Once we understand the concepts of A + B = C then we should not have to keep proving over and over again that we can think like a nurse. We have the license, we passed the clinicals and the tests, took the boards and now we should be able to just do what we are trained to do. Physicians do not have to explain their diagnostic process, they look at the patient and the tests, and formulate a diagnosis. Why can't we let them do the diagnosis then we use what interventions we are trained to use to help the patient?

    I think we make ourselves look like we are trying to prove that we know something by continuing to fill space with unnecessary verbage. Keep it simple and save costs, time, stress, and improve nursing morale. Nurses do not want to be chained to paperwork, they want to be out caring for patients.
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    Quote from nursemarion

    I agree we are not SUPPOSED to use medical diagnosis but it is more sensible and useful to formulate a care plan around a medical diagnosis. Weeping Edema, Poison Ivy, Decubitus, etc. So much easier than Alteration in Skin Integrity, or whatever the current NANDA term is. ....

    I think we make ourselves look like we are trying to prove that we know something by continuing to fill space with unnecessary verbage. Keep it simple and save costs, time, stress, and improve nursing morale. Nurses do not want to be chained to paperwork, they want to be out caring for patients.
    Therein lies the problem for me. The nursing diagnosis/plan of care is determined by, and relies upon, the medical diagnosis. Nursing is dependent upon medicine, just as the medical is dependent upon the nursing. I know that's not popular and we have to have our own convoluted "language" to prove that we're separate, but I fail to see how we are. For nurses to be good at what they do, they have to have an understanding of what doctors will do--treatments, meds, etc. They have to be able to understand the rationale for current care and anticipate what will be done next. Until nursing diagnoses and care plans actually take this into account, I feel like they do students and nurses a major disservice.
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    I do not agree that the nursing diagnosis is determined by and relies upon the medical diagnosis. The nursing diagnosis is determined by the patients health status and deviation from normals for that patient.

    While NANDA is cumbersome, it works well in the hospice setting where the POC is based upon the nursing process. In that setting, the fact that the dyspnea is caused by COPD vs. E/S CHF simply adds to the individualization of the plan to care for the nursing problem. The nursing actions include, but are not limited to, the medical interventions. This becomes important because hospice nurses are generally teaching the family/care givers how to provide the nursing care necessary to relieve the dyspnea.

    I can understand the difficulties in the acute care setting, the practice of nurses in that setting is really more medically oriented than it is nursing oriented. Most nursing goals in the hospital ARE directly related to and rely upon the medical diagnosis and treatment plan rather than the nursing process.
    Last edit by tewdles on Mar 31, '12 : Reason: content
    GrnTea and SHGR like this.
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    I love that I don't have to use NANDA for school. We also don't do care plans either. We use SBAR and the nursing process to create a concept map that has all pieces of the patient tied together as we care for them. It's really an effective way of learning how to be a nurse, because rather than studying the pt's data the night before and creating montrous care plans. We get our assignment at clinical start, take report, go through the chart, notes, meds and labs and do a primary physical assessment. From there we map put all of the patient's immediate needs and goals, and then long term goals and needs.

    It's really taught me how to think on my feet and for myself rather than following a care plan book. We develop our own style of concept maps and no two are alike.
    GrnTea, SHGR, Aurora77, and 1 other like this.
  10. 0
    this thread makes me want to jab my eyes out.

    green tea- as always your posts are chock full of knowledge

    NANDA can kick rocks...

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