Truth about Nursing diagnosis

candicane · Oct 20, 2004

The facility I work at just changed how we do care plans due to being cited for each pt only having one care plan for the primary diagnosis. Now they are all on a computerized flow chart, you go down to whatever your nursing diagnosis is and click on it then you can put your goal, if you are the one starting that plan or whatever interventions you have done. Not only that there is supposed to be a nursing diagnosis for every problem the pt has, even if that is a chronic problem that has nothing to do with their admission. For example a pt having joint replacement surgery would have: Acute Pain, Risk for infection, Impaired physical mobility, knowledge defecit, impaired tissue perfusion (DVT), if they have O2 and a cath, inneffective breathing patterns, or inneffective airway clearance and urinary elimination impaired. This is just for the surgery if they have a hx of anything else add all those too. Then once a day a careplan summary is to be written to let the rest of the shifts know what has been happening and what needs to be done. Of course most of this stuff is in our regular flowchart so we do a lot of doublecharting. If you chart something on the flowchart like a pain assessment you have to go into the careplan chart and put see flowchart: pain. As you can imagine this new system is very time consuming because we are supposed to look into their health history for anything that might need a care plan.

beckabeckahi · Oct 20, 2004

We were told to purchase a textbook by Lynda Juall Carpenito, who is supposedly the best of the pack in this area. Biggest waste of money EVER on any textbook. I agree with Dixielee, it's very evident that the people that came up with this so-called system really weren't about having people easily USE it, seems like more of a liner note on their curriculum vitae.

Yup, the Carpenito is pretty much USELESS!! Then of course there was the psych care plan book we were required to buy which I haven't even used during my psych rotation.

Care plan books with Rationales listed after EACH intervention are the best--you can even them with whole care plans for a specific medical dx. They saved me a bunch of time after struggling a few times with that Carpenito book.

j0414665 · Oct 20, 2004

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 instructor was so excited when someone showed her how to generate computerized nursing diagnosis. you said it right Dixielee:uhoh3:

leslie :-D · Oct 20, 2004

even though i would hate to use them qd in work, i think they are one of the most useful tools you'll ever learn in school.

they teach you to assess the problem, what interventions will be used and their outcomes.

it teaches the student nurse on what needs to be done for their pt. in priority order.

leslie

madore57 · Oct 20, 2004

I've had to use Nursing Care Plans in every ICU I've worked in since they shoved them down our throats in 1983. As I recall their rationale for NCP were to prove that we were working independently. In the real world, most of them are pre-printed. I do sit at the computer during some part of the shift - usually after the shift - and update the stupid things.

Part of me hates them because most Nurses ignore them. They are also time consuming and increase the amount of charting we have to do. The Nurses who SHOULD be reading and following the NCP are the ones who have never, ever looked at one. Ok, for the most part - I hate them. I've always included goals and outcomes in my Nurses notes anyway - even before NCP came along.

I was also told that another reason for having NCP was the same reason as having only BSN (preferably BSCN OR MSN) Nurses caring for patients at the bedside - to prove we are professional, have our own language and terminology and therefore deserve our salaries.

Whatever...

Eilleen.

Havin' A Party!, ASN, RN · Oct 20, 2004

... After 5 minutes, my eyes glazed over and I fell asleep. Guess I will go watch TV!... Glad I am not going thru that again! Next time I take a class it will be on quilting, pottery, gardening.....

Hahahahahaha!

vanadium71 · Oct 20, 2004

I just had clinical today and I had to do an assessment and use the 3 part nursing diagnosis. I really don't think in the real world that they do this lengthy of an assessment. There isn't possibly enough time for it.

leslie :-D · Oct 21, 2004

I just had clinical today and I had to do an assessment and use the 3 part nursing diagnosis. I really don't think in the real world that they do this lengthy of an assessment. There isn't possibly enough time
for it.

no vanadium, they aren't as lengthy in the real nsg world.

but it puts you in automatic pilot for when you do become a nurse.

assessment, intervention, plan- bing bing bing.

it will just come naturally after all this mundane work you're doing now.

leslie

roxannekkb · Oct 21, 2004

I'm a student and I was just wondering how much you actually use written 3-part nursing diagnoses and pt goals and nursing interventions and evaluations in the real world. Our program seems to stress them a lot more than what I've actually seen them used in clinicals. Thanks.

You will find out that you will have to forget most of what nursing school teaches you, if you hope to function in the real world of healthcare. That is, unless you plan to spend your entire career in academia, which is the only place you will need nursing diagnosis and goals.

When I first started school, an instructor was giving one of our first lectures on goals. She said that a nurse begins her day by asking her client what goals he or she would like to work on that day. I rolled my eyes, and told the instructor that if I were a patient in the hospital, and a nurse came into my room calling me her client and asking what goals I wanted to work on that day, I would call security.

Later on, another teacher, someone a bit more in touch with reality, told us that the only goal a patient has is to get the hell out of the hospital in one piece.

totallytheresa · Oct 21, 2004

I dread doing them too, this is why- because I get too hung up on the book!! I have good ideas in my head but when I go to the care planning texts to write them out, I second guess myself, etc... And then I sometimes think, well they have this problem too, and this one, etc... so then it goes onto, well will my instructor think I should have used this one because of the database?? But I do see their usefullness, especially when we KNOW something is good for the patient, we can use the scientific rationale instead of saying, because it makes them feel better :) And they organize my thoughts; this problem and why they have it, do this, and this is why, and did it work.

CarynQ · Oct 21, 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?

check out this website for history of ND. http://www.duke.edu/~goodw010/vocab/NANDA.html#History%20and%20Development

I graduated a year after they came out. Not sure if they have improved anything except communication. Personally, i find them pretty useless. In LTC we are writing interdisciplinary careplans. Does a LNA, OT or Dietician understand that stuff? what about families and clients? not hardly!

BittyBabyGrower, MSN, RN · Oct 21, 2004

Ours are PIP notes...Problem (ie Poor nippling/nutrition, Impaired Gas Exchange/BPD, Vent requirement, O2 requirement, Parenting/social,etc) Impression(Taking PO feeds every other feed with encouragement, needs O2 with feeds, not gaining weight well) Plan (Cont QOF, watch weight, consider fortifying MBM for increased cals, follow BMP every Monday)

Ours are short and to the point.