1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 1 Nursing Diagnoses: Issues and Controversies

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Why Nurses Use Nursing Diagnoses To describe client problems in sufficient detail to provide continuing care for clients with special needs To provide a standardized classification system to teach the science of nursing and communicate client problems to other nurses and disciplines To properly describe all the client responses that nurses diagnose and treat

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Student Care Plans Assist students in problem solving Prioritize and individualize client care Serve as directions for a student with a particular client Describe standards of care for a client problem or situation Allow for revision through additions or deletions

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? A nurse should never create a care plan for another nurse to follow.

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: A nurse may create a care plan for another nurse to follow when it is necessary to alert that nurse to additional care that is needed beyond the standard of care.

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Reasons Practicing Nurses Might Not Use Nursing Diagnosis In the past there was little or no discussion of nursing diagnoses, and medical diagnoses guided future practice. –Nursing diagnosis became a documentation assignment rather than a guide to assessments and interventions. Practicing nurses today may not understand the need to expertly diagnose and treat the client responses to medical diagnoses. –They may see themselves as the assistant of the physician, not as professionals in their own right.

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Domains of Expertise: Primary Care Nurse Practitioners vs. Primary Care Physicians

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins When Nursing Diagnosis May Be Viewed as a Negative Label “When an individual’s definition of health is not consistent with the nurse’s the person’s health value is judged as ineffective, maladaptive, or dysfunctional.” (Mitchell, 1991) The nurse’s determination of a client’s response as ineffective, maladaptive, or dysfunctional should be based on the client’s perspective of the problem and the nurse’s knowledge and expertise. –An ineffective response is ineffective for the client, not the nurse.

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses: Potential for Conflicts with Client Confidentiality Certain recorded information may compromise a client’s right to privacy, choice, or confidentiality. Nurses must take measures to ensure diagnoses do no harm to the client. Nurses must ascertain that there is permission to write, treat, or refer the diagnosis as appropriate.

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Nurses are not obligated to pass on all of a client’s nursing diagnoses to other nurses who will be caring for the client.

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Nurses are not obligated to pass on all of a client’s nursing diagnoses to other nurses caring for the client as long as the nurse can assure that all the diagnoses are addressed.

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Nurses’ Obligation to the Client Address applicable nursing diagnoses Protect the client’s confidentiality Nurses are not obligated to pass on all of a client’s nursing diagnoses as long as they are all addressed

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Role of the Professional Nurse Understand the pathophysiology of medical diagnoses and associated complications and treatments Monitor the patient’s responses Detect early changes in physiologic status Initiate appropriate treatments and/or consultations

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins Role of the Professional Nurse (cont.) Actively assist clients, families, or communities to: –Reduce or eliminate problems –Reduce risk factors –Prevent problems –Promote healthier lifestyles