The Scope of Nursing

While studying this past weekend for my first Nursing Fundamentals exam, I read the chapter on Nursing Diagnosis, a part of the Nursing Process. When we all think of nurses, we probably can agree that the general idea is that of someone who takes care of a patient, which is actually quite right on the mark. Thinking back to Mom’s time in the hospital, I can never forget the amazing care the nurses assigned to her took to make sure that she had the best time possible during a terrible ordeal. As I’ve said before, it was precisely witnessing the difference that care made on my mother that made me want to pursue this new career.

As I read my chapter, however, I realized that nursing care is actually a very codified activity. Yeah, nurses care for patients, and I always thought that they simply did what needed to be done. Thinking back to Mom again, the nurses brought her meds, yes, but also were there to alleviate her doubts, clarify her questions, soothe her sadness, monitor her progress, advocate for her needs. I took all those actions in stride, as part of “care.” Well, they are, but I’ve learned that each one of those actions is part of a specific nursing diagnosis which the nurses were addressing, seeking a positive outcome.

There is great emphasis on the independence of the nursing profession, and nursing diagnoses are arguably the primary way in which this achieved. These are actions the nurse can take independent of a physician’s orders, and define the variety of areas the nurse can intervene on to care for a patient. And the variety of areas honestly astounded me. Take a look at some example nursing diagnoses to see what I mean:

  • Anxiety
  • Disturbed Body Image
  • Decreased Cardiac Output
  • Risk for Caregiver Role Strain
  • Risk for Contamination
  • Acute Pain
  • Post-Trauma Syndrome
  • Chronic Low Self-Esteem
  • Sexual Dysfunction
  • Sleep Deprivation
  • Ineffective Thermoregulation

There are 188 nursing diagnoses and what was a revelation to me was understanding the scope of the word “care” when it comes to what a nurse does. In that small sample you can see the nurse addressing physical issues you’d expect someone in a hospital to be facing, but notice also the mental and social issues being addressed as well. Why? Because our patients aren’t only a medical diagnosis, they are an entire human being who isn’t only facing a physical ailment, but also is facing related factors such as anxiety from procedures, deficiency in knowledge of what’s being done, or even spiritual distress.

Oh yeah, that’s another nursing diagnosis: Spiritual Distress or Risk for Spiritual Distress. The Fundamentals of Nursing book says, “Nurses have a responsibility to assess client’s spiritual needs and intervene to meet those needs.” (Perry, Potter pg 342) That is fascinating! Our work as nurses extends to all levels of the human being, including the spiritual arena. And it’s easy to understand why: a patient that is in spiritual distress will not be in the right mindset to heal; she will be stressed, and that stress will prevent the physiological processes from taking their restorative course. And yes, I asked, even Atheism can be addressed via this diagnosis if needed.

So, thinking back to Mom’s care, what I took for granted to be nursing care was actually a series of nursing diagnoses that addressed issues my mom was having as a patient, whether those were Nausea Related To Impaired Digestive Function (and I’m making this diagnosis up, though I’m sure there is a correct one that addresses this issue Mom had) or Emotional Distress or Spiritual Distress. It’s not that nurses’ care was less than genuine, but that now I understand the codification that went on in the background to address each of those nursing interventions and how that codification allowed the nurses to objectively track my mother’s progress day by day.

As I said, I am fascinated by this realization. The scope of nursing is amazing, and the idea that we are allowed, encouraged and expected to take care of our patients on a holistic level–and that we have this codified system backing our assessments and interventions–fills me with excitement.


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