HEALTH FORUM

The second stage of the nursing process is making a nursing diagnosis. This
enables the nurse to translate the information gained during the assessment
and identify the nursing problems. In order to avoid confusion, it is worth
noting that diagnosis is not a concept unique to medicine: car mechanics
diagnose mechanical problems, teachers diagnose learning difficulties, and
consequently nurses diagnose nursing problems.

The language of nursing diagnosis originated in North America in the 1970s
in an effort to move the art, science and theoretical basis of nursing
forward. The benefits in a clinical setting have been positively described
by Mills et al. (1997) and Hogston (1997).

Nursing diagnosis is the second stage of the nursing process, often
described as a nursing problem, for which the nurse can independently
prescribe care.

From: Managing Nursing Care - Foundations of Nursing Practice by Richard
Hogston and Penelope Simpson.

See:
http://www.palgrave.com/pdfs/0333985923.pdf

--
Eddie Newall
http://www.freeinformationcentre.co.uk

Versed wrote:


I have been a critical care nurse for 9 years............I dont have
time to go through NANDA mumbo-jumbo to decide what my patient needs.
Yes I am a yank, but we dont even have the nursing dx. books in our
units. Once you get out of nursing school, you chuck those books and
begin to function in reality and use common sense and nursing
judgement.

--
Live on the webcam: I eat a Flake.

Just Adira, period. typed
<-snipped->

No.

I have seen some of those American nursing diagnoses textbooks and always
though they were completely over the top, making something that in practice
is usually very simple and straightforward into something that is
unnecessarily complex and elaborate. Same goes for nursing models.

In the UK we kept patients problems brief and simple.

--
Eddie Newall
http://www.freeinformationcentre.co.uk

Eddie Newall wrote ...

Thats a rather gross generalisation, and is extremely inaccurate. True
simply to the extent that both nursing diagnoses and nursing models tend to
be applied in the UK without 15 tonnes of verbiage.

But UK practice varies considerably, with no central leadership at all.

Nursing models are still widely used - less widely than 10 years ago, as
most academics cant be bothered, and have reverted to the medical model. In
a recent survey (Friday) 3 out of four students - first years, three weeks
into a surgical placement - did not know what a gastectomy was; 4 out of
four had no clue as to the suffix ectomy and three out of four did not
what gastric referred to. This tells us a little about the enthusiasm of
students - but a lot about the abilities and prioroities of the average
lecturer in one of the UKs top educational establishments. Dont even ask
what these students know about nursing matters ... its frightening.



Andrew Heenan
Real Nurse
http://www.realnurse.net/

Andrew Heenan typed:

<-snipped->

Regarding my gross generalisation, true, but this is email/Usenet. I wasnt
writing a formal evidence-based academic essay.


True, but heres another gross generalisation - it applies to virtually
everything related to nursing practice and education - considerable
variation and no central leadership. And apart from the Rcn Congress,
virtually no debate. One of the characteristics of educated persons,
especially those engaged in a profession, is that they debate areas of
concern.


Your gross generalisation could be right, I can only say what happens where
I work, which is that most of try very hard to reflect what students will
encounter in their placements. Much of our teaching is practice-driven,
irrespective of either our views or the evidence. For example, the almost
wholesale adoption of ICPs in the local Trusts is without any evidence base.
And as for the evidence-base for the nursing process and nursing models,
which are widely used locally, looking doesnt take long. If anyone cant be
bothered, whether they are in education or clinical practice, then I think
their attention should be drawn to the NMC Code of Professional Conduct and
to their contract of employment. The address of the nearest Job Centre might
also be relevant. I work my socks off, as do most of my colleagues, often in
my own leisure time. My own students regularly thank me for striving to help
them. If that doesnt demonstrate being bothered, what do you suggest I do
as well as or instead of what I am doing already?


I know that this is a gross generalisation, but in my experience ALL the
surveys of the knowledge of students AND qualified nurses indicate
widespread ignorance and misunderstandings. I cant remember one survey that
ever indicated otherwise. I teach both students and qualified nurses and am
sometimes saddened by their lack of knowledge, inappropriate attitudes, and
accounts of bad (sometimes illegal/unethical) practice. And even more
saddened by their general apathy for remedying the situation. And they
certainly dont take kindly to my comments and opinions. I am weary of being
told by some that anticoagulants dissolve blood clots, that terminally ill
patients become addicted to opiates, that there isnt time to use safe
manual handling techniques or to cleanse hands as often as is recommended,
that it is OK not to attempt resus even on patients who havent got a DNR
order, and so on.

A lecturer colleague of mine recently asked a nursing student who is in
supported practice, only weeks away from qualifying, to take him round the
ward and report on her patients. This is an elderly care ward, so the
patient turn-over is low. You know - name, age, consultant, current
diagnosis, relevant medical history, investigations, allergies, resus
status, nursing care, multi-disciplinary teamwork, discharge plans - the
sort of information that nurses discuss at handover and used to regard as
knowledge essential to the job. Needless to say, she though he was joking
and was very indignant that anyone should expect her to remember all that. I
wouldnt dream of generalising this to the majority of students, but I would
be very interested to know what a survey of students AND qualified nurses
knowledge of their patients revealed. Perhaps my colleagues expectation was
unreasonable - perhaps nurses no longer need to remember this type of
information. Apart from resus status, perhaps they just need to look it up?

Regarding prefixes and suffixes, in my experience this was always included
in the old hospital-based introduction to surgical nursing modules. With the
transfer to higher education, and the need to greatly increase the amount
taught about health, health promotion, psychology, sociology, social policy,
research, statistics, ethics, law, information technology - you name it and
it has been dumped into the curriculum - many subjects have been reduced or
have simply disappeared. Any fool ought to be able to see that there is far
too much for a 3 year programme. Five years maybe, but three years? No.

The students could have a prefixes/suffixes/surgical definitions worksheet
from college or it could be included in their surgical ward handbook. But
how many would complete it? How many would say - what do we need to know
this for? You appear to be referring to CFP students. In my experience some
students dismiss as irrelevant anything that doesnt seem relevant at the
time to them personally in terms of the current module or branch they intend
to do, or the area of nursing they intend to practice. A student who is on
their first CFP clinical placement, and who hasnt any previous experience
of working in care, will often see learning direct care practical skills as
the priority. A student intending to access the mental health branch, but
who is allocated to a surgical ward during CFP, might not see prefixes et
cetera as being personally relevant. And if a student asked for the evidence
that such knowledge has any significant influence on patient care, what
would we say?

I detect in your posting some of the old them and us service/education
tension, and the old attitude that if they dont know it then it hasnt been
taught (by lecturers, never nurses in practice). Sadly, teaching doesnt
always result in learning - learners, whether they are students or qualified
nurses, have to want to learn. It would be better if everyone in education
and practice worked together to try to ensure that nurses have the knowledge
and skills needed to underpin practice, to nurse patients properly and to be
life-long learners. I have seen 38 years of us and them and cant think of
anything it has achieved of a positive nature.

But then what would I know about anything, being an average lecturer in an
average university, whose abilities are dubious and who is unable to get his
priorities right?

--
Eddie Newall
http://www.freeinformationcentre.co.uk

May I put a point of view from a student perspective?

Three weeks into a first year placement your head is reeling and you are
physically exhausted. You have no clear role, some staff want you to pitch
in, others think you are interfering/incompetent. You want to apply what
you have been taught (so far) but are very aware of the amount you do not
know. In the common foundation year the training is not specialised yet.

Many staff go the extra mile to give you tips and support, but I have to say
that a qualified nurse with attitude testing my knowledge at this point
would likely be met with a blank stare!

As for prefixes and suffixes, I dont remember being drilled in them when I
first started training in 1969 - they were general knowledge from an old
fashioned education. Im sure younger students would appreciate a tip on
how helpful they are in decoding long words.

I agree that a student who genuinely does not know her long term patients is
in the wrong job - perhaps she should try the learning disabilities branch
(you get to know your clients pdq or live with permanent bruises). A lack
of respect for the elderly is sadly not unusual, as I know from personal
experience with my father.

I have nearly finished my first year (exam results pending!) and it has been
harder than I ever expected, even allowing for my advanced age. I am still
hanging in there only because of the sensitive support I have had from
dedicated mentors and tutors. So to Eddie, thanks. And to those who think
students are a waste of space, come back in a couple of years and well have
a little chat.

Cryn

The second stage of the nursing process is making a nursing diagnosis. This
enables the nurse to translate the information gained during the assessment
and identify the nursing problems. In order to avoid confusion, it is worth
noting that diagnosis is not a concept unique to medicine: car mechanics
diagnose mechanical problems, teachers diagnose learning difficulties, and
consequently nurses diagnose nursing problems.

The language of nursing diagnosis originated in North America in the 1970s
in an effort to move the art, science and theoretical basis of nursing
forward. The benefits in a clinical setting have been positively described
by Mills et al. (1997) and Hogston (1997).

Nursing diagnosis is the second stage of the nursing process, often
described as a nursing problem, for which the nurse can independently
prescribe care.

From: Managing Nursing Care - Foundations of Nursing Practice by Richard
Hogston and Penelope Simpson.

See:
http://www.palgrave.com/pdfs/0333985923.pdf

--
Eddie Newall
http://www.freeinformationcentre.co.uk

Versed wrote:


I have been a critical care nurse for 9 years............I dont have
time to go through NANDA mumbo-jumbo to decide what my patient needs.
Yes I am a yank, but we dont even have the nursing dx. books in our
units. Once you get out of nursing school, you chuck those books and
begin to function in reality and use common sense and nursing
judgement.

--
Live on the webcam: I eat a Flake.