What's your diagnosis?

Nursing, Jan 2000 by Christensen, Robert A, Taylor, Cynthia M

Otherwise, as it exists, nursing diagnosis remains unprofessional in its application and trivializes the profession by excluding certain aspects of what bedside nurses really do. For busy nurses, time is at a premium and should be used for activities that enhance patient care. Nursing diagnosis is simply one more demand on our time that doesn't help -and may hinder- our efficient delivery of patient care.

Defining our practice

BY CYNTHIA M.TAYLOR, RN, CNAA, MS

During the past 25 years, I've watched nursing evolve from task orientation and dependency to using a system of accountability. These years have provided exciting growth and the ability to broaden the limits of our practice. However, many members of our profession still negate the importance of nursing diagnosis as an essential element of our practice of nursing.

Unfortunately, many clinicians continue to minimize what has become the very core of nursing practice.

THE NEED FOR RECOGNITION

For many years we've contended that our profession deserves recognition and respect. At the same time, we struggle to describe to others what distinguishes our contribution to the health of individuals, families, and communities from that of other health care professions.

During my career, I've maintained a strong commitment to the nursing process and the ongoing development and application of nursing diagnosis in daily practice. Nursing diagnosis takes us way beyond the perception others often have of us as mere assistants to the physician or, worse yet, conduits through which a physician's orders are carried out.

The term nursing diagnosis first appeared in the 1950s, although at that time nursing educators didn't recognize it as a step in the nursing process. Originally, when the term was used in a nursing care plan, it most often referred to a patient's problems or needs. These could be medical diagnoses, signs and symptoms, or psychosocial needs.

Only in the 1970s did nursing educators and clinicians recognize nursing diagnosis as a step in the nursing process. In 1973 the North American Nursing Diagnosis Association (NANDA) began developing a taxonomy for nursing. Out of those efforts came the individual nursing diagnoses that have become central to the practice of nursing today.

According to NANDA, nursing diagnosis is a "clinical judgment about individual, family, or community responses to actual or potential problems or life processes. Nursing diagnoses provide the basis for nursing intervention to achieve outcomes for which the nurse is accountable." Another familiar definition comes from the American Nurses Association's 1980 Social Policy: "the diagnosis and treatment of human responses to actual or potential health problems that nurses are educated and licensed to treat."

During the past decade, many states have included nursing diagnosis as a requirement of clinical nursing and incorporated it into the NCLEX examinations. The Joint Commission on Accreditation of Healthcare Organizations recognizes nursing diagnosis as evidence of care planning.