Part Two: The Nursing Diagnosis
In my last post, I introduced the centerpiece of the RN’s legal standing to make independent assessments and plans around this. In this post, I want to introduce a Nursing Diagnosis so that RNs can be somewhat refreshed on the process, and people who might seek a Nurse Advocate for health advice, lifestyle help, or even wellness in relationships can understand both the structure and the application of the practical nursing diagnoses.
I chose one example to show. This is to illustrate the process and the structure of how RNs can help people in many various ways and stages of life. I like to say “we are nurses – there is little about human life we haven’t seen.”
This is one of the diagnoses I personally use in my practice to help people get “unstuck” from believing they are powerless in a primary relationship. To this end, I studied therapeutic conversation techniques called “Motivational Interviewing,” and “Appreciative Inquiry” to help people verbalize their feelings and identify what they desire, along with a certification in Assertiveness Skills, so that people can learn to verbalize honestly, and set personal boundaries for their self-esteem, lower stress levels, and to improve relationships.
Example diagnosis with samples of criteria (Sparks & Taylor):
Ineffective Relationships. Defined as: A pattern of mutual partnership that is insufficient to provide for each other’s needs.
Assessment is based on:
- Coping status, including method of dealing with general conflicts, level of patient’s communication with family and others; handling of negotiations regarding restriction of freedom, degree of patient’s separation from family, tolerance of patient’s expressed opinions, reaction to patient’s long-range goals; and age-appropriatness of dating, curfew refulations and money managment.
- Individual’s past response to crises, including stress management and communications patterns to express anger, affection, and confrontation.
- Does not identify partner as a key person
- No demonstration of mutual respect and support in daily activities between partners
- Reports dissatisfaction with complementary relations between partners and fulfilling each partner’s emotional and physical needs.
- Patient will express understanding of role as an individual, partner and / or member of the family.
- Patient will verbalize positive aspects of his or her relationship
Interventions & Rationals:
- Assist the patient with cognitive therapies that develop positive coping skills to help build self-esteen, as this fosters self confidence and a positive attitude toward personal relationships.
- Provide a safe environment and assist the patient and partner/family in communicating openly regarding positive aspects of their relationship in order to help facilitate positive interaction.
Evaluations for Expected Outcomes:
- Patient verbalizes positive aspects of relationships
- Patient verbalizes understanding of positive communication techniques
- Assessment of relationships and contributing factors
- Patient’s progress in problem solving skills and making choices
- Patient family interactions and family meeting notes
- Patient’s responses to interventions
- Outpatient resources identified and given to family or patient
- Evaluate the expected outcomes
This example shows the structure and model of using a nursing diagnosis to help people in a private practice setting. The invaluable part of this professionally conducted and documented intervention system is that the patient is empowered to have and own a set of notes that they can give to other care providers such as physicians or counselors.
I hope this illustration was helpful both to RNs who are thinking about private practice, and also to inform prospective clients (called patients in the textbook) of the depth and systematic methods used to help them. This same process is used for all of the 200+ diagnoses that RNs can use.
Reference cited above:
Sparks and Taylor’s Nursing Diagnosis Manual, 9th Edition, pages 693 and 694.
In sessions where the RN is not acting within scope, the process can be documented with the actual nursing diagnosis attached, and clear annotation and agreement is obtained that the session is NOT a nurse-patient relationship. Of course, legal assistance is always best obtained from a qualified attorney.
© Lizzie Bennett
Lizzie Bennett is a Registered Nurse and Ordained Minister of some years and owns Three Moons Medicine™ as her private counseling and coaching practice, a blog, educational forum, Facebook page, and outreach to support others on their journey.