a couple quick, general questions about care plans

[clearblue3]

Hey! Just a couple quick questions about care plans...Doing my first one. Do you have to "as evidenced by" in your diagnosis or is that optional? My instructor made it sound like that was optional?? or at least that is how I interpreted her comment on that. Also are you supposed to include medical diagnoses in the objective data? ie. can you put osteoporosis or should I put something about bone demineralization? If they don't go in the care plan, then is it just expected that everyone following the care plan has looked over their diagnoses in their chart? Thanks much!

[nep1980]

How did we come to believe that either of these groups are authorities regarding what is best for nursing practice?

Well beings as this is in a student forum and I am a student, IMHO I feel that both of these authorities hold weigh. At least when you are making a care plan to hand into an instructor. But the NANDA is what has been accepted in NORTH AMERICA, as the title would tell you and once again since I reside in North America and will be a practicing RN in North America just as I will need to practice under the authority of my states BON, I will to work within the guidelines set up in my area. Now will I question if something is right or wrong, if it is the best practice, is it evidence based, yes......But as far as nursing diagnosis I think the NANDA diagnosis are fine. I ask you do you have a problem with them???

[MunoRN, RN]

Well beings as this is in a student forum and I am a student, IMHO I feel that both of these authorities hold weigh. At least when you are making a care plan to hand into an instructor. But the NANDA is what has been accepted in NORTH AMERICA, as the title would tell you and once again since I reside in North America and will be a practicing RN in North America just as I will need to practice under the authority of my states BON, I will to work within the guidelines set up in my area. Now will I question if something is right or wrong, if it is the best practice, is it evidence based, yes......But as far as nursing diagnosis I think the NANDA diagnosis are fine. I ask you do you have a problem with them???

While NANDA does have "North America" in the name, that doesn't means that it is generally accepted by North America any more than the North American Man-Boy Love Association is accepted by North America (Welcome to NAMBLA's Home Page).

I understand that being a student, you need to make your instructors happy, yet I hope that as all students move through their school career, they always ask themselves if what they are being told is correct or best practice, which I'm glad to hear is a priority for you.

I do have a problem with them, but I'm hardly the only one. The largest accrediting body for hospitals, the Joint Commission, will count it against a hospital on their review if they use NANDA terminology in care planning because it inhibits transdisciplinary communication. (The Joint Commission makes a lot of bad recommendations too, but this one makes sense).

Patricia Benner, a prominent Nursing theorist and probably the best authority on Nursing Education today, explains what is wrong with NANDA far better than I can in her book "Educating Nurses; A Call for Radical Transformation".

The NANDA system encourages a pedagogical way of thinking which is useful in the initial stages of Nursing practice development but then has to be completely unlearned to move beyond that, which many nurses never do.

NANDA came about, at least partly, as a result of Nursing's perpetual inferiority complex we have with Doctors. Doctors have a very concrete, linear system for categorizing patients, which can come in handy, particularly when it comes to billing. In our attempt to match the Doctor's system of categorizing patients, we forgot that a core principle of what nurses do is that we don't put patients into broad, generalized categories but instead seem them as a complex mix of things that are easily defined, as well as those things which are unique and individual to that patient, and require a description that is equally abstract. In the process, we invented a system that put's patients into even broader, more generalized categories than 'medical' diagnoses do, essentially throwing the baby out with the bathwater.

If you're looking for a gift for your instructors, I strongly recommend Patricia Benner's new book, good luck with school.