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!)
To me, nursing diagnoses are a way to get students familiar with the entire nursing process. Do I like them, nope!! Does my instructor like them? Nope! Do we have to keep our mouths shut, do them, and just get through the program? Yes!
It's great to see so many opinions here on this topic. I know 2 seasoned (notice that I didn't say older.......) nurses who have been bedside nurses for their entire career, and they both agree that the nursing diagnoses should go by the wayside.
I'm ticked off tonight....Ghost Whisperer isn't on!!!
Have a good weekend everyone. Stay safe if you're out on the roads or shopping this weekend.
I just purchased my Nursing Diagnosis handbook for next semester. I've been poking my way through it, and my initial impression is that it looks like a method of organizing students' thoughts and a way to organize concepts.
How else to you teach a student to think like a nurse? Doesn't there have to be a hierarchical process? For those who feel nursing diagnoses are inappropriate, how do you instill the necessary thought processes in student nurses?
Sorry, I'm on the "I like care plans" bus. I was a MDS nurse for about 4 years, is probably why. Hated them in nursing school, but I went directly into LTC/MDS out of school, and it just clicked with me. We need to have a written plan, and follow it, even if most of it is just common sense. Some people don't have any of that, and need it written down, lol. Just bringing it all together helps, regardless of the language.
Pretty simple, pt has this problem, symptoms are this, and this is what we are doing to help. Doctors do this (or should) either in there PE, progress notes, etc. Why shouldn't we? We do a lot more than just what the MD orders, and it should be written somewhere that this is what we need to do. Just makes sense to me.
BTW, in nursing school, my instructors did tell me that the reason we couldn't site medical dx was b/c MDs didn't like.
Ok, so half of that was probably confusing, forgive me I'm tired, I'll fix it tomorrow. promise!
No it wasn't confusing, you made perfect sense. I'm glad to see you "get it".
Specializes in Community Health, Med-Surg, Home Health.
I think we are all entitled to have a feeling on any portion of our jobs, and should not be brow-beated or chastized for speaking about them in this forum in a condescending manner. I can understand the framework of patient centered care (multicollarearity brought this up successfully-a point that I really did not consider), but there is not much time in the real world for this, and nursing also existed without them in the past. IMHO, nursing diagnoses are really silly. Documenting a plan around a medical diagnosis is fine, since nursing autonomy is really in question, anyhow, but other than this, nurses have much more to do. It is time consuming and in many cases, if it involves the multidisciplinary team, there is no promise that most will happen, unfortunately (sorry to say but that is my experience).
yes, we 'know' to ambulate, dbtc, reposition, etc etc etc.
but how many really do this?
i've worked with too many nurses, who do not.
and complications develop.
i suppose for those who don't use these nsg interventions, then these reminders won't be of much help.
Leslie, the very idea that those lazy brain-dead nurses who don't bother to turn an immobile person q2o will do so because they wrote a nursing diagnosis re: impaired skin integrity is ridiculous.
Throw in the ROY model and you can literally lose your mind with overwritten concepts. Some diagnosis were devised just to "honor" a nursing theorist and their position.
Has anyone ever seriously seen "Energy field disturbance?"
I do see a value for diagnosis but it is in the sense of trying to identify and implement interventional strategies for patients and their problems.
One of my instructors made a point of saying that there are really 10 commonly used diagnostic labels. I personally think that diagnostic issues could be tightened up considerably through embedding diagnostic issues within Maslows hierarchy of needs.
Well, I think that nursing diagnoses tend to detract from the nursing profession as a whole. I understand that the nursing diagnosis justification was to "legitamize" and make unique the profession of nursing, and different from medicine.
Yet, let's face it, for those of us working in a hospital, we practice a lot of MEDICINE. We might as well face it.
If I think a patient may have a PE, I call the MD and say, "I'm worried the patient might have a PE".
How many of us have had the admitting MD call us and ask us what we think the orders should be?
How often are we diagnosing a MEDICAL condition and gently reminding the MD of it? Example real life conversation:
Me: "Dr. X, the patient is in Wenckebach heart rhythm. Do you want a cardiac consult?"
Dr. X: "Oh. OK."
Particularly when one of the nursing diagnoses is "Impaired Home Maintenance" (hey! they must have been to my house!) it tends to make me not want to take it seriously.
And for the record, I have 2 master's degrees in other (unrelated) subjects, as well as a BSN, experience as a working RN, and am in grad school for an MSN (where, interestingly enough, we don't discuss nursing diagnoses AT ALL).
I think the whole nursing diagnosis thing could be taught in a less awkward, more practical way. I get that it teaches 1) here is a condition 2) what it is related to 3) what to do about it. But I had teachers practically flunk people out because they didn't write it out in the stilted, formal language that they required.
Furthermore, I still think that nursing schools need to teach SKILLS as well as all this theoretical claptrap. (Martha Rogers, anyone?)
one part of me, rolls my eyes and mutters, "yeah, i know, i know, i know".
yet the other part is appreciative of the reminders of what is needed to do.
it's automatic to follow medical care.
not so, for nsg.
yes, we 'know' to ambulate, dbtc, reposition, etc etc etc.
but how many really do this?
i've worked with too many nurses, who do not.
and complications develop.
i suppose for those who don't use these nsg interventions, then these reminders won't be of much help.
but perhaps for the newbie who is not yet disillusioned and burnt out?
that s/he will recognize the need for such interventions?
i can only hope.
it seems in my part of the world, that nsg and its accompanying, specialized art and science, is a dying breed.
overall, i appreciate very much, what nanda attempts to do...
even if it is petty, to some.
leslie
Do you think even if you give the book about NANDA and give them pages and pages of nursing care plans they will change their habit and start turning the patients or make them ambulate??
I am afraid they wont....because those nurses are simply lazy....none of us can change their habit or attitude....its sad but its the truth:o
Do you think even if you give the book about NANDA and give them pages and pages of nursing care plans they will change their habit and start turning the patients or make them ambulate??
I am afraid they wont....because those nurses are simply lazy....none of us can change their habit or attitude....its sad but its the truth:o
Or those nurses aren't lazy, but have 6-8 patients, constant admits and discharges, (such as direct admits from MDs who are then MIA when trying to find them to get orders) piles of JCAHO paperwork, demanding family members, managers, doctors, etc.
Oh, but if I read the NANDA book, it will change all the above!
MiaKeaRN
178 Posts
To me, nursing diagnoses are a way to get students familiar with the entire nursing process. Do I like them, nope!! Does my instructor like them? Nope! Do we have to keep our mouths shut, do them, and just get through the program? Yes!
It's great to see so many opinions here on this topic. I know 2 seasoned (notice that I didn't say older.....
..) nurses who have been bedside nurses for their entire career, and they both agree that the nursing diagnoses should go by the wayside.
I'm ticked off tonight....Ghost Whisperer isn't on!!!
Have a good weekend everyone. Stay safe if you're out on the roads or shopping this weekend.