Nursing Diagnosis- NO MORE??

purplesteth · Apr 28, 2011

One of my favourite diagnoses is "Intolerance to activity." :lol2:

workingharder · Apr 28, 2011

In a few days I march across the stage and will be handed a rolled up piece of paper. Nursing diagnosis and care maps will be behind me. Good thing too, I doubt I could physically or mentally write another paper about my "feelings". Free at last.

MunoRN, RN · Apr 28, 2011

The original purpose of calling patients "clients" was to make them feel more empowered, the problem being that simply changing the term did nothing to address the reasons why patients are often disempowered, while at the same time offending a large portion of the patient population.

The term we use to describe someone speaks volumes about how we view them. The term "patient" implies that we see them as a participant in a therapeutic relationship, while the term "client" implies that we see them more as a participant in a business relationship or financial transaction, an implication that doesn't help in an already profit driven system.

Paul Krugman had this to say on the topic just last week: "Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? "

http://www.nytimes.com/2011/04/22/opinion/22krugman.html

elkpark · Apr 28, 2011

The original purpose of calling patients "clients" was to make them feel more empowered, the problem being that simply changing the term did nothing to address the reasons why patients are often disempowered, while at the same time offending a large portion of the patient population.

(Actually, the purpose of the change in terminology, which came out of the humanistic psychology movement of the '60s and '70s, was not to make the clients "feel empowered" (you can't make anyone else feel empowered), but an effort to help shift the attitudes of the providers -- to acknowledge that clients (in mental health, specifically, at the time) were not helpless people waiting patiently (from the same root as the noun "patient" :)) for us to "fix" them, but active participants in the direction, decision-making and implementation of their treatment. It was never about a "business relationship or financial transaction." I was around at the time and in the milieu that this was first being discussed and implemented. :))

ImThatGuy, BSN, RN · Apr 29, 2011

Why not just call them customers?

Mike's Wife · Sep 7, 2011

The first time I heard a professor refer to patients as "clients", I nearly laughed; it made me feel like I was about to do the patient's hair or nails or something. I will never call a patient a client. I'd like to hear a doctor call a patient a "client" - ha! Is it just the nursing profession that is told to do this? Along with NANDA giving us our own nursing diagnoses and thus nursing culture, we also have a unique descriptive word for the people we care for.

Why do we need to separate ourselves? Sure, we each have different jobs to do; but if one serves as the "hands" and one as the "feet", aren't we still part of the same "body"? If these parts aren't speaking the same language, I'm afraid that puts us at "Risk for falls"...

metricalpound · Sep 7, 2011

I know that many people here would like to just be pill pushers that are the hands and eyes of the MD's but I kind of like NDX's.

Let me explain.

1. Hospitals still use Nursing DXs. I've done my clinicals in two hospitals in NYC both have used NDXs. So in all fairness, it's still important to know them b/c hospitals still use them or at least they do in this major city.

2. One may ask, why do people still use them if they can just use "Emphysema?" This goes back to the NRS110 - the difference between Nurses and Doctors. Doctors treat illness - they treat Emphysema. Nurses treat the patient - and every patient is different. The patient with Emphysema and Schizophrenia gets treated the same as a patient with Emphysema and no Schizophrenia by an MD - the nurse however needs to treat the patient so she treats a patient with impaired gas exchange r/t ______manifested by_______; and impaired thought processes r/t ________ manifested by _________.

Also there are many disease processes, infections, etc. that people react differently to and thus you will have the same disease name, i.e. "Pneumonia" but will have a different NrsDX depending on what's wrong with patient.

nurse4forever · Sep 8, 2011

One may ask, why do people still use them if they can just use "Emphysema?" This goes back to the NRS110 - the difference between Nurses and Doctors. Doctors treat illness - they treat Emphysema. Nurses treat the patient - and every patient is different. The patient with Emphysema and Schizophrenia gets treated the same as a patient with Emphysema and no Schizophrenia by an MD - the nurse however needs to treat the patient so she treats a patient with impaired gas exchange r/t ______manifested by_______; and impaired thought processes r/t ________ manifested by _________.
Also there are many disease processes, infections, etc. that people react differently to and thus you will have the same disease name, i.e. "Pneumonia" but will have a different NrsDX depending on what's wrong with patient.

Hey.. we just learned that in lecture yesterday and I have no problems with NrsDX... I think all of it makes sense because we are nurses to treat the patient or client and not the disease. People always tell me to just be a doctor. And I respond by telling them, "I want to help the patient, not the disease they have."

szeles23 · Sep 8, 2011

I have heard from the faculty in my program that the formal nursing diagnosis is something they are moving away from. They say it doesn't really make much sense, that in the real world you use the medical terms, not things like "impaired gas exchange" being pneumonia. Either way we still have to know how to do it but it may go away in the future. All of my faculty are NP/MSN or PhDs. I don't really care either way as I plan to further my career after my bsn :)

Pneumothorax, BSN, RN · Sep 10, 2011

I'd love to do away with NANDA, NIC, NOC, and nursing theory. I think all of that is a SERIOUS detriment to the profession. Time to re-tool and figure out who/what nurses want to be.
Ironically, there's a thread in the educator/instructor forum about schools wanting to do away with pathophysiology as a focus because it is too science-focused. Stupid, stupid, stupid!!!! Nursing is nursing's worst enemy.

as much as i dont like actually making a patho map or writing out the pathophysiology of the pts principal problem, i think the patho is SO VERY important to whats going on with the patient. Why not get rid of pharm. class too.. :uhoh3: geesh!

Oh, wow, I didn't know it was an official recommendation that was made! When I first started nursing school, it made me sick seeing that the patient was referred to as a "client" in my textbooks. Still makes me sick, but I'm used to it now, although I never really feel right writing "client" so my care plans would always say "patient."

i still call them patients... :yawn:

we were told our first semster of nursing school, that we wont ever write care plans out once we graduate. THANK GOD!!!

i understand there is a reason for them but some of the interventions are so silly like "provide patient privacy"..well, ya, why wouldnt i?... kind of insulting.

anyways.ill be so happy that i wont ever have to look at another ndx again!

nurseprnRN, BSN, RN · Sep 10, 2011

::sigh:: i hear you all, and when i was a young and stupid student i said all this myself. now i find myself in a profession where i am required to demonstrate the scientific basis for my nursing assessment and opinions, and (i know you will hate to hear this) nursing diagnosis is it.

now, before you stop right there, consider something you have not thought of. it's not an either/or thing. as a demonstration, let's consider this: what's the difference between a medical plan of assessment and care for pneumonia (since that was mentioned) and the nursing plan of assessment and care for pneumonia?

sure, when the physician or nurse practitioner makes a medical diagnosis of pneumonia, the medical plan of care will likely be based on lung sounds, cultures, diagnostic imaging, sats, and the like, and include things like oxygen and antibiotics and periodic imaging to see how things are progressing.

nowhere is it written that nursing assessment does not and cannot include knowing the results of all those tests and exams. in addition, when i am assessing a person with pneumonia, i'm looking for nursing assessment bases of my nursing plan of care-- my nursing treatment plan.

if she's sob and drops her sats when i watch as she does adls, i'm going to be thinking of clever ways to decrease exertion (fatigue, impaired physical mobility, ineffective breathing pattern, activity intolerance, self-care deficit).

if she's hypoxic or hypercapneic (impaired gas exchange), i'm looking at the effects of those on other body systems, like mentation (impaired memory, anxiety), digestion, risk for pressure ulcers (risk for injury), and decreased healing of (whatever injury or surgery she had).

if she's been told she has to stop smoking, but she doesn't think she can or that it won't matter anyway, that's gonna prompt me to assess and treat for hopelessness: subjective state in which an individual see limited or no alternatives or personal choices available and is unable to mobilize energy on his own behalf, and powerlessness: perception that one's own action will not significantly affect an outcome; perceived lack of control over current situation or immediate happening.

if her sob and resultant disability is bad enough, i might see caregiver role strain, and look to see what i can set up to help with that.

sure, you say, this is all "common sense." well, if it were more common, we'd all be better off. but a lot of this is not in a medical plan of care. these sorts of things are purely in the nursing realm; they are not part of the medical plan of care. and truth be told, not all nurses are going to assess for and provide nursing care for all these things. that is beyond unfortunate, because they see their realm as solely to implement the medical plan of care ("i know what to do for pneumonia!") with some limited other interventions which may or may not be completely assessed for...because they don't know the scientific basis for their practice. (ps: i think "disturbed energy field" is a crock, too, but that doesn't invalidate all the rest of it.)

you wlll also note that i haven't put in all the "as evidenced by..." because an experienced nurse will already know that. the physician doesn't say, "pneumonia, as evidenced by whiteout in the left lower lobe, fever, positive sputum culture, and rales/ronchi." "pneumonia" is enough for a medical plan of care to start off-- the cookbook checklist of what they do.

i would bet you dollars to doughnuts that 95% of the students (and new grads, and others) who rant about how evil nursing diagnosis is have no idea what legal power it gives them, and how their very licenses are dependent on it. i'll bet you have not read your nurse practice act. i'll bet you haven't read the nanda 2009-2011 to see how much you can learn about how to do nursing, as opposed to merely implementing the medical plan of care. we do that anyway, but we do so much more. if you don't know that, you don't really know what you're licensed for. i commend them to your attention.

ImThatGuy, BSN, RN · Sep 11, 2011

I see nothing at all wrong with nurses being used to gather information and administer physician ordered treatments. I think NANDA diagnoses are stupid as well. If it's emphysema, as someone used as an example, then call it emphysema. Why say or even need to say impaired gas exchange or whatever. See? There's even ambiguity in finding a nursing diagnoses.