Tuesday, November 14, 2017

Nursing Diagnosis - An Aimless Pursuit

Your patient suddenly loses consciousness, blows his pupils with a narrowing pulse pressure and
has the beginnings of decerebrate posturing.   What's your diagnosis nurse?

"This patient is experiencing hypovigilance secondary to disruption in the flow of energy resulting in a disharmony of the mind, body, and/or spirit." Say what nurse? Old time diploma students never dabbled in this high minded, academic  activity of  the modern  nurse diagnosticians, quite the contrary, we were sternly advised, "Nurses do not diagnose."  This resulted in many deferrals to "Ask your doctor."

We were well versed in acute clinical contingencies (Ha..Ha...I can talk just like you smarty pants nurse diagnosers) and knew exactly what to do if the patients under our care had problems.
Verigo on arising-back to bed...A hemorrhaging arm laceration-slap a blood cuff on while the resident scrambles for hemostats...Hypoglycemic..Have some orange juice...A sluggish chest tube-milk it.  It's really just plain old common sense.

A bona fide diagnosis is based on objective and measurable data, not the whim of a nurse wordsmith spouting off gobbledegook. The evidence supporting the diagnosis would enable different practitioners to come to the same conclusion. I think that those folks a lot smarter than I call it inter- rater reliability.

Nursing diagnoses grant objective status to subjective information. When subjectivity is confused with fact and treatments based on unfounded assumptions are implemented, bad things can happen such as that infamous 1-10 pain scale.

When nursing transitioned from a diploma based hands on education training to an academic setting, office sitter, nurse big shots had to come up with entities to differentiate themselves. They came up with three humdingers that are indeed, unique to nursing. Nursing research, which, more accurately should be called clinical research if the purpose is to improve clinical care. We don't have doctor research. Nursing theory of which I have written jabbered about in a previous post and finally nursing diagnosis.

These discursive disciplines have one thing in common. They are unique to nursing and difficult for other healthcare entities to understand. If the end game is to be a valuable, contributing member of a collaborative, team effort they fall short. Lots of nurses, especially old fools like me cannot comprehend them so maybe we should drop the nursing from nursing diagnosis and work toward a common goal. Diagnosis that is based on objective fact and guides healthcare workers toward effective treatment.

Nursing is all about common sense and using what you know to directly and appropriately helping patients. Having a nursing life that involves only intellectual and down right incomprehensible material is not a good way to live. Some folks think that mastering complex linguistic feats  and fancy talk is going to make them look smart and sophisticated. Truly smart nurses have a high sense of humility and plain talk that really does help patients overcome illness or mishaps.  .


  1. There are some interesting discussions about this topic on allnurses.com

  2. Thanks for the tip. This seems to be a bedside nurse who is the bedrock of nursing practice vs. nurse academics who I affectionately refer to as nurse office sitters issue.