n
Nursing
I
Diagnosis:
n the January-February issue of this year’s JOURNAL, I wrote an editorial on nursing diagnosis, expressing the problems and frustrations I find with them. At that time I requested that you send your thoughts and opinions about this topic. Normally such responses would have been published as “Letters to the Editor.” However, I received 52 responses to that editorial and thus am summarizing the results here. I know this response is in no way a representative sample of the JOURNAL’S readership, but I wanted to share the respondents’ ideas and experiences concerning nursing diagnosis with you. If you have not had an opportunity to send me your ideas on this topic, I am still very interested in hearing from you. Of the 52 responses I have received so far, 50 did not find nursing diagnoses useful for their current clinical practice setting; one was using nursing diagnoses, and one liked the concept but was unable to use it in her work situation. Kelly Bottei, Coralville, Iowa, believes strongly that “nursing needs a system of its own to classify and label what nurses do.” She believes it is esssential that “ a language for nursing is developed as quickly as possible so that nursing can keep pace with the changes [in the health care system] while maintaining its identity.” She further notes that specialty nurses “should be encouraged to write their own diagnoses for their practice.” Nela Beetem, Holts Summit, Missouri, is not able to use nursing diagnosis in her work as a nurse practitioner but found it helpful when she was a state consultant for school nurses. Ms. Beetem noted, “Care planning based on the nurse’s diagnosis was made much easier.” In contrast to these two experiences with nursing diagnosis, 50 others had less positive views. Jo Ann Sayle, Evansville, Indiana, wrote, “nursing diagnoses are redundant” and “the terminology clouds communication.” She finds that, in her preventive health care setting, the diagnoses she uses are often neither medical nor nursing. She opts for the shortest and m>st descriptive diagnoses for her multidisciplinary setting. Gemma Doll, St. Louis, Missouri, noted that “a diagnosis should indicate the appropriate plan and not be ambiguous. For example, ‘skin integrity, impaired’ may mean burns, a weepy rash, or a laceration,” each “requiring different plans of care. As a practitioner, I want my diagnosis to clearly communicate the identified JOURNAL
OF PEDIATRIC
HEALTH
CARE
Your
Ideas
.
problem.” Similarly, Kayla Unell, Creve Coeur, Missouri, stated she finds %rrsing diagnoses to be statements of the obvious, without conveying the thought processes involved in reaching an assessment of the situation.” She further noted that “the words already exist to name normal and abnormal human responses to wellness and illness; these are words common to all who deliver health care . . . not the property of physicians.” Arthur Cherry, Topeka, Kansas, described his response to nursing diagnosis from the pediatrician’s perspective. “In my opinion the ‘nursing diagnosis’ is a symptom of a disease. The disease is endemic among physicians and has spread to the nursing profession. I would call it diugwsitis. The symptoms are caused by an idea that the physician has exclusive right to diagnostic terminology. Nurses have treated this disease by inventing their own terminology. This terminology uses circuitous doublespeak to describe clinical symptoms and diagnoses. Anything is OK as long as it is not used by physicians! Thus wheezes, rales, and rhonchi become “respiratory dysfunction. ” He further states, “It is time for this farce to end!” and ‘The articles in your JOURNAL are appropriately written in correct medical terminology. Attention Deficit Disorder is not called behavioral dyslimction.” He goes on to comment, “Your profession has proved that nurses can perform a very useful function in making medical diagnoses and treating illness. In doing so why can’t we use the same terminology? Each profession has its own unique contribution to make. Where your profession and mine overlap, let’s talk the same language. Our common goal is the welfare of the patient.” Many commented on the problems nursing diagnoses cause in interdisciplinary care settings. Catherine Quinn, Falls Church, Virginia, agreeing with the editorial, wrote, “Nurses should speak the same language as the rest of the health care providers.” She states, “I have found my role sufficiently well defined that autonomy and independence are not a problem. I do not try to separate myself from other providers and as a result have their acceptance and respect.” Phyllis Yetka, Ward Cove, Arkansas, stated that communication barriers resulting from nursing diagnoses are not only barriers with others in the medical profession, but with parents as well. “It is not uncommon for parents to bring in the Emergency Room discharge sheet and have com335
336
Editorial
merits on the nursing diagnosis. Many of the parents ask for an explanation and wonder why it is written in such a way. . . . If the nursing profession is there to assist people, we need to speak a language they can understand. I am also for nursing autonomy and independence, but not at the expense of the children I care for.” Helen Fleck, Walla Walla, Washington, agrees, “They [nursing diagnoses] are really ‘doublespeak’ and a great way to confuse the patient.” Other respondents noted additional problems with the use of nursing diagnoses. Linda Jonides, Ann Arbor, Michigan, stated that in times of concern about documentation and reimbursement “that it behooves all health care providers to be using the same language. I can’t imagine that any reimbursement agency, whether Medicaid or Blue Cross, wishes to have separate diagnostic criteria for the same problem for various providers. I would like to see nursing take a leadership role in
Volume 6, Number 6 November-December 1992
helping to simplify the system, not add to the complexity to it.” These are just a few of the comments I received, but they identify common themes. Pediatric nurse practitioners are concerned about the impact of nursing diagnoses on interdisciplinary practice; many believe that the push to make nursing unique may interfere with our goal of providing optimal care. As a group of professionals who have been in the forefront of advancing and expanding nursing practice, it is important that we explore these issues careMy. We must consider consumer needs as well as professional identity. The debate concerning nursing diagnoses is far from over. I hope we can have ongoing dialogue on this issue and look forward to hearing from more of you. Bobbie Crew Nelms, PhD, RN, CPNP Editor
The Journal is abstracted and/or indexed in the Iwm&mal Nutiw IT&X, the Cumulative Indoc M Nnr+q &Allied Health Litmrc, and MEDLINE. Authorization to photocopy items for internal or personal we is granted by M-by-Year Book, Inc., for libraries and other users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that 10~ per page per copy is paid directly to CCC, 20 Gqress St., Salem, MA 01970; phone (50&X)744-3350. The U.S. Government retains a nonexclusive, royalty-free license in and to any copyright on articles authored by government employees. 0891-5245/92 $00.00 + .lO.
Nursing
I
Diagnosis:
n the January-February issue of this year’s JOURNAL, I wrote an editorial on nursing diagnosis, expressing the problems and frustrations I find with them. At that time I requested that you send your thoughts and opinions about this topic. Normally such responses would have been published as “Letters to the Editor.” However, I received 52 responses to that editorial and thus am summarizing the results here. I know this response is in no way a representative sample of the JOURNAL’S readership, but I wanted to share the respondents’ ideas and experiences concerning nursing diagnosis with you. If you have not had an opportunity to send me your ideas on this topic, I am still very interested in hearing from you. Of the 52 responses I have received so far, 50 did not find nursing diagnoses useful for their current clinical practice setting; one was using nursing diagnoses, and one liked the concept but was unable to use it in her work situation. Kelly Bottei, Coralville, Iowa, believes strongly that “nursing needs a system of its own to classify and label what nurses do.” She believes it is esssential that “ a language for nursing is developed as quickly as possible so that nursing can keep pace with the changes [in the health care system] while maintaining its identity.” She further notes that specialty nurses “should be encouraged to write their own diagnoses for their practice.” Nela Beetem, Holts Summit, Missouri, is not able to use nursing diagnosis in her work as a nurse practitioner but found it helpful when she was a state consultant for school nurses. Ms. Beetem noted, “Care planning based on the nurse’s diagnosis was made much easier.” In contrast to these two experiences with nursing diagnosis, 50 others had less positive views. Jo Ann Sayle, Evansville, Indiana, wrote, “nursing diagnoses are redundant” and “the terminology clouds communication.” She finds that, in her preventive health care setting, the diagnoses she uses are often neither medical nor nursing. She opts for the shortest and m>st descriptive diagnoses for her multidisciplinary setting. Gemma Doll, St. Louis, Missouri, noted that “a diagnosis should indicate the appropriate plan and not be ambiguous. For example, ‘skin integrity, impaired’ may mean burns, a weepy rash, or a laceration,” each “requiring different plans of care. As a practitioner, I want my diagnosis to clearly communicate the identified JOURNAL
OF PEDIATRIC
HEALTH
CARE
Your
Ideas
.
problem.” Similarly, Kayla Unell, Creve Coeur, Missouri, stated she finds %rrsing diagnoses to be statements of the obvious, without conveying the thought processes involved in reaching an assessment of the situation.” She further noted that “the words already exist to name normal and abnormal human responses to wellness and illness; these are words common to all who deliver health care . . . not the property of physicians.” Arthur Cherry, Topeka, Kansas, described his response to nursing diagnosis from the pediatrician’s perspective. “In my opinion the ‘nursing diagnosis’ is a symptom of a disease. The disease is endemic among physicians and has spread to the nursing profession. I would call it diugwsitis. The symptoms are caused by an idea that the physician has exclusive right to diagnostic terminology. Nurses have treated this disease by inventing their own terminology. This terminology uses circuitous doublespeak to describe clinical symptoms and diagnoses. Anything is OK as long as it is not used by physicians! Thus wheezes, rales, and rhonchi become “respiratory dysfunction. ” He further states, “It is time for this farce to end!” and ‘The articles in your JOURNAL are appropriately written in correct medical terminology. Attention Deficit Disorder is not called behavioral dyslimction.” He goes on to comment, “Your profession has proved that nurses can perform a very useful function in making medical diagnoses and treating illness. In doing so why can’t we use the same terminology? Each profession has its own unique contribution to make. Where your profession and mine overlap, let’s talk the same language. Our common goal is the welfare of the patient.” Many commented on the problems nursing diagnoses cause in interdisciplinary care settings. Catherine Quinn, Falls Church, Virginia, agreeing with the editorial, wrote, “Nurses should speak the same language as the rest of the health care providers.” She states, “I have found my role sufficiently well defined that autonomy and independence are not a problem. I do not try to separate myself from other providers and as a result have their acceptance and respect.” Phyllis Yetka, Ward Cove, Arkansas, stated that communication barriers resulting from nursing diagnoses are not only barriers with others in the medical profession, but with parents as well. “It is not uncommon for parents to bring in the Emergency Room discharge sheet and have com335
336
Editorial
merits on the nursing diagnosis. Many of the parents ask for an explanation and wonder why it is written in such a way. . . . If the nursing profession is there to assist people, we need to speak a language they can understand. I am also for nursing autonomy and independence, but not at the expense of the children I care for.” Helen Fleck, Walla Walla, Washington, agrees, “They [nursing diagnoses] are really ‘doublespeak’ and a great way to confuse the patient.” Other respondents noted additional problems with the use of nursing diagnoses. Linda Jonides, Ann Arbor, Michigan, stated that in times of concern about documentation and reimbursement “that it behooves all health care providers to be using the same language. I can’t imagine that any reimbursement agency, whether Medicaid or Blue Cross, wishes to have separate diagnostic criteria for the same problem for various providers. I would like to see nursing take a leadership role in
Volume 6, Number 6 November-December 1992
helping to simplify the system, not add to the complexity to it.” These are just a few of the comments I received, but they identify common themes. Pediatric nurse practitioners are concerned about the impact of nursing diagnoses on interdisciplinary practice; many believe that the push to make nursing unique may interfere with our goal of providing optimal care. As a group of professionals who have been in the forefront of advancing and expanding nursing practice, it is important that we explore these issues careMy. We must consider consumer needs as well as professional identity. The debate concerning nursing diagnoses is far from over. I hope we can have ongoing dialogue on this issue and look forward to hearing from more of you. Bobbie Crew Nelms, PhD, RN, CPNP Editor
The Journal is abstracted and/or indexed in the Iwm&mal Nutiw IT&X, the Cumulative Indoc M Nnr+q &Allied Health Litmrc, and MEDLINE. Authorization to photocopy items for internal or personal we is granted by M-by-Year Book, Inc., for libraries and other users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that 10~ per page per copy is paid directly to CCC, 20 Gqress St., Salem, MA 01970; phone (50&X)744-3350. The U.S. Government retains a nonexclusive, royalty-free license in and to any copyright on articles authored by government employees. 0891-5245/92 $00.00 + .lO.
