Nursing Diagnosis

CodeteamB · Mar 29, 2013

Because critical thinking is a skill gained through experience for the most part, nursing diagnoses help students work through the fine points of managing a patient condition. Pain, by your example, is a complex part of nursing care. Because pain can refer to things more intricate than simply "patient X has a postoperative wound" pain can also be treated in a variety of ways by nurses that don't involve technical medical definitions. A patient can be given a prescribed pill yes, but they can also be repositioned, distracted, encouraged to move (post op knees/hips), encouraged through conversation, have pain reduced by decreasing anxiety related to medications, or simply set on a schedule of discussion about pain management adn reassessment.
Because it often takes coming into contact with these situations following a NANDA nursing diagnosis can help guide students down pathways that help them discover the critical thinking that they will do more naturally after a few years at the bedside.
This being said, most seasoned nurses no longer feel the nursing diagnosis is a valuable tool because they have the experience to see the critical thinking, without per se the "training wheels".
Also nursing isn't about completing tasks, it is about giving holistic care to an extremely vulnerable section of the population. I am not saying you have to hold hands, sing songs, and love every one of them, but you have to be able to look beyond the orders and scripts, and that takes practice.
Best of luck!
Tait

Couldn't agree more!

blackvans1234 · Mar 29, 2013

HELLO

SO nursing diagnoses are plans of nursing care to either prevent a likely complication, or managing a current complication.

For example, you have a patient with multiple contractures, who had their gall bladder out.

The medical perspective is the surgery, management and monitoring for possible infection, managing and monitoring CBC, ABG's blah blah blah.

The nursing perspective is:

A) Administer medical treatments per MD orders (as a competent healthcare professional)

Important- B) To PREVENT and MANAGE complications. Now as a competent nurse, you're well aware that this patient (just like many other patients) has a risk for infection, actual altered skin integrity, risk for DVT, atelectasis, etc. As a nurse, it is your yob to do things that will prevent these unnecessary complications from occurring. In nursing school, they force you to write care plans so they can ensure that you (as a budding nurse) are able to formulate this thought process and critically think about each Individual patient.

Anatomy doesn't change, patient history, individual susceptibility does. It is your responsibility to identify pertinent information from each patient, put 2 + 2 + 8 together, understand that it will get 12, and then prevent 12 (a complication) from becoming a reality.

So, to sum it up-

Nsg Dx is to ID any patient risks or current complications and individual nsg management.

If my contracted post op patient is on the floor, I have to give the meds, have special concern for postop complications. I then will do my meds, and have a completely separate thought process for preventing complications - Hypoxia, atelectasis, skin breakdown .

Through your care plan you are proving that you have identified these risks, and how you as a nurse (without a MD telling you what to do) will prevent them.

AKA deep breathing and coughing, splinting, turning and positioning , elevating heels off matress , ALWAYS ensuring patient safety ( a postop hip patient needs to effectively use their walker so they don't fall and break the other hip - AINT NOBODY GOT TIME 'FO 'DAT!)

That is what the nsg care plans are all about.

Sorta.

Nurses aren't sole pill pushers anymore..

I hope you blossom into a critically thinking / understanding nurse!

blackvans1234 · Mar 29, 2013

In practice, you don't write these things out. They are all just in your head, floating around.

In nursing school they need to make sure you're on the right path.

blackvans1234 · Mar 29, 2013

I will state this again, for emphasis.

In nursing school you are learning. There are students that will have an amazing understanding of the possible complications and nursing considerations, and there are students that will have no idea what / why we care.

These care plans get each student on the right track and in the right mindset.

Next time you are at clinical, think about your pt, think about their specific case and any complications. Then find the pts nurse, and ask what their specific nursing concerns are.

Chances are they will say things like ''risk for DVT, risk for skin breakdown, etc"

You could continue to ask them ''so how will you prevent skin breakdown?" Hopefully they will respond ''get patient up and in a chair, elevate heels while in bed, turn and position every 2 hours, ambulate TID"

FYI, I probably wouldn't ask what their interventions are, especially if you're not a first semester student. (You should know the interventions) - Best idea would be to say ''So to help prevent skin breakdown you're getting mr jones up for meals, turning and positioning him Q2H, making sure his skin is dry" If you're lucky the RN will say ''YEP! We also will elevate his heels in bed, as the heels are a concern for pressure ulcers as well"

By doing that, you've exercised your noodle and learned (or was reminded) about an intervention you may have forgotten (elevate heels)

Those are all nursing interventions. They are not written out because the RN is trusted to already know and think and prevent them without having to write it out. A student needs to prove their competence.

nursejami · Mar 29, 2013

I take it very seriously as well...I'd rather be doing and providing nursing care instead of writing care plans...someone else even posted that they have yet to have a job that used care plans... I have yet to complete a clinical at a facility that uses care plans and nursing diagnosis to treat patients

Just because you did not use them in clinical doesn't mean they don't exist. I did clinicals at my current workplace and we just didn't complete that aspect of the charting. Now that I'm working as an RN, we DO use and chart against nursing careplans.

NurseDirtyBird · Mar 29, 2013

In very few, overly simplified words: We cannot diagnose disease or prescribe treatments, that is the MD's job. But we can "diagnose" (recognize) responses to disease processes and treatments and "prescribe" and implement interventions to assist in the patient's recovery. That's pretty much our whole job...

allnurses Guide · Mar 29, 2013

So do you work as a nurse? Since you haven't used a ND in a while?...when I wrote "write" I meant write NDs and care plans I wasn't referring to documentation

I work in an APRN role now which is a bit different and does not use ND.

At some facilities your NCP is your documentation. When I cover our hospital patients I very much appreciate reading the ND and NCP because it gives me a good assessment about how the disease is affecting the individual as well as remind me there are other factors beyond their current affliction.

Esme12, ASN, BSN, RN · Mar 29, 2013

I take it very seriously as well...I'd rather be doing and providing nursing care instead of writing care plans...someone else even posted that they have yet to have a job that used care plans... I have yet to complete a clinical at a facility that uses care plans and nursing diagnosis to treat patients

I am the kind of person who reads the details of instruction manuals and follow them with meticulous detail.....I never had left over parts and get it out together the first time.

In school I HATED care plans...HATED THEM! I was even angrier (and thankfully re-leaved) when I realized they "weren't done" in "the real world"....but we did.....it was just called something else......everything we needed to know was on the Kardex.

Here is the deal......ND/care plans as they are used in nursing school are not how they are used on the job. While they have the same principal behind them.......they are slightly different.

Simply put.......Care plans are the recipe card on how to care for someone....logically, rationally. They tell you what is important for any particular patient....and what needs to be looked at, treated, considered first. Care plans as a nurse is a standard recipe card .....you already "know" how to bloom yeast.....as a student you look up, include the how to, and "learn" how to bloom the yeast so you can remember the how to for the future.

In the working world......they are an attempt to maintain consistency amongst the care givers and guide someone who has never cared for that particular patient before....helpful hints to that person. In consistency there is less errors.....less things missed because someone "didn't know".

In school, because everything is new, it helps the student learn about disease processes, develop that critical thinking and lateral thinking that is necessary to help students learn how to look at and consider the whole picture.....incorporate all the illnesses......find all the symptoms that are possible....assess what symptoms the patient has and what they need....then decide which one should I do first.

As an infant you have to how to pick up your head before you roll over....crawl before you walk, walk before you run.......Care plans are a detailed instruction manual on how to best care for another human being who is sick.

Does that help you understand better?

psu_213, BSN, RN · Mar 29, 2013

I take it very seriously as well...I'd rather be doing and providing nursing care instead of writing care plans...someone else even posted that they have yet to have a job that used care plans... I have yet to complete a clinical at a facility that uses care plans and nursing diagnosis to treat patients

At my first job as an RN, nurses had to chart a care plan. It was a bit different than the one in school but basically we had to identify their problems--for instance "imbalanced nutrition R/T...." and then specifically address in our assessment how we knew they were having that problem and how we, as nurses, were intervening to care for it. Trust me, if one of those problems was "pain," there was going to be a heck of a lot more intervention that just "give pain pills."

The nice thing was that this POC was point and click (although there were free text sections), so that made it easier that CPs from school, but it was most definitely a care plan with nursing diagnoses.

nurseprnRN, BSN, RN · Mar 29, 2013

As a nursing student I really don't understand nursing diagnosis. Patients have a medical diagnosis already why must nurses create another one and usually something so silly it is phrased in such a way that a normal person would not speak in such terms. For example...Hypoxia which we can all understand but they have created a nursing diagnosis such as inadequate tissue perfusion...I just dont get it...If I have a pt in pain I will admin pain pills not write about it...

This is why. Nursing is not a subset of medicine. We are not dependent on physicians for all we do. I know that you with your very limited understanding of this great profession haven't learned enough to understand that yet but let me try to help.

You wouldn't think much of a doc who came into the exam room on your first visit ever and announced, "You've got leukemia. We'll start you on chemo. Now, let's draw some blood." Facts first, diagnosis second, plan of care next. This works for medical assessment and diagnosis and plan of care, and for nursing assessment, diagnosis, and plan of care. Don't say, "This is the patient's medical diagnosis and I need a nursing diagnosis," it doesn't work like that.

There is no magic list of medical diagnoses from which you can derive nursing diagnoses. There is no one from column A, one from column B list out there. Nursing diagnosis does NOT result from medical diagnosis, period.

This is one of the most difficult concepts for some nursing students to incorporate into their understanding of what nursing is, which is why I strive to think of multiple ways to say it. Yes, nursing is legally obligated to implement some aspects of the medical plan of care. (Other disciplines may implement other parts, like radiology, or therapy, or ...) That is not to say that everything nursing assesses, is, and does is part of the medical plan of care. It is not. That's where nursing dx comes in.

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________."

"Related to" means "caused by," not something else. In many nursing diagnoses it is perfectly acceptable to use a medical diagnosis as a causative factor. For example, "acute pain" includes as related factors "Injury agents: e.g. (which means, "for example") biological, chemical, physical, psychological."

To make a nursing diagnosis, you must be able to demonstrate at least one "defining characteristic." Defining characteristics for all approved nursing diagnoses are found in the NANDA-I 2012-2014 (current edition). $29 paperback, $23 for your Kindle at Amazon, free 2-day delivery for students. NEVER make an error about this again---and, as a bonus, be able to defend appropriate use of medical diagnoses as related factors to your faculty. Won't they be surprised!

If you do not have the NANDA-I 2012-2014, you are cheating yourself out of the best reference for this you could have. I don't care if your faculty forgot to put it on the reading list. Get it now. Free 2-day shipping for students from Amazon. When you get it out of the box, first put little sticky tabs on the sections:

1, health promotion (teaching, immunization....)

2, nutrition (ingestion, metabolism, hydration....)

3, elimination and exchange (this is where you'll find bowel, bladder, renal, pulmonary...)

4, activity and rest (sleep, activity/exercise, cardiovascular and pulmonary tolerance, self-care and neglect...)

5, perception and cognition (attention, orientation, cognition, communication...)

6, self-perception (hopelessness, loneliness, self-esteem, body image...)

7, role (family relationships, parenting, social interaction...)

8, sexuality (dysfunction, ineffective pattern, reproduction, childbearing process, maternal-fetal dyad...)

9, coping and stress (post-trauma responses, coping responses, anxiety, denial, grief, powerlessness, sorrow...)

10, life principles (hope, spiritual, decisional conflict, nonadherence...)

11, safety (this is where you'll find your wound stuff, shock, infection, tissue integrity, dry eye, positioning injury, SIDS, trauma, violence, self mutilization...)

12, comfort (physical, environmental, social...)

13, growth and development (disproportionate, delayed...)

Now, if you are ever again tempted to make a diagnosis first and cram facts into it second, at least go to the section where you think your diagnosis may lie and look at the table of contents at the beginning of it. Something look tempting? Look it up and see if the defining characteristics match your assessment findings. If so... there's a match. If not... keep looking. Eventually you will find it easier to do it the other way round, but this is as good a way as any to start getting familiar with THE reference for the professional nurse.

NicuGal, MSN, RN · Mar 29, 2013

We may not think it is a valuable tool, but in the court of law you better know the difference between medical and nursing diagnosis. As the lawyer I once sat with on a case for our hospital said, " even though I know most nurses are often better at diagnosis than some doc's, in the court room you cannot make a medical diagnosis, you need you depend on nursing diagnosis".

nurseprnRN, BSN, RN · Mar 29, 2013

I take it very seriously as well...I'd rather be doing and providing nursing care instead of writing care plans...someone else even posted that they have yet to have a job that used care plans... I have yet to complete a clinical at a facility that uses care plans and nursing diagnosis to treat patients

I review medical records for a living as part of my work as a legal nurse consultant, and I can tell you that a great many excellent facilities DO use nursing care plans, with NANDA-I nursing diagnoses. They tend to be the ones whose nurses are not getting in trouble for lousy documentation or absent explanations of how they performed their autonomous nursing duty to the patient.

I am also a life care planner, and use nursing diagnoses to justify my recommendations for lifetime needs for catastrophically injured people. When an attorney asks me how I can prescribe things, not being a DOCTOR and all, I show him the NANDA and the ANA Scope and Standards of Nursing Practice.

I know you're very new-- we all were, and we all said pretty much the same thing for pretty much the same reasons when we were young and ignorant. The difference for you is that you have a lot of strong, experienced, mature nurses willing to take some time to explain in hopes that you will get it, sooner rather than later.

Good luck in your nursing journey. You have a lot more to learn than you think you do, and we need you out here.