April 13th, 2012
By Jennifer Olin, BSN, RN
Communication is the key to—ok, we can stop that sentence there. Communication is the key to everything. In healthcare we have a language we speak amongst ourselves that outsiders often cannot follow. Then, when we get to every specialty: medicine, nursing, pharmacy, and the different therapy specialties—we all have an even more specified language. After that, it breaks down even more to each subspecialty area: emergency room, ICU, operating room, public health—again, we all have our own “dialects” if you will. So, how do we ever get our point across?
In nursing, our language is defined, updated, and maintained by NANDA-I. The North American Nursing Diagnosis Association (NANDA) officially became NANDA-I (for international) in 2002 to reflect worldwide use of nursing diagnosis terminology. NANDA-I is a global force for the development and use of nursing’s standardized terminology to improve health care for all people.
Now if this were television, I think I would hear channels changing already. Hang with me if you can, this isn’t as boring as it sounds or as painful as you think nursing diagnoses are. There is a direct correlation between standardized nursing language and patient safety.
Just take a quick read of how NANDA-I describes the connection:
”Patient safety requires that clinicians quickly grasp the priority needs of a patient. Use of language that requires a written narrative is no longer effective in today’s high acuity environment. Just as the medical discipline uses standardized language to identify patient disease states – so that all caregivers of all professions understand what is meant by a “Myocardial Infarction” (heart attack) – it is also critical that when nurses use terminology such as ‘activity intolerance,’ all health care providers clearly understand what is meant and the appropriate plan of care. Lack of common definitions and defining characteristics (signs and symptoms) for nursing diagnosis language, leads to miscommunication and potentially, to mistreatment of patients. Standardized language ensures consistent communication and clarity – and therefore a better direction for patient care.”
Isn’t that what we are all after, better patient care? Communication, as I said before, is the key. NANDA-I provides evidence-based nursing diagnoses for use in clinical practice and is key to the emerging world of Electronic Health Records (EHRs). The language established by NANDA-I is translated into 15 languages and used in 32 countries worldwide.
It's About Content and Context
I know most of us link the language of nursing diagnoses with those ever painful nursing care plans, the required torture of attending nursing school. I must admit, it wasn’t until I started writing about nursing (about 10 years into my nursing career) that I started to figure why this nursing language is really important.
”The way it is taught in most nursing schools it is completely out of context,” said T. Heather Herdman, PhD, RN in a phone conversation earlier today. Herdman is the Executive Director of NANDA-I. “It’s taught in that first class of nursing school with no content. We are asking kids with no nursing knowledge to formulate diagnoses.
”The whole point of the nursing language is that everything is based on an assessment and you haven’t assessed or even met the patient yet,” Herdman continued. “How can we start talking about how to make a nursing diagnosis and applying them to patients until we’ve taught the content.”
In fact, this very topic is going to addressed at the 40th Anniversary NANDA-I Biennial Conference: Defining the Knowledge of Nursing-International Initiatives for Clinical Excellence being held in Houston next month. During the three-day event conference participants will focus on defining nursing knowledge, patient safety, clinical judgment/clinical reasoning, patient outcomes/patient-centered care, practice advances in health information technology, and advances in nursing education. It’s that last one in particular and a session entitled “Educating Faculty in Reasoning Behind Nursing Diagnoses” that has particularly captured my attention.
Herdman will be one of the experts leading the conversation. “I was in Diploma school first,” Herdman told me. “My teachers would always say, ‘well Gordon says’ or ‘Carpenito says’ you have to have a diagnosis for every aspect of every patient.” Herdman is referring to Marjory Gordon, RN Ph.D. FAAN, and Lynda Carpenito-Moyet, RN, MSN, CRNP, experts in the field of nursing language and nursing diagnoses.
Herdman related to me how years later she had the “privilege” of working for and with Gordon. She said she told Gordon how as a student she had an elderly, comatose patient she was working up for school. Herdman’s nursing teacher admonished her for not having nursing diagnoses for the patient’s spiritual life or sexual life, following up as usual by saying, “Gordon says” you have to address every need. Herdman laughed as she recalled Gordon telling her that her teacher has been a little off in understanding the purpose of the nursing diagnoses.
“Nursing language and nursing diagnoses classes are fabulous courses to teach,” Herdman said. “But you have to teach them in a way that makes sense.”
How NANDA-I Fits In The Business of Healthcare
It also makes sense that we, as nurses, all speak the same language when talking about our patients. It is a means to keeping our patients safe and in these difficult economic times it will quite literally mean saving money.
The old saying “never say never” takes on a profound reality when applied to hospital situations that shouldn’t happen but, in reality, often do. Referred to as “never events” these largely preventable problems such as falls, foreign objects being left in a patient’s body after surgery, infants being discharged to the wrong person, or patient death or serious disability associated with a medication error do happen. These events result in injury and death and add millions of dollars in additional healthcare costs.
While the solution to reducing never events is complex, the nursing profession can provide part of the solution. “One proven way of reducing never events is through the use of standardized terminology to document a registered nurse’s diagnosis and care plan for a patient,” Herdman said. “Ideally, a standard language provides the RN with diagnostic terms, their associated signs and symptoms, as well as the foundational scientific research.” The depth of information available to the RN about a term leads to greater accuracy in nursing diagnosis and care. “Some languages only offer a list of diagnostic terms, without associated patient signs and symptoms and without the research to back it up. Without these components the wrong term, or diagnosis, could easily be made.”
And that brings us full circle to Nursing 101. The nurse’s number one job is patient safety. Nursing language, nursing diagnoses and nursing care plans are all means to providing safe patient care that all of us with an RN after our names can understand. The language is used after meeting the patient, assessing their needs and giving some thought to what the best path to wellness will be. Sometimes it not just how you say it, but what you say.