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RN Team Makes Significant Contribution to Nursing Diagnoses


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By Megan M. Krischke, contributor

Can a small group of RNs help clarify communications and improve the standard of care for their entire profession? Yes, they can. Just ask the nurses at Aspirus Wausau Hospital in Wausau, Wisconsin, who helped write more than half of the newest nursing diagnoses sanctioned by NANDA International, the only diagnosis-specific association in the field.

RNs Contribute to Nursing Diagnoses
Jennifer Hafner, RN, Sheri Holms, RN, MSN, and Joan Klehr, RNC, were among the nurses at Aspirus Wasau Hospital who contributed 11 new nursing diagnoses to NANDA’s biannual publication.

Standardized taxonomy for nursing diagnoses had its beginning in the early 1970s and is commonly used in health care settings today.

A nursing diagnosis is simply a clinical diagnosis made by a registered nurse for the purpose of planning nursing outcomes and interventions, in other words, creating the nursing care plan. It differs from that of a physician’s diagnosis in that it not only assesses the patient’s medical condition, but also the patient’s response to the illness or injury.

Patients usually have multiple nursing diagnoses that cover not only their physical well-being, but also a host of related areas such as their psychosocial well-being and the well-being of their families and care givers. Nursing diagnoses must cover problems that a nurse can treat independently of the physician and must be written in a format that states the problem related to the cause of the problem as evidenced by the symptoms of the problem.

The North American Nursing Diagnosis Association (NANDA) was established in 1982 in order to help nurses standardize diagnoses and improve care plans. Twenty years later the group changed its name to NANDA International as a reflection of the worldwide interest in the field.

NANDA International exists to develop, refine and promote terminology that accurately reflects nurses' clinical judgments. This unique, evidence-based perspective includes social, psychological and spiritual dimensions of care.

Every two years NANDA reviews and publishes its current nursing diagnoses, typically adding around two dozen new diagnoses. For the 2009-2011 edition of the official publication, Nursing Diagnoses: Definitions and Classification, a cohort of nurses at Aspirus Wausau Hospital contributed an impressive 11 of the 21 new entries.

“In the past the people who wrote these nursing diagnoses were nursing Ph.D.s working in academia, while those of us working in patient care would sense the gaps in the official diagnoses available,” explained Sheri Holmes, MSN, APRN, BC, service line administrator for Aspirus Women’s Health.

“When I graduated from nursing school in 1974, we didn’t have nursing diagnoses. So when I went back to graduate school it was all new for me,” said Holmes, who earned her MSN in 2004 from the University of Wisconsin-Eau Claire and was the clinical nurse specialist on the Aspirus task force that created the new diagnoses.

The NANDA system lists five types of nursing diagnoses:

Actual Diagnosis - states a health problem the client/patient has that could benefit from nursing care.
Risk Diagnosis - states a health problem for which the client/patient is at higher than normal risk for experiencing.
Possible Diagnosis - states a health problem the client/patient may have now, but the nurse doesn’t have adequate information to make an actual diagnosis.
Syndrome Diagnosis - is used when clusters of nursing diagnoses are often seen together.
Wellness Diagnosis - used to describe an aspect of the client who is at a high level of wellness.

The cohort in Wausau was born out of a day-long seminar Aspirus held for nurses who were interested in developing nursing care plans and outcomes for the hospital’s electronic medical record. The nurses were divided into work groups based on their expertise.

“It was while we were in those work groups that we realized that we could not develop a nursing care plan because there was not a nursing diagnosis for that population’s condition. It is difficult to determine interventions and outcomes when there is no standardized diagnosis,” said Holmes. “For instance, the only diagnosis we had for the perinatal population was ‘ineffective protection.’”

“Once we got started on identifying these missing diagnoses, there emerged a group that was interested in continuing the work and we just fed off of each other’s ideas,” Holmes explained. “Heather Herdman, president of NANDA, mentored us through the submittal process.”

Holmes, along with Aspirus nurses Joan Klehr, Jennifer Hafner, Leah Mylrea Speltz, Kathy Weaver, Barb Heilmann, Corrine Snell and Shirley Wiesman wrote the 11 diagnoses, covering perinatal, medical-surgical and intensive care areas of nursing. Among the diagnoses written by the cohort were risk for bleeding, risk for electrolyte imbalance and dysfunctional gastrointestinal motility.

“Since we are with patients minute by minute, I’d like to see more nurses empowered to write diagnoses,” Holmes continued. “Any nurse who identifies a gap in the available diagnoses can take the initiative to write a new one. Writing a diagnosis requires the input of someone with a MSN who understands that level of research and writing—to guide or be part of that process—but you don’t have to have a MSN to submit a diagnosis to NANDA.”

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