Launching NANDAcast: A New Voice for Nurses Around the World

Heather Herdman: 00:00:00

Welcome to our very first podcast for Nanda International. The NANDAcast, we are specifically reaching out to nurses in clinical practice as well as students and the professionals who teach our students. I'm Dr Heather Herdman, the Chief Executive Officer of Nanda International. I'm a past president and past chair of our diagnosis development committee. So I suppose it's fair to say that Nanda International has been part of my life for the vast majority of my professional career. This podcast was the dream of Dr Anna Maria Napoleon, the chair of education for Nanda International. She and her team have worked to put these podcasts together establish a schedule of these offerings that I think will be really exciting and will introduce listeners to viewpoints from around the globe. Today, I am joined by Dr Camila Takao Lopes, Nanda International's Chair of diagnosis Development. Dr takecalopes is an adjunct professor at the police to School of Nursing at the Federal University of Sao Paulo in Brazil, and she's a Nanda international fellow. I think I might be right Camila in saying that you're our youngest fellow ever. So thank you for joining me today. Let's start by maybe just tell me where you went to school and where you did your nursing career. Hi

Heather Herdman: 00:01:19

Camila Takao Lopes: Heather. Hi everyone listening. Thank you for having me here today. On this first episode, I graduated as a nurse in 2007 from the Medical School of San Jose. Do you preto, which is a town near my hometown in the state of Sao Paulo in Brazil. And after that, I moved to the city of Sao Paulo to start my master's degree at the Federal University of Sao Paulo where I work now, and I did my Master's on Nephrology and Immunology. But when I was about to finish my master's study, and as I met other nurses, I felt I didn't have much of a personal and professional identity, so I decided I would look for a graduate program and be advised by a nurse, and I went through the CVS at the Paulista School of Nursing, and then I met Professor Alba bahus, who was my doctoral advisor, and when I started meeting with her and working with her research team, she really opened up my eyes to the importance of clinical practice and clinical reasoning and and the central role of nursing diagnosis to our practice. And that's when I kind of found myself and I started working and collaborating with other graduate students on their multiple studies on nursing diagnosis. I did my own study on risk for bleeding following cardiac surgery. I started working in the ICU. I specialized in cardiology, and that's when I felt I had the sense of belonging to something and and then it clicked for me. That's how I got involved with nursing diagnosis. And you were actually a visiting professor here in Brazil at our university when that happened. So you also played a great role in in in my decision making and this new identity that I fortunately was lucky enough to to develop.

Heather Herdman: 00:03:44

Well, it was, it was wonderful watching you develop and and I think you won the the award for the best dissertation the year that you did your doctor. And if that's right, am I right? I did. I did in 2016 in the area of nursing.

Heather Herdman: 00:04:02

It was a beautiful piece of work. Thank you. So how do you how do you see nursing diagnosis and clinical reasoning, you know today, now that you're thinking back on the last few years of working in this area, how do you see it contributing to professional nursing practice, and what would you say to nurses at the bedside as to why nursing diagnosis and clinical reasoning are so important.

Heather Herdman: 00:04:24

Camila Takao Lopes: Well, to me, clinical reasoning leading to nursing diagnosis or leading to decision making, really separate us from just doing tasks. Separate nursing from a series of routine tasks to evidence based decision making and really being an applied science and being a group of professionals who have a place at the interdisciplinary team. Able and make their own judgments, and based on that, make their own decisions.

Heather Herdman: 00:05:08

That's that's a really nice response. I think sometimes people, they say that nursing is part of the interdisciplinary team, but they forget that to be part of that team, we really do have to bring our own discipline with us to that team and so clinical reasoning and and our diagnosis kind of give a voice to that at the table that other professionals can can understand and kind of grab a hold of Yes,

Heather Herdman: 00:05:33

Camila Takao Lopes: and it really help, helps us move beyond just having a checklist of problems, and trying to solve all of these problems separately, and having a line of thought, understanding the underlying causes, what are the consequences, what? What's the level of severity for this specific person? So really individualizing and bringing this body of knowledge to it's showing it and sharing it with other disciplines.

Heather Herdman: 00:06:07

And I think too, that, you know, diagnosis in themselves, students sometimes confuse diagnosis and documentation. And that if, if we can think about diagnosis as the kind of that the end point of a judgment that nurses make. It's not, it's not just a series of things that we write, right? It's a way of describing the judgments that nurses have been making as they're working with that patient. Does

Heather Herdman: 00:06:37

Camila Takao Lopes: that make sense? It does, and it's later, I guess on my career as a professor, I realized how relevant it was to differentiate or to show the diagnostic process and the diagnostic product that we document later, and that it's not only about the documentation itself, even though it is extremely important and must be done. So having this differentiation with students has also been very important. Diagnosis as a process, diagnosis as a product. Yeah,

Heather Herdman: 00:07:22

that makes me think too about the role. So I think sometimes we have the role of the nurse, and then we have the nursing discipline, and we tend to sometimes forget that there are things, there are tasks that nurses do, because that's what we have to do, that, you know, we have to take a temperature or we have to give a medication. But the role doesn't define the nurse the knowledge of the discipline, so the concepts that nurses understand is really what defines us as a discipline.

Heather Herdman: 00:07:52

Camila Takao Lopes: Yeah. Well, thank you for helping me with this answer, and I I wonder, how was your experience with nursing diagnosis when you were a student? Well,

Heather Herdman: 00:08:06

I'm a little older than you, so I was probably in one of the first groups of people who got the student experience as we were launching nursing diagnoses, and it was not a positive experience. I'm going to be really honest, the teachers, the professors, didn't understand it well themselves. They weren't really clear how to talk about nursing diagnoses. And often we would have a lecture, and as we were walking out the door, they would be yelling, and the nursing diagnosis for congestive heart failure is whatever it was. And, you know, we had to do these unbelievable, ridiculously care plans that took hours and hours for patients before we had ever seen the patient, before we had ever, you know, done our first piece of assessment. We would get a name and an age and a diagnosis, a medical diagnosis, and and from that, we were supposed to magically come up with these care plans that addressed all the human responses and all the functional health patterns for a patient. And frankly, I thought it was a little ridiculous, so, you know, and we were, we would be in the hospital, and the nurses would say to us, oh, don't worry about this. You'll never, ever use it again when you get out into practice. So it was kind of a it was to me, it was, it felt like a waste of time, even though, honestly, I did learn a lot, but nobody was really helping us to synthesize that learning and to think about it in a way that it was more than an exercise. And

Heather Herdman: 00:09:41

Camila Takao Lopes: how did you go from that negative experience of learning diagnosis to becoming the CEO of Nanda International? How did you transition to that?

Heather Herdman: 00:09:53

Yeah, well, you know, it's funny how life comes around. I actually found myself working in a unit in in Boston, and. And neonatal ICU, and they did interdisciplinary rounds that were run by the nurses. So you'd have the physicians and the social workers and the nutritionists and the respiratory therapists and the primary nurse, and the nurse would introduce the infant and then say, you know, today I'm working on, you know, and at the time, it was probably altered nutrition, or pain, acute pain, or something like that could have been respiratory, paired respiratory pattern. And I remember when I was first orienting on that unit, sitting there, thinking, Oh, my God, they're using nursing diagnosis. What you know? What am I going to do? I don't remember these. How do I how do I use these? But as I watched these teams, I started to realize that when the nurse would say, I'm dealing with X, you know, whatever the diagnosis was, the rest of the disciplines would chime in, like, oh, you know, how are you going to address that? Or what are you doing for that? Is there anything we can do to help with that? And then, you know, everybody understood what they were talking about. And as I started to talk to the nurses on the unit, they said, well, it's so much faster to say somebody has impaired breathing pattern than to give a paragraph long description of what's going on with this kid. And it just clicked for me in a way that made sense. You know, they didn't have 13 diagnoses on a patient, either maybe they had three or four. Or, you know, if it was a really complicated kid, there might be five or six, but every shift you were focused on what was the priority for that shift? So it started to make sense in a logical manner for me. And then I actually met a woman who is now the president of Nanda, Dr Laura Rossi, who was our clinical nurse specialist at the time, and she would come down to our unit. She had several units, and she would come down to our unit and just kind of talk through the clinical reasoning process. What are you thinking? What are you thinking next? What else might it be? And she was, she would challenge you, or challenge your thinking in a way that I found really interesting, like it made me really stop and think about things from a different perspective. And and I started to realize that using these terms gave us a way to express our discipline that I didn't have without them. And then Laura actually recommended that I go talk to some staff members, some professors at Boston College for graduate school, and I ended up in a research course, and there was a faculty member who invited a guest, and that guest turned out to be Dr Marjorie Gordon. And she was, she was presenting her research that she was doing at the time in rehabilitation nursing, and she was so passionate about it and so interesting that I found myself walking up to this woman and saying, Would you by any chance need help with your research? Like, could I just, you know, like, anything, I'll do anything. And you know, we had this brief conversation, and I started working with her the following week. And I worked with her throughout my master. She was my chair, and, you know, she encouraged me to join Nanda. And I guess the rest is history.

Heather Herdman: 00:13:23

Camila Takao Lopes: Here I am, both mentors for us. I guess in our histories that made the difference made huge differences. So this is our first podcast. What? What is the intention of it? What do we want to accomplish with it. And why are we launching this podcast now?

Heather Herdman: 00:13:46

Well, again, I think you know this, really, this was the brainchild of Dr Anna Maria Napoleon. She's a Brazilian researcher and educator who is the chair of our education department and our education committee, sorry, and she really felt that this was a good medium for connecting with individuals around the world, and that because you can listen to it in the car or listen to it as you're walking, or, you know, what have you, it gave us a quick way of connecting with people and providing answers to some of The questions that we most commonly receive, either by email or in practice. So I think as a global whole, Nanda recognizes that there is a disconnect still today between what we learn in school and what happens in practice. And this is confusing. It's confusing to students, it's confusing to professors, it's confusing to nurses in practice. And so we're hoping that we can use this format in a way that we can answer some questions, maybe address some some of the questions that students have, but also that nurses in practice have offer some suggestions and provide some fresh content on a regular. Basis. So we're going to start out on a monthly basis, so we can kind of get a hang of how we do this, how we produce a podcast. But as things move forward, we're hoping that we can increase that frequency and that our listeners will recommend content that they would like us to explore as well,

Heather Herdman: 00:15:19

Camila Takao Lopes: and for the next sessions. What can we expect?

Heather Herdman: 00:15:24

Well, I'm going to start by saying I'm really excited that you're going to join me as a host, and you're going to be doing the the conversations with nurses who are Spanish and Portuguese speaking, because we get to take advantage the fact that you're trilingual, and so that's really wonderful, because a lot of the people we really want to interview are not native English speakers, and even though sometimes their English is quite accomplished, they they're very uncomfortable speaking in English. So so we'll be able to have these podcasts coming out in English, Spanish and Portuguese, at least, to begin, and maybe if we if we do really well, we'll expand to some other languages as well. In our upcoming sessions, we're going to have faculty members talking to us about methods that they have found helpful for teaching diagnoses and for helping students to integrate clinical reasoning into their practice. We get to have one of our Gordon scholars at Boston College. The Gordon program at Boston College is a joint program with Nanda International and the Boston College's Connell School of Nursing. They are our academic partner, and we will be speaking with our current president elect about a book that she and one of her colleagues have published on clinical reasoning and the nursing process. It's published in Spanish, but it's a wonderful book. I've been making my way through it slowly, because my Spanish isn't great, but it's so easy. The way that they've laid it out is so easy to grasp. And it's they use, they use diagrams and pictures in a way that is very helpful, I think, and students will like that, I think very much. So those are some of the guests we're going to have coming up. And you'll start to produce some of these same sessions in Spanish and Portuguese as we move along, so people can follow us to see the upcoming sessions, and they'll be on our website, and then you'll be able to pick them up wherever you listen to your podcasts.

Heather Herdman: 00:17:23

Camila Takao Lopes: Well, I am excited for that. I'm looking forward to what our guests have to say, and for this experience to be a podcast host for the first time. So thank you for this opportunity, and I hope to see everyone there to see or to know that you were listening to us there,

Heather Herdman: 00:17:42

yeah. Well, thanks for joining me for this first podcast, and congrats on your new role as co host as well. I look forward to listening to your upcoming episodes and to our listeners. I really encourage you to let us know your questions. What topics would you like us to cover or are there guests that you feel you would that we could really take advantage of? You know, maybe some students have some wonderful faculty member out there that has found a way to really help them understand the clinical reasoning process or to understand the diagnostic process. And maybe we don't know about this person, it would be great to invite them to come join us, and you can you can always reach us through our social media platforms, both on Facebook, on LinkedIn, on Instagram. You can send us an email. Our Our email addresses are on all of our websites, so it's easy to find us there, and we'd be really interested in hearing what it is you want to know, or what comments you might have or who you might like us to interview. So thanks for joining us on this first episode, and we look forward to seeing you as the as the sessions go further. Until then, I'm your host. Dr Heather Herdman for NANDAcast.