No more NANDA diagnoses?

ZASHAGALKA, RN · Dec 9, 2006

Yes, NANDA (btw, the other two prominent systems are NIC and NOC) is here to stay. It's written into our statutory guidelines BECAUSE those that pushed for it knew it was the only way to even give it lip service in the trenches. That was just yet another end run around clinicians. It IS wordplay. I just don't see how that advances actual care to waste my valuable active nursing time playing with words. Can I do it? Sure, I'm a college grad and long ago learned how to play the game.

Just because I can acknowledge its inevitability does not mean I have to grant it any respect. Like most of nursing, true collaboration with end users (something the ANA strongly advocates) was ignored. Instead it's foisted upon us clinicians and as a result, treated all too often as necessary, if useless, paperwork.

While I agree that students need a structure to their learning, this tool is simply grossly unwieldy. What it entrenches in nurses is the skill to hide our true contributions in pseudo-scientific language that can thusly be ignored by all power players. Even the head of NANDA, Judith Warren, in a report to HHS acknowledges that nursing's contributions are all too often all too invisible and there is no research to prove that NANDA improves things:

Testimony of Judith J. Warren, NANDA

"3. To what extent do you feel that your discipline and practice setting are well represented by the current system?

Nursing is invisible in the current systems, yet significantly influences patient care and outcomes. The only way to capture this influence is through research which is very expensive to conduct. The National Institute of Nursing Research in NIH no longer funds this type of research, nor do they fund classification development research."

In fact, I contend that NANDA and the like ENTRENCHES that invisibility by allowing our contributions to be ignored as 'another language'.

~faith,

Timothy.

psychonaut · Dec 9, 2006

You bring up a related point I have been struck with during my nursing education thus far: the seemingly thin skin posessed by the profession as a whole. Note I say "struck by" and not "confused by"; I fully realize that nursing is still working to move its perception from being assistants to physicians. However, I fail to see the need to try and make nursing some sort of parallel healthcare delivery system, instead of being part and parcel of medicine.

As I noted above, I can see the utility of a language set that is focused upon what a nurse does. However, I fail to see the point in making it so difficult to say, "Pneumonia can lead to a, b, and c symptoms, which can be treated within the nursing scope of practice by x, y, and z interventions," instead of making the disease dx a minor footnote to the "true" nursing dx.

Again, as a student, I am struck by how difficult it is to find a single list of medical diagnosis>>possible nursing diagnosis>>appropriate interventions. Sure, the info is out there, but seems to require a fair amount of rooting through textbooks, care plan books, etc. I own the NIC and NOC books, and though practice with them is increasing their usefulness, their Byzantine construction still frustrates me to no end.

Considering the constant harping on "critical thinking" in nursing education, I find it amusing to watch my peers regurgitate the same cookbook care plans from their care plan books, without actually delving into the implications of the underlying pathophysiology. I find it much more educational to examine the symptomology and disease process, then try to address the resulting needs with appropriate interventions, even if I still miss some silly NANDA.

As an aside, if it weren't for reading this site and knowing that there are nurses like some of those here, as well as some of my clinical instructors, I would be very despondent over my vocational choice. As it is, I simply tell myself to "suck it up" and remind myself that I'll be in the "real world" of nursing in eight months or so.

mysterious_one, ASN, RN · Dec 9, 2006

I am just wondering, I am from Germany, was an RN over there , came to the US in 1991, my degree was not accepted over here. I did not pursue it any further back than, because of several reasons, one major one was language issues and babies . Anyways, I am now back in nursing school and am amazed in the differences. First off ,I never had to write any care plans, never heard of nursing diagnosis, or any of that. I believe , we learned to critically think by getting more hands on experience in clinical setting. We had, besides our lecture and lab instructions, to be in clinical instruction/work settings at least 20 to 30 hours a week. We got a small salary for that. This was done in teaching hospitals and the nurses there took us under their wings and yes clinical instructors came and rotated amongst us, too. I do believe, a lot of actual nursing care over here, gets put on the back burner, because so much emphasis is put on all this documentation (care plans, etc.) for legal reasons , I know. I am just not used to this, and it is sad . A lot of new grads , come out of school , feeling totally unprepared (just read some of the other threads on here) for the real nursing world. Knowing how to write a care plan with an accurate nursing diagnosis and all the documentation in the world will not help this situation and will not really prepare you how to "critically think".

psychonaut · Dec 9, 2006

I think I like your way better...repetition of tasks, with feedback and reinforcement, leads to skill development. I've come to the realization that a great deal of the stuff we are doing in our "academic" setting is simply PhD research for our instructors; clinical instructors seem to be much more interested in our development as competent practitioners. Even though NANDA certainly comes into play with clinical care plans and write-ups, I have yet to be asked what the NANDA of my pt is, what NIC I will utilize, etc. at the bedside.

Daytonite, BSN, RN · Dec 9, 2006

i had decided not to post any more replies to this thread. i mostly post on the student forums to help students out because it helps me feel productive. i'm not interested so much in discussing my personal opinions about the subject matter because as students, you don't have much of a voice as to whether you can or can't have these things removed from your curriculums. what i can do is use my knowledge to help you in understanding some of what you are being asked to learn.

knowing how to write a care plan with an accurate nursing diagnosis and all the documentation in the world will not help this situation and will not really prepare you how to "critically think".

critical thinking is a purposeful, reflective and goal directed activity where you make judgments based on evidence (facts) rather than on nothing (conjecture). it is based on the principles of science and the scientific method. the nursing process is an extrapolation of the scientific method. the care plan is merely documentation of the process. in learning to write care plans, you are learning to think critically by considering a number of facts and making judgments about the nursing care to deliver. for this reason, care plans and care planning is a tool that is used by nursing schools to help you learn to think critically.

gauge14iv, MSN, APRN, NP · Dec 9, 2006

But couldnt care plans and Nanda Dx be in plain english?

It isnt the whole NDx thing I object to - I agree that it is necessary - and it something we do that is second nature after a period of time - however I ABSOLUTELY object to the (as Timothy put it) Pig Latin in which it is written. The language makes us sound as though we simply need to get over ourselvevs and is not useful to those who really COULD use it! (OT, PT, Psych, etc) Write it in real english - or at least medical terms that other disciplines can understand, not the hoity toity "look how much we think of ourselves so we're gonna talk down to the rest of the world and write in code" language that it presently is.

And for the record, I still object to the "Altered energy field" or whatever the thing is...cripes - talk about credibility issues!

firstyearstudent · Dec 9, 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.

I agree.

mysterious_one, ASN, RN · Dec 10, 2006

i had decided not to post any more replies to this thread. i mostly post on the student forums to help students out because it helps me feel productive. i'm not interested so much in discussing my personal opinions about the subject matter because as students, you don't have much of a voice as to whether you can or can't have these things removed from your curriculums. what i can do is use my knowledge to help you in understanding some of what you are being asked to learn.
critical thinking is a purposeful, reflective and goal directed activity where you make judgments based on evidence (facts) rather than on nothing (conjecture). it is based on the principles of science and the scientific method. the nursing process is an extrapolation of the scientific method. the care plan is merely documentation of the process. in learning to write care plans, you are learning to think critically by considering a number of facts and making judgments about the nursing care to deliver. for this reason, care plans and care planning is a tool that is used by nursing schools to help you learn to think critically.

i do agree, that it does help us to learn, but i think it is not enough. by going to clinicals once a week for 12 hours (and doing a care plan the night before) , i just don't see how this possibly can prepare a nursing student to "critically think" at the bedside , when there is no time to sit down to write a care plan for 5 hours. once we graduate we have to be able to think at the spare of the moment and make decisions right then and there. yes, it teaches us the nursing process, but i just think there is a better way to do this and i believe it is hands on training. i know it will come with time and it will become second nature, but for many grads it is just scary after a handful of actual clinical days in nursing school, to go out there and be the "rn",they supposed to be now.

Retired R.N. · Dec 10, 2006

But couldnt care plans and Nanda Dx be in plain english?
It isnt the whole NDx thing I object to - I agree that it is necessary - and it something we do that is second nature after a period of time - however I ABSOLUTELY object to the (as Timothy put it) Pig Latin in which it is written. The language makes us sound as though we simply need to get over ourselvevs and is not useful to those who really COULD use it! (OT, PT, Psych, etc) Write it in real english - or at least medical terms that other disciplines can understand, not the hoity toity "look how much we think of ourselves so we're gonna talk down to the rest of the world and write in code" language that it presently is.
And for the record, I still object to the "Altered energy field" or whatever the thing is...cripes - talk about credibility issues!

I also object to using that "Pig Latin" language. It makes us look like a clique of pre-teen children who have a secret club that won't admit anyone who doesn't know the proper passwords or like a group of people who don't understand medical terms so we use a lot of words to talk around the subject.

Is there anyone out there who can explain in ordinary plain English how an "altered energy field" is a science-based diagnosis? Is that actually a condition that Medicare or Medicaid will reimburse for?

gauge14iv, MSN, APRN, NP · Dec 10, 2006

I also object to using that "Pig Latin" language. It makes us look like a clique of pre-teen children who have a secret club that won't admit anyone who doesn't know the proper passwords or like a group of people who don't understand medical terms so we use a lot of words to talk around the subject.
Is there anyone out there who can explain in ordinary plain English how an "altered energy field" is a science-based diagnosis? Is that actually a condition that Medicare or Medicaid will reimburse for?

Exactly! I think we would be MUCH better served teaching nurses to understand medical terms more throroughly so that communication with ALL opf the other disciplines who speak it, is better. That would be better for patients.

Daytonite, BSN, RN · Dec 10, 2006

is there anyone out there who can explain in ordinary plain english how an "altered energy field" is a science-based diagnosis? is that actually a condition that medicare or medicaid will reimburse for?

i am posting to this for your information and not to get into a discussion about whether it's right or wrong. from nursing diagnoses: definitions & classification 2005-2006 published by nanda international, page 63, their official publication, it states the definition of the diagnosis, disturbed energy field (the language of it was changed recently), is as follows: "disruption of the flow of energy surrounding a person's being results in disharmony of the body, mind, and/or spirit." this diagnosis was specifically meant to include the practice of therapeutic touch which i know is a very controversial alternative therapy. they give 3 citations for references:

macraw, j. (1988), therapeutic touch: a practical guide. new york: knopf.
newshan, f., & schuller-civitella, d. (2003). large clinical study shows value of therapeutic touch program. holistic nursing practice, 17, 189-192.
nurse healers professional associates international, the official organization of therapeutic touchtm. 3760 s. highland drive, salt lake city, utah 84106; www.therapeutic-touch.org

you must keep in mind that all the nanda nursing diagnoses and associated outcomes and interventions have all been assigned numerical codes for computerized data storage. i have no doubt that the practical application of this diagnosis is for the billing and/or data transfer of therapeutic touch services so the practitioners of this modality can get paid or perform the required reporting of services to these folks. most third party payers (medicare, medicaid, insurance companies) insist on electronically submitted bills and/or data. not all treatments performed get paid by the third party payers, however. in some cases, the third party payers still want to know what was done for the beneficiary for statistical data gathering purposes. medicare and medicaid primarily do that as well as some of the state department of health. if there are other traditional services or charges included on these same bills, medicare and medicaid will deny payment of those other charges if an oddball service (such as therapeutic touch) is not coded on that same bill correctly. so, you have to look at this as most likely being a diagnosis that was developed to assist in allowing the normal flow of business to occur. if you're not performing therapeutic touch on patients, then you shouldn't be using this diagnosis anyway.

gauge14iv, MSN, APRN, NP · Dec 10, 2006

But billing wouldnt be done on NANDA anything - ever.

It is done in ICD-9 or 10 language which is wirtten by the AMA. And there is no E code for altered energy field! LOL

(Nor, I suspect, will there ever be)