Does anyone think nursing diagnoses are just plain silly?

[marie-francoise]

Does anyone think nursing diagnoses are just plain silly - overly literal and laughably complex? (please see examples at end of this post)

Are we trying so hard to legitimize nursing as a profession that we resort to such silly, "uniquely nursing" language? I think it was a waste of energy to have devoted so much time to developing this "uniquely nursing" language.

That energy could have been so much more constructively applied in, say, lobbying Congress to improve nursing working conditions and, say, public service announcements showing the public why nursing IS a profession & one that should be respected!

I mean, why can't we just use the same language as docs? We're all grown-ups with a pretty good grip on health sciences terminology - after all, we went to school in the subject! A pulmonary embolism is a pulmonary embolism. Constipation is constipation. I know the NDs give us "cues" as to what nurses can specifically & autonomously treat, but c'mon....

Do we really expect docs to read over such silly "diagnostic" language?

Some cases in point from my nursing textbook are provided below, with real-world translations. (Feel free to contribute others, either fictional or actual!)

Forgive me if I seem overly facetious or sarcastic. But these are nursing dx's really suggested by my textbook, and I found them not a little ridiculous:

NURSING DIAGNOSIS-ESE: "Impaired gas exchange related to interference with the diffusion of oxygen and carbon dioxide between the capillaries and cells secondary to excess fluid volume." (DUH!! That's how the lungs work!)

TRANSLATION: Patient has pulmonary edema.

NURSING DIAGNOSIS-ESE: "Constipation related to inadequate amount of fluid to provide volume for stool formation." (Ah! Didn't know constipation involved dry poos.)

TRANSLATION: Patient is dehydrated and constipated.

NURSING DIAGNOSIS-ESE: "Impaired gas exchange related to decreased volume of blood available to transport respiratory gases secondary to deficient fluid volume" (Yes! The blood DOES carry oxygen and CO2!)

TRANSLATION: Pulmonary problems related to hypovolemia.

NURSING DIAGNOSIS-ESE: "Fatigue related to altered cellular metabolism secondary to deficient fluid" (Yes! Cellular metabolism does affect the body!)

TRANSLATON: Fatigue related to hypovolemia.

[birdgardner]

Daytonite - regarding billing using Nursing diagnoses - my clinical instructor is getting her FNP now, and she says very smugly that NPs don't use NANDAs - they use medical diagnoses.

[SuesquatchRN, BSN, RN]

Is that supposed to be good or bad?

It's supposed to be a joke.

[FireStarterRN, BSN, RN]

Is that supposed to be good or bad?

The diagnosis doesn't specify in the title. Maybe it can be a "risk for misinformation r/t health seeking behavior r/t websurfing"

I have to admit right now that I just did this 2 days ago. I'm run down with some sort of general virus, got outbreak of herpes probably secondery r/t down condition, cold sores not going away. Got sudden onset of eyepain in left eye, secondery to contact lens use with extreme light sensitivity, watering, aching pain, etc and so forth. Went on internet, diagnosed myself with probable ophthalmic herpes.

Presented my diagnosis to eye doctor which was INCORRECT!

I joked with him that I'm sure he gets patients diagnosing themselves all the time.

[jnette, ASN, EMT-I]

Hah hah, in my case it would be:

[banana]HOME MAINTENANCE, Impaired- r/t too much time surfing the internet[/banana]

:lol2:

Sadly, I just recently had a patient for whom this "Home Maintenance- Impaired" would have fit perfectly and it was USABLE.

Pt. mentally challenged since childhood, multiple comorbidities, extreme poverty, lives with family who have cared for her independently since she was born, never asking for a red penny from any social assistance.

Unbelievably kind, generous, humble family.

When I walked up to their front door, the front step (wooden) was patched over with duct tape to prevent one from falling through the holes underneath.

I enterd inside and there were a half dozen or more old pots and pans scattered about on the flooring of the 2 room house to catch the rainwater pouring in from the old roof beyond repair. It was difficult to perform the wound care needed as there was literally nowhere I could place the patient out of the way of the leaks.

This sweet family welcomed me in with these words:

"We know it ain't much, but we're grateful we have a home at all. Just look at those poor folks in California who have just lost their homes, bless their souls! Sure wish we could help them out in some way..."

So yes.. there are circumstances where this would apply. Sadly so.

I went back to the agency after this visit and spoke with our SW.. and we are seriously trying to contact "Extreme Makeover" to see if they would be willing to do something special for this special needs family.

There are other options we are investigating as well. :)

[birdgardner]

It's supposed to be a joke.

You would think so, :) but click on the link.

[SuesquatchRN, BSN, RN]

You would think so, :) but click on the link.

No, birdgardner, I know that it's a real n/d. In this context, though, jlsRN was kidding.

[FireStarterRN, BSN, RN]

the funny thing about some of these diagnoses (click below link for comprehensive list)

http://online.statref.com/titles/titleinfopage.aspx?startdoc=314&enddoc=340&titleid=78&offset=7&level=1&state=false&maxdepth=4#scroll

is that some of them are extremely narrow and specific yet there are huge gaps too, plus some that are incredibly general.

for instance, under psychiatric diagnoses, the only one for injury listed here is this one:

injury, risk for — related to elder abuse

under community health section, there are only two pertaining to risk for infection;

infection, risk for — related to home infusion therapy

infection, risk for — related to increased incidence of tuberculosis

they are fairly specific, but the list omits many other risks. it sort of doesn't make sense.

[FireStarterRN, BSN, RN]

here's another example:

under community health, the only diagnosis relating to spirituality is this one:

spiritual well-being, readiness for enhanced — related to parish nursing

these lists seem like they never made sense to me. the above diagnosis is fine, but where are the other ones related to spiritual well being? it's as if they got started with this whole idea of nursing diagnoses, thought up a bunch of unrelated ones, got 20% of them done, then abandoned the project. it reminds me of when someone starts remodeling their house, then their contractor wigs out on them early in the project leaving a very incomplete project.

[marie-francoise]

All, please read three pages from Suzanne Gordon's "Nursing Against the Odds" (paperback edition):

Pages 32-33, 65.

She describes the nursing diagnoses situation better than I can.

I just got this book a couple days ago, long after my incredulity with the nursing diagnoses system set in. Her words served to reaffirm my feelings.

(BTW, Faye Satterly's "Where Have All the Nurses Gone?" is also quite a good book, although I don't think it addresses nursing dx, but rather the really big problems bedeviling the nursing profession today.)

I've read all the posts, including the rebuttals; but I still don't see why we can't use a good old-fashioned problem list that dares to use medical terms, and just list corresponding interventions - this would free up nurses' time to actually DO those interventions, I would imagine.

I know standardized language is needed for facilitating nursing research and reimbursement. But a whole bunch of standardized health sciences languages and coding already does exist - DRG, ICD-9, MedRA, etc., etc. And these are much more succinct and less baffling & roundabout than nursing dx's.

For those conducting research that must use some type of controlled, standardized language, these coding systems could be used instead of nursing dx. They could also be mapped to from free text, ex post facto, using computer programs. The NLM's UML system could be of help here.

One interesting observation: In the "Nursing Dx" section of the Taber's medical dictionary, the nursing dx's are broken down under medical dx's, as if in an attempt to give them context and coherence, and to give docs who are stymied when they encounter this odd, stilted language some sort of roadmap to go by. (The ones who choose to try to understand it.)

And things are never "here to stay". The concept that the Earth is flat persisted for a while, until a guy called Galileo came along. He got a lot of flak for calling a spade a spade. But in the end, the world came around... (forgive the pun...)

[Daytonite, BSN, RN]

A question:

Are you saying that an APN can submit a bill to Medicare with a diagnosis of "Impaired Tissue Perfusion" and get paid? My (albeit) uneducated understanding is that Medicare pays for ICD-9 diagnoses and CPT procedures.

I have a second career as a coder and HIM professional which is why I know so much about this stuff. Providers, particularly Medicare and Medicaid DO NOT PAY when the diagnosis is a symptom. The diagnosis must be a diagnosis which is another reason why NANDA worked to get a list of nursing diagnoses together. I am quite familiar with ICD-9 and CPT codes. There is a whole chapter in ICD-9 of symptoms and I can tell you from my coding days that claims with symptoms as primary diagnoses can often get denied payment.

[Daytonite, BSN, RN]

NURSING DIAGNOSIS-ESE: "Impaired Skin Integrity and Impaired Tissue Integrity related to surgical incision"

TRANSLATION: Patient has a surgical incision.

• Early 1070s and before (I was there and we did it this way): Surgical Incision on ____
  
• Now: Impaired Skin Integrity R/T surgical intervention
  • Meaning: patient was cut into by a doctor

Time progresses forward and the way we do things DOES change. Telephones now have push buttons instead of cranks and dials. No one complains about this.

Where's my explanation of hyper-literal language and hyper-literal descriptions that I asked for? I think if someone is going to use these terms that ought to at least be able to explain to people what they mean by them in the simple language that they are saying they are a proponent of.

[SuesquatchRN, BSN, RN]

"Surgical incision on x" is a far better description than the others.

Daytonite, I really value your knowledge and your willingness to teach and share that knowledge. But it strikes me that you are getting really frustrated because some of us don't like the the way it has been mandated that nurses do this particular task.

Let us not like it!

:)