Nursing diagnosis and care plans; a dysfunctional system
Nursing Diagnosis is a ridiculously cumbersome collection of vague and arcane phrases that does nothing to improve patient care and only mires nurses in a mass of bureaucratic paperwork, when their time would be better spent observing, assisting, and teaching their patients. Any truly useful personalized information in a nursing care plan is lost amidst the mass of mundane interventions regurgitated from textbooks. The idea that a multipage document that no one has time to read should be the basis of nursing care is ludicrous at best and dangerous at worst. The entire system is inefficient and impractical and should have been scrapped within a year in favor of a dynamic problem list with spaces for the optional entry of unique or personalized interventions.
People have problems, not nursing diagnoses. Skipping the nursing diagnosis and listing a few signs and symptoms would provide much more useful information without involving the nurse in the legal mire of making a diagnosis. A single page problem list would be a practical and efficient way to communicate between shifts. Nurses should already know the textbook interventions, and if they donít, they can look them up. That information does not belong in a communication document.
The only people who benefit from this system of Nursing Diagnosis and Nursing Care Plans are the self-aggrandizing but clearly out-of-touch-with-reality individuals who created, maintain, and teach the system, the software companies who sell it to institutions, and the publishers who sell texts so that nurses can understand and use this ill-conceived collection of paperwork.
What, you don't like "skin, altered integrity of"? I thought those things were stupid the first time I saw them and my opinion hasn't changed over the decades. You're right, they're a money-maker for a lot of people and a time-waster for nurses. There seems to be so much goofiness built into nursing; I long for the sensible and practical.
I must say that way back in 1980 when I was learning nursing diagnosis, and careplans- I kind of thought the same thing. However; those hours and hours spent in the classroom and on homework the night befor a clinical rotation pulling my hair out on nursing care plans and the nursing diagnosis has taught me how to assimilate in an orderly fashion, all this knowledge from several diciplines into what we call Nursing. Back them we still only used paper and pencil andhad to form a "nursing care plan" for a new admission, and update that care plan as needed. Yes, we all grumbled. But today- we, 30 yrs later, do those nursing care plans with the nursing diagnosis in our heads every time we have an encounter with a patient or their family.Walk into a patient's room just after report and what are you doing? Checking an IV, the site, is it red with pus coming out of it- that's a nursing diagnosis and part of that patient's care plan! Alteration in Skin integrity or risk of...???
The nursing process should teach us how to think, think logically and problem solve for each and every interaction we have with a patient or a family. It's the process with which we organize all that learned information into an orderly make sence fashion. These components should be so second nature,This is what the new nurses are missing from the benefit of having an old nurse as a preceptor. The nursing diagnosis, care plan aka nursing process is the essence of nursing's abilty to problem solve( scientific method) not just go into a patient and perform a "task" whether that patient needs it or not.It should be- does that patient need this task?? If not, let's get it d'cd, need tocheck thelabs and may need to call the Doc.- that's nursing judgement/ critical thinking/critical reasoning.So after all these years- I have to conclude- that I disagree with my original grumbling about the nursing care plans and nursing diagnosis formulation. i now see it as an cornerstone of what it is we as licensed registered nurses do. We no longer have to write out( that was the cumbersome part) all those nursing diagnosis or care plans that are now or should be check off boxes in our clinical documentation screens.
I do believe the formulation of a nursing diagnosis was supposed to some day become the basis for which nurses get paid, like the doctors do with the ICD-9 codes. Instead of us being part of the room rent fees.