No more NANDA diagnoses?

Bonny619 · Dec 7, 2006

I haven't heard that.

savedbutterfly · Dec 7, 2006

I haven't heard that either, where did your chief nurse get her information?

Daytonite, BSN, RN · Dec 7, 2006

you should have questioned her a little closer. she may have been referring to her hospital doing away with using nanda language and switching to another nursing diagnosis language. there are a couple of others in existence beside the one nanda has developed. nanda is used worldwide. nanda is alive and going strong. the nanda diagnoses, noc outcomes and nic interventions that are merged with it have all been assigned numeric codes and have been merged with snomed (systemized nomenclature of medicine), another computerized taxonomy that includes medical diagnoses and is owned by the college of pathologists. these are all proprietary owned computerized programs that have a great deal of capital invested into them and are going to be part of the computerized patient record which has been mandated by federal law. many hospitals are already using snomed coding systems for x-ray and laboratory tests and procedures. eventually, care plans, nursing diagnoses and nursing interventions will also be coded and become part of patient medical records.

anyway, as long as you know the nursing process and how it works, using nanda nursing diagnoses, or some other system of nursing diagnoses, isn't going change what you do for patients. it would only change the language you will use in writing care plans. it's like speaking the same language, but speaking it with a different dialect. nanda says impaired physical mobility. another system might just say immobility. same thing, just said a different way. the meaning behind it would not have changed at all.

so, my question to you is, do you know your nursing process? if you know and understand your nursing process, using nanda diagnoses or nursing diagnoses invented by an alien from the planet vulcan, the only thing that is going to change on your care plans is the language you use to write your nursing diagnoses. the assessment, determination of the patient's problems, outcomes, nursing interventions and rationales or evaluation isn't going to change at all. got it?

http://www.nanda.org/ - home page of nanda international

CityKat, BSN, RN · Dec 8, 2006

Indeed I know my nursing process:) This was told to me about a month ago. We were getting a lecture on the ventilator when she told us. I thought it sounded a little strange and she didn't clarify that it was that specific hospital, so that's why I was asking. Thanks for your help:)

ZASHAGALKA, RN · Dec 8, 2006

Why would getting rid of NANDA take away from nursing? More to the point, how does nursing gain respect by using arcane language that is widely considered un-necessary input for our allied health peers?

NANDA and the like are like pig-latin: we're sooo cool because we have a made up language. In fact, those around us don't think we're cool: they just tune us out. Is it no wonder we don't command any respect?

NANDA is useless in the trenches. It might be a good teaching tool, but those in the trenches could care less if it is officially done away with. It's been obsolete in our minds, for years. It's just another computer generated document to check off to prove to JCAHO that we care about such things.

Let me ask you this: look at the 'care plans' in the charts of active patients in your units and see how very rarely they are updated. In most cases, it's a necessary document to generate at the time of admission, and promptly forgotten about by nurses, and never once looked at by anybody else. Those plans are only updated if it's required, and, by cursory examination, you'll find it evident that such 'updates' are perfunctory and not practically oriented changes.

We've bought into self-defeating language like this and then complain that we aren't treated with respect. When our language is gibberish to our allied peers, why WOULD they treat such work as respect-generating?

If NANDA dies, good riddance. I would have murdered it long ago, if it had been within my power. NANDA and our other power-robbing language only serves to keep nurses 'in their place'. God forbid we actually use our knowledge to cross the sacred lines of professionalism! How dare we not know our place. Uppity nurses and all.

~faith,

Timothy.

Daytonite, BSN, RN · Dec 8, 2006

NANDA is useless in the trenches. It might be a good teaching tool, but those in the trenches could care less if it is officially done away with. It's been obsolete in our minds, for years. It's just another computer generated document to check off to prove to JCAHO that we care about such things.

Don't presume that everyone feels the same way. As someone in the trenches I couldn't disagree with you more!

NANDA is not a teaching tool. It is a nursing language, plain and simple. It is merely used to describe patient problems. Nurses have been assessing patient's, determining their problems, and describing patient problems for YEARS. That is not new. That is what nurses do! It's what I've been doing as a nurse for 30 years. That's never changed and not going to change. NANDA has merely taken on the task of developing a set of rules and guidelines of exactly how to write these things out on paper so we are all on the same wavelength. The idea was to avoid the mess that medical coders have had for years in working with medical diagnosis codes. Turning medical diagnoses into computer data revealed many problems that NANDA was formed to prevent when nursing care plans were going to need to be computerized. Before trashing NANDA and the work they do, please take time to learn the history of what they are trying to accomplish. I can tell from what has been posted that most nurses and nursing students are just uninformed about what NANDA does.

JCAHO's has no interest in NANDA is merely in parroting federal laws with regard to care planning. A lot of JCAHO standards are based on current laws. Title 42 mandates that every hospitalized patient of every facility that receives Medicare reimbursement MUST have a care plan that has been developed by a registered nurse. The electronic medical record (patient chart) has also been mandated by federal law and is going to come into existence whether we like it or not. That care plan is going to need to be reduced to computerized data. NANDA was formed years ago to address this problem by people much wiser than us who saw then what is about to happen in the next few years in our field. I'm sorry if you don't like what is happening. You have the choice of cooperating or being dragged along kicking and screaming. Either way, it is going to happen. To stay employed we will all need to comply with the rules. Otherwise, McDonalds always has openings.

ZASHAGALKA, RN · Dec 8, 2006

double post, see below.

~faith,

Timothy.

RN BSN 2009 · Dec 8, 2006

I dont think all that hard work will be thrown down the drain with no reason at all

ZASHAGALKA, RN · Dec 8, 2006

NANDA is not a teaching tool. It is a nursing language, plain and simple.

Just as pig latin is a language. But, if only the cool kids know pig latin, then it is utterly worthless as a viable form of communication. THIS is why our allied health peers rarely read our notes. In the pursuit of our 'own' language, we've made our communications unintelligible and more to the point, unnecessary input to our peers.

It is merely used to describe patient problems. Nurses have been assessing patient's, determining their problems, and describing patient problems for YEARS. That is not new. That is what nurses do!

While I agree with this statement, MY POINT was that very few nurses in the trenches actually use the computer generated care plans to guide that care. They are just another generated documented, soon forgotten about, and rarely readdressed unless mandated, and even then, the mandated 'updates' are perfunctory and not actually used to guide care. I offer a simple verification of this: go and LOOK at the care plans on the charts of practically any nursing unit in this nation and the disconnect between the official documentation and reality is distinct and noticeable.

They simply are not routinely referenced or used to guide care. While that might be a generalization, it's one that is on the money in most cases.

It's what I've been doing as a nurse for 30 years. That's never changed and not going to change. NANDA has merely taken on the task of developing a set of rules and guidelines of exactly how to write these things out on paper so we are all on the same wavelength. The idea was to avoid the mess that medical coders have had for years in working with medical diagnosis codes. Turning medical diagnoses into computer data revealed many problems that NANDA was formed to prevent when nursing care plans were going to need to be computerized. Before trashing NANDA and the work they do, please take time to learn the history of what they are trying to accomplish.

To the extent that nurses in the trenches are on the same wavelength with care plans, it is the wavelength that ignores them, in mass.

I really don't care what NANDA was trying to do. I care about the result: it's an utter failure in the communication process that serves to rob nurses of respect because we speak gibberish instead of a valid language that interfaces and actually COMMUNICATES with our peers. No matter the agenda in creating them, the result is power and respect robbing.

JCAHO's only interest in NANDA is merely in parroting the federal law. A lot of JCAHO standards are based on current laws. Title 22 mandates that every hospitalized patient of every facility that receives Medicare reimbursement MUST have a care plan that has been developed by a registered nurse. That's a JCAHO standard too. The electronic medical record (patient chart) has also been mandated by federal law and is going to come into existence whether we like it or not. That care plan is going to need to be reduced to computerized data. NANDA was formed years ago to address this problem by people much wiser than us who saw then what is about to happen in the next few years in our field. I'm sorry if you don't like what is happening. You have the choice of cooperating or being dragged along kicking and screaming. Either way, it is going to happen. To stay employed we will all need to comply with the rules. Otherwise, McDonalds always has openings.

Oh, I know it's not going away. My POINT was that most nurses are resigned to the extra paperwork, but not committed to the import of what that paperwork means. So, while I agree with you that they are a mandated part of the record, I disagree that they serve any purpose BUT to comply with yet another paperwork requirement.

I'm not naive. I know WHY they are there. I also know that the real purpose they serve is to make sure nurses don't stray beyond our place. The REASON why they are embedded in law is to teach nurses their place in the system. THESE are your limits, know them well. No, I get it. I just don't respect it. And, I'm not nearly alone.

If you want me to respect a 'language of nursing', make it one that my allied health peers can understand. Otherwise, we are just wandering around Babel, wondering why nobody understands or respects us. Personally, I aspire more from nursing then to relegate our input to an unintelligent form quickly stuffed to the back of the 'nursing' section of the chart, never to be seen again.

In 13 yrs of nursing, I've NEVER seen a careplan actually referenced in ongoing nursing care. Not once. And that includes working with hundreds of nurses in dozens of units in mulitiple states over the years.

It's just not relevant in the trenches. To the extent that it isn't, and it isn't, I FAULT those that created them. I certainly don't respect their input. Why should I? Those plans are evident enough that they don't respect mine.

In fact, I'll go one further: if you were to look at MY charts, you would see updated care plans. Why? Because I understand that it's a game and I know the rules of how to play. Just because I know HOW to play the game does not nearly translate to respect FOR the game.

I can tell from what has been posted that most nurses and nursing students are just uninformed about what NANDA does.

Exactly! And that is one of nursing's chief problems: an utter lack of praxis. The fact that our concepts don't tranlate well at all to the realities of nursing should be a stark wake-up call to our Ivory Tower. Instead, it seems to me that they relish their 'secret' knowledge. It's a secret handshake club, and I know full well that I'm not part of it. The real secret is that I'm also not interested in it, except to tear down the club walls.

The sooner nursing actually has real praxis, concepts that actually translate to the realities of nursing in useable form, the better off nursing will be.

~faith,

Timothy.

ZASHAGALKA, RN · Dec 8, 2006

Solution Page 6

~faith,

Timothy.

Tweety, BSN, RN · Dec 8, 2006

They simply are not routinely referenced or used to guide care. While that might be a generalization, it's one that is on the money in most cases.
~faith,
Timothy.

I agree they aren't "referenced" on a routine basis. And I agree with several of your points.

But the hallmark of RN practice is the ability to crtically think and care plan.

When you arrive for the day you care plan and you carry out that plan of care whether you reference it or talk about it or not.

ND is just a way to put it in writing and to teach it to students. We as experienced nurses do it naturally because this is what we've learned to do.

Mind you, I'm not fan of care plans and ND's but students need to learn "what do I do with this patient with CHF?". You as a cardiac nurse with experience just walk into to work and start to do it. If you had to teach someone in a classroom who doesn't know what to do, how would you do it? There should be a standard. There should aslo be evidence what you are doing and what the hospitals policies and procedures are for taking care of patients in their hospitals........this for the lawyers and JACHO.