Hi! Okay please understand I mean NO disrespect...I myself want to be a nurse and am taking prereqs to get into a program!!
I was looking at some of the textbooks used in the nursing program earlier today. One was about care plans, and it had something in it called "nursing diagnosis."
I guess i'm just confused. I was under the impression that staff nurses didn't diagnose, they carried out doctor's orders. I was under the impression that staff nurses needed an understanding of how the body works and the science behind the human body in order to catch any errors the doctor might make and to know when to alert the doctor of a change in patient's condition (I mean, you have to for example know what a normal heart rate should be under xxx conditions to know that it is abnormal to notify the doctor, for example). I was under the impression that a nurse needed a doctor's order to give a patient even tylenol (which I don't agree with at all but was under the impression that's how things went).
I don't mean any disrespect....just trying to clarify what the role of the nursing diagnosis is.
If someone could clarify my thought process or explain it better, I would sincerely appreciate it.
This stuff came about as people in nursing attempted to provide grounds for nursing to be taken seriously and accepted as a profession. The fact that the concept is not taken seriously says a lot more about why nursing is still not fully accepted as a profession.
I'm a student at present. I hate the care plans that we have to do with the silly nursing diagnosis that we have to include. I feel it's the doctors that should diagnose.
You don't. I mean you are always going to use a systematic method to asses your patients, but in the "real" world of nursing a lot of this nursing careplan stuff is NEVER used.
Like many things in nursing -- NANDA was originally a good idea ... but it went wrong in the implementation of it as people tried to take an academic concept and slap it onto real world situations without first going through the necessary translation and adaptation processes.
The "good idea" was to develop standard labels for common nursing problems so that nurses all over the world could use the same lables in the same way to describe the same problems, etc. That core concept is still a good idea. However, things went awry as the core group of people involved developed a system of nomenclature that was more suited for nurse-researchers than it was for direct care givers. Then, nursing leaders tried to force that nomenclature system into the bedside care-giver world without first adapting it so that it would fit that bedside environment.
So ... we have a good nomenclature for researchers being forced into use at the bedside by people doing direct patient care. It just isn't well suited for that and has never worked well. We all need to learn the differences between the needs of research/academia and practice -- and stop trying to force the formats, etc. of one into the other -- and that goes both ways. "Both sides" need to recognize the needs of the other and respect those needs.
It has no purpose...just busy work to educate in school and scrutinize if it's not done on the job. Primarily used to stick in the chart and never be seen again but to be monitored like hell. It's an archaic system likely caused by someone's thesis and has no practical meaning; the name sounds pretentious, as well.
But I do them like anyone else as if I have so much time on my hands.
Pre printed click and stuff in the chart is the best thing that's happened. Most nurses with common sense know to do xyz and it's their practice they're held liable for not some busywork self appointed JCAHO created.
This BS about "patient will..." like it's some machine or forced thing. Scientific-izing I agree is more for research. Soooo outdated but implemented during a time when the profession was grasping at importance and respect; unfortunately we all have to suffer.
I actually like some nursing diagnosis stuff, just wish it had a different name. Some of it is very good - 'constipation r/t chronic high blood sugars and dehydration' 1. Attempt better control of BS thru education and ac&hs bs w/sliding scale/ 2. Encourage 8 0z fluids minimum hourly while awake. 3. encourage more activity if appropriate.
Potential for skin impairment while on bedrest - Turn pt minimum q2hrs. Maintain optimal nutritional status. etc
This should all be part of the care plan. And they are all items we chart on, any way. Do we not track whether or not pt's have moved their bowels? Do we not turn pts and inspect their skin?
Some of it is a bit crazy - impaired religiosity? Was this someone who attend church frequently and wants daily visits by clergy? Impaired walking? VERY important - needs stand-by assistance for every ambulation. Needs bed alarm to alert staff if pt tries to get up per self. Obtain consult for PT to evaluate need for cane/walker.
This is not just malarky - - it's called NURSING CARE.
I think in many cases, the use of more formal and academic terms can actually place distance between caregivers, between members of the team, and between patients. I only use medical lingo when it serves to more quickly communicate with another health care professional.
I don't think the use of nursing diagnoses encourages anyone to respect nurses, just as the use of medical lingo and verbiage does not cause me to respect a physician.
Formalized language and diagnoses are not used in practice, not used for coding purposes to bill for nursing care provided, and I don't encourage my students to use it. What I do instead is to encourage them to see that many issues common to patients result in common interventions by the nurse, but that at the same time, every patient is different. I try to teach them standards of prudent care.
I find that the reason that many new graduates struggle is because far too much time is spent on verbiage and ensuring that care plans fit NANDA than is spent teaching students how to document, how to care for multiple patients and manage their time, and how to act safely in an emergency, things they will be doing on a regular basis in practice. I must say I have encountered some resistance in changing my classes and class activities to reflect what I actually see and do in my own practice, but I do believe it is worth it.
Nursing diagnoses are a great teaching tool. But that's where they should stay.
In the clinical setting, I find them embarrassing to our profession..they are either:
1) written by fruity space cadets, like: "impaired environmental interpretation syndrome" and "disturbed energy field" :dzed:
2) the same as a real (medical) diagnosis, just exorbidantly verbose, such as: "disturbed sensory perception (visual) r/t altered sensory reception, transmission, integration, biochemical embalance aeb deficient sensory acuity, deficient change in usual response to stimuli, sensory distortions, etc. etc." Guess what all this bs says..one word, the patient is: blind! :lol_hitti
There's definitely a place for most medical diagnoses except when a lobbyist pays for ADD then adds ADHD because the drug company gets into hot water for prescribing too much speed to people so they have to invent a new diagnosis to rationalize production and profit (in the old days, they'd tell the kids to run it off). You oughta see the "free" town hall style meetings for add and adhd are funded and docs are paid by the (in this case "legal" drug dealers) that watchdog groups have traced all funding, all forums back to the drug company (can get references if you'd like).
Every time someone gets a higher degree or gets big money from a study it changes from myacardial infarct to something or another cardiac insanity syndrome to....
I see a need for a care plan; should read like a recipe but all this "Patient will..." is nothing more than bovine fec.
It's yet another thing to make the profession weird in medical and the communities eyes. Only nurses understand it, only nurses use it, only self appointed entities enforce it.
Care plans are fine if they can be accessible and updated (not pencil and a paper)...like "this dude decompensates when he's on his right side so turn em left every time you spiff him up" LOL!
Careplans are annoying; however they assist students in a flow chart type of thinking. Identifying problems and fixing them....while not rocket science for us older nurses....maybe something new for a new nurse. They also help in entrenching the many interventions and nursing actions that are part of patient care.
I'd like to think that physicians may diagnose the current illness, but we look at the package. While the many NANDA listings can be goofy and out there, they impact certain areas of patient care and should not be discounted. Additionally, many physicians do not want to know about the whole picture....it would mean having to address mental health....an issue many are not comfortable addressing.
When they say nursing treats the whole person.....I'd agree when nurses are able to spend quality time with patients. Understanding what makes someone tick takes a lot of time....something we are not given when addressing our patients needs.
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mindlor
1,341 Posts
Well one last comment....
I find it embarrassing to watch doctors huddle up and giggle as they go over charts.......
Its sad....