Nursing Diagnoses: Issues and Controversies

Nursing Diagnoses: Issues and Controversies

Why Can’t We Use the Words That We Are Familiar With?

What words have nurses always used? Diabetes mellitus? Prematurity? Pneumonia? Difficult? Cystic fibrosis? For many years, nurses used only medical diagnoses to describe the individual problems that they addressed. Gradually, however, nurses have learned that medical diagnoses do not describe many individual problems in sufficient detail to enable other nurses to provide continuing care for individuals with special needs.

The fact is that nurses have always shared with other disciplines, such as medicine, respiratory therapy, and physical therapy, a common language for certain individual problems. Examples of terms from this language include hypokalemia, hypovolemic shock, hyperglycemia, and increased intracranial pressure. Any attempt to rename labels such as these should be viewed as foolhardy and unnecessary. For instance, dysrhythmias should not be renamed decreased cardiac output, nor should hyperglycemia be relabeled as altered carbohydrate metabolism.

The author of this text believes nurses should use preestablished terminology when appropriate, whether as a collaborative problem (e.g., Risk for Complications of Hyperglycemia) or as a nursing diagnosis (e.g., Risk for Pressure Ulcer). Nursing should continue to use the terminology that clearly communicates an individual situation or problem to other nurses and other disciplines.

Having said this, let us now examine the discipline-specific language of nurses. Have nurses had a common language or set of labels for individual problems that they diagnose and treat in addition to the shared language previously discussed? Before the advent of nursing diagnoses, how did nurses describe individual problems such as

  • Inability to dress self

  • Difficulty selecting among treatment options

  • Risk for infection

  • Breastfeeding problems

  • Stress in caring for an ill family member

  • Spiritual dilemmas

Sometimes a nurse would use the terms listed above, but sometimes not. Often the nurse had many options available to describe a problem.

Some nurses, particularly those with more experience, want to describe individual problems in any way they wish. Although an experienced nurse may be able to decipher inconsistent terminology, how can the nursing profession teach its science to its students if each instructor, textbook, and staff nurse uses different words to describe the same situation? Consider medicine. How could medical students learn the difference between cirrhosis and cancer of the liver if “impaired liver function” was used to describe both situations?
Medicine relies on a standardized classification system to teach its science and to communicate individual problems to other disciplines. Nursing needs to do likewise.

Although nurses traditionally have had a common language for certain problems, this language has been incomplete to describe all the individual responses that nurses diagnose and treat. As nursing diagnoses are developed, nurses discover new problems that affect individual/family, these problems, now labeled as nursing diagnoses as Caregiver Role Strain, Chronic Sorrow, Dysfunctional Family Coping, Risk for Compromised Human Dignity, require professional nursing interventions. For individual/family, these diagnoses are not optional.

Why Are Student Care Plans Different From Those Used in Practice?

Students are often told by practicing nurses that the care plans they write or type are not useful in clinical nursing. It is important to distinguish between care plans of students and care plans in practice.

Students create care plans to assist them in problem solving and to prioritize and individualize their care for an individual. Student care plans are directions for a student with a particular individual. Most of these care plans are standard or expected care for a particular problem or situation. After caring for an individual, the student can then revise the plan with additions or deletions. As the student progresses in the program, these plans should emphasize additional interventions needed because of the individual’s situation with less basic, standard care.

This type of care plan is not necessary in clinical practice. Predictive standard care should be known by experienced nurses on a unit. For example, if a surgical nurse is unfamiliar with the care needed for a person post hip replacement, he or she should have access to the standard care plan for the specific postoperative situation in a reference or online.

If Nursing Diagnosis Is So Important, Why Is It Not Used More by Practicing Nurses?

The majority of nursing programs identify the nursing process and nursing diagnoses as critical elements in their curricula (Carpenito-Moyet, 2010).

However, when practicing nurses were students, they most likely spent hours in the classroom listening to lectures about medical diagnoses and treatments. Unfortunately, more often than not, there was little to no discussion of nursing diagnoses. Nursing diagnosis became a documentation assignment rather than a critical concept to guide assessments and interventions.

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Dec 6, 2019 | Posted by in NURSING | Comments Off on Nursing Diagnoses: Issues and Controversies
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