216 Nursing Diagnoses and counting

I don't think its totally wrong at all, but how can they think about totally new ideas in a novel milieu without some sort of conceptual framework, some sort of rudimentary pathfinding guidance? I just think having the book in their hands is a useful tool.

I like to come at problem solving from as many angles as I can, and try to teach students that way too. I think it's a little bit like when you used to ask your mother how to spell a word and she would tell you to go look it up in the dictionary. "But Mom, how do I look it up if I don't know how to spell it?" "Go look and figure it out." A little bit, anyway. At least, that's what my mother used to tell me. And I ended up reading the dictionary for fun, lost in new words and ideas. (Explains a lot, doesn't it?) :)

If they thumb through the NANDA-I 2012-2014 nursing diagnosis book (NOT just a list) and light on one that might work based on guesswork or even rudimentary knowledge, and then they read the related factors and defining characteristics to see if it works, they may or may not choose that one (you may or may not pick that word...but learning what it's not is still useful and you might remember it later). But doing this they learn useful hunting skills, they get exposed to new words and ideas (diagnoses), often related to the original hunt and calling attention to themselves by proximity on the page at least. Sometimes this process piques curiosity, and sometimes it just clicks. I see it here all the time.

What do you think?

(And welcome to AN. You sound like a kindred spirit!)

GrnTea: Thank you so much for chiming in. I have been lurking in the shadows and reading your posts and admired the logic you bring to students on this site. I have a question first... is there a way on AN to take a discussion off-stage and private message members?

I am thinking deeply about starting a web page that can be a resource for my students and their and under class-men at our institution. I'm starting to reduce my hours at work (I'm old... let's face it!) and I have time to create things like this. (If you're full time faculty, you'll probably know that professors have way little time to be creative... they are just trying to keep their heads above water.)

Anyway... this idea still rudimentary and really on the drawing board, but I honestly covet serious critiques from faculty that I trust. It is search engine minimized on purpose right now because I may be saying things that are controversial... unintentionally so. Whether it's verbal or written, sometimes my brain's edit function is sketchy.

Anyway... let me know if there is a way to PM you if you don't mind. (If you're faculty, I totally understand. I know how limited your time may be. I don't want to be a bother.)

Thanks, E.

You send PMs by clicking on the poster's name at the top of a post. You get to a page with several tabs, one of which is "Send PM." And there it is.

I think you have to have a minimum number of what they call "quality posts" (i.e., not counting "Me too!" sorts of responses) before you can use (send messages using) the PM system. But hey, I think this sort of dialog is useful for students to see, so unless there's really something supersecret, why not let them in on it? I will probably copy this to that thread in that spirit. :)

I am not a professor any more but did teach students back when Florence and I ran the training school, and retain my love of making eyes open and, occasionally, blink.

I am thinking deeply about starting a web page that can be a resource for my students and their and under class-men at our institution. I'm starting to reduce my hours at work (I'm old... let's face it!) and I have time to create things like this. (If you're full time faculty, you'll probably know that professors have way little time to be creative... they are just trying to keep their heads above water.)

Anyway... this idea still rudimentary and really on the drawing board, but I honestly covet serious critiques from faculty that I trust. It is search engine minimized on purpose right now because I may be saying things that are controversial... unintentionally so. Whether it's verbal or written, sometimes my brain's edit function is sketchy.

Thanks, E.

Why not make your contributions here on this fully searchable site, and then just send the students here to get information? Esme is pretty awesome, I'm not so bad, and there are a number of other people here whose expertise is trustworthy. Tell your students who they are and you've saved yourself a world of fuss and bother. :)

Don't tell them who you are here, certainly, and then feel free to be as controversial or disinhibited as you like. Works for me. :)

I feel like far too many students are trying to "templatize" or "algorithmize" rather than simply think through what they're looking at.

I see this most in dose calculations but I think it's just as valid a critique in nursing diagnoses (which I personally dislike).

One needs to understand what's happening BEFORE trying to force things into an algorithm, equation, or template.

As any first-year computer science or engineering student will shout out, "Garbage In, Garbage Out"... this applies to nursing, too

Thank you all...

The issue is not really "NANDA-ites" vrs "NANDA-phobes" because that train has left the station. NANDA is the language we use in this profession. BUT... before the students can select the diagnosis that accurately COMMUNICATES the patient's problem (i.e., determine the authorized NANDA diagnosis) they actually have to understand what they are seeing.

I teach in an accelerated ADN program where the students are usually working on their second careers and have no health care background at all (retired Highway Patrolmen, lots of Veterans including former SEALs, ex Grammar School teachers, former building contractors, plumbers... it's really a hoot.) They are catechized (if you will) in Fundies about NANDA and they use Ackley as a text. In their second level Med-Surg class, they only write out ONE care plan... that's it. (Far be it from me... I know the faculty are teaching the nursing process at the bedside... but oh, well.) Then they do Psych, Ob, etc., etc. and finally get to my (final) med-surg level having forgotten everything they learned about clinical reasoning in Fundies. (That was so 18 months ago!)

We don't do "care plans" with seniors, but we give them a table to fill in with each of the steps in the NP. And they crash and burn BADLY. It's not that the students don't want to write out their clinical reasoning... it's that they think NANDA IS clinical reasoning and if they don't do it properly, i.e., use the "right" NANDA) they are going to be failed. Then, with their first patient of the senior level, we make them even more anxious when we say "no-no-no... that's not even close to what your data is suggesting" they assume they cannot do this nursing thought thing.

OK. So, here is what I do... I tell them they can write the problem statement (I don't use the "D" word) anyway they want as long as it is in the NANDA syntax and makes sense. This has been hugely liberating for both the students and myself. I've seen a big improvement, it gives me a chance to teach the patho principles at work in their patients, and... when it's all said and done... they can go back to NANDA/Ackley and pick out a proper diagnosis with a lot of confidence and they can defend their choice logically.

(Hope your eyes aren't glazed over at this point... I'm about to make my point!)

This approach is qualitatively different than telling them to use their Ackley (or insert your text of choice here) and a strict list of 216 diagnoses. This way, they must work through the steps of ordinary logic and build their case for why they've identified the patient's problem as they have.

IOW: I use NANDA as a goal, the pinnacle, the authorized way to articulate their reasoning to the profession at large. But I don't use NANDA as a means.

Oh, I am so long winded. Apologies. If I haven't put you to sleep, I would like your thoughts

Thanks much,

E

I think we're pretty much slouching towards the same Bethlehem. :) I always tell them to think about what they think might work (that's your

I tell them they can write the problem statement (I don't use the "D" word) anyway they want as long as it is in the NANDA syntax and makes sense. This has been hugely liberating for both the students and myself. I've seen a big improvement, it gives me a chance to teach the patho principles at work in their patients

and... when it's all said and done... they can go back to NANDA/Ackley and pick out a proper diagnosis with a lot of confidence and they can defend their choice logically.

I'd recommend adding the NIC-NOC-NANDA (Johnson, Bulechek et al.) book (if you're allowed to do that-- you could at least share a copy around the table at postconference, and watch their little eyes light up at the thought processes illustrated therein). It really helps them tie it all together. It also lets them know that there are real resources out there so when they can't think of it all themselves (or when they have a niggling suspicion that there just might be more to it than what they think of themselves) they can go to look for help on their own bookshelves.