Capstone Project Nursing Diagnosis

[vliepiene]

I am currently working in the operating room and for my capstone project, I want to write about the time-out protocol and how it is being incorrectly implemented, as seen by preventable medical errors and sentinel events. According to the NANDA format, it has to be Problem...related to...as evidenced by...., As told by my professor, I am not allowed to begin the diagnosis saying "Risk for..." as this shows that there is no evidence for the problem. However, this has left me confused as to how I should word my nursing diagnosis. My original diagnosis was: Risk for patient injury R/T improper implementation of time-out protocol AEB existence of preventable medical errors and sentinel events. How can I re-word this to match the format that my professor wants me to use?

[Halcyonn]

Could you possibly use "Knowledge Deficit" as your diagnosis? I am unfamiliar with the time-out protocol, but I gather from your post that your problem relates to some kind of knowledge deficit regarding its implementation. Think it could work?

[nurseprnRN, BSN, RN]

Your professor is wrong if she thinks "Risk for..." nursing diagnoses don't have evidence to allow you to make the diagnosis. The evidence for "Risk for ..." diagnoses are the risk factors. The NANDA-I 2012-2014 has a whole domain, Domain 11 (starts on p. 415), for Safety, and many, many of the nursing diagnoses in that section are "Risk for" diagnoses. What is one of nursing's prime responsibilities to patients if not safety? Are you sure you understand her accurately? How would she explain the "Risk for infection" or "Risk for perioperative positioning injury" using that criterion of "no evidence"? I would really like to know.

But. We have to deal with what we have.

I think your problem statement is perfect as it stands. However, if you have assessed injuries or are aware of them in the literature (which is more likely), just drop the "risk for" and use "Patient injury r/t lack of adherence to time-out protocol, as evidenced by avoidable errors / sentinel events." Your paper would cite the many reports and studies of such injuries and the decrease after protocols are implemented properly.

Just so we're clear, "Patient injury" is not a NANDA-I diagnosis. Although, interestingly, "Risk for injury" ...... is.

I would love to hear how this turns out.

[sassynerd]

I also come from a school that the professors have told us that any risk for diagnosis should never have the "as evidenced" part. They explain this as since it's only a risk for and it is potential to happen and hasn't happened yet. Therefore it's a risk and would not have evidence. I love this site so much because I Iearn outside of the school bubble and I hope it makes me a more educated, well-rounded nurse one day.