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.
*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...
*** Ah, satire. Ok. I don't happen to personally know anyone who believes the US health care "system" is superior to the national systems in places like GB and Canada. All of my friends and people I know who I have discussed the issue with would very much like to see American follow Great Britain's lead in health care.
My experience with a national health care system as a patient and the father of a patient in New Zealand was excellent. When I found they (the Kiwis) pay less in taxes than Americans do (I have dual citizenship) and receive such great health care at such low prices I am jealous. My son had a three day hospital stay in a Christ Church Hospital, received excellent nursing care and had two fantastic physicians, a pediatrician and an ENT caring for him and the bill was $34 USD. That was mostly for the food they served me as I was staying with him.
I hope you understand that there are huge differences in the opinions in America about the various health systems. Enough so that in my daily life I do not (knowingly) encounter anyone who believes the NHS is anything but a model for the USA. I would have to turn on the TV to Faux News to find the opinions you are making satire out of.
Still wondering about your use of ' ' marks rather than " ".
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I have heard both good and bad about both systems. Neither deserves denigration just improvement which will be forever ongoing.
Yeah. I see very little adversarial behavior here regarding the comparison of any two systems as both have advantages and drawbacks. I guess Zippy overestimated the prominence the NHS holds in our discussion - especially since single party payer arguments go nowhere - I'm sure if the President believed we could make that radical a transition he would've done it. Or at least try to power through the opponents by hitting the road to promote it as other pres's have done in the past.
Zippy your view that a "right wing propaganda" stands against one unified group of dissenters is just wrong. It's extremely complex with various factions hooking up and moving along in a more kaleidoscopic pattern of numerous factions not neatly defined as your guys and our guys (and gals pheww!)
I've never had an uncivil exchange here when discussing health systems with nurses who are from other countries. -they are all very fruitful and interesting as well.
*** Ah, satire. Ok. I don't happen to personally know anyone who believes the US health care "system" is superior to the national systems in places like GB and Canada. All of my friends and people I know who I have discussed the issue with would very much like to see American follow Great Britain's lead in health care.
My experience with a national health care system as a patient and the father of a patient in New Zealand was excellent. When I found they (the Kiwis) pay less in taxes than Americans do (I have dual citizenship) and receive such great health care at such low prices I am jealous. My son had a three day hospital stay in a Christ Church Hospital, received excellent nursing care and had two fantastic physicians, a pediatrician and an ENT caring for him and the bill was $34 USD. That was mostly for the food they served me as I was staying with him.
I hope you understand that there are huge differences in the opinions in America about the various health systems. Enough so that in my daily life I do not (knowingly) encounter anyone who believes the NHS is anything but a model for the USA. I would have to turn on the TV to Faux News to find the opinions you are making satire out of.
Still wondering about your use of ' ' marks rather than "".
As far as I know, this is just a style difference, both mean the same thing and both are correct as long as you use the same one at each end of the quoted bit. I tend to use single quotation marks too, I like the way it looks, and it's easier as you don't need the shift key!
Specializes in burn ICU, SICU, ER, Trauma Rapid Response.
As far as I know, this is just a style difference, both mean the same thing and both are correct as long as you use the same one at each end of the quoted bit. I tend to use single quotation marks too, I like the way it looks, and it's easier as you don't need the shift key!
*** Ah thanks. I have not seen them used that way.
"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.
So sad and so funny! I am with you 100% on this. I honestly haven't had a single thought about nursing diagnoses since I graduated from school 10 years ago, much less had occasion to actually use one. For heaven's sake, if I charted something like the above "diagnosis" I can't even imagine the eye rolls and snickers from all who read it!
They are still used in LTC and in Home Health. As an instructor, I was just having this same discussion with my class today. When I went to school and started nursing, there was no such thing as a nursing diagnosis. When I started a job in 2001 that used them I was lost for a long tim, trying to figure out why the heck we were doing it. Well, it's partly for reimbursement. And for being able to treat the patient in a holistic manner. The nursing diagnoses is supposed to cover the WHOLE patient, just as our care does. In the "olden days" we all went to work and did our best nursing care based on the doctor's diagnosis for that patient. But we were leaving out some imporatant areas of need. Plus that - your idea of best nursing care may have been different than the nurse on the next shift. So there was no continuity.
In the LTCF's, Te care plan is the "Bible" for the care of the residents. But I do agree that we should be able to tone down those nursing diagnoses somewhat - sometimes it's like grasping at straws to find things to use!
I work in LTC and have never used the traditional, convoluted nursing diagnosis in any care planning. The problem part of the care plan can be clearly stated without using either a medical diagnosis or a ridiculously worded nursing diagnosis. I fail to see how the flowery language we were required to use in school helped the critical thinking process.
I think this discussion is affecting my energy field!
Oh we do bear a terrible burden in trying to prove ourselves useful and important. So sad. It should be self evident that we are needed and important. We would be more so if we were not so tied to writing useless verbose care plans that say what could be said in a few short words. I too long for the old days of the Kardex. Paperwork has taken away what joy there was in nursing, the time spent with the patient.
I love the description of the wordiness as "hypnotic". Hilarious!!!!
I agree with one poster who said perhaps health care programs of nursing and medicine should start out together in school, for better mutual understanding. I don't know that this would be a cure though, because LPNs and RNs often start out together, with LPNs branching off after the first year. Still we have conflict between the two and turf wars. I think it is just the American way. We are not exactly a society known for cooperation, but more of a society of individualists. Wrong or right, it is our culture.
Specializes in Infectious Disease, Neuro, Research.
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.
Ah, but money is the motivator. If we cannot "sell" the inadequacy of the RNDX on a cost-containment/revenue generating basis, it will never happen. Or, if the use of an RNDX kills a President- that could possibly be an impetus for change, but I'm still doubtful.
But to answer your optional model- I vote "retire". It is repetitious and time consuming, and increases overhead and liability. (Be honest, check boxes are check boxes, it decreases personal responsibility by retarding the individual assessment process.)
Specializes in Infectious Disease, Neuro, Research.
We are not exactly a society known for cooperation, but more of a society of individualists. Wrong or right, it is our culture.
Historically, we are well known for what is accomplished by cooperation- and competition. Our greatest individualists have expressed their individuality by dedication to the society. The creedo of "tolerance", allowing overbearing expression of tribal identity (vs. cultural identity, e.g., subculture-culture) rather than identification with the primary culture is what is dissolving us- as it did with Rome and China.
Cooperation only in time of need, such as disasters. In general we are a very self-serving society- the "what's in it for me?" model. That of course is human nature. It is only cultural values that mold and shape behavior. Look at our public figures? Drugs, scandal. Self-serving selfish behavior. Not "How can I help the people? How can I make a difference in the world?" Oh I think American society has slipped quite low for many reasons. Lack of family unity, lack of parental involvement, economic woes that force parents to work all the time with long hours, long commutes, little energy left for kids, abusive employers, just a general fragmentation of society. There are worse societies out there, but we could certainly use improvement. Still, I am free to say these things which makes me glad to be an American.
Our health care system reflects these same issues. Selfishness, fraud and abuse. Uncontrolled lawsuits. People always looking for a way to make a buck out of suffering. The for-profit model does not belong in health care. It makes things worse, and is dragging us ever downward.
:lol2:
If we cannot "sell" the inadequacy of the RNDX on a cost-containment/revenue generating basis, it will never happen. Or, if the use of an RNDX kills a President- that could possibly be an impetus for change, but I'm still doubtful.
cdsga
391 Posts
I have heard both good and bad about both systems. Neither deserves denigration just improvement which will be forever ongoing.