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.
I agree it is a cumbersome system. And really, saying 1) "Impaired gas exchange related to effects of alveolar-capillary membrane changes" is just a description of 2) pneumonia! We can't diagnose either one, but we can certainly assess a patient and plan interventions, no matter what his diagnosis is called:uhoh3:!
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I thought that cow should be shot 18 years ago when i graduated.
I'm thinking it will be ignored to death like the 55mph speed limit, with those who don't realize what is happening in the real world of nursing. It began as something that was supposed to gain wide acceptance and fill nurses with joy that at last they can do something just like the doctors do. The student learning aid was not the original emphasis - but a fallback position - with no proof whatsoever (other than anecdotal) makes what is taught in NS any clearer. To me that is counter-intuitive in fact and "what is really going on with the patient" will be discerned with far more accuracy with the particulars of what is causing "impaired gas exchange". Sounds more like a way to teach 8th graders from a book called "Meet Your Lungs"
When the students revolt - not sure where you go after that. I've always found amusement in the "because we said so" bottom line when reality backs them into a corner with NANDA but for everything else "keep doing something that isn't working" would be a ridiculous argument to make.
What we (nurses and doctors) need to do is all train together from the start. That way we all learn the same language, and learn how to get along and work as a team.
When I saw Disturbed Energy Fields and Therapeutic Touch in that NANDA book, I immediately dismissed the entire thing as absolute nonsense.
I did the care plans and got good scores on them, but if they are going to put mumbo jumbo like that in their book they deserve every bit of criticism they get.
Twenty years ago when I graduated from school I worked in a place that used care plans effectively. There was a section of the kardex where we penciled them in. They looked something like this:
Activities: Monitor ABG and electrolyte levels, as available, Use a calm, reassuring approach, Encourage use of incentive spirometry, as appropriate, Encourage coughing to clear secretions, Isolate persons exposed to communicable disease, Place on designated isolation precautions, as appropriate, Administer IV fluids as ordered, Administer IV medications as ordered.
Every acute patient has to have at least one of these written by the nurse. And yes, I can bang out one of these in only about 15 minutes. I might even do two. Is it more complete? Possibly. More usable? You be the judge. Even though we do create them, it usually just seems like so much busywork. There's got to be a better way to communicate with each other what problem the patient has and what we are doing about it.
Specializes in Spinal Cord injuries, Emergency+EMS.
I was typing a long post about this very thing. Those allied healthcare professionals (such as PT/OT) receive a physician's order to initiate their services, not a nurse's order. I have yet to hear of a PT or OT initiate care to a patient based solely on an order from a Nurse. I would actually expect that such an order would be effectively ignored as an invalid order. If I were a PT or an OT, I wouldn't put my own License at risk...
This sums it all up, while Health professionals in the USA are concerned with 'orders' and 'billing' being the driver for who can do what and when then the system will continue to be creaking and disjointed, the fluffy, iffy and none specific language of NANDA doesn't help ,as for those saying what would a care plan look like without NANDA .... how about the care plans that RNs in the rest of the English speaking world write.
As a further example of just how 'inferior' the NHS is the only 'order' or 'request' that mandates a Doctors signature is a referral to another Medical team, every other order or request in the system just requires that an appropriately skilled practitioner completes it .
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
As a further example of just how 'inferior' the NHS is the only 'order' or 'request' that mandates a Doctors signature is a referral to another Medical team, every other order or request in the system just requires that an appropriately skilled practitioner completes it .
*** I see you described the NHS as "inferior" and in the past have seen you describe the NHS as "evil". Above you put ' ' Marks around the word rather than quotation marks. What does this mean? Why do you consistently describe the NHS with such words when the rest of your message seems to indicate that you do not feel the NHS is evil or inferior.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
This sums it all up, while Health professionals in the USA are concerned with 'orders' and 'billing' being the driver for who can do what and when then the system will continue to be creaking and disjointed, the fluffy, iffy and none specific language of NANDA doesn't help ,as for those saying what would a care plan look like without NANDA .... how about the care plans that RNs in the rest of the English speaking world write.
The only people at present who may have billing as the "driver" are NPs and other Advance Practice nurses. What do you do there to initiate treatment if not through a doctor's order? I would love it if an order would be delivered with a "pretty please" especially for the most arrogant S0Bs but sighhhh . won't happen.
As a further example of just how 'inferior' the NHS is the only 'order' or 'request' that mandates a Doctors signature is a referral to another Medical team, every other order or request in the system just requires that an appropriately skilled practitioner completes it.
That sounds like a recipe for chaos.
eliseinalaska - I'm familiar with the Kardex and pencil written entries - they worked great and were always up to date from us wielding the mighty eraser. Feels like heresy to even type that.
You know there are alot of things that were created to validate someone's job. Kardex's are great for day to day changes and for reporting. They are doing the same thing now with print off's. It's amazing how even though different, each nurse creates their own way of making patient care documentation easier. Print out's report sheets, etc. That should be a red flag to administrators. If you are creating short cuts, then the process is not working. The decision makers force work-arounds because they cannot speak effectively to the process and in my opinion are fearful of creating something that actually works, might be less of a need for their position? Lots of theories out there. The irony of this whole thing, is if you let the people who actually perform the care, design the process that works for their patient population and logistics then the administrators or managers would actually be free to do what they are supposed to do and would lessen their stress. It's getting over the perception of their own inferiority or discomfort of doing something that they are unfamiliar with that is the biggest roadblock. There are so many things administrators could do better- honing interviewing skills, working on budgets, grooming staff for promotions/career advancement, staffing properly, acknowledging good work, boosting morale, streamlining products, repairing units, ensuring proper staff educational needs, networking with other managers/peers to have good working relationships interdepartmentally. Wow isn't that a start?
Specializes in Infectious Disease, Neuro, Research.
To respond to the billing issue- it is not something we do(outside of possibly HH) but what the facility does to validate our salaries. The NANDA-variation checksheets/screens "validate" paying the RN. What are you doing/what are you treating/etc.. We need the equivalent of ICD codes offering treatment modalities and pathways that may be billed w/o using extravagant POC testing fees and bundled "office visits".
NANDA has been co-opted for this, and from the MBA standpoint it works well. Since nurses have no validated fee schedule, it is easy to tell employees what they are worth, with little option for verifiable cost-anlysis. We free-float in a purely subjective marketplace.
Wow this is kind of BS. They give you a wage based on level of experience. You can negotiate your wage but if you do you top out on the payscale. If you work in a specialty area and have multiple skill sets, you should get a great deal more money based on what you do and the acuity levels. But guess what, you don't because we don't want to be unfair. You get a little more money in specialty areas, but what if we billed like doctor's. Venipuncture, IV start, medication calculations, lab interpretation, constructing nursing diagnosis, and ,making sure you have all the right ones documented so you can get more re-imbursement (like home health), initial and on-going patient assessment, etc, etc, etc. Face it they start at a wage and give a few bucks for years in the profession. What if your certified, you still may not get reimbursed for that or degree. But we digress, this is not about billing, this is about the language of the nursing diagnosis and what good it is for and if it should be retired or overhauled or simplified.
Specializes in Spinal Cord injuries, Emergency+EMS.
*** I see you described the NHS as "inferior" and in the past have seen you describe the NHS as "evil". Above you put ' ' Marks around the word rather than quotation marks. What does this mean? Why do you consistently describe the NHS with such words when the rest of your message seems to indicate that you do not feel the NHS is evil or inferior.
I don't get it. Please explain.
*throws PMFB-RN a rope to pull them out the Sarchasm*
there are so many people on AN - reflecting the view of the USAn population who have swallowed the right wing propaganda who are so convinced of the superiority of the US (un)System it has become a staple of Satire aobut how 'inferior' and 'evil' the NHS is despite the evidence contrary...
Nursecathy123ca
99 Posts
I agree it is a cumbersome system. And really, saying 1) "Impaired gas exchange related to effects of alveolar-capillary membrane changes" is just a description of 2) pneumonia! We can't diagnose either one, but we can certainly assess a patient and plan interventions, no matter what his diagnosis is called:uhoh3:!