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The Diagnoses
206 NANDA-approved nursing diagnoses will be present in the Definitions & Classifications book for 2009 - 2011 Level of Evidence (LOE) Criteria Established for All New and Revised Diagnoses
Entry into the Taxonomy requires various levels of clinical evidence
Critical Thinking
Nurses need knowledge of diagnoses, definitions and defining characteristics, especially those common to the populations with which 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)
Diagnosticians interpret data within their fields of expertise in order to provide needed services A key element of data interpretations is that they are subject to error. A good diagnostician must realize that there are always risks to the accuracy of data interpretations Becoming a nurse diagnostician requires development of professional and personal skills and characteristics Competencies in intellectual, interpersonal, and technical domains Personal strengths of tolerance for ambiguity and use of reflective practice
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
Diagnostic Process
Assessment
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 differential diagnosis
Students learn to just pick a diagnosis rather than making decisions about the best explanation(s) for patient responses
Teaching Methods
Use of case studies can assist students in identifying cues 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, clinical conference discussions and in skills lab scenarios
The List
Automating the electronic record to populate the plan of care with nursing diagnoses when a particular medical 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
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 of clinical cases have the potential to be less accurate than indicated by the data
(Lunney, 2007).