why a separate nursing diagnosis?

[jallen5]

I am a pre-nursing student and did my first clinical last week. The patient had a medical diagnosis of hypothermia, hypotension and hypoglycemia. My teacher had me do my care plan on the hypotension and sepsis. I am supposed to write a holistic problem list, and in researching the internet trying to figure out what the heck that means, I have been struck by this question that is really nagging me: Why do nurses have to create a whole other nursing diagnosis? Why can't we use the medical diagnosis to create care plans? When I read over the NANDA list of nursing diagnoses, it just looks so strange to have to choose from those to work out a care plan. Can anyone help me understand this please? Thank you.

[BellsRNBSN]

Well, the way I see it is that the medical diagnosis is one that the doctor determines and decides how to treat. When it comes to the medical diagnosis, nurses are just carrying out the doctor's orders (and of course double-checking everything and thinking critically). The NURSING diagnosis is determined by the NURSE and it is the nurse who decides what interventions to implement to treat that nursing diagnosis.

Doctors don't spend anywhere near as much time with their patients as nurses do, and aren't always aware (or don't always care) of the other issues that arise, such as depression, disturbed body image, ineffective coping, etc. However, these are important issues that need to be addressed, and this is where the nurse steps in. Nursing diagnoses also center around nurses' responsibilities. For example, it is the nurse's duty to encourage her post-op patient who is taking opioid analgesics to drink plenty of fluids and ambulate in order to prevent constipation from occurring (as long as the patient is not NPO and is able to ambulate, of course). Also EXTREMELY important is preventing pressure ulcers from occurring in patients. Doctors do sometimes give orders regarding pressure ulcers, but a patient with initially healthy and intact skin who contracts an acute illness and is suddenly bedridden for weeks is obviously at a great risk for developing pressure ulcers, and the nurse must implement interventions to prevent this from occurring. Hence the nursing diagnoses regarding skin integrity. Nursing diagnoses also help guide the nurse when deciding what is necessary to teach the patient and patient's family throughout her shift and when discharging the patient. They also remind the nurse of what is important to assess and monitor in the patient.

This is all IMHO, of course. And from what I have witnessed in the hospital, it seems that learning how to make care plans complete with a nursing diagnosis, patient specific goals, interventions, and rationales is more about establishing a foundation in a student nurse for his or her future career. In reality (at the hospital anyway), nurses don't have time to make and then meticulously carry out such a long, detailed care plan for each of their patients. However, it is important to have had that training to holistically and competently care for your patients.

Just sayin'

[jallen5]

okay after what I saw today at the hospital in day 2 of clinical, you are 100% right. I learned an important lesson about how serious it is that a nurse be able to think and understand for themselves and not just "follow orders." It looks to me like critical thinking skills and compassion are the most important aspects of being a nurse. I have a whole new respect for this darned paperwork I have to do.

[EricJRN, MSN, RN]

Sometimes the way I think of it is that two people with the same medical diagnosis will have completely different presentations.

One patient with a medical diagnosis of septicemia might be alert and oriented, while another might be on the verge of cardiac arrest. Your patient assessment will lead you to distinct nursing diagnoses and very different treatment priorities.

[Asystole RN]

Registered Nurses are no longer "Doctor assistants." We do not practice medicine...what does this mean you ask?

Medicine is focused upon disease treatment and prevention. Nurses focus upon the person's responses to actual or potential health problems.

MDs treat disease, Nurses treat people.