Experiences of Nurses in the Process of Determining a Nursing Diagnosis and Needs for Applying a Nursing Diagnosis : Fostering Understanding to Support the Use of Nursing Diagnoses in Clinical Practice

Abstract

Purpose: This study illustrates through experiences of nurses while determining nursing diagnoses in terms of thought, behavior, and emotion. It demonstrates current issues in and the needs for support in the use of nursing diagnoses. Methods: Data were collected through conducting semi-structured interviews based on an interview guide concerning the experiences of nurses and their awareness of issues in the process of determining nursing diagnoses. Principal Results and Major Conclusions: Followingten categories were selected upon considering the experiences of nurses in determining nursing diagnoses from a thought perspective: [Comparison with defining characteristics], [Confirmation of defining characteristics, related factors, and definition], [Searching for potential nursing diagnoses from main symptoms and problems], [Considering nursing diagnosis from nursing intervention and outcome], [Patterned thinking relating to specific diagnoses], [Considering some temporary nursing diagnoses and monitoring progress], [Identification of multiple nursing diagnoses], [Comparison of some nursing diagnosesby pickingpotential diagnoses of defining characteristics or related factors, definition], [Integrating multiple nursing diagnoses], and [Avoiding nursing diagnosis decisions]. From the behavioral and emotional perspectives, emphasis was placed on [Confirming and reviewing with other staff to determine a diagnosis] and [Solo confirmation and review to decide on a nursing diagnosis]. These were found to be driven by: [Pressure to provide a nursing diagnosis], [Sense of burden over task load that goes with nursing diagnoses], [Anxiety when determining a nursing diagnosis], [Negative emotions towards nursing diagnoses], and [Decline of negative emotions towards nursing diagnoses]. Needs for nursing diagnosis application included [Needs for fostering understanding and learning of nursing diagnosis], [Needs for expanding the process of nursing diagnosis], [Needs for nursing diagnosis and nursing intervention for patients in specific situations], [Needs for the application of an electronic health record system], and [Needs for thinking ability in applying nursing diagnosis], suggesting a need to foster understanding of nursing diagnoses and application of examples. Introduction According to the Nursing Diagnosis Association International (NANDA-I), “A nursing diagnosis is a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability” (p. 464) [1]. It is also an important tool for keeping records of one’s thought process and practice when practicing nursing. Seventy-eight percent of office-based physicians used some form of an electronic health record (EHR) system in 2013 [2]. It is reported that the introduction rate for electronic health record systems in Japan is 27.3%, with over 70.1% of hospitals having more than 400 beds [3]. The prevalence of nursing diagnoses and use of an electronic medical recoding system might have the same tendency, indicating that nursing diagnosis is primarily being spread to medical facilities with a large number of beds. Consequently, there have also been studies conducted regarding the difficulties and issues with using nursing diagnoses, highlighting the fact that psychiatric nursing units have few nursing diagnostic labels, insufficient understanding of nursing diagnostic definitions and concepts, and insufficient assessment [4]. Issues concerning the accuracy of diagnoses have also been pointed out in a study of nursing diagnostic ability using mock cases [5]. As issues are still expected to arise in the application of nursing diagnosis, we considered it necessary to investigate what nurses experience in the process of determining nursing diagnoses, what is lacking in order to apply nursing diagnosis in practice, what difficulties exist, and what needs exist.