Many practicing students, nurses, and even some faculty, question the usefulness of nursing diagnosis. Unfortunately, nursing diagnosis is still joined at the hip with traditional mindless care planning. It is time to separate these conjoined twins so that both can function separately. Nursing diagnosis defines the science and art of nursing. It is as imperative to nurses and the nursing profession as medical diagnoses are to physicians, nurse practitioners, and physician assistants. It serves to organize nursing’s knowledge in the literature, in research, and in the clinician’s mind. Do not underestimate the importance of this classification. A clinician with expertise in nursing diagnoses can hypothesize several explanations for an individual’s anger, such as fear, anxiety, grieving, powerlessness, or spiritual distress. Without this knowledge, the individual is simply angry.
Care planning as it is taught in schools of nursing is an academic exercise, rather than a clinical guideline. As the student progresses in the program, this academic care plan must be transformed into a clinically useful product. Students should progress to utilizing standardized care plans rather than just creating them. Copying from books, such as this one, does not enhance one’s knowledge of nursing diagnosis and critical analysis. Students should start with a standardized document (electronic or preprinted) and then revise it according to the specific data they have acquired while caring for their assigned individual or family. For example, each student would have a standardized care plan for an individual experiencing abdominal surgery. If the person also has diabetes mellitus, then the collaborative problem Risk for Complications of Hypoglycemia/Hyperglycemia would be added along with monitoring interventions. If another individual, after emergency abdominal surgery from motor vehicle trauma, lost his wife in the accident, then Grieving would be added.
Faculty, nurse managers, administrators, and clinicians need to do their part. Change is imperative. Nursing must defend its right to determine its documentation requirements, just as medicine has done. If nursing continues to do business as usual, nursing as we want it—nursing as individuals need it—will cease to exist. Nursing will continue to be defined by what we do and write and not by what we know.
This sixteenth edition of the Handbook of Nursing Diagnosis has a new organizational philosophy and format. This author has taken the position that all nursing diagnoses are not equal in complexity. Some are not appropriate for beginning students. Some require advanced specialty preparation. With this philosophy, there are three levels of assessments and interventions:
Fundamental Focused Assessments
Extended Focused Assessments
Advanced Focused Assessments
Fundamental Focused Interventions
Extended Focused Interventions
Advanced Focused Interventions
For example, even in a horrific clinical situation and sexual assault, a beginning student can refer to the Fundamental Focused Interventions and is directed to:
Fundamental Focused Interventions
Ask the person “How can I help you?” If sexual assault is suspected, access the institution’s protocol e.g. Sexual Assault Nursing Examiners (SANE), Sexual Assault Response Team (SART), Women against Rape (WAR).
Seek to enhance control with compassion and clinical confidence with the following interactions and interventions (Hellman & Clark, 2014):
R:Because the perpetrator took away control of the individual’s body, this step is vital in starting the individual down the path of recovery.
From goals to specific interventions, Handbook of Nursing Diagnosis focuses on nursing. It provides a condensed, organized outline of clinical nursing practice designed to communicate creative clinical nursing. But more importantly, nurses from beginning students to seasoned nurses will have access to empathetic, scientifically sound nursing interventions.
As a nurse for over 50 years and a primary care nurse practitioner for over 26 years, I proudly bring my clinical expertise to the pages of this book.
Nursing is a sacred privilege with a profound obligation to care for others as if they were your parents, your siblings, your children, grandchildren, or the person you most love in this world. It is very clear that ignoring an individual or denying them the full impact of your nursing presence is not benign but instead a grievous professional offense.
Be aware of the power of your presence; the power of your touch.
Lynda Juall Carpenito APN
Handbook of Nursing Diagnosis, Sixteenth Edition comes with a complete Companion Website designed to enhance and expand upon key concepts and nursing diagnoses presented within this text. The following features are available for students, practicing nurses, and faculty members:
Expands the list of NANDA-I diagnoses presented within the text to include several advanced and specialty diagnoses, including neonatal jaundice, disorganized infant behavior, and autonomic dysreflexia.
Nursing Baseline Assessment Form
Appendix B presents a sample nursing baseline assessment form for students and practicing nurses to review.
Diagnostic Clusters
This in-depth look at diagnostic clusters provides more detail on the clusters identified in Section 4 of the printed text.
The Diagnostic Process, or Putting It All Together
Created by the author, this presentation walks students and practicing nurses through the diagnostic process, offering insights into clinical judgment, decision-making, collaborative problem-solving, and the challenges nurses face when making a medical diagnosis.
Instructor’s Manual
This resource provides faculty with helpful tips on ways to integrate the content into their courses.