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Old 12-31-2015, 04:45 PM
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Default Why can't I use a Care Plan Handbook for my care plans?

I got asked about one recently. The 2010 Nursing Care Plans is a problem, not the least reason of which is that it is not one, not two, but three versions behind of the current NANDA-I nursing diagnoses, it probably being based on (at best) the 2009-2011 issue, and more likely the one before that, given the amount of time it takes to get a textbook into production (and I say this as one who has contributed to a nursing care planning textbook coming out this year. OK, I needed the money.). A number of nursing diagnoses have been withdrawn since then, and terminology and defining characteristics much improved. If you've been using a 2009-2011 NANDA-I, or even the 2012-2014, you've already noticed the improvement in the latest issue (2015-2017) compared to your old one.

You can't use an outdated manual for planning your nursing care or how to delegate it (an RN responsibility which you will also be learning) any more than you could use an out-of-date hematology text to teach you about current work in, oh, genetic advances in leukemia diagnosis and treatment.

The other problem I have with "care plan books" is that students just copy them down into their work and don't learn anything much except copying skills. There's no critical thinking involved in copying. NO patient is just like any other; if you have four people with, say, diabetes, you cannot possibly assume that the care plan book's plan of care is appropriate for each of them.

Yet when students are assigned a "care plan handbook", it is almost always organized by medical diagnosis, which reinforces the totally wrong idea that nursing diagnosis is dependent on medical diagnosis AND discourages students from looking at nursing diagnosis as more broadly applicable to people with many different reasons for being in care.

As an example: Let's look at a nursing diagnosis that I have never, NEVER seen in a student plan of care, and hardly ever seen in any plan of care, "Ineffective sexuality pattern."
Ineffective sexuality pattern, Domain 8, Sexuality; Class 2, Sexual function
Definition: Expressions of concern regarding own sexuality
Defining characteristics:
* Alteration in relationship c significant other
* Alteration in sexual activity
* Alteration in sexual behavior
* Change in sexual role
* Difficulty c sexual behavior
* Difficulty c sexual activity
* Value conflict
Related (causative) factors:
* Absence of privacy
* Absence of significant other
* Conflict about sexual orientation
* Conflict about variant practice
* Fear of pregnancy
* Fear of sexually transmitted infection
* Impaired relationship c significant other
* Inadequate role model
* Insufficient knowledge about alternatives related to sexuality
* Skill deficit about alternatives related to sexuality

Now, I don't know about you, but when I had back surgery two years after I got married, I worried a LOT about sex with my sweet husband ("inadequate knowledge about alternatives related to sexuality"). I had awful pain that made movement and a lot of (umm, all but one) positions difficult or impossible ("alteration in sexual activity"). This experience made me learn to ask my back pain patients, when I did my initial eval, "When I ask you about sex, which of two common answers are you going to give me: 'Oy, it hurts so much I don't want to think about it,' or 'Oy, it hurts so much sex is the only thing that takes my mind off it!' ?" They laughed, but they all answered me one way or another. And by then I had developed and researched some alternatives to help them out, and the ability to communicate them (the plan of care).

Now, if you're a nursing student with a back surgery patient, you're going to think about assessing for and making plans to address pain, knowledge deficit about postop care, risk for infection, risk for injury, mobility, and self-care deficit. And you'd be right. But then you'd miss a golden opportunity to look at your patient as more than "the back surgery in 201B," and assess and address a very significant part of his (or my) life. THIS is why you don't want to use a "care plan handbook" that's dedicated to the proposition that all nursing plans of care stem from medical diagnosis.
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Old 02-18-2016, 10:54 AM
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Default Why NANDA-I? What's in it for me?

I recently got an email from an overseas colleague.
"I’ve been asked to elaborate an expert report on the use of standardized nursing languages in primary health care in XXX where I work the most.
Let me tell you a little about the issue:
The National Nursing Association has contacted me because they are receiving a lot of questions from the nurses working in Primary Health Care about what Language they should use. This is in relation with the use of electronic systems that not always are “Nursing Language friendly”, if you know what I mean, together with historical issues, and other.

The thing is that now, nurses are wondering whether they must use NANDA-I NIC and NOC and why they cannot use other languages like ICD-10 or, so to say SNOMED-CT, or other languages that are over there in the market.
Of course I have my own ideas, but I would like to hear about yours.
I will be very grateful if you could send me your opinions about this issue."

This is what I sent back:
In this country (US) the big concern is whether NANDA-I language is “relevant.” The biggest problem I have is with students who are given reference books that tie everything to medical diagnosis. Faculty teach this. Students say things like, “I have a patient with congestive heart failure and need to pick 3 nursing diagnoses.”

I tell them that they are in school to learn to be nursing diagnosticians in the same way that physicians go to medical school to learn to be medical diagnosticians, and for the same reasons: to plan care. This is usually quite a surprise to them— they rarely, if ever, have heard anybody say that. I know I’ve never heard anybody else say it.

Just as physicians assess data to make medical diagnoses, so do nurses assess data to make (not “pick” or “choose”) nursing diagnoses. The difference in those verbs makes all the difference. “Make” means the diagnostician is actively doing some thinking and deciding; “choose” depends on someone else’s thoughts.

I hear this in your question— why can’t nurses use medical diagnoses like ICD-10 or other? The way I like to explain it is that you should have a very clear idea from your nursing assessment what the patient needs that nurses do as part of a nursing plan of care, not part of delivering the medical plan of care. delivering the medical plan of care is not even the biggest part of what we do.

While medical diagnoses are sometimes, not always, part of the related (causative) factors, they aren’t always. What would your nurses do if there were no medical diagnosis? Stop and not plan any care at all, because they need physician direction to proceed? That’s clearly ridiculous.


What do you think?
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