Truth about Nursing diagnosis

kat911 · Oct 8, 2004

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.

I was never an A student and never really strived to be, not very good study habits, I learn better by doing and observing. I agree hands on is where you learn to be a real nurse. There are a lot of "Educated Idiots" out there who are 4.0 but wouldn't know what to do with a patient if you dropped one in thier lap. Compassion, caring and knowing what to do or when to do it doesn't come from a book, it comes from the heart and from an open and inquisitive mind. Doing nursing care plans helps you to learn to think the situatuion through, nursing diagnosis is just the "professional" way to say "problem list" like we used upteen years ago when I was in school. When the nursing diagnosis thing first started someone said it was a way to legitimize nursing. I don't need to be legitimized, I am a Professional Nurse! I don't need fancy ways of saying what a pateints' problems are and I don't need to try to prove myself to doctor's or anyone else. I am respected because I am good at what I do and I don't try to BS anyone. Nursing Dx are BS and have always been BS, they only became a requirement when JACHO insited they be part of the patient care plan. We let our own "nursing leadership" and I use that term loosely, push through this riduculous form of nurse torture. Shame on the NLN, the ANA and NANDA. :angryfire

Whew that felt good, been holding onto that for many years! :imbar

ScarlettRN · Oct 8, 2004

I have been an RN for over 6 years now and the facility I work in presently is the first one that acually makes the nurses write out ND daily. Unfortunately, the ones doing the writing are LPNs and they have to be taught what to put, which seems to defeat the purpose of an RN initiating and the LPN carrying out. I had forgotten most of the NDs until I started here, frankly.

rdb1947 · Oct 20, 2004

Nursing diagnoses.....Ahhh. Nursing diagnoses and care plans have their place, but truely...honestly, they are best for students in nursing in assisting them in their critical thinking skills, organization of care, and case management. The truth about nursing school is "we do it this way, but in THE REAL WORLD" as one of my old instructors used to say is very true. It helps you THINK like a nurse. So, in nursing school (learning the trade), I believe they are necessary. Now, in the real world...many institutions have preprinted (canned) nursing care plans/care paths already available to use where all you have to do is tweek it to individualize the care. Nursing diagnosis or terms of observation regarding a patients identified difficulties are again good for the nursing student...but again, in the real world...I can't say that they are honestly being used in any meaningful way. There is great truth that Nursing as a field has tried to make itself "independent" from the doc. This is also true regarding attempts to separate and further define its role away from other professions, such as social work. Much of this push began in the 1980's (am I dating myself?) when the field was tugging at itself from all sides. For example, there has been pushes in different locales to phase out the LPN/LVN. Fool hearty, but hospitals did release a lot of them in the 1980's because they were not an RN (trying to go to an all RN facility). Many of these hospitals had to rehire back these same LPNs because there were not enough RNs. We all have heard about the back and forth push to have all RNs become BSNs, but this failed too because of the same reason. The push you hear now is encouraging nurses to be advanced practiced (which does imply much more independence if you want to call it that). However, in advanced practice, care remains pretty much "supervised" under the doc. Nursing as a field has always had an identity crisis. So, to make a long story short, Nursing diagnosis has been ONE tool of many to help define who we are. Is it practical in the real world? Probably not.

I have been a Nurse for 35 years and when NDs and care plans came into "fashion", I was scared to death to do them. A Nurse Educator once told me that it was just writing down what I planned to do for my patient as related to each diagnosis. After that, it became simple. For a new graduate they can be an invaluable tool to promote better care for your patient. Also if you are a PRN or Float nurse, they can save your butt when you know nothing about the patient.

JamiRN · Oct 20, 2004

As a nurse who had to write ALL the care plans for a 119bed facility....Care plans have positives and negatives.

The good: when the next person comes on, they know what problems the patient has and what we are currently doing for them. IF they have a better intervention, they can add it to the care plan. It is a way for everyone to see what is working, what isn't and what has been tried.

The bad: They can be SO time consuming that in the REAL world of nursing, they are thrown together half*** and sometimes you don't even have enough time to read the highlights of the pt's problems. What really gets me, is that the higher ups...they seem to focus on the paper work becuase it is something they can read into AND it takes less time for them to criticise a careplan than it would for them to get out of their offices and see what the nursing team is really doing out on the floor. :rolleyes:

jward2006 · Oct 20, 2004

Oh, let me add my 2 cents about nursing care plans! I am a junior in a BSN program. Our school uses the "Roy Adaptation Model". First of all, the so called instructor we had for our nursing model class may have been a wonderful nurse...but she was not cut out to teach a college class. I am still trying to differentiate between focal, contextual and residual stimuli.... :uhoh3: :eek:

AND to the person who mentioned Technical Writing !!!! Please, do I really need to write a memo to start an IV???

That is my only complaint about our BSN program...too many B.S. classes :angryfire

Thank you for letting me vent!

llpn · Oct 20, 2004

I've been a nurse for 20 of my 35 years in medicine. Diagnosing was only an MD's tool. Nurses DO NOT DIAGNOSE.

zenman · Oct 20, 2004

I've been a nurse for 20 of my 35 years in medicine. Diagnosing was only an MD's tool. Nurses DO NOT DIAGNOSE.

That's funny! My brother is an auto mechanic and he makes diagnoses. I make nursing diagnoses as well as diagnoses based on Oriental Medicine when I work with my Zen Shiatsu clients.

judymai · Oct 20, 2004

My wife was told by her ASN instructors that Nursing Diagnoses were intended to provide a way to achieve independent nursing interventions that are independent of MD's. Indeed, she was told that such independent interventions were importent because without them there would be no need for nurses!!
To me this attitude is part of the problem. Nurses should be recognized for what they are, essential members of the health care team who's over all goal should be the best possible patient care. Furthermore, a key role of nurses as a "check and balance" upon physician error is seldom acknowledged. Of course independence from Dr's may be nice, but it shouldn't be achieved via convoluted methods that detract from the primary health care mission.
Can someone give the real "straight dope" on the origins of ND's, their history, purported usefulness ect. Also, what was done before ND's existed (to achieve the objectives that ND's now purport to fill)? Have they done anything to improve patient/client outcomes?

I have the previledge (and headache) of teaching the Nursing Process to first term ADN students. Although we teach nursing diagnosis, most of what I focus on is that the process is more in your head than on paper. Critical thinking and problem solving are so essential to nursinf practice and that is the TRUE nursing process.

As far as the background, before nursing process (and yes, nursing diagnosis) nurses from different parts of the country had difficulty working in new areas. Prior to 1955, a nurse educated in New York learned a "language" much different from those in the Northwest or South. Nursing process gave us a method of communication that could be understood by all.

That being said, the practice has been convoluted and nearly distroyed by NANDA and the powers that be. I do believe that requiring written care plans in nursing school provides a framework for student development. Not only do they develop problem solving skills, but it encourages them to increase critical thinking.

VickyRN, MSN, DNP, RN · Oct 20, 2004

I do believe that requiring written care plans in nursing school provides a framework for student development. Not only do they develop problem solving skills, but it encourages them to increase critical thinking.

I agree that the nursing process and nursing diagnoses provide a much needed framework for initiating and socializing students into our profession. Many people don't know this, but the NANDA diagnoses (along with correlating NIC and NOC) are research-based and tremendously helpful in developing evidence-based practice. And, the nursing process provides a "language" for our profession, something which sets us apart as "nurses."

We are thinking about substituting care plans at our school with mind or concept mapping, while retaining nursing diagnoses and the nursing process.

KLQ727 · Oct 20, 2004

I'll let you all in on a little secret.... you really USE this process in Home Health Nursing and eveloping a plan of care for your patient.

And I agree whole heartedly with the person who wrote that this helps you to develop critical thinking skills!!! An essential qualification for becoming a great nurse in any field.

Go to your local book store or nursing library and find home health related books by Robyn Rice and T.M. Marelli. These women show you how to take a patient's medical diagnosis and develop a nursing plan for their care in the home. With a little adaptation, you can make it work for any nursing environment. They show you how to look at the WHOLE patient, not just the task you are providing such as a dressing change. That's what nursing process is all about. The whole person is affected by, and affects the medical diagnosis.

When you can see the practical application of the process, it helps tremendously in understanding all those texts that are basically written at and for PHd level nurses. Nothing wrong with them, but I struggled with this whole business 30+ years ago, and not until I got into home health and read these other books and used them as my "bible" for years, did I really feel I "got it" completely.

Hope this helps!

lilycole · Oct 20, 2004

I can see th rational behind them, and agree it's a good thing to teach in level 1, but we spend soooo much time on them still any barely get any (if any) instruction in critical clinical skills.

I have been out of school for 2 1/2 years, and have never actually used nursing care plans the way we learned to write them in school. I have, though, used the knowledge I gained from doing care plans to plan care for my patients. Goals and interventions are used to guide care. Rationales are not written in "the real world". I think care plans are used in school to develop critical thinking, which is a very important part of being a nurse. When you are working as a nurse, it will be important that you guide your care and decisions based on the ability to think (to yourself) why you are doing what is best for the patient. To me, this is the same as taking math, algebra, etc in high school. You do need it, although in a different way, in the real world.

mamabear · Oct 20, 2004

I've been an R.N. since 1982. If there were nursing diagnoses around back then, nobody thought them important enough to include in our ASN curriculum, and many of my BSN coworkers don't recall having to use them either. In the early '90s, my employer at the time didn't do much with them, other than buy each unit a spiral-bound book with a list of "Official NANDA-approved" Nursing Diagnoses; we got a good laugh out of them.

In my opinion, they're as big a waste of time as nursing theory and nursing research courses: unless that's your professional speciality, why bother? And please, no flames. :nono: