nursing diagnosis

[jax]

Just curious as to what happened to nursing diagnosis?

They were the bane of my student nurses life. It always seemed like an exercise in word play more than any thing else.

One day the hospitals were using them, the next they were gone.

Can any-one remember that long ago to tell me why they went? Or if indeed they are still being used?

thanks

[gwenith, BSN, RN]

Supplanted by Care pathways (supposedly).

[jax]

thanks gwenith - it was one of those questions that has been floating around the back of my mind for quite some time.

[gwenith, BSN, RN]

I think the nursing diagnosis is more alive and well in the US than here - it is one of those tools which is great for educators but falls down in practicality.

We tend to be more job focused - but don't start me on the short comings of the whole ND or you will never shut me up!!!

I just always had a problem with the linear cause and effect premise underlying it.

[catcolalex]

im a nurse so dont get me wrong, but my opinion about nursing diagnosis is that it is a creation by a bunch of old ladies sitting in an office trying to figure out how to make nursing look more important. all the nursing diagnoses seem to be common sense to me. does it really make anyone feel better about themselves as a nurse that they can "diagnose" someone as constipated?

[indigo]

I'm an ADN-bound nurse just getting ready to start my final year of school. The whole concept of nursing diagnoses was completely new to me when I started. This system has been very useful to me as a student, and I believe that it will be also when I begin my career as a nurse. It gives me a framework to help me identify the needs of my patient; nursing diagnoses also define the concerns of a nurse. This system carves out our territory.

Years from now when I am experienced I will probably never think about nursing diagnoses. But for the newer nurse, I think it's a great system. BTW, I think "constipation" is an important nursing diagnosis. There are also some very interesting nursing diagnoses, such as "energy field disturbance." This is laughable, but on another level it really isn't. If you think about your patient holistically, this diagnosis may have some validity.

Don't get me wrong -- I HATE writing care plans and coming up with nursing diagnoses. But I do think this system serves a purpose.

[gwenith, BSN, RN]

Okay now you have me started!!!

I do think that it was a process that we had to go through to help us identify "our job" but I think that in reality it has NOT helped us to do so.

The underlying premise of assisting with formation of critical thinking is debatable - especially if veiwed from the point of educational psychology, it is premised upon a linear cause and effect which is not ameniable to all problems and it is clumsy and time consuming!!

There I have had my say and I feel better!!!

I do like pathways - not for everyone and at present they are still clumsy but if used properly they focus more on team intervention, they set the nurse back in the position of primary co-ordinator of patient care as was always our position. They outline a clear route from initial insult to recovery and can be used as a teaching tool. Many patients who are given the patient pathways are also more inclined to accept the care given as they have more realistic expectations of what should be done. Downside is that they are more usefull for high volume high turnover "routine care" patients. They are difficult to individualise and they are often way too long.

[leslie :-D]

and that is the major downside is that they rubberstamp an entire group and does not allow for variables or comorbidities. but if these kinks could be ironed out, pathways are clearly the way to go.

[Farkinott, RN]

Gwenith I agree with what you are saying........................

In regard to nursing diagnoses, I believe they are a crock of the proverbial.

Eg. "anxiety related to inability to breathe due to cigarette smoking = COAD"

This might be a bit rudimentary but from the exposure I have had in regard to nursing diagnoses it just seems like one more thing to complicate the process!

Ultimately i think nursing diagnoses were an attempt to legitimise nursing as a profession. In reality all they did is confuse the issue.

If we see the client as the central person interacting with all health streams then it would be foolish to create an additional "barrier" to the client's care by endorsing a so called nursing diagnosis.

Academic gobbledegook should be assessed and acted upon promptly. I am certain that nursing diagnoses fall into the category of gobbledegook.

I would welcome any opposing points of view (in the australian context) cos who knows?...........I may be wrong!

[gwenith, BSN, RN]

Even the "process" itself is open to contention i.e. Assessment, planning,implementation, evaluation - fine as a theory BUT does NOT address an evaluation/re-evaluation cycle - I do believe that a lot of "assessment" within the hospital context should be continuous evaluation. Good practice predicates a contiuous assessment re-evluation process.

e.g. MI pt admitted - still wanting to smoke - nurse A speaks to the patient about the adverse effects of smoking - outcome pt kicks off for a quick ciggie evaluation - maintains non-compliance - nurse b outlines strategies for successfully quitting - result patient nicks off for 2 cigarettes - re-evaluation - continued non-compliance nurse c speaks to family in attempt to create a peer support/pressure - outcome patient stays outside smoking during visiting hours - re-evaluation still ruddy well non-compliant nurse D decides what the heck and leaves the patient to decide upon and follow his own chosen path in life.

[Farkinott, RN]

Even the "process" itself is open to contention i.e. Assessment, planning,implementation, evaluation - fine as a theory BUT does NOT address an evaluation/re-evaluation cycle - I do believe that a lot of "assessment" within the hospital context should be continuous evaluation. Good practice predicates a contiuous assessment re-evluation process.

e.g. MI pt admitted - still wanting to smoke - nurse A speaks to the patient about the adverse effects of smoking - outcome pt kicks off for a quick ciggie evaluation - maintains non-compliance - nurse b outlines strategies for successfully quitting - result patient nicks off for 2 cigarettes - re-evaluation - continued non-compliance nurse c speaks to family in attempt to create a peer support/pressure - outcome patient stays outside smoking during visiting hours - re-evaluation still ruddy well non-compliant nurse D decides what the heck and leaves the patient to decide upon and follow his own chosen path in life.

I'm with you Gwenith. There is no point in wasting your breath on dodgy clients! Do what you can when you can and leave it at that. :)