I would like to ask students how/if they have been instructed to use "medical diagnosis" in formulating their care plans.
Medical and nursing diagnoses are two very different things. The whole thrust of the nursing process is wrapped around the whole person, family, community and restoring it/them to their best health. Medical diagnosis defines the disease. Nursing looks at health and deviations from it. Docs look at illness. Medicine has a narrow frame of reference, nursing an incredibly broad one.
But, in some circles, students are not allowed to use "COPD" or "stroke" or "Pancreatitis" anywhere in their care plans. I have had instructors tell me my students couldn't put "Anemia" or "Dehydration" in their assessment data as descriptors because these are "medical" terms.
I would like to know what you've been told (while a student) to do with medical terms when you articulate/write/discuss your plan of care.
We were not allowed to use medical diagnoses in the nursing diagnosis. We were, however, allowed to use medical terms in assessment data, say, medical history. So if nursing diagnosis was impaired gas exchange r/t alveolar changes AEB (insert evidence here), in the assessment I would state that patient has hx of COPD, when they were diagnosed, and any other related objective and subjective data which supports (ABG, O2 sat, reported fatigue, etc) My preceptors were sticklers for no medical words in nursing diagnoses.
I know it seems like a pain now, but it is very important to know the difference between nursing diagnosis and medical, especially if you ever get called into court. A lawyer will try to get you to say a specific diagnosis but you can only really answer what your nursing diagnosis is.
This is an excellent point. You always have to remember scope of practice. And yes, I've told my students treating "pneumonia" is not our role... We don't order antibiotics.
On the other hand, I don't like "RT disease process" because that usually means "RT-something-I-was way-too tired-to look-up-last-night." Besides, if the "disease proces" happens to be pneumococcal pneumonia... you're back to where you started... outside our scope of practice.
And from an educational standpoint, I can see that, if we say..."med diagnosis OK here, but not here" we're just confusing students. It certainly can be done by just "stating the problem" Sometimes I have to get the students to use "the Walmart test". It goes like this...
Me: "Why is this patient in bed 116B and not shopping at Walmart?"
Student: "Well, she's too dyspneic".
Me: "OK... what is making her dyspneic"?
Student: "Congestive heart failure"
Me: "What do you mean by that? What is it about her heart that's keeping her out of Walmart"?
Student: "Well, her left ventricle has been damaged, can't pump, and fluid is backing into her lungs, and she can barely get to the bathroom without desaturating."
True, this doesn't help them find the best NANDA right off the bat, but it moves them in that direction and away from getting stuck in the "MedSpeak Ghetto" where they stop thinking.
Does that make sense?
But can't it also get silly? It just sometimes seems the use of Medical terms is so frowned upon and penalized we're making it into some sort of magical curse, or "bad joo-joo."
From a teaching stand-point, I think that's a good approach. So, a student could say "Impaired gas exchange RT COPD AEB hypoxia and hypercapnea". It wouldn't be wrong... (I mean, it's accurate.) But if a student said "RT chronic airway obstruction, increased functional residual capacity, extreme work of breathing and decreased alveolar ventilation AEB hypoxia and hypercapnea..." I sure as heck would know the student understands the pathophysiology.
Yes, it's wordy. But in a written exercise... so what? (Now, if you're giving report yes, that's another kettle of fish. You would need to be much more succinct.)
Does anyone think my use of "functional residual capacity" or "alveolar hypoventilation" (or hypoxia, hypercapnea for that matter) make it too medical-ish and take away from the nursing diagnosis elements?
Perhaps that's the part I am getting hung up on. I agree, we don't ape the MD's and use their verbiage. But when we use scientific or pathophysiological descriptions, are we being dangerously "medical-ish"?
(I did not learn NANDA in school because it hadn't been thought up yet. Uh huh... I'm that old. So my questions are sincere. I want to be able to dialogue about this without messing up students and it really helps me for you to tell me what you're being taught.)
From a teaching stand-point, I think that's a good approach. So, a student could say "Impaired gas exchange RT COPD AEB hypoxia and hypercapnea". It wouldn't be wrong... (I mean, it's accurate.) But if a student said "RT chronic airway obstruction, increased functional residual capacity, extreme work of breathing and decreased alveolar ventilation AEB hypoxia and hypercapnea..." I sure as heck would know the student understands the pathophysiology.
Yes, it's wordy. But in a written exercise... so what? (Now, if you're giving report yes, that's another kettle of fish. You would need to be much more succinct.)
Does anyone think my use of "functional residual capacity" or "alveolar hypoventilation" (or hypoxia, hypercapnea for that matter) make it too medical-ish and take away from the nursing diagnosis elements?
Perhaps that's the part I am getting hung up on. I agree, we don't ape the MD's and use their verbiage. But when we use scientific or pathophysiological descriptions, are we being dangerously "medical-ish"?
(I did not learn NANDA in school because it hadn't been thought up yet. Uh huh... I'm that old. So my questions are sincere. I want to be able to dialogue about this without messing up students and it really helps me for you to tell me what you're being taught.)
I felt being "forced" to state the pathophysiology as a diagnosis helped to reinforce the understanding of the disease process for me. We also had an extra page of the care plan where we had to then translate our nursing diagnoses and care plan into layman's terms to show we could teach the patient/family without using "nursey terms" which can at times be cumbersome for those not familiar with it. It's all fine and good to look up a diagnosis, but if you can't explain it without a dictionary to the average person on the street, you're missing out on some great teaching moments.
I think your second impaired gas exchange diagnosis would be exactly what my instructors were looking for.
AmyRN303, BSN, RN
732 Posts
We were not allowed to use medical diagnoses in the nursing diagnosis. We were, however, allowed to use medical terms in assessment data, say, medical history. So if nursing diagnosis was impaired gas exchange r/t alveolar changes AEB (insert evidence here), in the assessment I would state that patient has hx of COPD, when they were diagnosed, and any other related objective and subjective data which supports (ABG, O2 sat, reported fatigue, etc) My preceptors were sticklers for no medical words in nursing diagnoses.