Comparative relevancy of nursing dx

[TheSquire, DNP, APRN, NP]

So, there was recently a rather long thread on this board about nursing diagnoses. The initial thesis, which was never really refuted, was that bedside nurses (i.e. those working primarily with medical surgical issues of varying acuity) have little/no use for NANDA nursing diagnoses. In the discourse that followed, major supporters of nursing dx tended to be successful mostly when they offered examples of psycho-social situations where medical dx do not exist or are wholly inadequate.

My main observation is that NANDA is great for things like "noncompliance" (or its PC-friendly renaming "Ineffective therapeutic regimen management") and other behavior-associated things that need to be addressed for our patients. However, for most bedside nurses, we're too concerned with things that are much more basal on Maslow's hierarchy of needs to have time to deal with psycho-social stuff. (E.g., if one of my patients is crumping, I'm not thinking about whether my other patients feel dis-empowered by relying on me for accomplishing ADLs.) Those things we do deal with regularly, relating to our patient's ABCs and ability to complete ADLs, are so mangled by NANDA in an attempt to not be "medical" that the relevant nursing dx are more hassle than they're worth. Why re-invent the wheel to come up with ever-increasingly obfuscatory ways of saying things, when we could just name them what the rest of the care team calls them and get on with doing our jobs? Further, as most nursing schools aim their students at the acute-care setting, and structure instruction accordingly, nursing students will continue to have the "uselessness" of NANDA impressed upon them during instruction, with significant reinforcement upon entering the inpatient work environment after graduation and licensure.

My personal take-home point was that NANDA does some things well, and those should be kept. However, the lengths to which the physiologically-based nursing diagnoses go to avoid medical terminology needs to be dropped, and the academic/instructional/professional language of nursing needs to be in line with what the rest of the care team uses. Without some major reform, NANDA will continue to be marginalized within the acute-care nursing community, and thus within nursing in general.

Thoughts?

[tater.jake]

I'll validate that. I spent a lot of time stressing about these in nursing school and they have turned out to be clinically irrelevant for the most part.

[classicdame, MSN, EdD]

they are irrelevant if not used. Just today I read a chart where the nurse was following every order the doctor wrote but could not tell me why the patient was there and if she was better or worse and what outcomes she was looking for. That is why you diagnose - to get an idea how to formulate outcomes.

I will agree that the NANDA DX are outdated to some extent. Mostly I believe the verbiage is not in the vernacular so the terms are not used.

[AJPV]

The NANDA Dx that aim at physiological problems are so obsessed with avoiding medical terminology (in order to somehow justify the importance of the nursing profession as being "unique" from medicine). Because of this, the NDx simply obfuscates and makes less obvious what the real problem is.