I HATE NANDA!!!! - page 3

by jmqphd

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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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    Yup hated NANDA as a student and as a practicing RN. I felt it was nothing more than a time suck. Although, I find it an excellent tool for an adjunct in teaching pathophysiology. It really forces students to think about what is REALLY happening PHYSIOLOGICALLY. I also add - "Due to" after AEB in our Nsg Dx to make sure the students are aware of the medical situation as stated above.
    GrnTea and tewdles like this.
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    Quote from dabearrn
    Yup hated NANDA as a student and as a practicing RN. I felt it was nothing more than a time suck. Although, I find it an excellent tool for an adjunct in teaching pathophysiology. It really forces students to think about what is REALLY happening PHYSIOLOGICALLY. I also add - "Due to" after AEB in our Nsg Dx to make sure the students are aware of the medical situation as stated above.
    I agree. Care Planning makes students identify the patient's problem and explain the proximal cause(s) of the problem then provide assessment evidence for it... these things are golden. They put flesh on the pathophys bone. You can talk patho till you're blue in the face, but when students see it in front of them and then have to grapple with the consequences of the disease process... WOW! You can almost watch the lights come on.

    Very cool.

    But I don't agree that NANDA is necessary for that to happen and actually would argue that it gets in the way.

    First, making students adhere to NANDA officially approved "diagnoses" inhibits intellectual growth. It's as if their thoughts about the patient and his/her disease only matter if they can select the right pigeon hole to stick them in. Only the authorized diagnoses are allowed!

    I have totally dropped the term "diagnosis". I tell the students to (I know this sounds radical!!!) "tell me what the patient's problem is." Damn... I'm such a rebel!

    Secondly, NANDA is a crutch. Once I've found the most likely officially approved "diagnosis" it doesn't matter how much data I have that doesn't match up. If NANDA says that's the closest "diagnosis" well... that's as far as the student has to reason.

    I DO stick with Maslow to make them explain their reasons for how they prioritize their "problem statements". And I stick with NANDA syntax. But I STILL HATE NANDA.
    tewdles likes this.
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    Hmm...so this is why one of my instructors constantly made me change my problem statement despite me pulling it STRAIGHT from my book? Are you that instructor? lol!
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    Wow! Thank you for giving voice to a long held frustration.

    Years ago as an ADN and then an RN-BSN student, I found the nursing diagnosis system useless and demeaning to nurses. It seemed like its sole purpose was to provided alternative terminology for nurse so they didn't step on the doctor's toes by using their proprietary medical diagnosis. The whole system seemed convoluted and insincere. It certainly did not facilitate my clinical reasoning nor help me understand my patients better.

    When I began working in the real world I was relieved to discover that the nursing diagnosis system only received token acknowledgement on admission when the initial care plan was written. After that the focus shifted to the intervention plan and the diagnoses were never mentioned again.

    Several years ago when I began to consider pursuing a masters degree, my distaste for the nursing diagnosis system was a major stumbling block. I could not stomach the thought of devoting hours of study to nursing theories that might use nursing diagnosis as a foundational principle. This ultimately led to my choice of a masters program in another health related field, not nursing.

    As I read this thread I am encouraged to see that I'm not alone in my dislike of nursing diagnosis & that at least one nursing school is moving away from its use. I hope this is the start of a trend.
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    Quote from jmqphd
    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 there (actions). Followed of course by evaluation and re-designing care based upon results.

    How in the world can a NANDA statement drive clinical reasoning? I read student care plans daily. If I see the term "Ineffective breathing pattern" again I will absolutely poke sharp sticks in my eyes.

    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. Puh-leeeze!

    Why not just state what is wrong with a patient? How about

    "Hypoxemia related to intrapulmonary shunt (secondary to pneumonia) AEB %sat 89 on Room Air, respiratory rate of 28, tachycardia and fever"

    or something like that? It isn't a medical diagnosis and by golly, it immediately identifies the types of goals and actions that logically follow.

    I have found NANDA to be an insurmountable obstacle to teaching students clinical reasoning. They work with their patient for the day, then that night, pull out their "nursing diagnosis" text, run their finger down a list of "diagnoses" and pick something that seems to fit the majority of their assessment findings. And from there, the care plan spirals down to a bunch of superficial blather.

    Said enough. I'm sure I'm going to be flamed, but I just needed to vent.
    Why flamed? You are actually using your brain and pointing out the obvious. Thank you.

    Of course, I agree with you. Recently I read a post by a nursing student who wanted advise on what NANDA diagnosis to use. The case was an older man coming in with vitals that fit a sepsis protocol like you wouldn't believe yet the student was trying to figure out if Inappropriate Nutrition ( or whatever it's called) would be his primary diagnosis because the guy had lost 5 lbs in the last few weeks. I mean, the man was going to be an RRT in about an hour, but the student could not see the real picture as she was trying to fit her patient to the diagnosis.

    NANDA diagnosis are a huge disservice to nurses.

    Sent from my iPhone using allnurses.com
    Dharmamom likes this.
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    When I was in my Master's program, we used medical diagnoses....hmmm...I thought that's how it was everywhere.

    And....my personal favorite: "Spaghetti brain related to nursing schools as evidenced by confusion, sleepiness, and a strong urge to either run away or hit the instructor."
    Dharmamom likes this.


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