Why Nursing Diagnoses Need to Go
NEW Cancer Nursing Today column
What exactly is a nursing diagnosis?
The column I’m sharing with you today is very nursing-specific and addresses an issue that many people outside of health care, and maybe even outside of nursing, know little about: nursing diagnoses.
I confess that I have always found nursing diagnoses a little silly. They are intended to teach what nursing professors call “the nursing process” and they are emphasized during clinicals in nursing school. They are distinct from medical diagnoses, and despite the focus placed on them when nurses are training, in actual practice they function like a secret nurses’ code that no one else understands or takes seriously or honestly has any interest in at all. The idea of nursing diagnoses is that they give nurses diagnostic language to clarify what a patient’s health issues are and present them more holistically than medical diagnoses usually do.
As you will learn from my column, many nursing diagnoses are maddeningly vague, to the point of uselessness, and they also have always had a flavor of competing with doctors. Indeed, the wikipedia description of them communicates that idea: “Nursing diagnoses foster the nurse's independent practice (e.g., patient comfort or relief) compared to dependent interventions driven by physician's orders (e.g., medication administration).” I presume that a nurse wrote that description, and yet it completely fails to capture the job of nursing. Nurses’ authority arises from their unique and valuable clinical contributions and that authority is theirs alone, independent of physicians. Doctors do give orders, yes, as the wikipedia entry says, but part of a nurse’s job is to independently evaluate those orders in order to catch mistakes. I once stopped a doctor from giving a patient chemotherapy based on the intrathecal dose (into the brain) of a drug rather than the intravenous dose. That’s an important part of every nurse’s job and just one aspect of real nursing work that nursing diagnoses do not capture or address.
Read the column and leave a comment. I’m interested!
Cancer Nursing Today
I remember when I first learned about nursing diagnoses. I’d started my accelerated nursing program steeped in chemistry, microbiology, and physiology, only to encounter these strange “diagnoses.” They seemed nothing more than vague descriptions of patients’ health issues, such as “risk for decreased cardiac tissue perfusion” and “acute pain” to describe a heart attack. Those labels aren’t wrong exactly, as any nurse knows, since a myocardial infarction involves reduced blood flow to the heart muscle, causing pain, muscle damage, and in the worst cases, death. But that’s the problem with many nursing diagnoses (NDs). A heart attack is an emergency, but the relevant NDs don’t capture the urgency of the medical diagnosis. That is, there’s a specificity to high-stakes clinical care that NDs lack and focusing on them in nursing school can leave nurses unprepared to do the job of nursing well.
I’m not alone in finding NDs lacking in needed clinical specificity. Recent research done in an emergency department in Spain reported that nurses found NDs not only confusing, but also at odds with their real work: “We found that [NDs are] a language that is difficult to use and is not adapted to the practice and [actual cases] of patients attending these hospital emergency departments.” The authors believe that NDs can give nurses greater professional cohesion via a shared language, but the nurses themselves felt the opposite—that NDs were an American import that wasted time they didn’t have.
I’m in Portland, Oregon…
Doing research for my next book. And no, I’m not ready to write more about it in this newsletter. But soon I might be. In the meantime, here’s a pic of me with Emily McGahey, Midwife and Clinical Director of The Midwife Center in Pittsburgh. I keynoted at their recent conference and had a blast.
Hugs to all,
Theresa
Thank you for speaking up. I hate nursing diagnoses! Most of my career was in the ICU and no one I worked with found ND helpful. In fact, they got in the way of patient care as we had to take valuable time to document and update ND on the chart which no one then read. I always felt ND was "busy work" to justify the need for our profession.
Nursing diagnosis became a " thing " when I was in my BSN program back in the 70s. When you built a care plan, we had to incorporate the nursing diagnosis / diagnoses as part of the flow sheet. We had to fine a nursing diagnosis for each problem.It seemed to only work with patient education. But in the real work world, you could identify a " need" or a "change", was it a nursing diagnosis or were you just problem solving? Supervisors and team leaders never used nursing diagnosis in discussing a patient. Nurses are too busy. In theory, it's great.
I recently had my annual physical with a NP. We discussed lifestyle changes to reach a " goal ". She may have made a nursing diagnosis to make suggestions. Or maybe I made a nursing diagnosis and we mutually agreed on a " plan " Yay! A care plan! But were we thinking nursing diagnosis at the time? Probably not.
Thank you, Theresa. I love your columns