Use of Nursing Diagnosis

Dranger · Jan 14, 2014

Does anyone besides the nursing staff ever look at or use the defined Nursing Diagnosis for a patient? If so who and what is done with it?

Real nurses don't even use it. We might say in passing he or she has a knowledge deficit, fluid imbalance or skin integrity issues but we don't actually do nursing care plans. That is only for school, which is why I hated them.

THELIVINGWORST, ASN, RN · Jan 14, 2014

My hospital system has a program that nurses can assign diagnosis and it orders testing, interventions and assessments. It's pretty cool because it helps you tie your thought process and nursing interventions to patient outcomes.

SL2014 · Jan 15, 2014

We are required to use nursing diagnosis once per shift in charting per JACHO requirements.... Do you really use them... No Not at all.

grandmabutterfly · Jan 20, 2014

Still waiting for more responses before I decide if nursing diagnoses are just Nursing School jargon for nurses want to be important

sjalv · Jan 21, 2014

Still waiting for more responses before I decide if nursing diagnoses are just Nursing School jargon for nurses want to be important

C'mon, that is so pejorative to nurses.. you realize where you are, right? I have been told time and time again that we won't be writing care plans as nurses (at least in the hospital setting) but the idea is that writing care plans and doing case studies assists nursing students in developing their clinical critical thinking skills .. which we WILL use as nurses. No one likes doing care plans, but I can see how they are improving my clinical skills and helping me learn about different pathologies and problems.

grandmabutterfly · Jan 21, 2014

I might actually appreciate nursing diagnoses if we were writing care plans related to human beings (or not as the case may be for hospital work). And I'm in my last semester of LPN. Writing a care plan might be a great challenge.

My instructors won't even discuss our critically thought out suggestions but jump to the "we're right and you don't know what you're talking about" innuendo type response instead of creating a teaching moment. I've received more appreciation as a nurse assistant for a unique, creative suggestion.

sjalv · Jan 21, 2014

I might actually appreciate nursing diagnoses if we were writing care plans related to human beings (or not as the case may be for hospital work). And I'm in my last semester of LPN. Writing a care plan might be a great challenge.
My instructors won't even discuss our critically thought out suggestions but jump to the "we're right and you don't know what you're talking about" innuendo type response instead of creating a teaching moment. I've received more appreciation as a nurse assistant for a unique, creative suggestion.

If you aren't writing care plans, then what are y'all looking at nursing diagnoses for?

nurseprnRN, BSN, RN · Jan 21, 2014

I review medical records for a living as a legal nurse consultant and I can assure anyone that has the slightest doubt that the best nursing services in the best hospitals do use and document a mindful process of assessment and planning for nursing care, and they save themselves a great deal of pain and trouble later for having done it. The ones who only "follow doctor's orders" and don't develop an active plan of care reflecting nursing education and autonomy are the ones who show up on my desk. If this isn't done, a given nurse may deliver a good shift of care, but the next one (or three) is just drifting along with a checklist of tasks. The continuity is lost ... and if there is no documentation of that plan of care, well, there lies many a nursing malpractice suit.

To sum up in a few colloquial words, then, you bet yer sweet bippy that nursing assessment and diagnosis are used at work in real life. Don't listen to the people who think they are sounding really smart when they say they never use it. I may be seeing them sometime sooner than they think, and they will not look so darn smart then.

WillyNilly · Jan 21, 2014

Use them daily. Yes, our programs write them but we still need to individualize them to the pt needs. Risk for fall or injury? Bet your bottom I will add intervention of nonskid slippers, bed/chair alarms and frequent rounding to them. I include pt stated goals and teaching to it as well. If pt refuses or in unable to comprehend d/t cognition I chart it. At least I can show an attempt was made.

THELIVINGWORST, ASN, RN · Jan 21, 2014

Use them daily. Yes our programs write them but we still need to individualize them to the pt needs. Risk for fall or injury? Bet your bottom I will add intervention of nonskid slippers, bed/chair alarms and frequent rounding to them. I include pt stated goals and teaching to it as well. If pt refuses or in unable to comprehend d/t cognition I chart it. At least I can show an attempt was made.[/quote']
Yes! We use them without even realizing it.

BrandonLPN, LPN · Jan 21, 2014

About a year ago I had my duties "enhanced" to include being responsible for the monthly summaries on the residents on my LTC unit. This was followed by a stint as an emergency "stop-gap" MDS coordinator. I soon realized the purpose of all this formerly mysterious busywork was to give proof to the nursing care (as distinct from, say, medical care) we claimed to provide. And thus, you know, justify our reimbursement and jobs and stuff.

I was horrified to discover all these new duties heavily utilized the dreaded nursing diagnosis. After having not so much as glanced at a nursing dx since nursing school, I was suddenly expected to make it the foundation of these care plans and monthly summaries I was writing. Each dx was care planned and each month I have to write a summary for each one summarizing progress, the nursing care provided and whether or not the stated goal has been met that month.

I have to admit, it's been a bit of an eye-opener. If nothing else, nursing dx can be a useful tool for organizing thoughts and planning care. I can't imagine writing a coherent summary without them. And, I've discovered that the nursing care we provide is much broader in scope than the medical care provided.

The medical care provided for a CHF patient here amounts to medication and blood work. The nursing care involves a bit more. Monitoring lung sounds and for SOB with exertion. If they are SOB, are we intervening to decrease exertion? Are we elevating the HOB to ease breathing? Are we elevating extremities to reduce fluid retention? In decreasing his exertion, are we discouraging mobility? Is his fatigue causing depression by preventing his going to activities? Are the diuretics increasing his fall risk?

If we're going to claim to be a facility that provides 24/7 skilled nursing care, all of this needs to be addressed. The nursing dx helps define what makes nursing a distinct practice. Understanding what makes nursing care distinct from everything else opened my eyes to all that we actually do. And all the stuff we should be doing but aren't.

I've also seen that how we use nursing dx in the real world bears little resemblance to how they're used in nursing school. There's no need for all that "as evidenced by..." crap in the real world. I don't need to provide a list of reasons for my "impaired gas exchange" dx any more than a physician needs to provide one for his dx of CHF. I think students are forced to go through justifications for their dx as a learning process. An experienced nurse knows what constitutes "impaired gas exchange" and just uses it as a jumping off point for interventions to be implemented and goals to be set.

I am still mistrustful of NANDA. I'm a man who has little time for silly foo-foo nonsense, and NANDA seems fond of silly foo- foo nonsense. "Impaired energy flow"? Please.

And, I'm mistrustful of the fact that only NANDA approved dx can be used, or else the universe will collapse or something. I suspect the real reason is because the folks at NANDA enjoy the sacks of $$$ they get each year when the "official" NANDA book has to be published.