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.

[FireStarterRN, BSN, RN]

here's a diagnosis just for the night shift! good think we have nanda to clarify the situation!

sleep pattern, disturbed-related to external factors

[SuesquatchRN, BSN, RN]

jlsRN, I'm dying here! Oh, my! The dogs are looking at me like I'm nuts. Well, maybe they're right!

[oldiebutgoodie, RN]

My favorite is still:

HOME MAINTENANCE, Impaired-related to inadequate support system

Like, in why the heck doesn't my support system clean the house instead of me??? That's why it's impaired!

Oldiebutgoodie

[Multicollinearity, BSN, RN]

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.

I had to go get my diagnosis book and look this up about religiosity. My question was this: has NANDA pathologized agnostics or atheists?

Thing is, the diagnoses of impaired religiosity and readiness for enhanced religiosity make sense to me as I'm reading them. It would appear they apply if the patient has a certain religious belief and feels a desire to practice it, but is having difficulty for some reason, etc. (This is a vast over-simplification.)

What's wrong with recognizing religious distress and accommodating patents' needs? If you had an agitated and upset patient and you discovered it was because she couldn't do her daily religious rituals, wouldn't that be important for you to know even as busy as you are? Wouldn't this nursing diagnosis simply label this? I guess I'm wondering if it could occasionally be a relevant nursing diagnosis?

[marie-francoise]

My med-surg textbook just offered up this one, in the course of my studying. Even the pithier ones seem to use too many words:

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

TRANSLATION: Patient has a surgical incision.

oldiebutgoodie: You crack me up! I totally agree with your posts, and enjoy them! "Impaired home maintenance" is also one of my favorites.

[FireStarterRN, BSN, RN]

My favorite is still:

HOME MAINTENANCE, Impaired-related to inadequate support system

Like, in why the heck doesn't my support system clean the house instead of me??? That's why it's impaired!

Oldiebutgoodie

Hah hah, in my case it would be:

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

:lol2:

[FireStarterRN, BSN, RN]

here's a new one since i was in school. it applies to our patients who have diagnosed themselves!

health-seeking behaviors — related to locating health-related information on the internet

[Daytonite, BSN, RN]

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.

oldiebutgoodie

i have to disagree with that. i spend a lot of time answering nursing diagnosis and care plan questions on the student forums. 99% of the questions are about nursing diagnoses and almost never about interventions. the students seem to have the interventions nailed down and very seldom ask about them. now, whether they can successfully take them from the paper to real practice is another thing. what they get confused about is actually determining what their patient's "nursing problem/s" is/are and then picking the right diagnosis. they falter on the assessment which contributes to their failure to identify the patient's problem/s, but i think that is expected since assessment is something that one perfects with time and experience.

as for wording, schools are very concerned these days with the poor usage of written english by students. the last couple of instructors i have spoken to said the school administration had made it clear to them that they were to start introducing essay questions on tests and requiring more assignments that required actual writing of prose. i'm seeing students who are not only having to write care plans, but case studies which are a variant of the care plan in an essay form.

i have to express that i am greatly distressed that so many discount the fact the a huge majority of independent advanced practice nurses rely on nursing diagnoses as part of their billing function in order to get paid for the services they independently provide. we're not hearing from them here, i don't think, but staff nurses primarily. every nanda nursing diagnosis has an assigned computer code number and has been merged with snomed, a computerized coding system, which makes the billing function much easier for this group of our colleagues. there is so much more to nursing diagnoses than just using them in care plans, but it seems that people are so angry that they don't want to hear about those really practical uses of them in the business side of healthcare.

as we approach the age of the electronic medical record, and it is coming because medicare has mandated it, the required care plan that has to be part of every patient's chart will need to be reduced to computerized code for medical record storage. nanda nursing diagnoses, noc outcomes and nic interventions were designed to do that. as i said, every nanda diagnosis, every noc outcome and every nic nursing intervention has a code number that has been assigned to it so when a care plan comes along with any of these elements in it, they can be easily "stored" in that patient's electronic medical record. these initiatives were way ahead of their time because they were already working with medicare years ago on how to accomplish this. what i think happened is that educators came along and handled things incorrectly in the way that they literally shoved this stuff down nurses throats. it could have been done differently and been more palpable to all. instead, we now have huge groups of nurses who are angry, and rightfully so, and it's in part due to the fact that they have not been told why these nursing diagnoses were really developed and to be used.

they are not going to go away. medicare has invested too much into their creation. whether people like it or not, medicare drives the healthcare of our country. when medicare makes a landmark decision, all the insurance companies and healthcare providers sit up and listen. if they don't, then their reimbursment (payment for services) suffers for it.

[oldiebutgoodie, RN]

I have to disagree with that. I spend a lot of time answering nursing diagnosis and care plan questions on the student forums. 99% of the questions are about nursing diagnoses and almost never about interventions. The students seem to have the interventions nailed down and very seldom ask about them.

Which kind of supports my point-- are the students having problems with the problem the patient has, or with the wording and the stilted definitions provided by NANDA? I would argue the latter.

Oldiebutgoodie

[oldiebutgoodie, RN]

I have to disagree with that. I spend a lot of time answering nursing diagnosis and care plan questions on the student forums. 99% of the questions are about nursing diagnoses and almost never about interventions. The students seem to have the interventions nailed down and very seldom ask about them. Now, whether they can successfully take them from the paper to real practice is another thing. What they get confused about is actually determining what their patient's "nursing problem/s" is/are and then picking the right diagnosis. They falter on the assessment which contributes to their failure to identify the patient's problem/s, but I think that is expected since assessment is something that one perfects with time and experience.

As for wording, schools are very concerned these days with the poor usage of written English by students. The last couple of instructors I have spoken to said the school administration had made it clear to them that they were to start introducing essay questions on tests and requiring more assignments that required actual writing of prose. I'm seeing students who are not only having to write care plans, but case studies which are a variant of the care plan in an essay form.

I have to express that I am greatly distressed that so many discount the fact the a huge majority of independent advanced practice nurses rely on nursing diagnoses as part of their billing function in order to get paid for the services they independently provide. We're not hearing from them here, I don't think, but staff nurses primarily. Every NANDA nursing diagnosis has an assigned computer code number and has been merged with SNOMED, a computerized coding system, which makes the billing function much easier for this group of our colleagues. There is so much more to nursing diagnoses than just using them in care plans, but it seems that people are so angry that they don't want to hear about those really practical uses of them in the business side of healthcare.

As we approach the age of the electronic medical record, and it is coming because Medicare has mandated it, the required care plan that has to be part of every patient's chart will need to be reduced to computerized code for medical record storage. NANDA nursing diagnoses, NOC outcomes and NIC interventions were designed to do that. As I said, every NANDA diagnosis, every NOC outcome and every NIC nursing intervention has a code number that has been assigned to it so when a care plan comes along with any of these elements in it, they can be easily "stored" in that patient's electronic medical record. These initiatives were way ahead of their time because they were already working with Medicare years ago on how to accomplish this. What I think happened is that educators came along and handled things incorrectly in the way that they literally shoved this stuff down nurses throats. It could have been done differently and been more palpable to all. Instead, we now have huge groups of nurses who are angry, and rightfully so, and it's in part due to the fact that they have not been told why these nursing diagnoses were really developed and to be used.

They are not going to go away. Medicare has invested too much into their creation. Whether people like it or not, Medicare drives the healthcare of our country. When Medicare makes a landmark decision, all the insurance companies and healthcare providers sit up and listen. If they don't, then their reimbursment (payment for services) suffers for it.

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.

A comment:

"What I think happened is that educators came along and handled things incorrectly in the way that they literally shoved this stuff down nurses throats. It could have been done differently and been more palpable to all. Instead, we now have huge groups of nurses who are angry, and rightfully so, and it's in part due to the fact that they have not been told why these nursing diagnoses were really developed and to be used."

This is the first thing you have said that I can agree on!

Regards,

Oldiebutgoodie

[FireStarterRN, BSN, RN]

I have to say that my nursing school did not emphasize these silly things. They covered them, gave us a handbook, and said to just use the handbook, and we had to come up with them, mostly in my first semester. They spent more time preparing us for Boards, my school had a high pass rate apparently. (98% we were told)

[birdgardner]

here's a new one since i was in school. it applies to our patients who have diagnosed themselves!

health-seeking behaviors-related to locating health-related information on the internet

is that supposed to be good or bad?