Those despised Nursing Diagnoses

[mattcastens]

So I've been studying for my CCRN and keep running into the Nursing Diagnosis sections. It makes me wonder ... has anyone used them for any practical purpose since getting out of nursing school??

I, unlike a lot of nurses, do understand why we learned them -- to help us learn to think through problems and potential problems our patients might encounter. However, I can't for the life of me figure out why or how they're used in the real world. For that matter, I have never seen them used in the real world.

Comments, anyone?

[debbyed]

I work ER. Our most frequent nursing diagnosis are as follows:

Frequent Flyer

Idiot

Brain deficient

Defective sperm recepient

[NRSKarenRN, BSN, RN]

Nursing Diagnosis are used extensively in home care to focus on and document what you are doing in the home. Our nursing note (2 pages) has diagnosis codes at the top of page 2--we document teaching done based on diagnosis underneath: checkmark format with areas for individualization. They are a big help in going into a home cold as a relief nurse.

We also use several standardized care plans along with visit flow sheets for our specific programs: CHF, COPD, Diabetes, Gestational diabetes, Post partum so that we are all teaching the same things on visit # 1, 2, 3, 4 etc and helps prevent redundence + missing teaching something in the days of managed care. Some patients will have only 1 or 2 nurses see them....others wind up with 6 - 8 different RN's if needs extensive, long term wound care, difficult mgmt, needing weekend visits, vacation coverage etc.

So if i am seeing a COPD patient on visit #3, I know that I am to focus on CP assessment, review of correct inhaler/nebulizer use and teach pursed lip and diaphramatic breathing, teach medications 5+ 6 on med list (if more than 4 meds listed) and evaluate prednisone taper and side effects( if pt using med). Explanation of diagnosis and meds 1, 2, 3, 4, already taught----that way 3 nurses aren't all teaching Prednisone use and theodur but forgetting teach difference between albuteral and steroid inhalers with their potential for oral thrush.

[BrandyBSN]

In the hospital where we do clinicals we use Nanda, NIC, and NOC extensively. Its not just the students, but on the Med Surg floor their entire documentation routine it based on N-N-N. Some complain, but they are mostly the nurses that never learned them in school. I really like them, because if I am taking care of a patient, I can identify what direction I should be heading in with my interventions. L&D, ICU, and PCU also use them a lot, but not so much in the ER.

BrandyBSN

[KRVRN, BSN, RN]

I work NICU and we don't use nursing dx much. Every baby has a Kardex that is SUPPOSED to have a care plan on it for each problem but that pretty much falls by the wayside. No one looks at it if there is one and every baby has mostly the same issues anyway.

Every once in awhile we WILL get a baby with some uncomon problem and there won't be full unity in how we treat the baby. A nursing dx list or care plan might help in these cases.

As an example: the other night I had a baby that had developed cor pulmonale. Now, it said nothing nowhere about her being on fluid restriction and her feedings were ordered ad lib with a minimum amount to feed. As the order reads, that means feed her whatever, whenever she wants as long as she eats the minimum. So, I crammed about twice what they were wanting into this baby because hey--she wanted it. I get home and the day nurse calls me to tell me that the baby was on fluid restriction (I hadn't even thought of this), they have to give lasix, why did I do that, and that minimum amount listed was actually the EXACT amount they wanted (the order SAID MINIMUM), etc.

Now, I don't fully understand cor pulmonale and our suggested NICU text has nothing about it. I could only look it up in a adult med-surg text but it didn't seem to carry over. (assess JVD on a fat baby?) As a nurse, I can't use my critical thinking nursing judgment to come up with interventions if I don't understand the complete problem. I only had a vague explanation from the other nurses around me.

So a care plan or nursing dx list sure would have helped (besides having clear orders).

[hoolahan, ASN, RN]

I work in home health, like Karen, but my agency does not use the nsg dx the way hers does. She has sent me a copy of her notes for CHF program, and they seem very organized. My agency functions under constant disorganization!

I have never seen nsg dx used for any realistic pupose since nsg school, and I HATE nursing texts which set-up their chapters in this way!

Frankly I think it's a lot of wasted paper. I know WHY nursing uses them, to show that nursing is it's own science, different from medicine, shows our "orders", etc... Unfortunately, we rarely have the time it requires to properly design or address a care plan. Perhaps in the idealistic world of nursing school, it works, but I have never seen anyone pay the least bit of attention to this in my many jobs, only when the state or JACHO comes a round.

[P_RN, ADN, RN]

Karen what you describe is like our critical pathways. They actually WERE useful, in that they specified where a patient would/should be on a certain day.

The care plans with the NANDA were absolutely a joke. They were prewritten and in the computer so all we had to do was select an admission dx and there was the careplan. You could even enter the careplan into the computer before the patient even hit the floor.