"Nursing diagnosis doesn't have anything to do with quality of care. It's probably some high faluting idea drummed up by intellectual types that has very little to do with the actual practice of nursing. It actually has more to do with documentation of care than delivery of care. Why create more paperwork when persons in longterm care are already overburdened with paperwork?"
These special editions of the Journal of Gerontological Nursing were developed to respond to these reactions that nurses often have about nursing diagnosis. Based on the belief that nursing diagnosis is an important key in continuing improvement in nursing care of older persons, both volumes are devoted to sharing with nurses some of the work that has been done with specific nursing diagnoses that will further enhance the care of gerontological clients.
Nursing diagnoses define nursing. They describe discrete problems that nurses treat. The process of arriving at a nursing diagnosis, the problem-solving process, requires thoughtful consideration of the available data or identification of additional data needed, based on presenting signs and symptoms to identify the problem. This leads to the prescription of nursing actions that will intervene with the cause of the problem. Effectiveness of the intervention can be measured by changes in the presenting signs and symptoms.
Nursing diagnoses are not mere labels to problems but include signs and symptoms and related factors which allow other nurses and clients to understand what we are talking about and share their experiences and data with similar problems. Nurses can also share what works to resolve or treat those particular problems. Authors who contributed to these issues were asked to share their experiences by describing specific nursing diagnoses and interventions that they have used. In these articles, the process of arriving at a diagnosis is illustrated, actual practice situations are reported, and nursing knowledge needed to intervene with the problem is organized around specific diagnoses. The framework for selection of diagnoses to write about came from a study by Maas, Hardy and Akins which described the incidence of diagnoses among older, chronically ill persons in long-term care.
It is our hope that the articles will be helpful in each nurse reader's clinical practice; that they will stimulate each reader to explore more information about nursing diagnoses; and most importantly that they will stimulate more sharing among nurses so that all older persons can benefit from the experiences of nurses and clients around the country. Nursing diagnosis can only develop to its full potential if it continues to be built upon clinical practice and research experiences of nurses. Each of us must contribute to make this a reality.