NANDA Nursing Diagnoses in Contemporary Mental Health Nursing Practice - Chance or Thread?
Authors: Wolfensberger, P.
Publisher: Cardiff University, School of Nursing and Midwifery Studies
Place of Publication: Cardiff UniversityAbstract:
This essay has been submitted in partial fulfilment of the requirements of the Masters Degree in Nursing Studies - Module: Contemporary Practice in Mental Health Nursing.
Our world is changing rapidly. At the beginning of the 21st century, for many people in the first world it would be impossible to live without computers and the internet, mobile phones, ATMs (automated teller machines), GPS (global positioning system) and many more technological achievements which are meant to make our lives easier. New information and communication technologies are also enforced in health care to provide structured health information about individuals, families or communities and to support continuity and efficiency across the complete patient journey (RCN, 2006). A huge variety of different software products for electronic patient records is used in hospitals and health care institutions worldwide. Standardized nursing language and terminologies have been identified as essential parts for effective use of electronic health records. Do these achievements make nursing easier?
In Switzerland two separate projects initiated by nursing commissions of the departments of health in the cantons of Zurich (Bernhart-Just et al., 2007) and Berne (Baumberger et al., 2004) focused on the question which nursing classification systems best describe the different steps of the nursing process (Brobst et al, 2007) and therefore should be included in electronic health records. The experts from both projects recommend the implementation of the NANDA-I nursing diagnoses classification (NANDA, 2007), the nursing outcome classification (NOC) (Moorhead et al., 2008) and the nursing intervention classification (NIC) (Bulechek et al., 2008) as standardized terminologies to use in electronic health records.
Additionally, increasing health care costs demand for better financial control and for budget limitations. The implementation of diagnosis related groups (DRGs), designed to group hospital patients into classes, which are clinically homogenous with regard to the consumption of hospital resources, can be seen as a governmental response to health care budgets which are getting out of control. One might argue that this is the same background for the use of standardized nursing language and nursing classification systems: to make nursing more calculable, measurable, controllable and hence limitable! However, efforts and failures to find a unique nursing language or standardized classification systems for nursing have begun much earlier than within the focus of health care budgets and the implementation of new information and communication technologies. The need for a language, which is different from the medical terminology, to use among nurses, with other health care professionals and also with the public has been discussed for more than 30 years (Johnson et al., 2006).
Much in contrast, or so it seems, to the development of standardized nursing language, terminologies or classification systems there is the enforcement of new concepts and models of practice in mental health nursing. Empowerment and recovery are two of these concepts which are currently influencing contemporary mental health practice not only in nursing but in multidisciplinary teams with nurses, therapists and doctors. The Tidal Model (Barker & Buchanan-Barker, 2005) is a model of psychiatric and mental health nursing which has a growing impact on mental health nursing in different countries and which, with a strong support of narratives and the patients own language or voice, does not seem to match the ideas of standardized language at all. It is the experience of the author of this article that in mental health nursing with a special focus on highly individual care and concepts focusing on empowerment and recovery the use of standardized language or nursing classification systems seems to be more controversial than in other nursing practice fields. Therefore the author is trying to point out the advantages and disadvantages of NANDA in mental health nursing. The framework of the Tidal Model will be used to support the discussion. NANDA as an example of a specific classification system has been chosen because of its increasing use especially in Switzerland and a vast amount of literature about it. The Tidal Model as an assumed contrast or opposition to the use of classification systems in mental health nursing has been chosen because it implies the ideas of empowerment and recovery as well as a clearly holistic paradigm: it is used as a synonym for contemporary mental health nursing practice.
Preferred by: Peter Wolfensberger