Nursing Diagnosis in Education:Teaching Strategies

Chapter ThreePart Two

Nursing Diagnosis in Education:Teaching Strategies

ContributorsBarbara Krainovich-Miller

Maria Müller-Staub

Teaching Strategy #1 Introduce the Nursing Process Framework

• Assessment

• Diagnosis

• Outcomes Identification

• Planning

• Implementation

• Evaluation (American Nurses Association 2010)

Nursing Process Framework

Teaching Strategy #2Introduce Evidence-Based Nursing Diagnosis

• Indicate There are Multiple Approved Taxonomies

• In Era of Patient Safety and Quality, Nurses Must Use the Best Evidence

• Help Students Understand the Importance of the Nursing Process as a Framework for Nursing Practice

• Based on Studies, NANDA-I Best Fulfills Taxonomic Validation Criteria, and is the Most Used and Best Developed Classification of Diagnoses(Anderson et al. 2009; Bernhard-Just et al. 2009; Müller-Staub et al. 2007)

• NANDA-I Recommends Three Taxonomies(NANDA International 2012)

Introduce the Concept of Evidence-Based Taxonomies (Classification Systems)

Evidence-Based Taxonomies

• NANDA-I: Taxonomy II (NANDA-I)

• Nursing Outcomes Classification (NOC)

• Nursing Interventions Classification (NIC)(Bulecheck et al. 2008; Herdman 2012; Moorhead et al. 2008)

Recommend Evidence-Based Classification Systems

Evidence-Based Taxonomies

Teaching Strategy #3Link Nursing Diagnosis as an Evidence-Based Theory for Practice

Students Need to Understand:

• Why Nursing Process is More than Carrying Out a Series of Steps

• Nursing Diagnosis as a Part of the Nursing Process is an Example of a Theory for Practice

Example:

• Begin with the Individual Rather than Family and Community

• Assessment Component Requires Collecting Objective and Subjective Data During First Individual (Patient) Interaction

Teaching the Nursing Process

Teaching Strategy #4Synonyms for Nursing Process

Help Identify Synonyms for Nursing Process:

• Clinical Judgment

• Diagnostic Reasoning (Combines Assessment and Diagnosis)

• Clinical Reasoning

Compare and Contrast:

• Problem-Solving Process Versus Nursing Process

Teaching the Nursing Process

Teaching Strategy #5Emphasize the Importance of the History and Physical Aspect of Nursing Process

History and Physical (H&P) Assessment

• Explain Use of Functional Health Patterns for Conducting an H&P to Formulate Valid Diagnoses (Gordon 2008)

• Differentiate Between Comprehensive Versus Focused Assessment

• Provide Students with Clinical Examples of When to Use a Focused Versus Comprehensive H&P Assessment

Teaching First Phase: Assessment

Teaching Strategy #6Give Concrete Clinical Examples of Defining Characteristics

• Start with Explaining Defining Characteristics (Objective and Subjective Data) for a Particular Diagnostic Concept

• Divide Students Into Two Groups:

• Group 1 Should Determine What is Objective or Subjective Data

• Group 2 Should Determine What are the Signs and What are the Symptoms (Defining Characteristics)

• Provide Comparison of What the Two Groups have Identified

Examples for Students

Defining Characteristics

Teaching Strategy #7Simulation for Teaching Nursing Process

Use Simulation as a Teaching Strategy:

•Use Faculty-Developed Standardized Case with Hi-Fidelity Patient Simulator

•Faculty Should Play Role of Patient’s Voice

•Ask Students to Conduct a Focused H&P

•Use Debriefing for Student Feedback and a Discussion of What Was the Subjective Versus Objective Data

Simulation

Teaching Strategy #8Use Examples to Emphasize Accuracy and Validity of Nursing Diagnosis for Quality Patient Outcomes

Review:•Concept of Accuracy

•Concept of Validity

•What is a Taxonomy and Its Primary Purpose

Teach Students How to:•Cluster Objective and Subjective Data During Assessment

•Use NANDA-I’s Taxonomy II (2012-2014)

•Work in Partnership with Patients to Determine Accuracy of Diagnosis

Discuss:•One Diagnosis from Each of 13 Domains

Teaching Second Phase: NDx

Teaching Strategy #9Demonstrate Clustering and Verifying Data to Formulate Nursing Diagnoses

Give Students Format to Use After Collection of Data

•Students Should Identify Data and Cues that have been Clustered to Support Diagnoses

•Students Should Then Indicate If Data Presented for Specific Diagnosis Fits with a Source from the NANDA-I Taxonomy II

Clustering and Verifying Data

Teaching Strategy #10Provide Multiple Realistic Examples of Related Factors for Commonly Occurring Nursing Diagnoses

Give Students Description and Example of “Related Factors”

•Discuss Nursing Interventions for Related Factors

•Discuss When Treatment of Related Factors is Not Possible, and When Nursing Interventions Focus on Defining Characteristics

Examples of Related Factors

Teaching Strategy #11How to Help Students Choose Preliminary Nursing Diagnoses

Preliminary Nursing Diagnosis Labels (Diagnostic Hypotheses) are Selected from Initial Clustering of H&P Assessment Data

•Encourage Students to Browse 13 Domains of Taxonomy II to Select Diagnostic Hypotheses

•Use Alphabetical List of Diagnostic Concepts in Domains of Taxonomy II

Preliminary Nursing Diagnoses

Teaching Strategy #12How to Help Students Understand the Accuracy of a Nursing Diagnosis

Accuracy of Diagnosis is Determined by Comparing Assessed Data to NANDA-I’s Taxonomy II

•Definition of Nursing Diagnoses (= Diagnostic Concept)

•Defining Characteristics

•Related Factors and Validation with Patients

•Offer Examples of Common Actual (Problem), Risk and Health Promotion Diagnoses

Accuracy of Nursing Diagnosis

Accuracy of Diagnosis is Determined by Comparing Assessed Data to NANDA-I’s Taxonomy II

•Verifying Findings

•Comparing Interviews with Physical Exam

•Clarifying Ambiguous Statements

•Double-Checking Abnormal Findings

•Checking Contradicting Findings

Validating Diagnostic Hypotheses

Teaching Strategy #13How to Help Students Prioritize Nursing Diagnoses

Students Should Provide Prioritized List of Nursing Diagnoses

Review with Students:

•Rationale for Prioritization

•When Prioritization Should Occur

•Prioritization Should be Completed After Data were Clustered and Verified with Patient and with NANDA-I Taxonomy for Accuracy

•Teach Students to Prioritize with Patients in Clinical Settings (Patient-Centered Care)

Prioritizing Nursing Diagnoses

Teaching Strategy #14Review Linkages Between and Among the Components of Nursing Process to Derive Accurate Nursing Diagnoses for Improved Patient Outcomes

Accurate and Valid Nursing Diagnosis Nurse-Sensitive Outcomes Interventions Desired Treatment Effects

Use Established Classification Systems:

•NANDA-I Taxonomy II

•NOC

•NIC(Bulecheck et al. 2008; Herdman 2012; Moorhead et al. 2008)

Linking NDx to Outcomes and Interventions

To Demonstrate Critical Thinking, Students Should:

•Conduct Electronic Data Based-searches Focused on Diagnosis, Outcome or Intervention

•Critically Appraise the Evidence

•Compare Findings to NANDA-I, NOC or NIC

(Bulecheck et al. 2008; Herdman 2012; Moorhead et al. 2008)

Critical Thinking

• American Nurses Association (2010) Nursing: Scope and Standards of Practice, 2nd edn. Silver Spring, MD: American Nurses Association.

• Anderson CA, Keenan G, Jones J. (2009) Using bibliometrics to support your selection of a nursing terminology set. CIN: Computers, Informatics, Nursing 27(2): 82-90.

• Bernhard-Just A, Hillewerth K, Holzer-Pruss C, Paprotny M, Zimmermann Heinrich H. (2009) Die elektronische Anwendung der NANDA-, NOC- und NIC - Klassifikationen und Folgerungen für die Pflegepraxis. Pflege 22(6): 443-454.

• Bulechek GM, Butcher BK, Dochterman JM. (2008) Nursing Interventions Classification (NIC), 5th edn. St Louis, MO: Mosby.

• Gordon M. (2008). Assess Notes: Nursing Assessment and Diagnostic Reasoning. Philadelphia: F.A. Davis.

• Herdman TH. (ed). (2012) NANDA International Nursing Diagnoses: Definitions and Classification, 2012-2014. Oxford: Wiley-Blackwell.

• Moorhead S, Johnson M, Maas M. (2008) Nursing Outcomes Classification (NOC), 4th edn. St Louis, MO: Mosby.

• Müller-Staub M, Lavin MA, Needham I, van Achterberg T. (2007) Meeting the criteria of a nursing diagnosis classification: evaluation of ICNP®, ICF, NANDA and ZEFP. International Journal of Nursing Studies 44(5): 702-713.

References