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!)
Why would a doctor necessarily know about nursing diagnoses? They learn about medical diagnoses in school. Nurses do not learn how do make medical diagnostic decisions. Doctors don't learn how to make nursing diagnostic decisions. We nurses, however, do learn how to make nursing diagnostic decisions. We both do learn about the medical and nursing treatments we each give.
But as a nurse I'm expected to understand the medical diagnoses. I may not be expected to diagnose MI, but I'd better know what it is. You go up to any practicing RN, they'll know what the medical diagnoses of each of their patients is (or what they're ruling out.) Because the medical diagnosis is important to the care of the patient. The nursing diagnosis, if it's so important to the care of the patient, then shouldn't the MDs know them? But they don't care, because the nursing diagnosis makes no difference to the care of the patient. As long as I do the interventions, all is good, it doesn't matter if I based my nursing interventions off of a nursing dx of "decreased perfusion" or off of the medical dx of "MI."
As if I am the only one who is sarcastic here .....perhaps they should ban sarcasm from this website alltogether....this is all I have to say:
truth hurts;)
If they do that they'll need to get rid of the rolls eyes smile! :rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes:
Though I can't really relate because I'm not yet a nurse, but I think it shouldn't really matter how we document as long as we get the point across and the pt. gets the care the need. Annoying or not, mandated or not.
Wow such a heated topic! I graduated around 10 year ago and to be honest I have used NANDA approved nursing diagnosis very little--my first year out I used them a bit otherwise I cannot remember the last time I used a NANDA approved diagnosis. I do find them to be silly and a waste of time. Unlicensed staff become confused by them as do patients or families and even some nurses ( I still am unsure how to measure or assess the altered energy field but on a side note I am pretty sure mine is altered )
The last facility I was at, before leaving patient care, nursing diagnosis (they could be used if you wanted to though) was not used, care plans with "problems" were used. So care plans are definitely important, NANDA approved diagnosis, in my opinion, not so much.
When one writes DO NOT USE BETADINE for wound care due to allergy--hives and you find the daughter=in=law insisted as it helpwed 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!
I think the issue is not care plans in a hospital or long term care facility, but the wording the awkwardness, and the time spent in nursing school on the wording of these things ratherthan on teaching skills, patho, pharm, etc.
The above care plan item is PERFECT. "DO NOT USE BETADINE" sums it up. We know what to do. No "Risk for injury due to rash aeb allergic reaction" blah blah blah.
The current nursing diagnoses don't add any credibility to our profession. I think it detracts from it.
When you are a student or new nurse they can be useful, but as an experienced nurse they are not needed and are just plain ridiculous.
No professional RNs that I have known over the years, except for educators and managers, put any stock in them. They consider them one more irritating piece of paperwork that has to be done at the end of the shift.
I can't help but wonder if this was the result of some PhDs needing to come up with an original thesis years ago and some how it turned into paperwork monster!
But as a nurse I'm expected to understand the medical diagnoses. I may not be expected to diagnose MI, but I'd better know what it is. You go up to any practicing RN, they'll know what the medical diagnoses of each of their patients is (or what they're ruling out.) Because the medical diagnosis is important to the care of the patient. The nursing diagnosis, if it's so important to the care of the patient, then shouldn't the MDs know them? But they don't care, because the nursing diagnosis makes no difference to the care of the patient. As long as I do the interventions, all is good, it doesn't matter if I based my nursing interventions off of a nursing dx of "decreased perfusion" or off of the medical dx of "MI."
Well, I'll bet you CAN diagnose a "suspected MI". Pt looks gray, reports substermal pressure, pain radiating down left arm or in jaw...
Or elevated troponins?
You call the doc and say, "Pt has substernal pressure, elevated troponins, etc". Not decreased perfusion.
My point is nursing diagnoses try to make nursing so much different than medicine.
I know a nurse who is great with all the treatments, the ambulating, turning, maintaining fluids, etc. But when asked why the patient is on our floor, she doesn't know. (Turns out he was septic. Kind of makes you go on the alert for symptoms to watch for.)
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?
Daytonite,
I don't think the posters here are angry and not willing to listen. I do think the posters on this topic are FRUSTRATED, and despite pretty widespread disagreement with nursing diagnoses, educators also refuse to listen.
And my point is besides the general awkwardness of some of the wording, nursing schools spend too much time teaching the wording, not the interventions.
i don't think the posters here are angry and not willing to listen. i do think the posters on this topic are frustrated, and despite pretty widespread disagreement with nursing diagnoses, educators also refuse to listen.
and my point is besides the general awkwardness of some of the wording, nursing schools spend too much time teaching the wording, not the interventions.
We don't use NANDA diagnoses where I work, though I was taught about them during my training. We do use primary nursing and care plans, but the style is up to the individual - I tend toward the narrative.
I understand that the diagnoses can help students understand why nursing interventions are being done, hopefully triggering a lightbulb moment - I think sometimes everything's so overwhelming it can be difficult to see past the tasks to the underlying theory etc.
My issue with NANDA is the more esoteric diagnoses, like the oft-cited "impaired energy field" (thank you, Rogers), and the 2006 additions about religiosity. I'm not equipped for, let alone have the time to, assess and assist my patients to achieve their potential for enhanced religiosity. And though I work in acute care, I don't think I'd be any better equipped to do it in long term or home care either.
....perhaps they should ban sarcasm from this website alltogether....this is all I have to say:
:rolleyes:
wooh, BSN, RN
1 Article; 4,383 Posts
But as a nurse I'm expected to understand the medical diagnoses. I may not be expected to diagnose MI, but I'd better know what it is. You go up to any practicing RN, they'll know what the medical diagnoses of each of their patients is (or what they're ruling out.) Because the medical diagnosis is important to the care of the patient. The nursing diagnosis, if it's so important to the care of the patient, then shouldn't the MDs know them? But they don't care, because the nursing diagnosis makes no difference to the care of the patient. As long as I do the interventions, all is good, it doesn't matter if I based my nursing interventions off of a nursing dx of "decreased perfusion" or off of the medical dx of "MI."