Nursing Times blogger Tony Barlow considers nursing diagnosis, drawing from his own medical experiences to consider his feelings toward the approach.
My boss wants me to do another course and has suggested two based on the direction that nursing appears to be moving.
The first one - nurse prescribing - I immediately discounted.
The second, however, I am very interested in: nursing diagnosis.
I initially thought/presumed: “Here we go again, nurses forgetting that they are a nurse”, as the word “diagnosis” appears to be medically orientated. However, I am completely wrong in my presumption about this concept – nursing diagnosis actually relates to the recognition of the reaction of the patient to being given a medical diagnosis. Let me explain…
A few years ago I was diagnosed with multiple sclerosis - a medical model diagnosis. I am sure that you all know the signs/symptoms of MS – muscle weakness, spasms, fatigue - the list goes on, so I will refrain from boring you with all the details. However, I could deal with these symptoms by adapting my life and activities so that managing the condition became simple. What I couldn’t deal with was the depression that accompanied the diagnosis - the feeling that life had ended at the age of 35.
I questioned the point of carrying on as I knew my likely prognosis was very bleak indeed. I felt extremely stressed and let everyone know about it. I was angry and definitely made sure that everyone knew – friends, family and work colleagues. I stopped doing many activities that I normally enjoyed, leading to that vicious circle of lack of reward leading to lack of motivation, which in turn feeds the start of the cycle once more.
So, you can see that the medical diagnosis led to symptoms and consequences that were outside of the medical definition of MS. It is these symptoms and consequences that form the nursing diagnosis.
I see nursing diagnoses as being at the heart of good nursing care. It is the individualisation of a person’s condition that surely defines the difference between a poor nurse and an excellent one. The NMC code clearly states that people should be treated as individuals - the nursing diagnosis does exactly that. It virtually ignores whatever the medical diagnosis is through valuing the idiosyncratic implications of the diagnosis.
The concept of nursing diagnosis appears to be well grounded in our colleagues across the pond, who are certainly leading the way on this concept and I hope that I get the opportunity to study there. And in case you were wondering where this concept fits into the nursing process, it becomes assess, diagnose, plan, implement, review.
Medics can deal with the medical condition; we should deal with the person.