RISK FOR diagnosis

[RED1984]

My clinical instructor and I are not seeing eye to eye regarding how to write a nursing diagnosis.... I know that she is the one that grades me, and she is the MSN-RN, and I'm just a student....so I should just do as she says; right?

Well, she is my 4th clinical instructor thus far and the only one to say:

(her exact text, i copy/pasted)

"You need to write out the nursing diagnosis in a standardized way. the format should follow as this: related to as evidenced by; risk factors are not the correct way to write a care plan as you have it written here. "

These are my RISK FOR diagnoses: (copy/pasted from care plan)

1. Risk for ineffective tissue perfusion. Risk Factors: ↓BP, ↓saO2%.
2. Risk for falls. Risk Factors: unsteady gait, ↓BP, generalized weakness.
3. Risk for impaired skin integrity. Risk Factors: bed rest, bowel incontinence.
4. Risk for infection. Risk Factors: Indwelling urinary catheter, IV, hospital admission.

I realize that my diagnoses are far from being perfect, BUT is she correct in stating that "Risk for" diagnoses are to be documented "Risk for...... R/T..... AEB....." ??

I use the NANDA International 2012-2014 book as a reference and that is where I learned to list risk factors for the Risk for dx rather than the way she wants it done.

What are your thoughts? I would REALLY appreciate if any nursing instructors could give me a little feedback ? THANKS SO MUCH!!

[RED1984, BSN, RN, EMT-P]

You're right Esme, she is the one grading... But she's WRONG and that's why I'm bringing it up higher in the faculty chain. The coordinator and or director can change the grade if they need to.

I'll stand up for myself because I'm right. When I'm wrong, I'll be the first to admit it as well :)

[MendedHeart]

Pick your battles wisely, they are all on the same side.

[minniprophett]

Risk for diagnoses do not have AEB, hence the "risk for." This means that it can happen, but has NOT happenend, so there will not ever be AEB with a risk for diagnosis. When you write a "risk for" you can have a r/t....risk for electrolyte imbalance r/t insufficient fluid intake. AEB refers to the signs and symptoms (SS) your patient has. If there are SS (AEB) then you cannot have a risk diagnosis because you actually have a nanda - nursing diagnosis.

[Esme12, ASN, BSN, RN]

RED1984 said:

You're right Esme, she is the one grading... But she's WRONG and that's why I'm bringing it up higher in the faculty chain. The coordinator and or director can change the grade if they need to.

I'll stand up for myself because I'm right. When I'm wrong, I'll be the first to admit it as well ?

I get it Red.....but sometimes...in the bigger picture...being right isn't what it is cracked up to be.

I will fight for what is right...I usually do for I loathe inaccuracies...however....being right sometimes has a price.

[Nurse Kyles, BSN, RN]

I would really tread lightly with this one. Personally I would just talk to the instructor about what she wants, and try to do my assignments her way. I really do not think it is wise to try to get your instructor in trouble by going up the faculty chain. It could possibly do you much more harm than good in the long run.

[Esme12, ASN, BSN, RN]

Let us know how it turns out!! I love to hear how things turn out.

[RED1984, BSN, RN, EMT-P]

Quote

Let us know how it turns out!! I love to hear how things turn out.

I will! ?

[LoriRNCM, ADN, ASN, RN]

Esme12 said:

Uhmmmmm.......This is exactly what your instructor said.......I guess you and argue that she wants the related to wording....which is not correct by NANDA.

The correct statement for a NANDA-I nursing diagnosis would be: Risk for _____________ as evidenced by __________________________ (Risk Factors).

It should be......

1. Risk for ineffective tissue perfusion as evidenced by....... Risk Factors: ↓BP, ↓saO2%.
2. Risk for falls as evidenced by........Risk Factors: unsteady gait, ↓BP, generalized weakness.
3. Risk for impaired skin integrity as evidenced by..... Risk Factors: bed rest, bowel incontinence.
4. Risk for infection as evidenced by......Risk Factors: Indwelling urinary catheter, IV, hospital admission.

Interesting. Our school has us do Risk dx without the AEB. Their rationale is "It's a 'Risk' diagnosis, so you have no evidence to use as AEB, because it hasn't happened yet." Hmmmm.......... now I feel in a pickle. I guess I will do it as they say, since they are grading my papers. But very interesting indeed.

[Esme12, ASN, BSN, RN]

I don't know what to think any more....that is right off the NANDA I site....so they don 't follow NANDA. I do know they are changing the wording (hi! Grntea).

Whatever advice I have given here....pls follow your schools requirements. I am not grading your work...((HUGS))

[nurseprnRN, BSN, RN]

lorirn2b said:

Interesting. Our school has us do Risk dx without the AEB. Their rationale is "It's a 'Risk' diagnosis, so you have no evidence to use as AEB, because it hasn't happened yet."

They are completely correct. You have risk factors to identify (and those are listed in your NANDA-I with every "Risk for..." nursing diagnosis), so we don't think you are pulling it out of y, um, the air. But that is different from "as evidenced by..." something you can see, touch, or measure.

[guinte3]

Hello! I saw your comments in another thread about A&P at university of phoenix online. I am thinking about enrolling for that class. Was that class transferable and exactly how hard is it opposed to on campus? Thanks! -Kim

[RED1984, BSN, RN, EMT-P]

It was transferable to the college I completed my ADN at. Was it harder than on campus? I couldn't tell ya I only did it online. I didn't find it very challenging at all, but I also took it over 4 years ago- instructors and syllabi may have changed. It is also a very expensive university- if money is an issue, I'd do it at a community college.