Presentation on theme: "Nursing Diagnosis in Health Care Organizations: Factors that facilitate – and complicate - implementation."— Presentation transcript:
1 Nursing Diagnosis in Health Care Organizations: Factors that facilitate – and complicate - implementation
2 Medical DiagnosisTerminology used by physicians and advanced practice nurses (nurse practitioners) for a clinical judgment that identifies or determines a specific disease, condition, or pathological state
3 Nursing DiagnosisTerminology used by professional nurses that identifies actual, risk or wellness responses to a health state, problem or conditionTerminology used by professional nurses that identifies a person’s, family’s, or community’s motivation and desire to increase wellbeing and actualize human health potential
4 Comparisons Medical Diagnoses Nursing Diagnoses Chronic obstructive pulmonary diseaseCerebrovascular attackAmputationNursing DiagnosesIneffective breathing patternActivity intoleranceDisturbed body imageReadiness for enhanced coping
5 Nursing Diagnosis: Definition The NANDA definition of a nursing diagnosis was adapted from a national, Delphi study by Dr. Joyce Shoemaker (1984)Nursing diagnosis is a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable (NANDA, 1997).
6 Suggested Revision to Definition of Nursing Diagnosis (2008) A nursing diagnosis is a clinical judgment that nurses make about individual, family and community responses to conditions/life processes. Based on that judgment, the nurse is responsible for monitoring of client responses, decision-making culminating in a plan of care, and implementing interventions, including interdisciplinary collaboration and referral as needed. The nurse is wholly or partially accountable for the achievement of the desired outcomes.
7 The Diagnoses 206 NANDA-approved nursing diagnoses as of 2008 Level of Evidence (LOE) Criteria Established for All New and Revised DiagnosesEntry into the Taxonomy requires various levels of clinical evidence
8 Diagnosis Requires Assessment Identifying human responses that are related to medical diagnosis without a complete assessment to determine the presence of defining characteristicsLack of instruction on clustering assessment data to derive a list of potential diagnosesLack of hypothesis testing to determine best diagnoses for each patient
9 “The List”Automating the electronic record to populate the plan of care with nursing diagnoses when a particular medical diagnosis is usedBecomes a documentation tool rather than an individualized plan of care to direct nursing interventions to meet important patient outcomesPuts patients at risk / NegligenceMay ignore or miss important diagnoses for patientsPlan of care does not address critical outcomes for patients
10 Teaching MethodsRequiring students to develop and detail care plans with “every possible diagnosis” creates resistance that carries into practiceSets up situation that is not realisticCannot address every possible diagnosis in a short hospital stayBecomes a “thing to do” rather than truly understanding and applying diagnostic reasoning and differential diagnosisNurses learn to “just pick a diagnosis” rather than making decisions about the best explanation(s) for patient responses
11 Physician BarriersLack of understanding of difference between nursing and medicineBelief that medicine should direct all nursing careLack of collegiality or interdisciplinary collaborationNursing may not be seen as an autonomous profession“Practicing medicine without a license”Nursing seen as subservient to medicineLack of understanding of purpose of nursing diagnosis
12 Organizational Buy-In Nurse administrator(s) must understand benefits and support the use of standardized languagesNursing diagnoses articulate phenomena of concern to nurses, and provide a common language for the conditions that nurses treatNursing outcomes provide measures of nursing effectivenessNursing interventions demonstrate what nurses doData can be used to demonstrate when nurses are more effective than unlicensed personnel or when more nurses are needed to achieve desirable outcomes
13 Organizational Buy-In Nursing staff must understand that diagnosis is more than a “task”Articulates the critical thinking and clinical judgment of nurses as they care for patientsConsistent education is importantUpdating staff on revisions and new diagnoses is critical
14 Provide On-Going Staff Education Highlight use of standardized nursing language in organizational newslettersblasts with “diagnosis of the month” and case studies to illustrate proper diagnosisPeer review / patient grand rounds with actual patient information or use of case studies
15 Nursing Diagnosis Linkages Cannot stop with identifying the diagnosisLink to outcomes related to the diagnosesIdentify nursing interventions related to the desired outcomesStrength is in the combination of all three components of standardized nursing languageDiagnosis outcomes interventions
16 Physician Collaboration Articulate difference between nursing and medicineEncourage collegiality and interdisciplinary collaborationIdentify purpose of nursing diagnosis and impact on patient outcomesDemonstrate local impact of nursing diagnoses on patient outcomes
17 Health Care Today Financial pressures Early dischargesFewer hospital admissionsDiminished nurse-to-patient contactLess time to assess patients and identify accurate diagnosesLess time to work with patients/familiesPatient/family education suffersLess time to support them in regaining health
18 Clinical Decision Making Health care professionals face complex decisions daily regarding patient care— and must do so with decreased resources (less staff, less time, less money for equipment and supplies)What is the area of concern that nurses can treat/prevent/monitor? (Diagnosis)What is an appropriate goal for this patient? (Outcome)What treatment is most effective? (Intervention)
19 Quality Nursing Care Accurate Assessment and Diagnosis Defining characteristicsRelated factorsRisk factorsIdentify Attainable Patient OutcomesEfficiencyUtilize Proven InterventionsEffectiveLeast resource-intensive
20 Standardized Nursing Language Critical for improving patient careLack of standardization leads to:Inability to identify assessment criteria that are key to diagnostic accuracyInability to determine effective interventions that lead to positive outcomesInferior patient care
21 Standardized Nursing Language Provides evidence-based terminologyDescribes practiceDrives researchDocuments the impact of nursing care on health care quality
22 Implementation Educate staff and other disciplines Case review to improve diagnostic abilityReflect diagnostic ability and usage in staff evaluationsKeep it practical – address diagnoses that can actually be treated in your settingRefer to nurses in other settings for other diagnoses, as neededHome health careHospiceSchool Nursing
23 ImplementationTeach managers / administrators how to track data to demonstrate what nurses do and how they impact patient outcomesRoutinely share data with staff nurses and other disciplines that demonstrates impact of nursing care on clinical outcomes, through the use of standardized nursing language
24 Implementation Identify gaps in the NANDA-I taxonomy Revise / develop diagnoses that are needed in your practiceSubmit them to NANDA-I electronically for acceptance (www.nanda.org)
25 Standardized Nursing Language and Evidence-Based Practice Provide nurses with researched concepts (diagnoses), outcomes for which nurses are accountable and interventions that have been proven to be effectiveWhy would we use anything else?
26 What do we need?Emphasis on development, testing and validation of new diagnostic conceptsRevision of current diagnoses that lack sufficient evidence-based defining characteristics, risk factors or related factors
27 The Future of Nursing Diagnoses NANDA-International’s aim is to link with organizations across the world that have as their purpose nursing language developmentIncrease diagnosis submissionIncrease clinical testing of diagnosesEnsure cultural sensitivity of diagnoses
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