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.

[SharonH, RN]

I posted this to the general forum since I want to know how real nurses feel about nursing dx's, and also since only a relatively few people read the students' forum.

And, yes, I independently purchased the Nursing Diagnoses text, and still hold to my opinion - about the dx language itself. The book's descriptions of the INTERVENTIONS, though, were genuinely useful. The book itself is a useful read. Forcing nurses to use the dx language in real life, though... different story. The language is way out in academic left field (not politically, but figuratively).

And I hear what you're saying, but still think that Nursing Diagnoses need to be seriously revisited, esp in this day and age where nurses are being asked to do WAY too many things in a limited about of time, as it is.

Docs don't have to recite and chart each and every bodily process underlying/associated with a medical problem. Forcing already time-strapped nurses to do that, and using such hyper-literal language while they're at it, just adds more time away from patients. And the hyper-literal descriptions required in the ND's are just ridiculous.

And some of the language DOES appear to be the product of 1970s ethos - e.g., "Readiness for enhanced family processes". Sorry, but it just doesn't ring right. We need to get real.

Do you have a problem with the nursing diagnoses themselves or the language used to describe them? As nurses, our jobs are to treat the human responses to illness, that is one of the official definitions of our jobs, thus the nursing diagnosis. It would be absolutely inappropriate to write "COPD" or "Diabetes" since we are unqualified to diagnose patients.

The purpose of listing nursing diagnoses and the accompanying interventions is to organize and prioritize care. Unfortunately, many nurses feel as you do that this is "silly" and "unnecessary" and that the medical care supercedes nursing care instead of the two going hand in hand. That is also the reason, I saw many patient suffer unnecessary post-op complications or prolonged hospitalizations because the nursing end of their care was neglected in favor of the medical care. I don't care how many antibiotics you hang or how much lovenox you administer, they are pretty worthless if you don't ambulate the patient, or turn, cough and deep breathe them. What heck good does it do to apply oxygen and administer breathing tx if you are going to leave the head of the bed down and if you don't encourage use of incentive spirometer? What's the point of applying SCDs and never ambulate the patient post-op? Why give IV fluids but not encourage PO intake? These are nursing interventions people!

Nothing used to embarass me more than to see physicians write orders like the following: "Turn patient" "provide skin care" or "push fluids". These are all nursing interventions that you might find under those silly nursing diagnoses you all feel so pointless. Many of you here also seem to feel that if physicians don't validate them, they don't have any meaning. That's unfortunate for our profession and for the care of our patients.

[Shantas]

FYI. . .a written care plan is a required element in every acute hospital and nursing home patient chart. This is mandated by federal law (Title 42, Sections 482 and 483 in case you want to verify this for yourself), not by JCAHO. Most facilities have tried to make the care plan writing process as easy as possible for their nurses because they know it is a tedious and time consuming process. Canned care plans or skeletal care plans are something that nursing diagnoses easily adapt to. Let me be crystal clear, however. Care plans are the documentation of our problem solving efforts of our patient's problems. Like them or not, they are here to stay because the federal government says so and since they are the biggest payer of health care--they win. If you want to fight Washington be my guest, but you won't win. Nursing diagnosis has given us uniformity and consistency in documenting patient problems. Before them, you sometimes sat there trying to figure out what to write on the care plan in the column where it said "problem". Believe me, I know. I was working back then.

I think these laws are created by those people who left bedside nursing and ultimately forgot what it is like to do bed side nursing with the fear that their finger nails may get dirty!!

Just like anything else in nursing, just put up with all the grabage that the management and the feds tell us to do after all they are giving us money....

[pagandeva2000, LPN]

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!

[Daytonite, BSN, RN]

I posted this to the general forum since I want to know how real nurses feel about nursing dx's

Well, I'm a real nurse (licensed for 32 years) and I'm telling you how I feel about nursing diagnoses and I disagree with your student opinion!

And, yes, I independently purchased the Nursing Diagnoses text, and still hold to my opinion - about the dx language itself. The book's descriptions of the INTERVENTIONS, though, were genuinely useful. The book itself is a useful read. Forcing nurses to use the dx language in real life, though... different story. The language is way out in academic left field (not politically, but figuratively).

The NANDA taxonomy DOES NOT include nursing interventions. I don't know what book you purchased, but it was not a NANDA publication. Who's forcing you to use nursing diagnoses? Your instructors? If your grade depends on it, well. . . An employer? If your paycheck depends on it, then. . . Otherwise, don't use them.

Please! The NANDA language is "out in academic left field"? I say tomato; you say to-mah-to. That's all it is. That's what academia is, using a different word to express the same thing. Only fascists want things their way.

And I hear what you're saying, but still think that Nursing Diagnoses need to be seriously revisited, esp in this day and age where nurses are being asked to do WAY too many things in a limited about of time, as it is.

How would you know if nurses are being asked to do way too many things in a limited amount of time? You're a student. You've never worked as a licensed RN!

Docs don't have to recite and chart each and every bodily process underlying/associated with a medical problem. Forcing already time-strapped nurses to do that, and using such hyper-literal language while they're at it, just adds more time away from patients. And the hyper-literal descriptions required in the ND's are just ridiculous.

And, what medical school and residency did you go to that you know this? There are two doctors in my family. Believe me, they get raked over the coals about what is in the charts and about the medical background and physical exams of the patients they are caring for when they are medical students and in their residencies.

Please give me examples of this hyper-literal language and hyper-literal descriptions in the nursing diagnoses that you are referring to. I don't know what you mean by this term and I'm wondering if you even know what it means, so please define it for me.

And some of the language DOES appear to be the product of 1970s ethos - e.g., "Readiness for enhanced family processes". Sorry, but it just doesn't ring right. We need to get real.

FYI. . .Readiness for Enhanced Family Processes is a nursing diagnosis that was added to the taxonomy in 2002 which, if you had taken the time to check, you would have not made the mistake of equating with the 1970s. It is a diagnosis that is primarily used by advanced practice nurses who perform counseling services and need to bill for those services.

Dear student. . .the nursing process is

1. Assessment
   
2. Problem identification
   
3. Planning
   
4. Implementation
   
5. Evaluation

It is an ongoing, never ending cycle. It is a problem solving process. I can cite several sources that tell you that. It is a mental process. The physical process is the written care plan. An advanced degree in health care doesn't make you a nurse. Passing the NCLEX and getting your RN license will legally make you a nurse. You have a lot to learn about this profession. And, you are blindly trashing nursing diagnoses without having done your homework about them. I sincerely hope you don't approach your clinical performance with the same recklessness.

[Daytonite, BSN, RN]

I think these laws are created by those people who left bedside nursing and ultimately forgot what it is like to do bed side nursing with the fear that their finger nails may get dirty!!

Just like anything else in nursing, just put up with all the grabage that the management and the feds tell us to do after all they are giving us money....

Then, get into politics and get it changed.

[ERRNTraveler, RN]

all I have to say is......

I am SO glad I work in ER- we're not required to do care plans or nursing diagnoses, and I am SO glad I'm not a student, so I don't have to deal with holier-than-thou instructors....

[gerry79]

I have yet to do a care plan or use a nursing diagnoses. Just tolerate it until school is over and then happily watch nursing diagnoses go the way of the Woolly Mammoth......

[birdgardner]

Ah, Daytonite, you and I have gone a round on NANDAs before. Your suggestion that if we don't llike them, we go into politics and change them just backs up my belief that NANDAs are more about politics than patient care. I would rather deal with poop than politics.

Since the interventions for say, anaphylactic shock are rather different than those for pneumonia, why call them both Impaired Gas Exchange differentiated by a really long "related to...secondary to...?" Why not plan nursing interventions off the medical diagnosis while keeping in mind that we do more than following doctors' orders?

And yes, I agree that there are some things the physicians may not address that we have to address and it would help for us to be able to name them, but why do it with such an assault on the English language as "Readiness for enhanced family processes?" I think a phrase that long should be self-explanatory.

I'm sure you'll be pleased to know that your concern that I was getting bad grades on my care plans was unfounded. :) I'm learning a lot from the care plans - but I still hate having to use NANDAs.

I'm curious - do you teach full time, or do you still work clinically as well? You invest a lot of time teaching about NANDAs on the forum, and I appreciate NANDAs a bit more because of it - I see now how you can make them the basis of a really good patient care plan. But it still seems to me that you can make a patient care plan just as good in real terms (not school terms) without having to resort to the jargon and politics of NANDAs.

[ERRN92]

It probably has more to do with the AMA...they get really anal about nurses "diagnosing" pts. God forbid we should cross the line and come to an actual educated theory as to what is wrong with our pt.!!

[SuesquatchRN, BSN, RN]

Since the interventions for say, anaphylactic shock are rather different than those for pneumonia, why call them both Impaired Gas Exchange differentiated by a really long "related to...secondary to...?" Why not plan nursing interventions off the medical diagnosis while keeping in mind that we do more than following doctors' orders?

Thank you, thank you, thank you.

Of curse we don't diagnose. But we know what the patient has, and that's what we're treating! This round the mulberry bush nonsense taxonomy is so awkward and useless.

[leslie :-D]

and I am SO glad I'm not a student, so I don't have to deal with holier-than-thou instructors....

why the disrespect?

daytonite feels just as strongly in defense of nanda, as do those who find it senseless and annoying.

if one wants to be recognized professionally, one needs to act/respond in same.

leslie

[SuesquatchRN, BSN, RN]

why the disrespect?

daytonite feels just as strongly in defense of nanda, as do those who find it senseless and annoying.

if one wants to be recognized professionally, one needs to act/respond in same.

leslie

Ah, I would say the disrespect has primarily gone in one direction.