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.
Hi Kathryn--you hit the nail on the head! Nursing diagnoses are busy work to justify our profession, as if the work we do is not itself justification. It makes me sad that nursing faculty see nursing diagnoses as a way to make nursing's value stand out, rather than finding ways to research, document and prove our real value. No ICU could run without amazing nurses and no nursing diagnosis is ever going to capture the life-saving work those nurses do. Thank you for writing!
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.
Thanks for writing, Mary! I love this story that you tell about learning nursing diagnoses and what they were supposed to accomplish and how nurses don't have time to practice this way. I also love the label "problem solving." Nurses are great at problem solving, and I agree that some of the nursing diagnoses can teach a way of thinking about solving problems, but many of them don't and veer away from looking the real problem in the face. I'm also glad to hear you and your NP came up with a plan together. That, as you know, is the essence of good nursing!
What an interesting article. I had really never given thought to a nursing diagnosis controversy. I can certainly understand that they are not useful in an emergency room or in emergency situations. However, I always saw them as a means of driving the caring part of nursing care. Most of my professional career was in home care. In home care, nurses use nursing diagnosis to prioritize and document the care they are giving. For example, knowledge deficit of medication regimen or diet would direct the nurse to do medication or diet teaching during a home visit and then document patient response at a subsequent visit and show that one of the goals of home care had been met. In a hospital setting it could drive other nursing measures. For example, at risk for skin breakdown would lead to ensuring position changes and perhaps a specific mattress for the bed. I have long been retired and perhaps things have changed, but I do see nursing diagnosis as a means of thinking about and addressing the caring part of nursing care. It is different from the medical component although related.
This is an important complement to my article. You highlight the value of some nursing diagnoses and how they address aspects of care that often get left out of focuses in medicine, such as patients being at risk for pressure ulcers or not understanding their medications. Those are important issues and it's good that nurses are trained to think about them. I found the psychosocial nursing diagnoses the most useful, though I didn't get into that in the column (there's only so much space) and the "at risk of" ones could also benefit patients, as you point out, especially in home care. My wish would be to find a way to combine, as you put it so eloquently, "the caring part of nursing," with an understanding of medical diagnoses--a both and, rather than one trumping the other. Thanks for writing and sharing your thoughts!
One of the original intent was to link nursing diagnoses to nursing interventions to patient outcomes for the purpose of charging for our unique professional services. That which is billable is valued. As it is, nursing care is lumped in with the furniture. However, what we accomplished was the development of an autistic language that precluded other health care professionals from reading our notes. In my youth, a uniform problem list was kept on the cover of the patient's chart to which any service could add. "Newly diagnosed with diabetes" was clear and every service had a role in addressing it. My example for my students of the ridiculousness of nursing diagnoses per NANDA nomenclature is this diagnosis of myself: Alteration in nutrition, actual: excess. It is much clearer to say I am overweight.
This made me smile. I appreciate you giving the history of nursing diagnoses and also pointing out that other specialties could not make heads or tails of them: "an autistic language that precluded other health care professionals from reading our notes." You are right--the language used in them is so strange, as if they were developed by robots to be intentionally vague. And yes, using the word "overweight" is much clearer, with the added benefit of everyone knows what it means. Thank you for this comment.
As usual, Theresa, you are raising important questions! I learned bout nursing diagnoses after I had graduated from a hospital diploma program in 1967. For me, it was new to think of nursing as having an independent scope of practice outside the list of skills regulated by the College of Nurses of Ontario (Canada). They may have served their purpose. I agree that they are vague - I once raised in an international meeting that the evidence for many of them was tautological and this was not well received. Now that it is clear that professional nursing has independent and interdependent functions but no dependent functions, outside of delegated medical orders (which I wish you would tackle next) it may be time to sunset the nursing diagnoses. Kathleen MacMillan, PhD, PEI, Canada
Hi Kathleen. Thank you for this comment. I agree with you that nursing finding a way to give a lexicon and way of thinking to independent practice is exciting and for me that is why nursing diagnoses as a teaching tool, very narrowly applied, could be useful. I also agree with you that the evidence for nursing diagnoses is tautological and I can imagine that other nurses were not happy to hear that opinion from you. I will think over your suggestion that I next consider delegated medical orders. I'm not sure how aware people are that nurses are considered a check on physician orders and I know that nurses don't get the credit we deserve for doing that work. I will mull...
OMG. I can't imagine you being a jerk, but I'm glad my column gave you some solace. I had the same feeling you did when I first learned about nursing diagnoses in nursing school. I honestly couldn't believe anyone would take these strange vague statements seriously, but I was piously informed that they were very important. But, important to whom? I think the answer is, to nurses as a way to distinguish themselves from physicians. It makes me very sad that so many nursing faculty members don't seem to understand how important nurses are and, as I said, that we don't need to compete with doctors to prove that. Thank you for validating my experience of nurses wanting to understand clinical situations better, and thank you for your humility in trying to meet nurses where we are. I'm sorry that this one attempt at least did not work out.
I read this post with great interest, Theresa, as I have never completely understood nursing diagnoses. Over the years, I was invited to give clinical presentations to nurse colleagues, and to a person, they wanted specifics on the medical diagnoses made on their patients so they could both understand and communicate status changes better. I actually felt like I was a poor colleague to a nurse in my practice when we would discuss this topic, because I thought these nursing diagnoses didn’t correlate with medical diagnoses as I understood them. Her response was the holistic feature you mentioned, while I countered that doctors would want more detail than those diagnoses provided. This discussion caused a cooling in our work relationship, which I regretted, so I tried to educate myself about nursing diagnoses, but the lack of relevance to the ICD 10 and CPT codes then in use was a problem for me. And what made it worse was that my training in Family Medicine favored such a patient-centered, holistic approach…
Sorry for the long response. Theresa, thank you for discussing this topic; I feel less like a jerk for my previous lack of understanding of this issue.
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.
Hi Kathryn--you hit the nail on the head! Nursing diagnoses are busy work to justify our profession, as if the work we do is not itself justification. It makes me sad that nursing faculty see nursing diagnoses as a way to make nursing's value stand out, rather than finding ways to research, document and prove our real value. No ICU could run without amazing nurses and no nursing diagnosis is ever going to capture the life-saving work those nurses do. Thank you for writing!
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
Thanks for writing, Mary! I love this story that you tell about learning nursing diagnoses and what they were supposed to accomplish and how nurses don't have time to practice this way. I also love the label "problem solving." Nurses are great at problem solving, and I agree that some of the nursing diagnoses can teach a way of thinking about solving problems, but many of them don't and veer away from looking the real problem in the face. I'm also glad to hear you and your NP came up with a plan together. That, as you know, is the essence of good nursing!
What an interesting article. I had really never given thought to a nursing diagnosis controversy. I can certainly understand that they are not useful in an emergency room or in emergency situations. However, I always saw them as a means of driving the caring part of nursing care. Most of my professional career was in home care. In home care, nurses use nursing diagnosis to prioritize and document the care they are giving. For example, knowledge deficit of medication regimen or diet would direct the nurse to do medication or diet teaching during a home visit and then document patient response at a subsequent visit and show that one of the goals of home care had been met. In a hospital setting it could drive other nursing measures. For example, at risk for skin breakdown would lead to ensuring position changes and perhaps a specific mattress for the bed. I have long been retired and perhaps things have changed, but I do see nursing diagnosis as a means of thinking about and addressing the caring part of nursing care. It is different from the medical component although related.
This is an important complement to my article. You highlight the value of some nursing diagnoses and how they address aspects of care that often get left out of focuses in medicine, such as patients being at risk for pressure ulcers or not understanding their medications. Those are important issues and it's good that nurses are trained to think about them. I found the psychosocial nursing diagnoses the most useful, though I didn't get into that in the column (there's only so much space) and the "at risk of" ones could also benefit patients, as you point out, especially in home care. My wish would be to find a way to combine, as you put it so eloquently, "the caring part of nursing," with an understanding of medical diagnoses--a both and, rather than one trumping the other. Thanks for writing and sharing your thoughts!
One of the original intent was to link nursing diagnoses to nursing interventions to patient outcomes for the purpose of charging for our unique professional services. That which is billable is valued. As it is, nursing care is lumped in with the furniture. However, what we accomplished was the development of an autistic language that precluded other health care professionals from reading our notes. In my youth, a uniform problem list was kept on the cover of the patient's chart to which any service could add. "Newly diagnosed with diabetes" was clear and every service had a role in addressing it. My example for my students of the ridiculousness of nursing diagnoses per NANDA nomenclature is this diagnosis of myself: Alteration in nutrition, actual: excess. It is much clearer to say I am overweight.
This made me smile. I appreciate you giving the history of nursing diagnoses and also pointing out that other specialties could not make heads or tails of them: "an autistic language that precluded other health care professionals from reading our notes." You are right--the language used in them is so strange, as if they were developed by robots to be intentionally vague. And yes, using the word "overweight" is much clearer, with the added benefit of everyone knows what it means. Thank you for this comment.
As usual, Theresa, you are raising important questions! I learned bout nursing diagnoses after I had graduated from a hospital diploma program in 1967. For me, it was new to think of nursing as having an independent scope of practice outside the list of skills regulated by the College of Nurses of Ontario (Canada). They may have served their purpose. I agree that they are vague - I once raised in an international meeting that the evidence for many of them was tautological and this was not well received. Now that it is clear that professional nursing has independent and interdependent functions but no dependent functions, outside of delegated medical orders (which I wish you would tackle next) it may be time to sunset the nursing diagnoses. Kathleen MacMillan, PhD, PEI, Canada
Hi Kathleen. Thank you for this comment. I agree with you that nursing finding a way to give a lexicon and way of thinking to independent practice is exciting and for me that is why nursing diagnoses as a teaching tool, very narrowly applied, could be useful. I also agree with you that the evidence for nursing diagnoses is tautological and I can imagine that other nurses were not happy to hear that opinion from you. I will think over your suggestion that I next consider delegated medical orders. I'm not sure how aware people are that nurses are considered a check on physician orders and I know that nurses don't get the credit we deserve for doing that work. I will mull...
OMG. I can't imagine you being a jerk, but I'm glad my column gave you some solace. I had the same feeling you did when I first learned about nursing diagnoses in nursing school. I honestly couldn't believe anyone would take these strange vague statements seriously, but I was piously informed that they were very important. But, important to whom? I think the answer is, to nurses as a way to distinguish themselves from physicians. It makes me very sad that so many nursing faculty members don't seem to understand how important nurses are and, as I said, that we don't need to compete with doctors to prove that. Thank you for validating my experience of nurses wanting to understand clinical situations better, and thank you for your humility in trying to meet nurses where we are. I'm sorry that this one attempt at least did not work out.
I read this post with great interest, Theresa, as I have never completely understood nursing diagnoses. Over the years, I was invited to give clinical presentations to nurse colleagues, and to a person, they wanted specifics on the medical diagnoses made on their patients so they could both understand and communicate status changes better. I actually felt like I was a poor colleague to a nurse in my practice when we would discuss this topic, because I thought these nursing diagnoses didn’t correlate with medical diagnoses as I understood them. Her response was the holistic feature you mentioned, while I countered that doctors would want more detail than those diagnoses provided. This discussion caused a cooling in our work relationship, which I regretted, so I tried to educate myself about nursing diagnoses, but the lack of relevance to the ICD 10 and CPT codes then in use was a problem for me. And what made it worse was that my training in Family Medicine favored such a patient-centered, holistic approach…
Sorry for the long response. Theresa, thank you for discussing this topic; I feel less like a jerk for my previous lack of understanding of this issue.