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]

I always thought they were silly, but I haven't dealt with them since nursing school. Yes, I think they are silly and make us look foolish.

[FireStarterRN, BSN, RN]

Addendum: they do have a use in nursing school to orienting nurses to be to the nursing process...

[FireStarterRN, BSN, RN]

P.s. I only read the opening post and no others. Need to run to the Post Office... We're going to see 'A Christmas Carole' tonight at the University...

[S.T.A.C.E.Y, LPN]

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

I agree with you 100%!!!

While I do use the nursing process every day at work, and I do understand that it is a very important part of nursing, I'm glad I don't have to return to using silly nursing diagnoses and writing out care-plans as I had to in nursing school. Defend the nursing diagnoses all you want, but at the end of the day I'm still glad they're no longer a part of my daily life.

[leslie :-D]

when i first started nsg school, i remember watching a film on virginia henderson.

i think she was the renegade of her time.

anyway, she very much poo-pooed nurses not being able to cite med'l dxs.

she thought it "poppycock" that we presented s/s, rather than just calling it "mumps" or whatever the dx at hand, was.

my kind of woman/nurse. :)

leslie

[birdgardner]

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.!!

I don't think it's about the AMA at all. Much more about ANA. I talked with a couple doctors about this - one was Huh? Never heard of NANDAs. Didn't have time for them. Said we should use medical diagnoses "between us." That is if we thought a patient was DKA, tell the doctor the patient looks DKA - we just can't tell the patient or the family.

The other doctor, my mother-in-law, who used to be a nurse way back when before NANDA, thought they were nonsense, and a self-important attempt by some nurses to give themselves diagnoses to play with.

[Daytonite, BSN, RN]

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.

i spend a lot of time trying to explain them to students because i eventually figured them out. the nursing diagnoses are nothing more than labels. years ago we just wrote out on care plans that a patient had diarrhea, nausea or pedal edema. there were some instances when we realized that pedal edema and congested lungs were part of the patient's underlying congestive heart failure problem and some of the nursing interventions overlapped. nanda has helped a bit with that. when i went into my bsn program in the early 80s i struggled with learning nursing diagnoses. i didn't get them. it took years before the light bulb suddenly went on and i can't tell you what finally flipped the switch, but when it flipped the light flooded the room. all nanda has done was replaced the wording and in some cases grouped some of the problems together (like with congestive heart failure) that we once used for the patient problem on the care plan. a quick look at a nanda reference helps you get the diagnosis correct--it only takes a few seconds to check a nanda reference.

what nursing instructors have done with nanda has created the 3-part nursing diagnostic statement. those diagnostic statements are only used in nursing school. their value, however, is to show the critical thinking that goes into how the patient problem is arrived at and incorporates some of the pathophysiology and medical diagnosis into what is going on with the patient. it also helps you to delineate the rationale behind what it is you are treating in the patient. after school is over, all you need is to identify patient problems. as i said whether you call it a tomato or a red round fruit--does it matter? if the boss says you need to call it a red round fruit because that is what their computer system is going to accept, then that is what you do. i don't see the big deal in making a fuss about it.

in answer to your question, no i am not an instructor. i was, however, a preceptor and part of a committee that managed a new grad program at a large city hospital. these days i cannot work since i have many medical problems. i am currently undergoing chemotherapy for cancer of the colon and i have days when i feel like crap. i spend a lot of time on the nursing student assistance forum and the general nursing student discussion forum answering questions to help students because it helps me feel like i am giving back to a profession that has been so important in my life. i get insensed with people who are disrespectful of the hard work that many of us do to promote our profession. i have been a certified rn and a certified rn, intravenous. i have been a member of several nursing associations. i've met and shook the hands of some of the nursing leaders whose names you see in nursing textbooks. we are not all old crones or eat our young. many of us truly want to assist and help the newbies acclimate to the work. but, it's hard to do when people bring negative ideas into the profession with them.

i honestly don't remember expressing a specific concern about your getting a bad grade on your care plans. i answer so many care plan questions and i suppose what i might say depends on how i happen to be feeling on any particular day. grades are, unfortunately, at the mercy of the instructor who is grading them. if what i said upset you at the time, i am truly sorry. my concern is to help you understand this stuff in as painless a way as i can express it. i will agree that the educators have made the material a bunch of incredible gobble-de-gook. it can be explained in much easier terms--the "spoonful of sugar" method is so much better, don't you think?

[Ruby Vee, BSN]

does anyone think nursing diagnoses are just plain silly - overly literal and laughably complex?

yes, yes, yes!

[Shantas]

I did study those nursing diagnosis and I am very capable of developing nursing care plan otherwise the reputable instituation where I have graduated from would not have given me the degree and the California Board of Nursing would not have given me the right to use RN after my name or to work in the state of California as a RN....in other words all of us who are against NANDA are not stupid.

I already know the basic fact that I need to ambulate my patient after they have a surgery I dont need bunch of papers to remind me of what I need to do for the best interest of my patients.

As far as politics goes....I prefer to do what I am trained to do which is taking care of sick....besides I would not want anyone to be out of a job....afterall they have to keep their finger nails tidy...I dare not make them do things that will spoil their beauty.....

[ERRNTraveler, 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

I wasn't disrespecting anyone any more than anyone else. Actually, I found Daytonite's attempt to "educate" the OP to be condescending & arrogant.... I have very little tolerance for people who "talk down" to others.

[marie-francoise]

I guess I'm a little surprised by the "oh you're just a student" belittling tone of one of the previous posters. Is this the type of personally disrespectful tone I can expect from my future managers and preceptors? I certainly hope not.

Even as a student, though, one can detect blarney when one sees it - and that, I feel, is what the nursing diagnoses are.

Anyway, my frustration is not a personal one, nor is it with anyone in particular (unless you count NANDA). It's with the nursing diagnoses themselves - esp the tortuous, overly literal descriptions of pathological processes that nurses are expected to use in planning care for each patient.

Someone asked for examples - my original post provides examples.

I'll sign off for now, since I think I found my answer.

[jackson145]

I asked the nurses I work with in Med/Surg and some I used to work with in the ED. They pretty much agreed that care plans and nsg dx are dinosaurs and every last one of them said they never use either in the course of their day (one of the gals is daughter of VP of nursing). They all said that there would be a lot of nonsense during NS that everyone just has to put up with for a little while.