02 Tips for Teaching Nursing Diagnosis

8/12/2019 02 Tips for Teaching Nursing Diagnosis

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Tips for Teaching Nursing Diagnosis

and the Use of

NANDA International Terminology


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Nursing Diagnosis: Definition

The NANDA-I definition of a nursing diagnosis wasadapted 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).


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The Diagnoses

206 NANDA-approved nursing diagnoses willbe present in the Definitions & Classifications

book for 2009 - 2011

Level of Evidence(LOE) Criteria Established forAll New and Revised Diagnoses

Entry into the Taxonomy requires various levels of

clinical evidence


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Clinical Decision Making

Health care professionals face complexdecisions daily regarding patient careandmust do so with decreased resources

What is the area of concern that nurses cantreat/prevent/monitor? (Diagnosis)

What is an appropriate goal for this patient?(Outcome)

What treatment is most effective? (Intervention)


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Critical Thinking Nurses need knowledge of diagnoses, definitions and defining

characteristics, especially those common to the populations withwhich they work and the diagnostic processes that are used to

interpret patient data

Skills of analyzing, logical reasoning, and applying standards are

thinking processes required for accurate diagnosis in nursing

These skills are developed through:

Discussions of how data should be clustered to generate accurate diagnoses

Relation of data clusters to diagnoses

Comparisons of existing data to expected data based on research findings.

Lunney (2009)


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Diagnosis Requires Assessment

Identifying human responses that are relatedto medical diagnosis without a complete

assessment to determine the presence of

defining characteristics

Lack of instruction on clustering assessment data

to derive a list of potential diagnoses

Lack of hypothesis testing to determine best

diagnoses for each patient


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Teaching Methods Review proper method to complete patient assessment to

determine the presence of defining characteristics Clustering of defining characteristics is often misunderstood :

presence of one defining characteristic does not necessarily require a

diagnosis

All nursing interventions do not require a nursing diagnosis

Medication administration for a condition that is not a primary focus of

nursing care is related more to a medical diagnosis

Need to test hypotheses

Need to evaluate success of plan of care and reassess continually


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Diagnostic ProcessAssessment

Cluster cues / defining characteristics

Collect additional data to narrow list of potential diagnoses

Generatelist of potential diagnoses

Implement plan of care based on identified diagnoses

Evaluate success of plan of care

Determine diagnosis/diagnoses to be treated


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Quality Nursing Care Accurate Assessment and Diagnosis

Defining characteristics

Related factors

Risk factors

Identify Attainable Patient Outcomes

Efficiency

Utilize Proven Interventions

Effective

Least resource-intensive


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Quality Nursing Care Accurate Assessment and Diagnosis

Defining characteristics

Related factors

Risk factors

Identify Attainable Patient Outcomes Efficiency

Utilize Proven Interventions Effective

Least resource-intensive


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Teaching Methods

Requiring students to develop and detail care plans

with every possible diagnosis creates resistance Sets up situation that is not realistic

Cannot address every possible diagnosis in a short hospital stay

Becomes a thing to do rather than truly understanding

and applying diagnostic reasoning and differentialdiagnosis

Students learn to just pick a diagnosis rather than makingdecisions about the best explanation(s) for patient responses


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Teaching Methods

Use of case studies can assist students in identifyingcues in patient situations that may be defining

characteristics of one or more nursing diagnoses

Hypothesis generation and differential diagnosis

skills can be developed through case studies, clinicalconference discussions and in skills lab scenarios


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The List Automating the electronic record to populate the

plan of care with nursing diagnoses when a particularmedical diagnosis is used

Becomes a documentation tool rather than an

individualized plan of care to direct nursing interventions

to meet important patient outcomes

Puts patients at risk / Negligence

May ignore or miss important diagnoses for patients

Plan of care does not address critical outcomes for patients


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Reportable Quality Measures:

Where is Nursing?

Management of diabetes: Percent of adults with diabetes who had a foot examination in past

year

Percent of adults with diabetes who had an influenza immunization in

past year

Percent 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 population


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The Role of Nursing in Patient Quality

Percent of adults with diagnosed diabeteswith HbA1c < 7.0% (optimal)

Readiness for enhanced family coping

Health-seeking behaviors

Readiness for Enhanced Self Health Management


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The Role of Nursing in Patient Quality

Management of diabetes:

Hospital admissions for short-term complicationsof diabetes per 100,000 population

Anxiety

Ineffective coping

Ineffective health maintenance

Risk for injury

Deficient knowledge

Ineffective Self Health Management


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Diagnostic Difficulties

Significant overlap of cues (Defining

Characteristics) to diagnoses

Contextual factors such as culture can change the

perspective on diagnosis

Many studies have verified that interpretations ofclinical cases have the potential to be less

accurate than indicated by the data (Lunney, 2007).

Documents

02 Tips for Teaching Nursing Diagnosis