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.
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
That said, if you have a pt. with decreased breath sounds, an x-ray that shows consolidation, and a pt. coughing up purulent sputum; you know, I know and EVERYBODY else knows the pt. has pneumonia.
Tough. You don't get to utter the word until the MD says so. Yeah, it's not always effective, but it is NOT going to change.
*** I work as the night shift rapid response nurse a a medium sized teaching hospital. At night I work with very inexperienced 1st & 2nd year residents. When I get a call from a staff RN to see the patient with the symptoms you mention above I will work them up and if I think it's pneumonia I will say so when I call the physician. In addition I will begin to set up treatment for that disease (start an IV, get tubing and IV pump ready, collect a sputum sample, prepare patient education materials etc) To say we (RNs) can't utter the likely diagnosis is inaccurate. More accurate would be that we can not enter that diagnosis in the medical record.
can you imagine how tedious report would be if we spoke in terms of nursing diagnosis? Oi vey. My pneumonia pts have pneumonia. Their lung sounds are ______, 02 sat______, HR and BP _______ & _______ and labs ________. The end. Short, sweet and to the point.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I don't see how going from specific information and standard nursing interventions to vague descriptions helps someone to "think like a nurse" when there is already a diagnosis made by the physician or why it would be a good idea to produce independent nursing actions based on something called "impaired gas exchange". If all you knew was that how could you produce independent nursing actions and what might they be? How would it change evidence-based interventions derived from the diagnosis that we would already either be doing or know of a recognized intervention for that specific dx that is not part of the care plan and suggest that it could or should be? Without a specific dx how could you do that?
Because not every pneumonia pt. can benefit from "standard nursing interventions". Try getting a CP pt. to use an IS. "Standard", but not really helpful to this pt. You HAVE to be able to think critically, and not rely on the cookbook standards. SO many nurses do NOT have this ability. Hence, nursing diagnosis.
I was thinking of "standard nursing interventions" meaning those diagnosis specific things we do for something like pneumonia vs asthma vs COPD or emphysema that in most cases there will be an order for such as PD and percussion or assisting the patient to a position most effectively to maximize air exchange for reactive airway disease. So I apologize for my inexactitude. :) I wasn't advocating the use of cookbook standards unless it's a protocol in place via policy and procedure.
I agree that if you are doing patient education specific to their diagnosis explaining "impaired gas exchange" rather than a bunch of confusing med-speak it is a good idea! I think I was trying to nail down a scenario where your actions would change based on that one factor (calling something "impaired gas exchange" vs the actual diagnosis) as well as taking a closer look at when doing assessments.
I'm not seeing it so much as a negative as I do see it as possibly unnecessary to the acheivement of the same goals you would have without it. Since everyone's learning styles are different, I'm sure the NANDA approach would be superior for some students.
Since it appears from what people are saying here that they do not use NANDA in their work, could they integrate it better if there were a Clinical Nurse Specialist who knows her NANDAs upside down and inside out could be used as a resource person where he or she would be needed vs a blanket requirement for everybody, everywhere etc. Nurse Nanda! (not really:p)
My reply got stuck in the middle of the last reply due to my lack of critical thinking!
lolPremium membership! I never leave home without it! Apparently I am compelled to fix minutiae I notice or be riddled with anxiety . . . .
From the first moment I learned about nursing diagnoses, right through the 20 years I've been a nurse educator, I have said that these were just another symptom of nurses trying to be little physicians. I totally agree that I don't need a nursing diagnosis to be able to give patient care.
This goes hand-in-hand with the nursing care plan. That was a concept that was developed to teach nursing students how to think about all aspects of nursing care and defend their decisions and care. It wasn't meant to be used in the hospital with RNs who actually knew the knowledge base, but some nursing administrator saw it in use, thought it a good idea, used it, published about it, and . . .
They always seemed to me like a learning tool for students. A total waste of time for working nurses. They make us look like we are trying to make something self-evident sound professional. Dyspnea, impaired gas exchange, WHATEVER. The interventions are the same. Writing a care plan should be a simple collection of well thought out interventions. Skip the stupid nursing DX. I have hated them since the 80s.
This isn't really relevant to nursing dx, but what program are you in doing BSN to DNP? I haven't found one, but would love to know where you are attending so I can look into that program!!
As far as Nsg Dx goes-I agree, it's archaic, but at the same time, it's guiding how we care for patients...I agree with a PP it's primarily an educational tool.
Nursing DXs do not connect porcesses, unless your individual learning method is verbally relational and non-exclusionary. The problem with the Nursing DX is that it assumes utter lack of knowledge or insight. It is a statement of the obvious. 99.9% of the time we will have a working medical DX (from the MD), and the issue is our ability to effectively support our reasons for intervention/tx for the purposes of reimbursement. If we have a DX, we should have established care-pathways.
Really ??????????
What if you don't agree with the Medical diagnosis? Many of you are basically saying docs don't make mistakes.
With a nursing diagnosis, you are able to do interventions on your own regardless of the correct or incorrect medical diagnosis.
Do you really want to depend on the doc for your intervention? You can definitely consider his or her opinion, but I have just as many stories from my years in practice about docs being wrong and nurses figuring out the problem based on their experiences. Treating patients on your own may produce positive results to a non diagnosed problem. Yes, the ND process is long and should be revamped, but...
be careful about giving up our practice to docs who make a diagnosis on a patient they may spend no more than 10 minutes assessing.
Having to use certain verbiage to state your diagnosis is very difficult and too time consuming. There are nursing diagnoses that are tabulated such as the CPT codes. After those there are interventions you can choose from . It's called PNDS language. It is helpful when trying to standardize documentation for the computerized patient record. Still to this day we hold the medical diagnosis over the nursing diagnosis. Even if the patient has an unknown medical problem, general health assessment or hospitalization for evaluation what do you say? Basically you provide comfort measures until the doctor orders certain treatment modalities. What nursing diagnosis do you put for that? Fear and anxiety? Whatever. All they are doing is trying to validate the reason for nurses. Something that will never be able to be quantified.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Really ??????????
What if you don't agree with the Medical diagnosis? Many of you are basically saying docs don't make mistakes.
I don't think NANDA was ever intended as a tool of diagnosis - how can you be sure your nursing dx opinion is correct without the authority to order diagnostic tests? How can you treat it without ordering labwork, prescribing drugs, etc? You would get yourself into some deep waters if you were to either do or not do an intervention based on NANDA if you don't agree with the diagnosis.
With a nursing diagnosis, you are able to do interventions on your own regardless of the correct or incorrect medical diagnosis
.Can you describe a situation where you would let a nursing dx trump the medical diagnosis?
Do you really want to depend on the doc for your intervention?
Yes. There aren't a whole lot of things in the nurse's scope of practice you can do without an order.
You can definitely consider his or her opinion, but I have just as many stories from my years in practice about docs being wrong and nurses figuring out the problem based on their experiences.
You don't need a nursing dx to figure something out based on your experiences. Maybe I misunderstood your intent with this post. If I did I apologize in advance.
Once we have been through nursing school and have a little experience under our belts we KNOW what to do. We are trained. We see someone with a feeding tube and we raise the head of the bed. We see someone immobile and we start a turning schedule. We do these things because we are licensed. Doctors do not have to write out their rationales for everything they order. They just do it because they are professionals as our we. Every time we write the stupid diagnosis it is like we are back in school trying to coach ourselves through a process that we already know. It makes us look inept. We need a new care plan!
Apparently I am compelled to fix minutiae I notice or be riddled with anxiety . . . .
PMFB-RN, RN
5,351 Posts
That said, if you have a pt. with decreased breath sounds, an x-ray that shows consolidation, and a pt. coughing up purulent sputum; you know, I know and EVERYBODY else knows the pt. has pneumonia.
Tough. You don't get to utter the word until the MD says so. Yeah, it's not always effective, but it is NOT going to change.
*** I work as the night shift rapid response nurse a a medium sized teaching hospital. At night I work with very inexperienced 1st & 2nd year residents. When I get a call from a staff RN to see the patient with the symptoms you mention above I will work them up and if I think it's pneumonia I will say so when I call the physician. In addition I will begin to set up treatment for that disease (start an IV, get tubing and IV pump ready, collect a sputum sample, prepare patient education materials etc) To say we (RNs) can't utter the likely diagnosis is inaccurate. More accurate would be that we can not enter that diagnosis in the medical record.