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.
Dang. You can do all this from your phone? It was only a couple years ago I started texting.
:crying2:You make me feel old.
It did take pretty much the whole day type it with the little tiny keyboard combined with fat fingers, and I still haven't gotten in to texting so we should feel equally old.
It did take pretty much the whole day type it with the little tiny keyboard combined with fat fingers, and I still haven't gotten in to texting so we should feel equally old.
Not that I want you to have to use that keyboard anymore by replying all the time but:
I found texting to be a gift from God. I use it for the simple messages ("Are you still coming?" or "I'll be a little late") and keep actual phone conversations to a minimum. Since doing this, I've been able to switch from the "Unlimited minutes plan" to one that offers plenty of minutes at half the cost (with texting included of course). I more than chopped my phone bill in half.
Hmmmm, I'm so off topic. How to relate this to ND:
Compromised coping R/T excessive phone bills...................yeah, that works. It makes no sense, but neither do the RL ones so..........who cares?
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.
Again, I usually say what I mean. Never said that they were removed, just said that most medical interventions are at the secondary prevention level especially when it comes to screening. Screening tests are done to evaluate potential or obvious signs of disease. Screening does not prevent the disease, it tests for it. Education, immunizations, higher environmental standards, adequate food, shelter, clothing, and water prevent the disease, hence primary.
What 'nursing school definition?' I don't make stuff up when teaching nursing students. It is a Community/Public Health Definition. You can read about it when you read the PM I sent you. Leavell and Clark (1958) and community health primary prevention. This is the original model which has been updated over the years. It is the accepted definition of prevention in community health (not just community nursing).
I will address your points, however.
1. This isn’t a Cleveland Clinic website, it is a US News and Health article talking about the Cleveland Clinic so I don't see it as reliable. But I am unsure of where you are seeing lipid panel as primary prevention.
They say "Prevention" has two meanings when dealing with coronary artery disease. Primary prevention aims at preventing heart and blood vessel disease in individuals who haven't had a heart attack or symptoms of coronary artery disease and have no known clinical evidence of CAD. Secondary prevention is aimed at individuals with known CAD.
The single most essential element in primary prevention centers on a set of measures collectively termed therapeutic lifestyle changes …research shows that making even the smallest lifestyle changes can reduce the risk of coronary artery disease, heart attack, stroke, and other serious cardiovascular conditions.
I just emailed Kate Nagel, MPH the director of the Department of Public Health and
Research (PHR) at the Cleveland Clinic. Met her at a speech she gave and I asked her to further clarify the article.
2. This information is from 1989 and it doesn’t even list an author or a medical journal that it is from. Anyone could have written or maybe I am not able to see as much in my view as you did yours. I was trying to get a medical and or public health definition. Sure, anyone can use 'primary prevention' interchangeably with secondary if they don't refer to the proper definitions. Words are interchanged in health care all the time; ie: RN's and LPNs, PA's and NP's, but there are differences.
"Clinicians should emphasize the primary prevention of
…….Secondary prevention of CAD (screening) by performing..."
This website is talking about reducing risk factors by intervening.
“In many countries, there is enthusiasm for 'healthy heart programmes' that use counselling and educational methods to encourage people to reduce their risks for developing heart disease. These risk factors include high cholesterol, excessive salt intake, high blood pressure, excess weight, a high-fat diet, smoking, diabetes and a sedentary lifestyle.”
Again, maybe I am not seeing something here but it does not talk about lipid panels, it is a study to determine how to reduce risk factors.
I have to admit that I am about done with this thread. I don't like to argue just to be right, in fact I like to learn just as much as I like to discuss. Just ask Ericklson. He wrote a great article that I think he should use as he advances his career. I have learned a lot from him and others. I also come to this blog so I can hear how nurses at the bedside feel about what is valuable to them and what isn't so I can hopefully make changes in my practice and instruction to advance the whole practice of nursing. Many nurses complain about us, but when we are here, it is not always welcoming.
A great deal of people like to complain about nursing instructors, administrators, and the like, and that can be understandable. But I can't just 'let go' of things that some people don't agree with. My students are my first priority, but I also must follow the guidelines of the community, the school, and the NLN. They have standards and expectations about what and how we teach. NANDA is a big part of that vision. IMO, if bedside nurses want to get rid of ND, then they have to come up with the solution. Change always seems to start there.
I have to admit that I am about done with this thread. I don't like to argue just to be right, in fact I like to learn just as much as I like to discuss. Just ask Ericklson. He wrote a great article that I think he should use as he advances his career. I have learned a lot from him and others. I also come to this blog so I can hear how nurses at the bedside feel about what is valuable to them and what isn't so I can hopefully make changes in my practice and instruction to advance the whole practice of nursing. Many nurses complain about us, but when we are here, it is not always welcoming.
A great deal of people like to complain about nursing instructors, administrators, and the like, and that can be understandable. But I can't just 'let go' of things that some people don't agree with. My students are my first priority, but I also must follow the guidelines of the community, the school, and the NLN. They have standards and expectations about what and how we teach. NANDA is a big part of that vision. IMO, if bedside nurses want to get rid of ND, then they have to come up with the solution. Change always seems to start there.
:crying2:Me thinks me made one joke too many.
<_>
>_>
:DSoooooo..................who does everyone think is going to win the World Series?
Eh, N/M...........thats a sad topic too (for me). I'm a Pirates fan.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I have to admit that I am about done with this thread. I don't like to argue just to be right, in fact I like to learn just as much as I like to discuss. Just ask Ericklson. He wrote a great article that I think he should use as he advances his career. I have learned a lot from him and others. I also come to this blog so I can hear how nurses at the bedside feel about what is valuable to them and what isn't so I can hopefully make changes in my practice and instruction to advance the whole practice of nursing. Many nurses complain about us, but when we are here, it is not always welcoming.
I really appreciate all the time you've spent here and I've learned a lot from your input. I think even engaging in the process of thinking outside the linear boundaries of the medical model can lead to solutions that might be a bit unconventional, but work for that patient. I noted that you came across the idea of doing the elimination/reintroduction of foods to help pinpoint your daughter's sensitivities, which is something we used quite a bit within the specialty of allergy- but her symptoms were not textbook allergy symptoms so it could (and sounds like it was) overlooked.
I was struck by another thought reading these posts and specifically addressing the issue of the nursing process becoming something we subconsciously do whether it is written down or not - if you carry that idea a bit further you can be in the realm of intuition which is even less quantifiable but no less real as any nurse who works with the same patient population for years can "just know" things. It feels a bit odd even to me but I'm sure it leads to an "early catch" of a patient going downhill, for example.
I won't go there, though because I do not want to drive "erik" over the edge, at least tonight anyway. Of course, now I know that "erik's" name is not "erik" and he thinks it was pretty funny anyone would think that. Just as it is funny anyone would think TomThumb's name was "Tom".
I really appreciate all the time you've spent here and I've learned a lot from your input. I think even engaging in the process of thinking outside the linear boundaries of the medical model can lead to solutions that might be a bit unconventional, but work for that patient. I noted that you came across the idea of doing the elimination/reintroduction of foods to help pinpoint your daughter's sensitivities, which is something we used quite a bit within the specialty of allergy- but her symptoms were not textbook allergy symptoms so it could (and sounds like it was) overlooked.
I was struck by another thought reading these posts and specifically addressing the issue of the nursing process becoming something we subconsciously do whether it is written down or not - if you carry that idea a bit further you can be in the realm of intuition which is even less quantifiable but no less real as any nurse who works with the same patient population for years can "just know" things. It feels a bit odd even to me but I'm sure it leads to an "early catch" of a patient going downhill, for example.
I won't go there, though because I do not want to drive "erik" over the edge, at least tonight anyway. Of course, now I know that "erik's" name is not "erik" and he thinks it was pretty funny anyone would think that. Just as it is funny anyone would think TomThumb's name was "Tom".
"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."
as i posted long ago, there are, in fact, arenas where it is critical for a nurse to be able to demonstrate expertise to non-nurses. when i go to deposition to defend my life care plan, i will be challenged on whether i am able to do that and on what basis. i have my nurse practice act, which outlines my legal responsibilities, my ana standards and scope of practice (which i recommend to all of you, if you haven't read it already-- email me and i can send you a pdf, or you can get it at any online bookstore), and the nanda book. you don't have to use it the way i d, but i am able to use it the way i do precisely because you do use nursing diagnoses every day in your practice, whether you realize it or not. i would like to have you see that there can be a larger view than is immediately apparent from the bedside (and yes, i have spent many, many, many years bedside, doing exactly what you do, and laboring under the same perspective, so i can relate).
someone else has gone to the trouble to look at how you do it, test it for scientific rigor, and write it up systematically to explain to non-nurses what the nursing process is all about and why. you can be snotty about how you don't need it, but without it, you wouldn't have a leg to stand on, legally and conceptually. that would be a very shaky position for a lot of reasons. big picture, folks.
Stalkers, jokes, conflict, drama. This thread has it all. I laughed, I cried. I was moved in so many ways. Whoever knew that our NANDA could be so exciting? Two thumbs way up from another Pirates fan. They WILL win the series one of these days.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
How'd you know that anyway?
:mad:Are you spying on me?
:DI never had a stalker before. Kinda neat.
You? Me? 10 other nurses and a Foley ----? You forgot??? :bluecry1:sigghhh . .C'est l'amour. . .anyway ---
eriksoln on Jun 23, 2011, 12:04 AM
"I had a light hearted thread in AN Central where I admitted where mine came from. I think I brought it up once after too.
My screen name is a Dungeons&Dragons player I created and had a lot of fun with when I was a teen-ager. How I came up with the name of this Paladin was:
1. I had just watched Karate Kid the night before and couldn't get out of my head how Mr. Miahgi said Danny's name: "Danial-son".
2. A friend of mine, named Erik, had recently broken up a fight that was..........well, unfair............he was protecting the younger/smaller kid from the bully type situation.
So, when I created my Paladin character, I combined the two and came up with Eriksoln. I love it how people are under the impression my first name is Erik lol. Even had someone tell me they thought it was a play on Erikson and his stages."
Anyone who would fail to grasp this simple explanation as opposed to assuming your username of eriksoln means your name is Erik obviously can't cirtical think their way out of a paper bag (or a Ziploc bag). And I thought it was a play on Maslow's Hierarchy of Needs so there. :)
now back to the topic - apologies for ability to stay on topic, impaired.
for anyone who may be thinking this makes no sense it's just some thread crossover from:
:lol2:
:bluecry1:
MunoRN, RN
8,058 Posts
It did take pretty much the whole day type it with the little tiny keyboard combined with fat fingers, and I still haven't gotten in to texting so we should feel equally old.