[jjjoy]

Student care plans are not a direct concern to me at this time. I just saw a student and instructor the other day in the hall discussing how to word something in the care plan they were reviewing and it reminded me of the frustrations of student care plans. Not that we had to write them but that what exactly was required for them didn't seem the most effective way to cover content. They did reinforce the nursing process, as they should, it just seemed there could be a more effective way of writing and using them.

I simply have an interest in education and have taught non-nursing subjects in the past. Nursing is such an important profession and there's so much to cover in so little time in school and sometimes I imagine how my own education at the very least might have been done differently since I felt that we learned more about how to write care plans just so than about how to function as a nurse - that is how to implement the plans and to reach the goals.

[LiveToLearn]

I am also an instructor, and my thoughts on care plans are as follows.
1) NCLEX doesn't test on NANDA terminology. NCLEX questions are developed by reviewing new graduate practice (what new grads are actually doing in the first 6 months of practice), and since NCLEX finds that new grads are not using this terminology word-per-word in practice, neither do I. My students are to explain the problem in plain english, with a focus on understanding pathophysiology and nursing care.

2) If I am a patient, and not breathing well, I don't care if my nurse knows whether it is ineffective airway clearance or ineffective gas exchange, I just want him or her to recognize an emergency and take the needed steps (O2, positioning, call for help, etc) that I need them to take so I can live. There is a lot of new literature on new grads and failure to rescue. I don't EVER want my students to be unable to recognize an emergency because they spent 8 hrs a day gathering information and not actually caring for the patient.

3) So.....what do I do instead? I have students give brief oral care plans about their patients, and I ask questions. Not just knowledge based questions like "What is vtach?" but "What would you do if you found a patient with this rhythm? What would your first intervention be?" After all, if the nurse recognizes vtach, only to go sit at the nurses' station and drink coffee, that recognition of a fact is useless.

I want any grad coming through my courses to KNOW that they can apply the standards of safe care and make quick decisions. Research tells us that in rescue/emergency situations, the nurse typically makes a decision within 30-60 seconds. I want my students to think like a nurse! They also make rounds. I have them gather assessment data with another student, and they compare notes. What is the most important care for the patient right now? I've found that the old standard care plans only tell me what you COULD do, not what you are actually doing. Most students copy out of a book. I am not interested in how well my students can copy from a book, I want to know how they think. I am also right in there with the students. If the patient vomits, I am there to help clean it up, as well as to ask the student what should we do now to help them out? There are so many other assignments my students do (brief concept maps, acting as lead nurse, conference presentations, etc.) I also have them practice giving and receiving report and "calling the doctor," which I never got a chance to practice while in school.

4) I also care about my students' well-being. I wouldn't feel safe caring for a patient on 2 hours of sleep and I am an experienced nurse. There is no way I would ever ask a new student to assume care for a patient, knowing that he or she had been up most of the night preparing care plans for my class. How can I tell them to lead a balanced life if I don't model one, and make my expectations reasonable? When the do a care plan for me, it is done "on the spot"- right then and there, either a 5 minute care plan that is oral or written. I don't belittle them if they or wrong, or hover over them while they write. I just try to redirect them with questions if they are off-target. Students are the future of nursing. I have made a committment to treat them as such, and not burn them out before they ever begin to practice. So many new grads quit in the first year of nursing. I think it's because they are so unprepared for the realities of nursing as it is. We don't do them any favors by having them complete 5 care plans per rotation with 15-20 pages each.

[Luptyloo]

This is an awesome thread! Scribble and Daytonite, your comments are very informative and helpful! I hope to have teachers like you two who will give an indication not just how to do something, but what they want me to learn from it. I enter nursing school this year and really appreciate the foreknowledge of the tool that care plan writing is. Daytonite, your mention of problem solving and critical thinking will help me approach them from that angle and hopefully learn more from them!

[jjjoy]

LiveToLearn, I like your approach. I had exactly two clinical instructors that were more focused on the actual practice of nursing as opposed to the theoretical practice of nursing, if that makes sense. They were part-time instructors who were still working and seemed to have a better sense of what new grads would need to prepared for. Some of the full-time, tenured professors seemed less comfortable in the clinical environment, emphasizing perfectionistic technique and procedure that often conflicted with what we saw the staff doing in practice (and addressed this by simply reminding us that we should always do things the right way no matter what we see other nurses doing).

Lectures were mostly straight coverage of textbook content without time for more than just the quickest of questions due to the need to cover so much material. And test questions were written trying to reflect NCLEX style questions, and thus had barely any relationship to textbook/lecture content (and never time to thoroughly review tests after we took them).

And finally, care plans. Ours were to reflect those standard care plans that you note - lots of potential nursing actions, but little application to any one particular patient... which makes sense. A formal care plan addresses all of the potential issues. It's a good exercise for class. But that's not as effective for the patient you are responsible for right here and right now, when you don't have time to review several references. You need to be able to do a quick assessment, prioritize their needs (in conjunction with other patient needs), and be ready to recognize a crisis and take action.

Instead of teaching bedbaths and transfers at the beginning, then easing into wound care and bandages... I think they should teach basic emergency care first off... what do you do if you find an unresponsive patient in the bed? Honestly, we had early ambulation, turn q2, encourage fluids (where appropriate) pounded into our heads over and over and over, but what to do *right now* with an unresponsive patient, a very hypotensive patient, etc? And what distressing symptoms constitute a immediate crisis versus an MD call versus a concern to follow up on? Those felt more like tag-ons... oh, well, if the patient is in crisis, assess ABCs and call for help... now did you ensure that the diet ordered was appropriate?

What can I say? The objectives of my nursing program seemed rather vague... it wasn't to be a ready-to-hit-the-floor acute care nurse... those specifics you would learn in the extensive orientation hospitals would provide new grads. To "think like a nurse?" what kind of nurse? public health? acute care? OR? vaccination clinic? It felt like the only clear goal was to pass the NCLEX, to complete X number clinical hours, to check off the skills list, to cover 1000 pages of this and that subject area.... so I vent sometimes, and hope to see positive changes in trends in nursing education. : )

[jjjoy]

FYI - a moderator editted the original title of the threat. I just had "Rant: student care plans" - the rest was added by a moderator. I do think care plans have a purpose in nursing and nursing education.

[poliwog]

Thank you! As a new nursing student, I found your post very helpful. Im fwding it to my study group. Its nice to have some perspective from the instructor's point of view. Thanks!

[Daytonite]

Student care plans... What's their purpose?

Here is all I have to say about this since it has been made a sticky. . .

The purpose of students doing care plans is to assist them in pulling information from many different scientific disciplines as they learn to think critically and use the nursing process to problem solve.

This is not the same purpose of care plans done by employed licensed nurses in the work place. Those care plans are done to document the solutions to patient's nursing problems and they become a permanent part of the patient's chart.

[Daytonite]

Originally Posted by poliwog

Thank you! As a new nursing student, I found your post very helpful. Im fwding it to my study group. Its nice to have some perspective from the instructor's point of view. Thanks!

Unless I'm very wrong, this thread was not started by an instructor! It started out on the General Nursing Discussion Forum by someone who is no longer a student and ended up here for some reason.

[studentinnursing]

I get it too!! Makes perfect sense that you would not take a care plan out of a book, period, when everybody is different, bodies react differently, comorbid conditions, medications they are taking, etc. You sound like an awesome teacher and I am excited all over again about starting school. I'm just doing prereq's now, but I've been doing transcription/editing for 13 years, so when I'm listening to histories, meds, allergies, exams I'm sorta "practicing" and always have, guessing what doc is gonna do/not gonna do/why/why not and then seeing if I'm even close when I'm listening to impression and plan, just a medical transcriptionist, and now here I am years later going into nursing. I don't know much about "care plans" as they pertain to my ADN bookwise but will soon find out, and I may be crazy, but it is the most fascinating part to me. My gosh, that's what it's all about, right? I love anatomy and physiology too . I'm hoping my studies go well AND be so enjoyable I'll never want to do anything else.

[amberfree]

Thank you scribbler. Your post was great and I am thankful for it as you have explained the reason behind care plans in a way students can understand. I start the nursing program in three weeks and I am excited and scared. Care plans were one of my fears, but now I think I understand the purpose of them, which helps. So many thanks to you for sharing!