i've been an adn for 16 years. recently, i finished my bsn and now am through my first year of a dnp program. like most students, i struggled with learning to understand a nursing diagnosis during my adn schooling. since that time the term has cropped up in various situations but usually as a passing comment. it has in no way benefitted my practice as a nurse. in fact, when i bring up the subject with colleagues i often get a smirk or an eye-roll!
the subject of nursing diagnoses happened to come up in one of my grad school classes the other day. i decided to take a stab at this sacred cow and suggest that maybe they are burdensome and irrelevant to a working nurse that they simply aren't utilized. my professor's response was a textbook explanation that i've only heard repeated on a college campus. "if you say your patient has pneumonia, you are using a medical diagnosis which is outside your scope of nursing practice. you must have a nursing diagnosis to be able to implement and evaluate your interventions." i may be wrong, but i'm pretty sure i've been able to implement and evaluate my nursing interventions without needing a nursing diagnosis.
personally, i believe the idea for a nursing diagnosis comes from the ongoing and hard-won independence from the thumb of the medical community. i am all for the continued growth of nursing science. however, on this point we overshot the mark. there is simply no justifiable rationale for calling pneumonia something like
"impaired gas exchange related to effects of alveolar-capillary membrane changes. or
ineffective airway clearance related to effects of infection, excessive tracheobronchial secretions, fatigue and decreased energy, chest discomfort and muscle weakness. "
why not just say the patient has pneumonia? because it a medical diagnosis and we don't practice medicine? baloney! its a pathologic condition. call it what it is. we dont need to reinvent the wheel.
why do we hang on to this? we need to eject it from nursing and maybe realize we don't use it like we thought we would. a lot of time and energy is wasted on this topic in nursing programs that could be better spent elsewhere.
So one night, I started looking through some nursing care plans for nausea and vomiting to make sure I was doing all I could to relieve her symptoms... When I looked at a few of the care plans, it talked about doing a 'dietary holiday' as an intervention for all the nausea, vomiting and diarrhea NDs... one of the books I have it even talks about the prevalence of celiac relief and how nursing and dietary are the only ways to treat the disease.
Thanks for sharing! (and enjoy your 6 weeks!)
Thing is, what is the difference between 'diagnosing' diarrhea and nausea and simply having made the observation of diarrhea and nausea? It sounds to me like the nursing care plan book with it's comprehensive list of possible interventions is what helped, not a 'nursing diagnosis'. With or without 'nursing diagnoses', a nurse or physician or dietician or worried mother can identify chronic diarrhea and nausea as a problem and research possible etiologies, diagnostic tools (such as a dietary holiday), interventions, etc.
Page 1 of the US Dept of Health and Human Services - National Digestive Diseases Information Clearinghouse notes celiac disease as a possible cause of diarrhea.http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/
Thing is, what is the difference between 'diagnosing' diarrhea and nausea and simply having made the observation of diarrhea and nausea? It sounds to me like the nursing care plan book with it's comprehensive list of possible interventions is what helped
Yes, but you have to have a reason for your nursing interventions. An assessment is not a concrete label or classification of the problem. It is an observation of one or more symptoms of the problem. Diarrhea and nausea may be almost one in the same (assessment/diagnosis) but impaired mobility is a culmination of unsteady gait, lightheadedness, feet shuffling, etc. The ADPIE is just another way of labeling the scientific method.
Page 1 of the US Dept of Health and Human Services - National Digestive Diseases Information Clearinghouse notes celiac disease as a possible cause of diarrhea.http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/
Maybe I will have to tell all the docs to use this link instead. :) The second doc we saw did a scope. I thought he checked for all possible causes, he did not. He was the first one I went back to to tell him what my daughter has. Truth is, according to APA, there are 1,795 reasons for N&D. The hindsight is 20/20 here.
Specializes in Clinical Research, Outpt Women's Health.
I can't believe all of you long winded people are still going on and on about this (have I offended everyone?)......:lol2::lol2:
I agree it is useful for teaching students, but I think an acute care nurse with their hands full of patients and everything else would do this automatically and only has time for Erik's plain old English.
I know, I know, I have tried. Believe me, I would like nothing more than to free myself......
Do it, let it go. Some of the posts I just read the first and last sentence. They take too much RAM from my mind to try and figure out what the poster is trying to say other than "I like Nursing Diagnosis" or "I hate Nursing Diagnosis".
Clearly we are of two camps here, debating their usefulness in real life (questionable except for professional care planners), in nursing school (yes and no, maybe?), and in their use as a secret language/tool to show that we are professionals! (whaaa??? no one will ever buy that!).
Still it is eerily fascinating to see the variety of responses from the verbose and sesquipedalian (LOL-using big words to impress us all) to the simple "I can't believe all of you long winded people are still going on and on about this " (CrunchRN, 2011).
OMG I have got to stop reading this too! I am losing my sanity.
The ADPIE is just another way of labeling the scientific method.
ADPIE is a problem solving process that works very well without the D. This particular format of problem solving works well for nursing. It also works for problem-solving in many other areas as well. Assess, Plan, Implement, Evaluate. To assess is to identify the problem that needs addressing. Heck, I'd argue that the diagnostic process is *part* of the *assessment process*
If an initial assessment identifies the problem to be addressed, then go straight to planning. If the initial assessment doesn't provide enough to plan an intervention, then one detours through the diagnostic process as part of the assessment step.
Assessment? chest pain
Plan? it depends on if the cause of the chest pain can be determined
Diagnostic detour: consider possible etiologies and run tests = further assessment
My internet access is currently limited to my IPod which for some reason won't open a PM, and I'm not sure this is really that off topic. What you seem to be saying, is that Nursing has redefined terminology to remove "medicine" from the equation, which definitely seems related to ND's, as there now seems to be the commonly held definition for Primary prevention as well as the Nursing school definition, which seems to only confuse things, a la Nursing Diagnoses.
A1c's and Lipid panels are universally considered Primary Prevention for CAD in every source I can find. Primary preventions assesses for and manages risk factors for the development of disease prior to the presence of disease, once that disease is present in the individual, these same efforts become Secondary Prevention. Cholesterol/LDL/HDL levels contribute to the development of CAD, which is why we do lipid panel screening to assess for the presence of a risk factor so that it can be managed even when no CAD is present, which is Primary Prevention. It's questionable to what degree, but diabetes is often considered a contributing factor for the development of CAD, which is why the Cleveland Clinic specifically lists A1C's as a part of Primary Prevention for CAD: http://health.usnews.com/health-conditions/heart-health/coronary-artery-disease/prevention
The American Heart Association also lists lipid management and A1C tests as Primary Prevention methods for CAD:
My internet access is currently limited to my IPod which for some reason won't open a PM, and I'm not sure this is really that off topic. What you seem to be saying, is that Nursing has redefined terminology to remove "medicine" from the equation, which definitely seems related to ND's, as there now seems to be the commonly held definition for Primary prevention as well as the Nursing school definition, which seems to only confuse things, a la Nursing Diagnoses.
Dang. You can do all this from your phone? It was only a couple years ago I started texting.
:lol2:
:D:D
jjjoy, LPN
2,801 Posts
Thanks for sharing! (and enjoy your 6 weeks!)
Thing is, what is the difference between 'diagnosing' diarrhea and nausea and simply having made the observation of diarrhea and nausea? It sounds to me like the nursing care plan book with it's comprehensive list of possible interventions is what helped, not a 'nursing diagnosis'. With or without 'nursing diagnoses', a nurse or physician or dietician or worried mother can identify chronic diarrhea and nausea as a problem and research possible etiologies, diagnostic tools (such as a dietary holiday), interventions, etc.
Page 1 of the US Dept of Health and Human Services - National Digestive Diseases Information Clearinghouse notes celiac disease as a possible cause of diarrhea.http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/