n
Nursing
N
Diagnosis:
m-sing diagnoses have been around for sometime and have really caught: on. Nursing programs are educating students from their earliest days to determine and utilize nursing diagnosis. Students learn the diagnoses and to eagerly apply them in care plans and discussions of patient care. Nurses talk of “skin integrity, impaired” or %ltered protective mechanisms.” However, I find I cannot speak-or think-this way, and many of my professional colleagues do not either; but our opinions seem to be lost or, perhaps, not expressed. The decision to use nursing diagnosis seems to have been made by the nursing profession, and I am not comfortable with this decision. In fact, I find nursing diagnosis a turn-off, but a topic that is definitely emotionally arousing. I realize my personal response can be traced back to my early teaching days when I was trying to help undergraduate students apply the nursing model with complex terminology in their patient care and care plans. Students went around the ward speaking of deficiencies in the eliminative or ingestive subsystems to refer to problems such as difficulty breathing. This type of thinking and talk made sense to those who also understood the model, but other members of the staff did not know what we were talking about! Indeed, students had to develop two sets of care plans, one for me to grade and one for others to use to provide care. To me this was a waste of time and created unnecessary communication barriers. To me nursing diagnoses have the potential to do the same thing. Why are we creating a separate language that is often burdensome and has the potential to be misunderstood by those not educated in the use of this language. I certainly understand the rationale for the use of nursing diagnosis-to promote professional independence and autonomy. Some also note that reimbursement for nursing care may be based on nursing diagnosis and that staffing patterns may be determined based on the nursing diagnoses of the patients. These are all important concerns and issues, but are we all sure nursing diagnoses will solve these problems?
JOURNAL
OF PEDIATRIC
HEALTH
CARE
Opinions,
Please!
n
I am all for nursing autonomy and independence, but I am not sure this is the way. For example, Seahill’s (1991) study, which compared nursing diagnosis and goal-oriented treatment planning in inpatient child psychiatry, found in this multidisciplinary setting that the use of separate nursing diagnoses was problematic. Seahill noted several reasons for avoiding separate nursing diagnoses in that setting: (a) the multidisciplinary nature of the setting, (b) the emphasis on the whole patient found in that setting, and (c) the importance of effective information sharing. Perhaps these same reasons apply to the great majority of the settings where nurse practitioners practice. As editor of this journal, I find few PNPs submit articles that include nursing diagnoses. Is that because we do not use them? Over the past 5 years of this journal, not one reviewer has requested nursing diagnoses be added. Why? Is my bias affecting this process or are PNPs not using nursing diagnosis and, if not, why? I am interested in your feedback. Who is using nursing diagnoses, how and what have been the outcomes? Indeed, the Executive Board of NAPNAP has established a task force to study the utilization of nursing diagnosis among the membership and to determine if this is an issue or concern of the membership and, if so, how. I want this journal to be responsive to the readers’ needs concerning nursing diagnosis. To do this I need your help. Please send me a letter or give me a call about this issue. Your input will be very beneficial both to the NAPNAP task force and the journal. THANKS for your help! Bobbie Crew Nelms, PhD, RN, CPNP Editor REFERENCE Seahill, L. (1991). Nursing diagnosis vs. goal-oriented treatment planning in inpatient child psychiatry. Imqe, 23, 95-97.
Nursing
N
Diagnosis:
m-sing diagnoses have been around for sometime and have really caught: on. Nursing programs are educating students from their earliest days to determine and utilize nursing diagnosis. Students learn the diagnoses and to eagerly apply them in care plans and discussions of patient care. Nurses talk of “skin integrity, impaired” or %ltered protective mechanisms.” However, I find I cannot speak-or think-this way, and many of my professional colleagues do not either; but our opinions seem to be lost or, perhaps, not expressed. The decision to use nursing diagnosis seems to have been made by the nursing profession, and I am not comfortable with this decision. In fact, I find nursing diagnosis a turn-off, but a topic that is definitely emotionally arousing. I realize my personal response can be traced back to my early teaching days when I was trying to help undergraduate students apply the nursing model with complex terminology in their patient care and care plans. Students went around the ward speaking of deficiencies in the eliminative or ingestive subsystems to refer to problems such as difficulty breathing. This type of thinking and talk made sense to those who also understood the model, but other members of the staff did not know what we were talking about! Indeed, students had to develop two sets of care plans, one for me to grade and one for others to use to provide care. To me this was a waste of time and created unnecessary communication barriers. To me nursing diagnoses have the potential to do the same thing. Why are we creating a separate language that is often burdensome and has the potential to be misunderstood by those not educated in the use of this language. I certainly understand the rationale for the use of nursing diagnosis-to promote professional independence and autonomy. Some also note that reimbursement for nursing care may be based on nursing diagnosis and that staffing patterns may be determined based on the nursing diagnoses of the patients. These are all important concerns and issues, but are we all sure nursing diagnoses will solve these problems?
JOURNAL
OF PEDIATRIC
HEALTH
CARE
Opinions,
Please!
n
I am all for nursing autonomy and independence, but I am not sure this is the way. For example, Seahill’s (1991) study, which compared nursing diagnosis and goal-oriented treatment planning in inpatient child psychiatry, found in this multidisciplinary setting that the use of separate nursing diagnoses was problematic. Seahill noted several reasons for avoiding separate nursing diagnoses in that setting: (a) the multidisciplinary nature of the setting, (b) the emphasis on the whole patient found in that setting, and (c) the importance of effective information sharing. Perhaps these same reasons apply to the great majority of the settings where nurse practitioners practice. As editor of this journal, I find few PNPs submit articles that include nursing diagnoses. Is that because we do not use them? Over the past 5 years of this journal, not one reviewer has requested nursing diagnoses be added. Why? Is my bias affecting this process or are PNPs not using nursing diagnosis and, if not, why? I am interested in your feedback. Who is using nursing diagnoses, how and what have been the outcomes? Indeed, the Executive Board of NAPNAP has established a task force to study the utilization of nursing diagnosis among the membership and to determine if this is an issue or concern of the membership and, if so, how. I want this journal to be responsive to the readers’ needs concerning nursing diagnosis. To do this I need your help. Please send me a letter or give me a call about this issue. Your input will be very beneficial both to the NAPNAP task force and the journal. THANKS for your help! Bobbie Crew Nelms, PhD, RN, CPNP Editor REFERENCE Seahill, L. (1991). Nursing diagnosis vs. goal-oriented treatment planning in inpatient child psychiatry. Imqe, 23, 95-97.
