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!)
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!
Oldiebutgoodie
I know many nurses cant do what they are supposed to do becuz they have too many patients but too little help....I am one of those too, but there are nurses who just dont do their jobs because of their habits and they dont even help others. So I feel that no matter what we write in papers things wont get done if we dont change our attitude or if there is not enough support services for the nurses.
So why bother with all these paper works?? Why not pay attention to the real needs....more bedside help....it will not only help the patients but also increase the morale among nurses.
And we wont be arguing here about nursing diagnosis, we will happily do what we are tarined to do.:)
Specializes in med/surg, telemetry, IV therapy, mgmt.
So why bother with all these paper works??
Because the federal law says we have to document this stuff, that's why. The federal law does not stipulate that we HAVE to use nursing diagnoses. That's a facility decision. Ask the powers in charge of your facilities why they are requiring the use of nursing diagnoses. I know the reasons and have already mentioned one big reason, but I feel that most of you are so angry you really don't want to hear it, but ask your leaders. The replies you get, if you go to the right people, will not be what you expect to hear and they do not necessarily involve the nursing department. We work in healthcare and whether we like it or not, we are part of a larger team. If the facilities we work for don't get paid for what the nurses do, no money comes in, there is no money to pay salaries and nurses won't have any jobs. Where will nurses work then?
So, if the profession gets rid of nursing diagnoses, then what do you put in their place on the care plans and who is going to decide this?
I think that the various nursing organizations should come together and vote. Let's bring nursing out of the dark ages and get some newer ideas in there. Everything changes over time, I have been told that almost on a weekly basis in my current career, so why should nursing diagnoses stay stagnant? They say "if it isn't broke, don't fix it", but this may be a situation where a little tweaking may do the trick. Just MHO.
Because the federal law says we have to document this stuff, that's why. The federal law does not stipulate that we HAVE to use nursing diagnoses. That's a facility decision. Ask the powers in charge of your facilities why they are requiring the use of nursing diagnoses. I know the reasons and have already mentioned one big reason, but I feel that most of you are so angry you really don't want to hear it, but ask your leaders. The replies you get, if you go to the right people, will not be what you expect to hear and they do not necessarily involve the nursing department. We work in healthcare and whether we like it or not, we are part of a larger team. If the facilities we work for don't get paid for what the nurses do, no money comes in, there is no money to pay salaries and nurses won't have any jobs. Where will nurses work then?
I'd probably go work at the bakery or a candy store! Might gain another 20 pounds, but at least it would be fun.
Specializes in Vents, Telemetry, Home Care, Home infusion.
Care plans in the hospital may be very redundent but crucial in the out of hospital setting when lay caregivers are involved.
Those of us in home health, SNF, community residential settings dealing with mentally challenged and disabled community, along with assisted living use careplans that aides, attendents and family members can follow to care for their loved ones. Developed with patient input, these instructions are vital to ensure patient needs are met and care activities organized and individualized for each patients "quirk"s.
When one writes DO NOT USE BETADINE for wound care due to allergy--hives and you find the daughter=in=law insisted as it helped with her c-section wound 5 years ago, or family insists on giving rice pudding to their dad despite instruction on THIN liquids who then aspirates, you have a great legal devise to protect you!
Because the federal law says we have to document this stuff, that's why. The federal law does not stipulate that we HAVE to use nursing diagnoses. That's a facility decision. Ask the powers in charge of your facilities why they are requiring the use of nursing diagnoses. I know the reasons and have already mentioned one big reason, but I feel that most of you are so angry you really don't want to hear it, but ask your leaders. The replies you get, if you go to the right people, will not be what you expect to hear and they do not necessarily involve the nursing department. We work in healthcare and whether we like it or not, we are part of a larger team. If the facilities we work for don't get paid for what the nurses do, no money comes in, there is no money to pay salaries and nurses won't have any jobs. Where will nurses work then?
I worked clerical at the hospital before I switched to being a nurse tech. One thing I noticed was that the medical side doesn't always realize the importance of having the paperwork in order. A lot of docs and nurses said they only wanted to focus on patient care and shouldn't have to be burdened with knowledge of Medicare and what tests weren't covered. Also, as an ED clerk, there were too many times when I wasn't allowed to get near enough to a patient to get the info I needed for billing (not talking about codes and such-only about half of our ED patients should have been in ED setting). I was always told that my job wasn't as critical as theirs. Then one day our CEO asked those nurses if they felt strongly enough about patient care being all that mattered that they would work for free. Of course, they all said no. He then told them that if they continued to stand in the way of the business side of the hospital that we wouldn't earn enough from those ED patients to sign their paychecks!
Of course, I would never insist on busting into a room to get an insurance card when something critical is going on but it has to be done eventually.
Once, a nurse told me she was too busy with the patient to let me in and then she let them go home without me ever seeing them. Later when their test came back with a critical value, we couldn't find them because the phone # in our computer was old. If I had been allowed to do my job that patient could have been reached and gotten the medicine the needed for their liver before too much damage was done.
I try to always be understanding of the rest of the staff now that I'm doing tech work and I hope when I'm a nurse I don't forget my years of business work.
I can see some value in Care Plans and nursing dx's; but, why do they have to be so totally ridiculous-sounding?
Also, as a practical matter, I barely have time to take care of direct pt care issues; let alone an overly-verbose pile of male bovine excrement. Thank God my facility's computerized charting software takes care of this crud directly from assessment data!
But, you know what? MY pts get their meds on time, they get ambulated, they get bathed, they get PO fluids when appropriate, they get turned, they get their INT sites rotated and new tubing placed. They get their orders processed in a timely manner and their charts checked. Their labs are drawn and abnormal results called to the MD regardless of the hour. No pt of mine sits for hours in their own excrement, or deals with uncontrolled pain. Most of all, MY pts get an absolute bulldog of an advocate - I couldn't care less how badly I pi$$-off a MD or a family member in order to take care of a pt and their wishes/needs.
In short, my pts get the very best of nursing care: and "I don't need no esteenking" NANDA dx's or care plans to tell me what needs to be done next: that's what assessment and critical thinking is all about.
In short, my pts get the very best of nursing care: and "I don't need no esteenking" NANDA dx's or care plans to tell me what needs to be done next: that's what assessment and critical thinking is all about.
Oh well I will continue to take care of my patients, I will continue to fill in the blank to make the management,feds and JACHO happy....hope fully one day I will be able to retire and say adios to nursing and I wont have to loose my sleep over those nursing diagnosis and nursing care plan.....life is good;)
I think that nursing diagnoses as well as care plans are the dumbest inventions of the planet earth. How and why do you have to make a plan for how to nurse a person? Nobody reads them except other nurses that are higher than we are, such as nursing supervisors, or regulatory agencies. Doctors don't read them, dietiticans, social workers, no one else on the interdiscipilinary team is even remotely concerned about them. As an LPN, I don't deal with them, really (thank GOD) in my current position. But, if I ever had to, I would probably go competely insane!
We have to write a new "PIE note" updating the care plan each shift as do the respiratory therapists. They pop up mixed in with the MD's progress notes. The MDs have asked that they be separated because they can't find what they want quickly because our useless PIE notes are in the way.
What I find fun is when I find one written by an obviously tired RN or RT at the end of their shift. Particularly funny is when the goal was to "maintain pain" or just a plain goal of "pain.":lol2:
Daytonite, BSN, RN
1 Article; 14,604 Posts
So, if the profession gets rid of nursing diagnoses, then what do you put in their place on the care plans and who is going to decide this?