Clinical Support For Eliminating The Nursing Diagnosis Of Knowledge Deficit

An investigation of the appropriateness of the use of the nursing diagnosis, Knowledge Deficit, in specific clinical instances and examination of the diagnosis in light of validation criteria provided clinical support for eliminating it. The authors conclude that Knowledge Deficit falls outside of the boundaries of the discipline and that the label encourages nurses to focus attention on the promotion of knowledge as an entity rather than addressing a behavior related to the patients' lack of information. Removal of Knowledge Deficit from The North American Nursing Diagnosis Association (1986) taxonomy would force nurses to use other diagnostic labels.     

Conceptual Basis for the Organization and Advancement of Nursing Knowledge: Nursing Diagnosis/Taxonomy

An analysis of the conceptualization embedded within the development of nursing diagnoses, including the historical perspective on this process, is presented. Although there are conceptual issues still to be resolved, nursing diagnosis can be considered as a conceptual approach to developing disciplinary knowledge.     

Beyond Knowledge Deficit to a Proposal for Information-Seeking Behaviors

TOPIC. Nursing assessment of knowledge or informational needs.
PURPOSE. To present a brief evolutionary analysis of knowledge deficit in terms of its significance, application, and use, and to present a proposed diagnosis, "information-seeking behaviors."
SOURCES. Literature review of knowledge deficit and "information-seeking behaviors."
CONCLUSIONS. Knowledge deficit is a nursing diagnosis that is significant for identifying a patient's need for education or knowledge. Its application has revealed limitations to validity and subsequent use. "Information-seeking behaviors" is proposed as an alternative diagnosis. Antecedents and defining characteristics are presented and areas for future research proposed.     

Beyond Knowledge Deficit to a Proposal for Information-Seeking Behaviors

TOPIC. Nursing assessment of knowledge or informational needs. PURPOSE. To present a brief evolutionary analysis of knowledge deficit in terms of its significance, application, and use, and to present a proposed diagnosis, “information-seeking behaviors.” SOURCES. Literature review of knowledge deficit and “information-seeking behaviors.” CONCLUSIONS. Knowledge deficit is a nursing diagnosis that is significant for identifying a patient's need for education or knowledge. Its application has revealed limitations to validity and subsequent use. “Information-seeking behaviors” is proposed as an alternative diagnosis. Antecedents and defining characteristics are presented and areas for future research proposed.     

社会学基础知识与其有关护理诊断的探讨

在我国开展整体护理,护士的观念转变是十分重要的,必须认识到护理对象是一个生物、心理、社会的综合体。此外,在实施整体护理应用北美护理诊断协会的１２８个护理诊断中则因为缺乏社会学知识仅用了其中一部分,而有关社会方面的护理诊断则应用较少。为深入开展整体护理,在护士中普及社会学知识是非常必要的。在学习社会学概论中用社会学的几个基本概念联系有关的护理诊断进行了初步探讨。     

Deficient Knowledge Nursing Diagnosis: Identifying the Learning Needs of Patients With Cardiac Disease

OBJECTIVES. To identify the learning needs of patients with cardiac disease and the aspects of the disease and anesthetic and surgical procedures about which Brazilian patients have the greatest gaps in knowledge. METHODS. Eighty preoperative patients answered a General Evaluation Questionnaire, a Questionnaire to Evaluate Patient Knowledge, and the Mini‐Mental State Exam. FINDINGS. Fifty‐nine patients had learning needs. More than 50% of the patients were mistaken or unable to answer questions about the disease, and the goals of and type of surgery to be performed and anesthesia to be used. CONCLUSIONS. Most patients had poor performance on the questionnaire that assessed their knowledge about coronary artery disease and its treatment. PRACTICE IMPLICATIONS. This study can contribute to health professionals' assessment of patients' knowledge. OBJETIVOS. Identificar as necessidades de aprendizagem de pacientes com doença cardíaca e os aspectos da doença arterial coronariana e da revascularização do miocárdio do nos quais os pacientes brasileiros apresentam conhecimento deficiente. MÉTODO. Oitenta pacientes responderam o Questionário para avaliação geral, o Questionário para avaliar o conhecimento e o Mini‐Exame do Estado Mental. RESULTADOS. Cinqüenta e nove pacientes apresentaram necessidade de aprendizagem. Mais de 50% dos pacientes erraram ou não souberam responder as questões referentes ao nome da doença, aos sinais e sintomas de complicação da doença, aos objetivos e tipo de cirurgia e anestesia. CONCLUSÃO. Muitos pacientes não apresentaram bom desempenho no questionário para medir conhecimento em relação à Doença Arterial Coronária e seu tratamento. IMPLICAÇÕES PRÁTICAS. Este estudo poderá contribuir para a avaliação do conhecimento dos pacientes por profissionais da saúde.     

Reevaluation of a Nursing Diagnosis: Spiritual Distress

The purpose of this paper is to reevaluate the nursing diagnosis of spiritual distress in relation to Marjory Gordon's criteria of discriminatory power, generality, flexibility, usefulness, and inclusiveness. The author suggests that nursing's perspective of the spiritual dimension and spiritual distress is both narrow and inadequate in today's multicultural, multidimensional healthcare setting. Views of spirituality from multiple disciplines are discussed to illustrate the diversity of the phenomenon and contrast views that primarily emphasize religiosity and psychosocial factors. Reevaluation of spiritual distress and spirituality must come in the form of holistic and humanistic approaches in nursing education and research, integration of the spiritual dimension within nursing curricula, and recognition of multidisciplinary, global perspectives of the spiritual phenomenon. The author stresses the importance of the spiritual dimension and its impact upon a person as a multidimensional being.     

Nursing Diagnosis: The Importance of a Definition

Nursing as an evolving science entertains the usage of terminology that lacks clarity and the singular application of terms. The resulting semantic confusion leads to difficulty in operationalizing definitions for use in taxonomic efforts and in research. Examples of this confusion exist where the term nursing diagnosis is used as concept, category, process, and product. Four suggestions are made to alleviate these difficulties.     

An Analysis of the Nursing Diagnosis Ineffective Management of Therapeutic Regimen Compared to Noncompliance and Orem's Self-Care Deficit Theory of Nursing

The authors compare the nursing diagnosis ineffective management of therapeutic regimen with that of noncompliance and with Orem's concept of self-care deficit. The article describes how the diagnosis of ineffective management of therapeutic regimen is more comprehensive than noncompliance. A question of patient autonomy is raised considering how the patient manages his or her therapeutic regimen. The major conclusion is that the nursing diagnosis of ineffective management of therapeutic regimen is based on continuous interaction between patient and nurse. The authors recommend that noncompliance be eliminated as a nursing diagnosis.     

Nursing Diagnosis Research: Computer-Aided Research in Nursing

The authors describe the development of a research tool for studies on nursing diagnosis by the Computer-Aided Research in Nursing (CARIN) project. The tool, a computerized assessment guide, has reliable and valid items for the identification of patient problem areas. The patient information in the assessment guide, nursing diagnoses identified by the clinical nurse specialist, and a statistical interface are linked in a customized computer program for the CARIN project, providing a system capable of analyzing patient problems from several perspectives. The system provides an accurate assessment and subsequent analysis of patient problems, as well as large data sets. Implications for the future of nursing diagnosis research are discussed.     

Nursing Diagnosis in Perspective: Response to a Critique

As noted above, I have attempted to respond to Shamansky and Yanni's critique of nursing diagnosis. This has included an identification of some critical assumptions that underlie their work, the contexting of their arguments in the history of scientific discovery, and a listing of various misconceptions and distortions concerning nursing diagnosis.
I have concluded that the authors' basic premise was a desire to eliminate rather than ameliorate nursing diagnosis. The authors had an unstated preconception of a preferred model of conceptualizing nursing, which they did not directly state as their preconception. They systematically listed real inadequacies of nursing diagnosis efforts as an argument for abandonment. They reflected limited understanding of or information about the nursing diagnosis literature. They tended occasionally to overstate their case.
I believe that my dissatisfactions with nursing diagnosis efforts are more informed, more complex, and more numerous than theirs including such quandaries as taxonomic principles and research units of analysis. However, my responses to these problems are proactive rather than reactive, committed to amelioration rather than elimination. While I feel that the authors have provided a salutory service in delineating their concerns, I look forward to other critical reviews that might provide the intuitive insights to address the next steps in the evolutionary development of nursing diagnosis.     

Predicting Violence: Nursing Diagnosis Versus Psychiatric Diagnosis

Predicting violent behavior is a major concern for nurses as well as other mental health professionals. Two diagnostic assessment systems (Nursing Diagnosis-NANDA and Psychiatric Diagnosis- DSM III-R ) were compared in their ability to predict assaultive behavior. The nursing diagnosis potential for violence suggested a difference ( p = .07) between the assaultive and control subjects. No differences were found between assaultive and control subjects on psychiatric diagnoses. Nursing diagnosis is based upon measurable behaviors and is time specific. Clinical implications and further research endeavors in this area are suggested.     

Diagnosis of Cognitive Deficit in the Aged

The main effects of aging on the brain are similar to those of diffuse brain damage and are manifested as behavioral change or cognitive deficit. Changes due to aging must be differentiated from those due to focal cerebral lesions, including remediable pathologic disorders, and from involutional psychosis. The classic neurologic examination can be extended to aid in the diagnostic process.     

Toward a Unique Knowledge Base in Nursing

This article explores the subject of unique knowledge in nursing by attempting to answer three questions: 1) what is unique knowledge, 2) does nursing have a unique knowledge base, and 3) is a unique knowledge base essential to nursing? It argues that knowledge becomes unique because of the unique perspective of the discipline in which that knowledge is incorporated. A survey of various attempts to define the unique focus of nursing is followed by a discussion of the importance of such a definition if nursing is to establish itself as a professional discipline.