Nursing diagnoses are a critical part of the nursing process and have been a large part of nursing education and clinical documentation for more than 30 years. Utilization of nursing diagnoses in practice is largely unknown because of lack of published research on the topic. The evolution of computerized charting has revolutionized the format and style of nursing documentation. The purpose of this study was 1) to examine the self reported utilization of nursing diagnoses by registered nurses and 2) to examine the attitudes of registered nurses towards nursing diagnoses. This study employed the use of the Internet to distribute, administer, and collect surveys and data. A random sample of 950 registered nurses who submitted their e-mail address to the Florida Department of Health (FDOH) received an e-mail invitation, and 133 (14 percent) responded to the survey.
Most of the participants (93 percent) were advanced practice nurses (APN), educated beyond the bachelor degree level. Both utilization variables in this study displayed a slight tendency by subjects against the use of nursing diagnoses in practice. Utilization of nursing diagnoses was significantly correlated with the participant’s personal attitude towards nursing diagnoses (rs = 0.65, p < 0.001). Utilization was also significantly correlated with the views of other nurses the respondent knew (rs = 0.45, p < 0.001). These correlations were consistent with the Theory of Planned Behavior (TPB) by Ajzen. The survey contained two text response items and an area for comments. The most prevalent themes that emerged as reasons for documenting nursing diagnoses were: (1) to improve patient care, (2) to enhance communication, (3) to develop care plans, and (4) to adhere to policy. The most common reasons for not writing nursing diagnoses were: (1) poor use of time, (2) no application to their role as an advanced practice nurse, (3) not read, and (4) different language used by advanced practice nurses.
The study’s findings, that personal attitude / value and subjective norm influence the usage of nursing diagnoses, can be employed to promote implementation of nursing diagnoses in the practice setting. Further study is needed to examine whether reinforcement of personal attitude / value and subjective norm factors in the educational and clinical settings will increase nurses’ use of nursing diagnoses.
