Nursing Diagnosis as a National Standard: Lessons from Mexico

Heather Herdman: 00:00:00

Welcome to the Nanda cast I'm your host, Dr Heather Herdman, Chief Executive Officer of Nanda International, today I have Dr. Hortensia Casteñada Hildago with me. Hortensia is a professor of nursing in Tampico, Mexico. She is the president elect of Nanda International, and the co author of a recent textbook on clinical reasoning entitled nursing process, a theoretical and practical guide to responding to health needs, which is published by Elsevier publishers in Spanish. She holds her doctorate in nursing from the Universidad de Alicante in Spain. Her master's in nursing management from the University of Nuevo Leon in Mexico. Her masters of education from the University of Tamaulipas, Mexico. She has a specialty operating room nurse certificate from Tokyo in Japan. Her Bachelor of Nursing is from University of Tamaulipas in Mexico, and then she has a postdoc in as a pH Leader Program at Emory University in Atlanta in the United States, and a postdoc leaders in international health program from the pan America health organization and World Health Organization. So we're tensia, thank you so much for being with me today. I'm glad to have you on.

Heather Herdman: 00:01:26

Dr. Hortensia Casteñada Hildago: Oh, thank you, Heather. I'm so thrilled to be here, and I'm so honored to accompany this podcast, and so happy to be here with all of you. So

Heather Herdman: 00:01:37

to just get started, can you tell us just a little bit more about your career trajectory and your Spanish will probably be a lot better than mine in pronouncing the names there, but I think people would just like to know a little bit about you and kind of how you worked your way through your career as a nurse.

Heather Herdman: 00:01:54

Dr. Hortensia Casteñada Hildago: Well, thank you. Yes, I just got my when I got my major in Japan, I came back to work in Mexico, and I was invited to be a supervisor in a general hospital. I was quite young, but, you know, quite intended to keep working hard. So I accepted the position. And yes, it was so hard because I was so young, but I liked it so much I have under my supervision, supervisor, supervision tasks to do, to help so many other nurses to, you know, to get adjusted to the work and to keep working with them. And then it wasn't enough to have a major so I started, after a few years, I started the program of the master in higher education, because I wanted to become a professor at the University, and that helped me a lot. But when we were like finishing that program, the government and the universities asked the professors to have a May another masters, but in the area of the professor. So we started the Masters in the science of nursing program, and it was so exciting to travel to another state of Mexico, to keep you know, like studying, and to to know so many other professors from several parts of this country. And when we thought it was like, we are finishing and this is what we needed. Then they asked for the PhD training. So we started, I started a search to get a doctoral program to bring it here to Mexico, because as I was invited to study at the University of Texas, there was this political figure in Texas who invited me to go over there. I went to have an interview at the University of Texas to get the PhD there, but they couldn't bring the program to Mexico, and the university wanted us to be a group. So I started the search in Spain, and I found a program who could come, and the professors could come to our country, and there were like 16 professors in my university who entered this program. And so it was like the professors come over here to teach, and then we went to the University of Alicante to have this research space, and that's the way I got my PhD. I really like it, and I enjoyed so much to study in a university like that. It just

Heather Herdman: 00:04:32

sounds like you had one step and then the next step and then the next step, you just kept on going,

Heather Herdman: 00:04:36

Dr. Hortensia Casteñada Hildago: Yeah, that's right. It's like the life of nurses. We have to, you know, go from the one step to the other one, and when you think you're finishing, then you need to go to another and another one. And I think it's, it's challenging, but at the same time, it's exciting to keep, you know, studying and working, and that's why I'm so grateful for this opportunity.

Heather Herdman: 00:04:58

I think you're a wonderful example of that. You're always learning, you're always doing something new and encouraging other people to do the same. So, so I'm wondering if you might want to share some some concerns or objections that you might have faced at the at the beginning anyway, to starting to use nursing diagnoses when you were teaching.

Heather Herdman: 00:05:19

Dr. Hortensia Casteñada Hildago: Oh, yes, it was not easy at the beginning, you know, because in my country, we were learning about nursing diagnosis. And fortunately, Dr March Gordon came to Mexico, and also Dr Johnson came, they came together, and they had this large group of nursing professors who wanted to learn about nursing diagnosis. So after that, those professors, you know, spread all over the country to teach the rest of the professors about nursing diagnosis and about the nursing process as well. So we were struggling to get used to it. And at the beginning, even the other professors were not like so used to it and did they didn't like it and that they would just wanted to keep doing the things that we used to do before. So in the beginning with it was like kind of hard in this country, but I think that after we understood the importance of the taxonomies, and, of course, the use of nursing processing as our tool to care for patients, then it moved a little bit, you know, smoother. And now there's no, no one university in our country that is not working with nursing diagnosis and, of course, with the taxonomies. So now we feel like quite comfortable, but in the beginning it was like struggling to to be, you know, for people to believe in what we're we're doing. And I had, you know, an advantage, because my friend Dr Nora Gonzalez was a student, a student in that course with Dr Gordon and Dr Johnson. She was there, so she was, you know, a first line learner, and she was delighted with learning all this information, so she came over here, and she was so excited to teach us all about nursing process and the taxonomy, so I'm so grateful for that chance as well. Oh,

Heather Herdman: 00:07:24

that's wonderful. I was actually a master student with Marge Gordon and Dottie Jones when they came to Mexico, so I remember them preparing for that class and being very excited about it when they came home from there. So that's kind of interesting, yeah, and that's how, if you think about it, that was in the late 80s, maybe 1990 somewhere around there. And so in a very short period of time, really, you have moved an entire country from not using the nursing process to everybody uses it. So yes, that's quite an accomplishment.

Heather Herdman: 00:07:57

Dr. Hortensia Casteñada Hildago: It is. And we are glad that even when people say that this is not going to, you know, to keep growing. And the other side, we have a lot of people trying to learn about nursing process, and they're asking, and they want to know, and they want to learn more and more about the taxonomies. It is not like they just pull the book and find the diagnosis. They want to understand the process, and that's so good.

Heather Herdman: 00:08:23

That's great. That's great. So could you share maybe an example of when you were teaching, and maybe struggle to help a student, or students appreciate the importance of nursing diagnosis and to help them see it as representing the knowledge of the discipline, not just as a documentation tool. Hi,

Heather Herdman: 00:08:45

Dr. Hortensia Casteñada Hildago: well, for example, when we were asking the students, have you ever wondered how a nurse can receive a quick hand of report from another nurse and immediately begin providing care for a patient they previously did know nothing about, can you please? This is a question that I asked my students. How do they know what to do? How do they can, you know, prioritize and make a plan, a care plan. So the students, in the beginning, I think also that they try to imagine and try to figure out how, how a nurse will understand and will assume what to do when they have a patient in front so, yes, this is a little bit hard when they they have not been in the clinical settings yet, when, when they have been like for in the fourth or maybe fifth semester that they have been in the hospitals or the clinicals. Then they came and they said, Well, yeah, now I understand that I have to see the patient, to understand the patient, and to understand how the nurses is, how the nurse is, like asking the patient things, or watching things, observing things. And so I think this. You know that they they go to clinical practice here in Mexico, for example, they can access to the clinical settings, and they work directly with patients. And I think that helps a lot, because now they can the students can understand and see what the patient is struggling with.

Heather Herdman: 00:10:20

I think that's a really interesting question, asking, what happens in a handoff. I never, I never thought about that before from a from a standardized language perspective, but it makes it so much easier and faster to give a very kind of well defined explanation of what's going on with the patient. Yes, by using terms that you already understand. So even though you don't know the patient, you have an idea when you walk in the room of what you're going to see. That's, that's, that's a brilliant tip. I like that. So what led you and Dr Nora, who you have you've mentioned before, who is your co author? What? What? What was it that prompted you to write your book on the nursing process?

Heather Herdman: 00:11:04

Dr. Hortensia Casteñada Hildago: Well, the struggles were not only for the students. They were also for the professors. So we know, and we understood that maybe sometimes people don't like to read, you know, like these humongous books that explain nursing process and so, so we were trying to teach, and after she was my professor, then I understood the whole thing as a whole. And then we thought to ourselves, maybe people will like to have an easier way to approach the nursing process and an easier way to teach to the students, and the students wants something to go like, you know, these times it's like people wants everything faster and immediately. So it's easy for the students to just go to the book and then decide what part they need to know in order to keep studying and learning about nursing process. So we had, she had a plan. She always wanted to write a book about nursing process because she's so passionate about it. And I thought to myself, well, this is going to be a bunch of work. And it was because, you know, she and I were the main authors, and we had to edit the whole book and to edit the ideas of the professors who came to work and to collaborate. We had another girl first, like, for example, Dr Takao, and she was brilliant, and her chapter needs no work to add and no revision to be she it didn't need it anything like that, but some of the chapters needed a whole revision, and it took us longer than we thought, but at the same time, we had to accomplish, you know, a date line that we had. So it was, it was like exciting, but now we are so happy to know that there's a lot of people saying, Okay, this, I understand the book. It's easy to use it now. It has. It helped me a lot when I'm teaching. And we know for sure that there are, like, four or five programs from particular, from people who have their own enterprises, and that they provide training courses for nurses that, and now they're using our book. This is still good. And a lot of universe, yeah, it is, yeah. And a lot of universities in our country are using the book also as the main reference for the nursing subject. So we are so happy about that, and now we're planning in the next one.

Heather Herdman: 00:13:46

See, once you get started, you just can't stop. Yeah, I will say to our to our listeners, if you haven't seen this book, and I will give you some more information on it later on. But as a non Spanish speaker, I have been working my way through the book, and I can understand it. So it's a very visually helpful book. There's a lot of graphs and figures in it, and I think models that make it very easy to understand what's being said. And when I first received it, I was kind of struck by how small it was. It's not, it's not, you know, three inches thick, but it's, it's concise, and it's clear, and it kind of takes out all of the extra verbiage and just the facts, that's right, it's really, really nice and like, it's really well done,

Heather Herdman: 00:14:36

Dr. Hortensia Casteñada Hildago: really well. Thank you. Thank you. So yeah, if

Heather Herdman: 00:14:40

you could, if you could make sure that everybody who reads your book came away with one key thing, and I know that's asking a lot, but one key thing, what would it be?

Heather Herdman: 00:14:50

Dr. Hortensia Casteñada Hildago: Critical thinking? I think, yeah, oh, yes. And do you know what? First the book, it was developed, because we have this semi. Are in our Mexico neighborhood Nanda network group. We have this training, and we knew that we have to start with critical thinking. And thus we also had the same idea for the index of the book and for the first chapter of the book. And I think that maybe I will be helpful for so many nurses around the world. But

Heather Herdman: 00:15:29

are you referencing artificial intelligence? Yeah,

Heather Herdman: 00:15:32

Dr. Hortensia Casteñada Hildago: yeah, and I would like people to know that it is helpful too, yes, but we have to keep thinking from ourselves. And, you know, the clinical reasoning will come from our brains. It will not come from a tool or from a, you know, a cell phone or whatever. So I think that we nurses, we have to keep learning and to keep sharing the knowledge and information, but we also have to keep thinking and to be critical from our own thinking. So I think that will be the main thing that I would like to have, and to keep working with and to keep sharing about this information that we have, and then we are teaching that to our students, and then they will go to the clinical settings, and they'll use what a thing that it was produced in a cell phone, or the thing that it keeps going and growing and growing, you know, in your own brain and in your own thinking. So I think that critical thinking and critical reasoning and great and clinical reasoning will be the thing that I will, you know, enlighten every time that I have the opportunity. I

Heather Herdman: 00:16:50

think that's an excellent point. I was recently having a conversation with Dr Gail Keenan, who is a informaticist, and we were talking about artificial intelligence and its role in nursing process. And, you know, she kept emphasizing, even though the tools are getting so much better, and there's so many things we can do, she'd say, but it's not thinking for the nurse. You know, it right? I still need the nurse to do the thinking. But what if AI can do is make that easier. It can put things, kind of all the pieces together in one place, so the nurse can review things in a cohesive manner and then say, okay, given what I know and given my knowledge, I can now take this data that I've collected and put it together in a in an easier way, but using my own, as you say, your own brain. So I don't think it's going to replace us.

Heather Herdman: 00:17:41

Dr. Hortensia Casteñada Hildago: I hope not. And the thing is that I have to have the expertise, the experience of No, no, AI will, you know, replace the expertise, the experience a nurse has, and then I will use everything. I will not say that we're not doing, you're going to use AI, but I will, you know, compliment something, but it will be my ideas that has to keep growing. Yeah, absolutely,

Heather Herdman: 00:18:11

yeah. So congratulations on this book. I just, I think it's wonderful, and I'm really enjoying it as I as I walk through it and thinking, Oh, I should have thought of that. There's some really nice, just simple things that would be really good for, I think, all educators, to see. So hopefully you'll you'll also have translation available. Yeah, in the future, we hope so. But for our Spanish speaking audience, you can purchase this really wonderful book. It's published by Elsevier, and it is available through Amazon or through Vital Source in bookshelf. So you know, please take advantage of this book. I think you will really, really be happy with it and find a lot of really good tips there. So Hortensia, you've been very involved in ensuring that nursing diagnosis, interventions and outcomes are are required for use in in Mexico, by by all nurses. And I know this was a it probably felt like a very long process, but I think actually, those of us looking from the outside were kind of amazed how quickly it happened. Yes, why did you feel this was so important? And and you know, what would you tell nurses if they asked you, why you think it's so important?

Heather Herdman: 00:19:29

Dr. Hortensia Casteñada Hildago: Well, yeah, it's been like, it looks like it's not that long, but it's kind of fighting hard in order to get the things. And what we are thankful is that the union of nursing schools in Mexico accepted that the nursing diagnosis was a tool and that we needed the taxonomies, and then the Ministry of Health had it as well as a, you know, as a document in what, in where the. Schools, and it's hospitals and clinics could base their development about nursing process. So it was there, but it wasn't like it has some failures and some things that we have to, you know, to change and to update. And so I, I think it is so important because we work with patients, and the important thing is to assume that, assume that we have in front of us a person who suffers or not, but maybe has doubts about their health situation. And therefore it is so important to connect with people and from there to understand their human experience. And if we can teach this to other nurses and to share this information with nurses in the clinical practice, then we'll we'll find the importance of working with nursing process. And that's what I told the authorities at the Ministry of Health. We have this model, but it is not updated, and it has some failures on it, so please let us fix it, and let us, you know, update it and to add some of the information that will be quite good enough for the whole country to follow the model. So we work in the model, like for two years, and when it was published, it was like, you know, like a wave in the country. It was published a day before Christmas holidays, so it was like a boom, you know, yeah. And people, you know, keep writing and asking so many things. And now the the model of care in Mexico. It has the importance of the nursing process as a tool and the use of the standardized languages as well, but it also has this evidence based nursing that it just didn't have before. And we have to keep you know making the clear that the importance of the evidence base is there, and that we are reading the most updated information, those papers that are published today, but it wasn't published yesterday. So we have to keep reading and to keep showing the importance of working with with a with a person, you know, there's a human being in front of us, and that person needs a nurse, not anyone, but a nurse, if a nurse is, you know, struggling with emotions and with knowledge and research and all this information that that belongs to a nurse, then we'll have, you know, a perfect cocktail. We need this information. We need knowledge. We need to be supported by our authorities as well in order to be prepared to keep working with human beings. So I don't think there's another professional in the world who can do what nurses do. And also I know that nurses are quite important, because they know what to do. You know, when you have an in an emergency set, then the nurse is kind of leading the things, because she knows what to do, and we want them to know what to do that it with with an evidence based information, not just because of the experience or because the institution says this or that, but what do you think about that? So I think that's the importance of being, you know, keep learning and keep teaching, and also to be honest and to know what do I know and what I don't know and what to relearn, because maybe what I learned before, it was not the what it's working now, word Work turns around quite fast, and these times is going, you know, these times are going quite fast, so we need to run with it, these times as well. And I think that we nurses are always prepared for changes, and we are accustomed to the cows, but we need to have information and knowledge in order to be in front of the chaos and know what to do, and not just be scared of the cows, but to face it,

Heather Herdman: 00:24:31

I think that's interesting. Your point about constantly updating, because probably one of the things we hear the most complaints about is the frequency of updating the terminology, and that it's really difficult because you have to change your teaching methods or your teaching tools. And I had a whole lecture on this, and now you've changed that. And yeah, it's it's an interesting problem, because there was a time when our diagnosis. This would not change for a decade or more, and and I think probably with some of the physiologic diagnoses, that's going to be true, because once you understand the physiology, you understand the physiology. But as we have you know, diagnoses and coping, stress tolerance, or in in different areas where we're learning more and more about how, you know, hormones affect things, or how sleep pattern affects things, and how your gut affects everything. It seems like we're having to really relook at and there's just this huge proliferation of research that, you know, somebody will say, Oh, this diagnosis, it's it needs reviewed and, and I'll think we just, that was just reviewed in the last cycle, and then they send all this new research, and it's just, it's a, it's a difficult to keep up with, yes that, and it does cause a little bit of trauma, I think, as people have to relearn or or reorganize how they think about a diagnosis. And yet, as you point out, it is critically important that we keep up. And a lot of you know, when you look at International Classification of Disease, for example, that is continually being upgraded. And there are times when I was on a call the other day and somebody said, you know, this one diagnosis has been through seven updates in the last one year, because, because research is just coming out so fast. So I understand it's frustrating, but I think you made a really good point that we have a social responsibility right to stay up to date with the evidence. Yeah,

Heather Herdman: 00:26:41

Dr. Hortensia Casteñada Hildago: and science moves forward. I mean, it's not going to be like, you know, there and frozen, and it's not going to happen. And I think that it's also a challenge to keep you know, the track of the moving forward of science and the nursing of science. It's it keeps going and going. So we need to accept that and to to embrace it. I mean, we're not going to fight against that. We need to embrace, you know, the growing and that we nurses keep learning and, you know, accepting that a new thoughts. I think it's exciting. So I really like it, and I like that our taxonomy evolved, evolved. I do like it.

Heather Herdman: 00:27:24

Yeah, great. Well, I really appreciate your time today, wondering if you have any last words of wisdom you might leave our listeners with. Thank

Heather Herdman: 00:27:32

Dr. Hortensia Casteñada Hildago: you, yeah. Well, I don't have words of wisdom but, but I really would like to see that nurses keep growing and learning and doing research. This is going to be so important, and yes, to be together, to fight, you know, to be a stronger profession all over the world. And that means that we need to study, to keep learning and to use nursing process of as our tool to teach to risk, to do research and to care for our patients in the clinical settings.

Heather Herdman: 00:28:08

Yeah, thank you, and thank you all for joining us here on the nandacast. I hope you've enjoyed my conversation with Dr. Hortensia Casteñada Hildago, who will become the president of Nanda International in June of 2025 at our international conference in Lisbon, and we hope to see you all in Portugal. And don't forget to sign up for our newsletter@www.nando.org and you can follow us on LinkedIn, Instagram and on Facebook until next time, keep defining nursing one concept at a time.