Truth about Nursing diagnosis

rollingstone · Oct 7, 2004

Dixielee said:

Nursing diagnosis is one of the silliest things I have seen come down the pike. They were invented by nurses who had worked themselves "up the ladder" so far, they had nothing to do but invent more work for those of us who are taking care of patients. They must justify their own jobs by creating paperwork for caregivers. These are the folks that usually end up being JCAHO surveyers!
In other words, they are completely useless. :rotfl:

My sentiments exactly.

directcare4me · Oct 7, 2004

Dixielee said:

Nursing diagnosis is one of the silliest things I have seen come down the pike. They were invented by nurses who had worked themselves "up the ladder" so far, they had nothing to do but invent more work for those of us who are taking care of patients. They must justify their own jobs by creating paperwork for caregivers. These are the folks that usually end up being JCAHO surveyers!
In other words, they are completely useless. :rotfl:

Amen, and I say again, amen!

directcare4me · Oct 7, 2004

I have thought for a long time now that nursing as a profession has a big insecurity problem and like someone else said, an identity crisis. Not happy to be doing the hands-on actual care of patients, as if that is beneath us as "professionals", they want to make up a lot of theory to go along with "hands-on" care. I heartily believe that nurses must have a strong theoretical background in anatomy, physiology, psychology, microbiology, some pharmacology--I'm sure I've left something out--and must use this knowledge every day in delivering safe and effective care to ill people. But all this other busy-work stuff is just to make themselves "feel" like a professional, I guess. It allows them to carry a briefcase for all those papers, instead of a stethoscope.

I feel like a professional at what I do every day. I don't need a lot of paper work stuff in order to feel that way. I take care of patients, sick people. My critical thinking is good, and I understand the mechanisms of what I'm doing, and what to look for. If they didn't have all this paper stuff to create and expand upon and do research on, they wouldn't have anything to do, because I don't believe they want to do patient care.

Farkinott, RN · Oct 7, 2004

I would just like to add that nursing diagnosis is a crock in this country too! It's created by academics with far tooo much time on their hands!

purplemania, BSN, RN · Oct 7, 2004

as an experienced nurse I have worked in only two hospitals. Both use nursing diagnoses in abbreviated versions. I believe the idea while you are in school is to train you in the nursing process. You will need to practice over and over and over until you are able to process information, from assessment to intervention and evaluation, in a systematic manner. If you cannot verbalize a diagnosis you cannot apply the information from your assessment and you cannot intervene appropriately. Nursing is much more than tasks. Think of these assignments as exercises, just like football players run and pianists do finger exercises. The exercise is not "the real thing" but prepares you for the "real thing". Good luck in school.

2rntish · Oct 7, 2004

The last care plan I did in school was 24 pages. My best friend and I choose our patients. They were identical, same diagnosis (CHF), same Dr, same meds...I suggested he do the first half, I would do the last half...we would swap and have a complete Care Plan.

We did it and turned them in. Identical Care Plans to two different instructors. He got a 96, I got a 74.

The worst part of it was I couldn't complain because they would know we cheated.

And the last JCAHO nurse surveyor I talked to agreed that nursing diagnosis/Care Plans made no sense to him.

Roland · Oct 7, 2004

This one is even better. I know a person who got mostly A's, and her paperwork was always top notch. She was in class with another person who had recently immigrated from Africa, and spoke English as a second language (but was still a really good student). Unfortunately, the clinical instructor didn't "like" the paperwork of the recent, immigrant student because the writing wasn't sufficiently "smooth". So to get her friend through school the "fist" person actually wrote some care plans ect. for the girl from Africa. Guess what.. the instructor STILL didn't like the paperwork (written by the American "A" student) and gave a low grade.

The point is that the process is quite subjective. On the up side it seems as if most nursing programs make you do care plans, and ND's in the clinical part of the program which is usually pass/fail rather than assigning a specific grade.

IMustBeCrazy · Oct 7, 2004

Yes, I agree that the NANDA list is in TEXTBOOKS (which we spend considerable $$ on). That is not the problem.

The bigger problem is implementing them correctly since a list in a textbook or dictionary does not teach you when and how to properly use the diagnoses, understand what I mean?

And the bigger issue is that the 'guru' of Nursing Diagnoses, Carpenito, can't seem to explain it in a way that someone without 10 years of nursing experience can sufficiently understand. That was my point.

I don't have a problem doing a process/procedure/paper on anything if it is explained sufficiently. But it seems every text I have read that tries to 'explain' this material is so user-unfriendly that most people come away shaking their heads. I learn more from the nurses I work with than this mumbo jumbo.

BadBird, BSN, RN · Oct 7, 2004

Nursing care plans are for JACHO inspections, I see no purpose in them, just a waste of time. During school it helps a student learn but once out in the working field it is just another nuisance created by someone to justify their own salary.

Indy, LPN, LVN · Oct 7, 2004

I've got a copy of Carpenito's sitting here on my shelf, that someone lent me for my 2nd year. Last year I bought a copy of Ackley and Ladwig's Nursing Diagnosis Handbook. I read about the first 1/3 of Carpenito but used Ackley and Ladwig in all my care plans so far.

Comparison: Carpenito does a good job of explaining what the dx's are, and why the whole ND system exists. Beyond that, it makes absolutely no sense whatsoever to me. Ackley and Ladwig's book has one flaw: it lacks a list solely of the diagnoses by themself, in oh... alphabetical order would be nice. Instead, you look up the condition and find a listing of possible diagnoses listed under it. I like their system, they are clear and concise. I think Carpenito spends too much time trying to define who fits a diagnosis, where Ackley and Ladwig have a very thorough listing of the interventions, each intervention has a rationale.

I have had no problem using this book so far; when I know I'm getting my care plan patient I go to the book the day before and list the dx's they are likely to have based on the info I got out of the chart... then list possible interventions and try to include things that did not seem obvious to me. That way when I'm there, maybe I'll remember some things to do that make me look like I have a clue. :rolleyes:

Honestly, other than training in critical thinking, ND's can put me to sleep faster than reading a phone book.

-Indy

HyperRNRachel · Oct 8, 2004

Roland said:

This one is even better. I know a person who got mostly A's, and her paperwork was always top notch. She was in class with another person who had recently immigrated from Africa, and spoke English as a second language (but was still a really good student). Unfortunately, the clinical instructor didn't "like" the paperwork of the recent, immigrant student because the writing wasn't sufficiently "smooth". So to get her friend through school the "fist" person actually wrote some care plans ect. for the girl from Africa. Guess what.. the instructor STILL didn't like the paperwork (written by the American "A" student) and gave a low grade.
The point is that the process is quite subjective. On the up side it seems as if most nursing programs make you do care plans, and ND's in the clinical part of the program which is usually pass/fail rather than assigning a specific grade.

Amen! I just finished 8 weeks of my second medical surgical rotation. The hosital was wonderful, the nurses were as helpful as they could be, and I learned a great deal about patient care. BUT today I learned I only earned an 89 in the class because, as my clinical instructor said, "I know you can do better work on your care plans!" Crap, isn't nursing, the actual hands on interaction with a real live patient more important than the fact that my client goal was too wordy, or not wordy enough??? The last 8 weeks the clinical instructor loved my client goals. The grading is so, so, so, subjective.

There were students not doing a dang thing, no patient interaction, no critical thinking, no running around trying to see and do every skill possible, yet they can write (or copy) a care plan so they deserve a higher grade????

O.K. I am finished blowing off steam. Onward and upward.

nadia562002 · Oct 8, 2004

I hate nursing diagnosis. THe outcomes and goals in those books are just plain stupid and down right lofty. It seems to me that these statements are rather judgemental and or reaching to make more work for the nurse. But I must admit that after all is said and done, these nursing diagnosis serve a purpose in the real world aside from the outright pain they inflict on the nursing student.