Help with NANDA for dying patient

nurseprnRN, BSN, RN · Jan 31, 2014

1) There is no such thing as "a NANDA." Well, there is, but it's an organization and its proper name is NANDA-I. You have been asked to make a nursing diagnosis, the current list of which is to be found in the NANDA-I 2012-2014.

2)

Readiness for enhanced comfort r/t impending death aeb expressed desire to increase morphine

I am unsure that this would be the best NANDA for this scenario. I don't want to use powerlessness or hopelessness because she understood the choices that she was making and to her this was her way of taking power. Any insight would be greatly appreciated!

All nursing diagnoses have-- must have-- defining characteristics and related/causative factors as defined by NANDA-I. (Exception: "Risk for.." diagnoses have risk factors.) This is nonnegotiable. You can't just make them up.

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. "

There is no such defining characteristic as "expressed desire to increase morphine" in this nursing diagnosis, and there are no related/causative factors for this diagnosis. You must use the NANDA-I 2012-2014, the most current edition. I know that many people (and even some faculty, who should know better) think that a "care plan handbook" will take the place of this book. However, all nursing diagnoses, to be valid, must come from NANDA-I. The care plan books use them, but because NANDA-I understandably doesn't want to give blanket reprint permission to everybody who writes a care plan handbook, the info in the handbooks is incomplete. Sometimes they're out of date, too-- NANDA-I is reissued and updated q3 years, so if your "handbook" is before 2012, it may be using outdated diagnoses.

Since it's clear that you didn't have a copy of the NANDA-I 2012-2014 when you were doing this assignment, you're in luck: It's Friday, and with the free 2-day shipping Amazon gives students you can have it by Monday, and instantly if you have a Kindle or other electronic reader (I have a copy on an iPad). :)

Now, given the very limited assessment information you have supplied us, let's see if we can't look at at least one possible nursing diagnosis for this situation, her situation, based on your assessment of her. If I understand you correctly, she is (was) terminally ill and in hospice care for comfort and dignity at end of life. You don't say what her physical symptoms are other than implying that she has pain, because she was asking for more morphine.

So it seems to me that you should go back one page in your NANDA-I 2012-2014 to "Impaired comfort," because it seems to me that you are describing someone who is not comfortable if there are no appropriate nursing interventions made. Related /causative factors include "illness-related symptoms," or "treatment-related side effects," which you would specify by giving the ones she found unwanted; defining characteristics are many, but they include reporting being uncomfortable.

I suggest you also look closely at the diagnoses "Risk for compromised human dignity," with risk factors of loss of control of body functions (actively dying), and perceived intrusion by clinicians (she clearly chooses to stop that). And never let anyone tell you that "risk for" diagnoses aren't "real" or cannot be priorities. If you go to the section on Safety you'll see that almost all of them are "risk for" diagnoses, and what do nurses do if not promote safety as a priority?

lmsullivan · Jan 31, 2014

Thank you! I have Ackley and I knew that I was forcing the diagnosis to fit my needs versus finding a diagnosis that fit my supporting data. I was stuck where I was an unable to move forward. I think impaired comfort was definitely where I was trying to go. I appreciate your help.

nurseprnRN, BSN, RN · Jan 31, 2014

Thank you! I have Ackley and I knew that I was forcing the diagnosis to fit my needs versus finding a diagnosis that fit my supporting data. I was stuck where I was an unable to move forward. I think impaired comfort was definitely where I was trying to go. I appreciate your help.

Happens a lot-- get the book and I think you'll find yourself much more comfortable with fewer "forces." :)

Esme12, ASN, BSN, RN · Feb 1, 2014

Thank you! I have Ackley and I knew that I was forcing the diagnosis to fit my needs versus finding a diagnosis that fit my supporting data. I was stuck where I was an unable to move forward. I think impaired comfort was definitely where I was trying to go. I appreciate your help.

I use them both....one makes sense with the other.