CARE PLANS - HELP..HINDERANCE...N/a

bunky, BSN, RN · Jun 29, 2000

Great learning tool for students. Hinderance and just another piece of useless paperwork in the working world. If we didn't have that nursing care plan done, would none of us know what to do? Of course we would!

Nancy1 · Jun 29, 2000

I know this is probably not the most poplular answer, but I feel that Care plans are living breathing documents that need to be refferred to daily and updated as needed. I do realize that my staff do not agree with me, and there are only a few that actually review the care plans.

When they are properly used they can be your map for caring for your patients.

I know I will get a lot of flack on this one. NA

LRM · Jun 30, 2000

I'm with you Nancy, km, in oz nursing care plans (NCP) are our legal docs that identify what we did for the pt on our shift. Maybe they are used different in USA bunky?

RN writes plan each day,(often continuence from day before) but alters care as needed, ticks & signs NCP (3 signatures per 24 hrs). For example: HYGIENE: assist x 1, maybe changed to 'self' next day if pt is independantly showering. All nurses check their NCP beginning of each shift & they are a great bonus for agency or pool staff (Temps from within hospital).

The clinical notes DO NOT have to repeat care given (eg: don't need to write "assisted pt with shower" but if difficulties arise or a divergent from plan is needed these may be documented. A clinical entry for day shift could say "all cares given as per nursing care plan" no more. Pain & extra drugs given would be written in clinical notes but thats about all.

NCP must correspond to computer generated nursing stats (done once per shift) in case these are audited.

Maybe we have different NCP documentation, usually they cover (& these vary from hospital to hospital): hygiene needs, mobility, education needs, procedures, obs, sensory deficits/needs, mental health, labs needed/taken, discharge needs, technical (blood sugars, dressings), presure area care, misc.

Normally outlined on one page (same page can be used for a week or so) Some hospitals add goals, interevntion,evaluation but this is often overlooked as there is too much info. to read thru at start of shift. Simple plan of care for the shift is easy to follow & easy to read.

Hope this is of some help.

jkh · Jun 30, 2000

I agree that the nursing care plan, when used properly generates continuity of care and benefits both the care giver and the cleint to reach or maintain optimal health and function. Where else in the chart can you fing everything you need to know about the client such as elimiantion patterns, mobility patterns, pain, patterns of behavior and sleep patterns etc. The interventions give directions so each caregiver is doing the same thing the same way. If it not working or the one of the client's "patterns" changes the care plan is changed to identify the prgress or prevent a decline. When all this information is in one place in the chart it does act as a quick reference to facilitate care.

Julie, RN · Jul 1, 2000

As a new nurse, I find the pt careplans to be extremely helpful in guiding my care and in giving change of shift report. We mark all tx's, PCA changes, labs, consults, diet, nsg diagnosis (general: mobility/activity, nutrition, teaching, ...), etc. Basically anything involving the pt's care is written down on the care plan and when completed or no longer active it is yellowed out (just like on a MAR). I'm pretty sure I am talking about a "careplan" since that is what the pre-printed sheet of paper states at the top of the page (and is what everyone calls at my work place), plus it mainly revolves around nsg diagnosis /c a few other helpful notes: tx, labs.....

[This message has been edited by Julie,SN (edited July 05, 2000).]

bunky, BSN, RN · Jul 1, 2000

Sounds like you guys are talking about a Kardex not a care plan. Nothing gets erased from the careplan where I am. Most of the things like tx's etc, are put on the Kardex, and that is what we erase, and we use our Kardex's heavily during report but NEVER the careplan. I agree it is a good learning tool, but when you have a diagnosis from the doctor, after awhile in nursing you know what to do with these patients and what you have to watch for! And you can refer to the data base if you aren't sure what's normal for this person pre-hospitalization.

[This message has been edited by bunky (edited July 01, 2000).]

JillR · Jul 5, 2000

My opinion. Kardex--expremely helpful. Careplans---a waste of time.

LRM · Jul 6, 2000

So are you saying that you have to write out clinical notes, careplans and Kardex (not heard of Kardex down here, assume they are a filing system will days Tx, pts needs, ect) each shift?

Like I said, we use NCP as legal docs so they must be accurate & updated each shift & the info doesn't need to be duplicated on other docs.

Bunky, you say after a while you know what to do with each diagnosis but how about new nurses to the ward (agency, pool) and inexperienced nurses. Surely a plan (written by an experienced nurse) that identifies accurately the client's needs allows for continuity of care & safe nursing practice?

bunky, BSN, RN · Jul 22, 2000

LRM, a Kardex is not a legal document, but it does contain all the important facts at a glance, like diet, and needs like whether or not the patient is receiving PT, labs to be done, X-rays, and in some places it even contains all the meds that the person is on. It also contains things like whether or not the person is at risk for falls, or bleeding, or on restraints. This Karedex is updated whenever there's a change or a new order. The careplans are to be updated daily, and this always falls on the night shift, although it is supposed to be whenever you notice something new. At the facility where I am at now, the care plans are so brief, one could not possibly take any meaningful info off of them. For example, you have selected diagnosis to choose from, so say it's potential for infection. Well it doesn't allow you to be specific, there is no space to write in goals, or implementation of any standard of care one would follow, so how can that be of help to anyone? The more meaningful history data is on the nursing history, and the Kardex contains info that a new nurse to the unit would find helpful to know. From the look of the careplans here, they are so streamlined just to fill the state requirements, just barely. Another facility I worked at had HUGE careplans, and as a result, they got ignored. They tried to be too alll encompassing rather than focusing on why the patient was actually there. This is sad, but nursing diagnoses like "Disturbance in body image" just aren't used here because there is no time to care about that! Unless the patient is actually expressing those feelings or behaviours, the emotional psychosocial diagnosis aren't used and interestingly enough they aren't amongst the ones on our list of diagnois to choose from either. Doesn't that say something extremely sad?!

We do a lot of duplicate paperwork here just to cover your butt. For instance we will chart about lung sounds, and O2 sats even though RT is charting the same thing. If the pt has a fracture, we'll talk about them being up on crutches or getting out of bed etc, and walking with a walker, even though PT is charting the same things. Unlike what you describe, which we did use in Canada too, each discipline here has their own set of notes in a chart, and many times we overlap because the patient is there for a problem that requires more than just nursing care. Each shift does and documents on a flow sheet type of chart a head to toe assessment on a general surgical unit where I am right now. We then document much of those same findings on our nurses notes, and the push here is to document on our nurses notes every two hours! Even if nothing has changed, we are still to write something that proves we at least looked in at that patient. A new nurses note and attached flow sheet is began everyday and is used by all three shifts.

Does that answer your questions LRM?

[This message has been edited by bunky (edited July 22, 2000).]

hollykate · Jul 23, 2000

I tend to agree with both Bunky and LRM. Care plans are a little overkill when you are familiar with the unit and the pt population. But, when we get off-service (because of tight beds this year we had a bunch of med-surg pts on a postpartum floor)patient, getting the care plan, or "standard of care". The standard of care states what any pt with a fx, or gi sx, or what not, needs to have (TCDB, or certain wierd labs. After a while, youmemorize your pt. population, but when that one wierd pt rolls in, it can be a life saver.

nanjam · Jul 25, 2000

Although care plans can be appropriate when current and focused, they are often viewed as one more thing to do, one more piece of paper to address.