Presentation on theme: "Nursing Diagnosis: Definition"— Presentation transcript:
1 Tips for Teaching Nursing Diagnosis and the Use of NANDA International Terminology
2 Nursing Diagnosis: Definition The NANDA-I 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).
3 The Diagnoses206 NANDA-approved nursing diagnoses will be present in the Definitions & Classifications book forLevel of Evidence (LOE) Criteria Established for All New and Revised DiagnosesEntry into the Taxonomy requires various levels of clinical evidence
4 Clinical Decision Making Health care professionals face complex decisions daily regarding patient care— and must do so with decreased resourcesWhat 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)
5 Critical ThinkingNurses need knowledge of diagnoses, definitions and defining characteristics, especially those common to the populations with which they work and the diagnostic processes that are used to interpret patient dataSkills of analyzing, logical reasoning, and applying standards are thinking processes required for accurate diagnosis in nursingThese skills are developed through:Discussions of how data should be clustered to generate accurate diagnosesRelation of data clusters to diagnosesComparisons of existing data to expected data based on research findings.Lunney (2009)
6 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
7 Nurses Are Diagnosticians Diagnosticians interpret data within their fields of expertise in order to provide needed servicesA key element of data interpretations is that they are subject to error.A good diagnostician must realize that there are always risks to the accuracy of data interpretationsBecoming a nurse diagnostician requires development of professional and personal skills and characteristicsCompetencies in intellectual, interpersonal, and technical domainsPersonal strengths of tolerance for ambiguity and use of reflective practice
8 Teaching MethodsReview proper method to complete patient assessment to determine the presence of defining characteristicsClustering of defining characteristics is often misunderstood : presence of one defining characteristic does not necessarily require a diagnosisAll nursing interventions do not require a nursing diagnosisMedication administration for a condition that is not a primary focus of nursing care is related more to a medical diagnosisNeed to test hypothesesNeed to evaluate success of plan of care and reassess continually
9 Diagnostic Process Assessment Cluster cues / defining characteristics Collect additional data to narrow list of potential diagnosesGenerate list of potential diagnosesImplement plan of care based on identified diagnosesEvaluate success of plan of careDetermine diagnosis/diagnoses to be treated
10 Cue Generation and Nursing Diagnosis Cues are analyzed in relation to possible diagnosesExisting cues are matched with the expected cues for the diagnoses being consideredDuring the evaluation of cues and related diagnoses, nurses may decide that there are not enough data to make a diagnostic decision or that there is enough evidence for one or more likely diagnosesIf there are not enough data to make a diagnosis, then the next step involves a focused search for additional cuesIf there is enough supporting evidence, a diagnosis is made and then validated
11 Quality Nursing Care Accurate Assessment and Diagnosis Defining characteristicsRelated factorsRisk factorsIdentify Attainable Patient OutcomesEfficiencyUtilize Proven InterventionsEffectiveLeast resource-intensive
12 Quality Nursing Care Accurate Assessment and Diagnosis Defining characteristicsRelated factorsRisk factorsIdentify Attainable Patient OutcomesEfficiencyUtilize Proven InterventionsEffectiveLeast resource-intensive
13 Incorrect Diagnostic Process Cluster cues / defining characteristicsCollect additional data to narrow list of potential diagnosesGenerate list of potential diagnosesImplement plan of care based on identified diagnosesEvaluate success of plan of careAssessment OR Identify Medical DiagnosisDetermine nursing diagnosis/diagnoses to be treated
14 Teaching MethodsRequiring students to develop and detail care plans with “every possible diagnosis” creates resistanceSets 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 diagnosisStudents learn to “just pick a diagnosis” rather than making decisions about the best explanation(s) for patient responses
15 Teaching MethodsUse of case studies can assist students in identifying cues in patient situations that may be defining characteristics of one or more nursing diagnosesHypothesis generation and differential diagnosis skills can be developed through case studies, clinical conference discussions and in skills lab scenarios
16 “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
17 Reportable Quality Measures: Where is Nursing? Management of diabetes:Percent of adults with diabetes who had a foot examination in past yearPercent of adults with diabetes who had an influenza immunization in past yearPercent of adults with diagnosed diabetes with HbA1c level > 9.0% (poor control); < 7.0% (optimal)Hospital admissions for short-term complications of diabetes per 100,000 populationNursing diagnoses represent the phenomena of concern to the nursing profession. The consistent utilization of standardized nursing terminologies such as NANDA-I’s nursing diagnoses within electronic health records is necessary to enable collection and analysis of nursing data and nurse-sensitive outcomes. Without this ability, nursing remains relatively invisible to patients, and hospital administrators are more likely to consider nurses solely as the single largest line item in terms of hospital expenses. A true analysis of nursing’s impact, enabled by the accurate and consistent use of standardized nursing languages, will enable linkage of nursing care to patient outcomes – demonstrating the invaluable impact of nurses on patient/family/community well-being.
18 The Role of Nursing in Patient Quality Percent of adults with diagnosed diabetes with HbA1c < 7.0% (optimal)Readiness for enhanced family copingHealth-seeking behaviorsReadiness for Enhanced Self Health Management
19 The Role of Nursing in Patient Quality Management of diabetes:Hospital admissions for short-term complications of diabetes per 100,000 populationAnxietyIneffective copingIneffective health maintenanceRisk for injuryDeficient knowledgeIneffective Self Health Management
20 Diagnostic Difficulties Significant overlap of cues (Defining Characteristics) to diagnosesContextual factors such as culture can change the perspective on diagnosisMany studies have verified that interpretations of clinical cases have the potential to be less accurate than indicated by the data(Lunney, 2007).