I HATE NANDA!!!!

[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.

[Whispera, MSN, RN]

I agree with you!

Sooooo many times NANDA diagnoses are just not helpful. String their little phrases with the RT and AEB part, all the time avoiding medical diagnosis terms and you can get a phrase that sounds like someone with hypoxemia strung it together. Students are trying to wade through it, but especially at the begging of their learning, NANDA diagnoses throw twisted thinking into their learning.

I've run across one psych nursing diagnosis that particularly makes me want to stick a needle in my eye: Ineffective denial. I've read what the NANDA book says, including examples, and it looks to me like denial is effective or it wouldn't be denial. If it's not effective, it's not denial. Let's throw THAT one out! Most students who try to use that one would get tangled up in a whole lotta bookbabble.

I could go on, but probably shouldn't....

[SHGR, MSN, RN, CNS]

May I politely raise my hand in class and ask you to clarify, jmqphd? Are you proposing that SBAR should replace the NANDA diagnoses?

[jmqphd]

No, Suz... not at all. I have always appreciated SBAR as a practical and necessary communication tool. It has elements of the nursing process in it, but it's more static... describing the situation in a moment of time. (I may be viewing it to narrowly, though... so correct me if I'm wrong.) I also like SBAR because it's still in the hands of the nurse, to use it well or poorly. There's not a text book with approved "situations", "backgrounds", "assessments" and "recommendations."

And there is also not an International organization of influential nurses that have conventions where they cook up new diagnoses for us plebians to use.

I know, I know... I have this burr up my backside. It just makes things so darn confusing for students.

[Summers_Off]

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.

:uhoh21: Do you have a camera in my house???? :uhoh21:

[Wishinonastar, BSN]

My denial is never effective. I share your distaste for NANDA and the current nursing care plan process. Ineffective care planning as related to lack of access to effective care planning tools.

[SHGR, MSN, RN, CNS]

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.

[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.

[BostonTerrierLover, BSN, RN]

Wuh, painful flashbacks, exiting thread, good luck people!

[jmqphd]

Oops. Double posted.

[jmqphd]

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.

[jmqphd]

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.