Medical Model vs. Nursing Model...Huh?

[amanda sue]

When reading about the differences between nurses and doctors/physician assistants, I always hear the claim made that nurses operate via a nursing model and make nursing diagnoses, whereas doctors and physician assitants operate via a medical model.

What does this mean?? What are the differences between a nursing model and a medical model??

Thanks so much!

[lovemyjob]

nursing model and diagnosis only refers to diagnoses/actions that a nurse can do.

Ex.

Alteration in nutrition R/T feeding intolerance.

Actions: HOB at 30', check annd report residuals greater than --, monitor for emesis, administer reglan/zantac as ordered, administer feddings at ordered rate, monitor for dehydration, obtain labs as ordered and report critical values. etc

These are things that a nurse does. Also, a nursing diagnosis cannot use a medical diagnosis because we cannot make medicla diagnoses. I am sure someone else can prob explain it better, but I gave it a shot!

[Soup Turtle]

Nurses deal more with the person's response to a disease and doctors deal with the physical disease itself...or something like that.

[Blessed2BeMommy]

Physicians are licensed to make medical diagnoses. A medical diagnosis is specific and related to a pathological disease process. Medical diagnoses are relatively uniform and are treated the same from individual to individual.

Registered nurses are licensed to make nursing diagnoses. A nursing diagnosis is based on the client's physical, sociocultural, psychological, and spiritual response to an illness or health problem. Nursing diagnoses will vary according to the client's state of being. Nursing diagnoses may be actual or potential problems that a client may experience.

For example:

Medical diagnosis: Crohn's Disease

Possible Nursing Diagnoses:

Anxiety

Deficient Fluid Volume

Deficient Knowledge

Diarrhea

Imbalanced Nutrition: less than body requirements

Ineffective Coping

Ineffective Health Maintenance

[sanctuary, BSN, MSN, RN]

Physicians are licensed to make medical diagnoses. A medical diagnosis is specific and related to a pathological disease process. Medical diagnoses are relatively uniform and are treated the same from individual to individual.

Registered nurses are licensed to make nursing diagnoses. A nursing diagnosis is based on the client's physical, sociocultural, psychological, and spiritual response to an illness or health problem. Nursing diagnoses will vary according to the client's state of being. Nursing diagnoses may be actual or potential problems that a client may experience.

For example:

Medical diagnosis: Crohn's Disease

Possible Nursing Diagnoses:

Anxiety

Deficient Fluid Volume

Deficient Knowledge

Diarrhea

Imbalanced Nutrition: less than body requirements

Ineffective Coping

Ineffective Health Maintenance

Well done!!

[LilPeanut, MSN, RN, NP]

Some of that goes out the window though when NPs get involved, since NPs can dx disease as well

The medical model is very illness and disease related. It's all about the parts of the body that are going wrong.

The nursing model is much more holistic. It's not only the disease/process, but how the person responds to the disease/process. That is why I prefer the nursing model. There's much more emphasis on treating the patient, not just the disease.

[Jabramac]

On a very basic level:

Physicians treat diseases, nurses treat a persons response to diseases.

[amanda sue]

Ah, I see. Thank you!

[santhony44, MSN, RN, NP]

Physicians are licensed to make medical diagnoses. A medical diagnosis is specific and related to a pathological disease process. Medical diagnoses are relatively uniform and are treated the same from individual to individual.

Registered nurses are licensed to make nursing diagnoses. A nursing diagnosis is based on the client's physical, sociocultural, psychological, and spiritual response to an illness or health problem. Nursing diagnoses will vary according to the client's state of being. Nursing diagnoses may be actual or potential problems that a client may experience.

For example:

Medical diagnosis: Crohn's Disease

Possible Nursing Diagnoses:

Anxiety

Deficient Fluid Volume

Deficient Knowledge

Diarrhea

Imbalanced Nutrition: less than body requirements

Ineffective Coping

Ineffective Health Maintenance

I think that NP's combine the two. We make medical diagnoses, but we still see patients from a nursing point of view.

I will be the first to admit that I don't think in terms of nursing diagnosis. I don't think: Medical diagnosis is Crohn's, my nursing diagnoses are diarrhea, knowledge deficit, etc etc.

I think of the medical diagnosis and the nursing stuff just seems to sort of come along with it in my mind. I think I see medical diagosis from a nursing point of view even though I'm the one making the diagnosis myself.

Working in the hospital, you get to know pretty much what you're going to do for a particular patient, based on the medical diagnosis, and you change that to fit your particular patient. Same thing in the clinic.

I hope this makes some sense.

[scattycarrot, BSN, RN]

I think there is more to this than already discussed. One of the major differences between the medical model and the 'social' model of nursing is that the medical model focuses on the same factors for each patient; these being presenting complaint, history, examination, differential diagnoisis, tests and exams to confirm/rule out suspected diagnosis and treatment whereas the nursing model (as previosly noted by Blessed2bemommy) are more individualistic and focus on how the patients disability or illness (as well as treatments) may affect their physical, social and emotinal wellbeing.

Nurses,using the nursing model, do not tend to think in terms of differential diagnosis and it is this which truly seperates the 2 models in my opinion. During assessment and examination using the medical model, the examiner must think of the most likely cause of the patients problems but must consider many different options and the aim is to find the causative agent so that a treatment can be started(hopeully!). Whereas in nursing, in most cases, by the time we meet the patient, a medical diagnoisis has already been made or there are at least suspisions as to the cause of the problem, and our ultimate goal, whatever, the diagnosis is to holistically care for that individual. I don't think Np's confuse the issue as during the NP's education the focus and their priorty is on the factors already mentioned re: the medical model and the nursing model seems to follow....I think santhony44 puts it better!

I have rambled...sorry but I hope this makes sense!

[jjjoy, LPN]

I can sort of see what people are trying to say in differentiating nursing practice from medical practice. I agree with the model that nurses help people maintain the highest level of health and well-being. In a hospital, that usually means carrying out doctor's orders and assisting with comfort and hygiene.

I don't see the use of nursing diagnoses in most cases, however. I can see the idea behind their development but they just aren't useful in most settings. We can learn how and when to apply various nursing measures without having to apply a specific nursing diagnosis to do so, and without diagnosing (and practicing medicine) either. If a diagnosis has already been made, then the nursing interventions are based around the appropriate supportive care. If a diagnosis hasn't been made, then the nursing interventions relate to the presenting symptoms.

[Daytonite, BSN, RN]

When reading about the differences between nurses and doctors/physician assistants, I always hear the claim made that nurses operate via a nursing model and make nursing diagnoses, whereas doctors and physician assitants operate via a medical model.

What does this mean?? What are the differences between a nursing model and a medical model??

Thanks so much!

You ask a very interesting question that goes to the heart of the definition of what a model is to begin with. I think one needs to start by defining what is meant by the word "model". A model is basically a pattern, a standard, to be copied and/or imitated. You will find it defined this way in a collegiate dictionary. So, when talking about a "nursing model" or a "medical model" you are talking about the professional behavior being practiced by a nurse or medical doctor. And, that is pretty much what each (nurses and doctors) are taught when they go to their respective schools. Nurses are taught according to a nursing model and physicians are taught according to a medical model. Each profession has developed standards of care for it's members to adhere to and follow. Their licensing laws reflect those standards. Based on those, there are certain things that doctors can do that nurses cannot; vice versa, there are certain things that nurses can do that doctors cannot. If you want to know what those specific things are it would help to (1) read state law for nursing and medical practice and (2) the job descriptions for nurses and doctors.

Making nursing diagnoses or medical diagnoses are merely tasks that each group does within their job descriptions. In it's strictest sense a diagnosis is a decision or opinion resulting from the examination and observation of facts. A car mechanic can also make a diagnosis about what is wrong your car. The difference between a nursing diagnosis and medical diagnosis is based upon the standards of care each profession uses and applies in arriving at their decision (or opinion, or diagnosis). Medical diagnoses are the most widely known. We recognize them when we hear them: pneumonia, influenza, polio, heart attack. We recognize some automotive diagnoses as well: blown head gasket, flat tire, cracked engine block. Nursing diagnoses are not as well known and so a puzzlement to most when we first hear about them: impaired skin integrity, total urinary incontinence, ineffective tissue perfusion. Keep in mind that we are talking about different standards of care, different facts being observed, different decisions being made and this all results in different treatments being rendered to address the problems. Doctors are taught to look for certain types of things in making their diagnoses; nurses are taught to look at certain types of things in making their diagnoses (some may be similar to the same ones the doctors are also looking for); car mechanics are taught to look for certain types of things in making their diagnoses. The thinking processes they are using are the same, but the set of facts each profession deals with are different. Don't get too hung up on diagnosing. It is only one of many things done by both doctors and nurses that is part of something called the "scientific process".