written care plans, i know you don't want to hear this, are the nursing school equivalent, i think, of term papers. they are the written expression of the nursing process. it is an extrapolation of the scientific process. care planning is nothing more than a way of solving a problem. we actually problem solve every day of our life using the very same process. however, nursing school has given us very specific rules to follow and they want us to break it down to it's atomic level and examine every little piece and part of it and that is usually what gets everyone's knickers in a twist. in our everyday life we solve problems using this similar process in a matter of seconds without even thinking about the process itself.
i answer a lot of questions about care plans for students here on the forums and i have 5 care plan books and nursing diagnosis books to use as references to help me out. that is because i don't want to give a student incorrect information. however, a written care plan is a creative endeavor, involves using good rules of english and nanda's nursing language (a new term nanda has come up with). i also have the ackely/ladwig nursing diagnosis book. it's value, i think, is in the cross reference index at the beginning and the fact that it gives you interventions with rationales. so does a nursing textbook. however, for bare bones information about nursing diagnoses i use nanda-i nursing diagnoses: definitions & classification 2007-2008
published by nanda international as a reference. the same information that is in this little book is what is reprinted in all the current care plan/nursing diagnosis books that are on the market following nanda guidelines. all these other books do is have added features (assessment information, goals, interventions, etc.).
the writing of a care plan follows a definite sequence and most students who are new at it and do not follow this sequence get confused and messed up with what they are doing right off the bat. i write about this sequence all the time on these two threads:
which are stickys in their respective forums (that means they always appear in the top of the thread listings so you can find them easily). each care plan book, especially your copy of ackley/ladwig's nursing diagnosis handbook: a guide to planning care
has a section at the very beginning of the book where it talks about the nursing process and writing a care plan. please read it. not just once, but several times, at different times. there is more information packed into those few pages than you could imagine. it starts with a short discussion on how to formulate a three-part nursing diagnostic statement: pes which stands for
and can be further explained as
problem (the nursing diagnosis) -etiology (called the related factors by nanda they are a kind of label for a group[s] of symptoms that follow) - symptoms (abnormal data you obtained during your assessment of the patient--also called defining characteristics by nanda)
everything in a care plan occurs as a result of your initial assessment of the patient. this is a critical point of care planning and care plan writing so i'm repeating it: everything in a care plan occurs as a result of your initial assessment of the patient
. from your initial physical exam and review of the patient's medical record you determine the abnormal data, signs and symptoms [that's the "as evidenced by" stuff you referred to in your post] that form the basis of everything else you are going to do for the patient. that includes choosing the nursing diagnoses, the goals
and the interventions. it is all very logical. however, if you don't have good assessment data, then your care plan will not be stellar. interventions are targeted at the patients signs and symptoms [that "as evidenced by" stuff]. goals are what you anticipate to happen as a result of the interventions you plan to perform. everything goes in a logical progression. some students, however, get confused and go right for a nursing diagnosis trying to back into this process and are immediately lost in the forest.
let me give you an example of something you commonly experience that relates to problem solving. you are driving along and you hear a boom and you suddenly have difficulty steering the car. you pull over and stop. you sit for a minute stunned trying to figure out what is going on. finally, you decide to get out of the car and take a look at the outside of the car to see what might have happened. you are, at this point, performing an assessment. in the nursing process this would be step #1. you basically know that you should have four inflated tires, but you find one flatter than a pancake. this is an abnormal finding--a symptom--in nanda terminology, a defining characteristic. after having a good cry your brain kicks into action. you've got a flat tire! you've just progressed to step #2 and determined what the problem is! now the little squirrel starts running in his wheel up in your brain as you start kicking around possible solutions here. you've just moved on to step #3, the planning phase. you could get the tools out of the trunk of your car and change the tire. you could call aaa on your cell phone and ask for help. you could stand at the side of the road, show some leg, stick out your thumb and wait for someone to stop and help. these are all interventions. your goal is to get a good tire on the car asap so you can continue on your journey. you cannot achieve this goal without enacting one of the interventions. get that? the goal and interactions are tied together. ok, so you decide to call aaa. that's step #4, putting the plan into action. they tell you they'll have someone there within 45 minutes. and, sure enough, about that length of time later, a truck shows up and a very nice guy changes your tire for you. step #5, evaluation--mission accomplished.
now, if you want to see lists of goals (some fancy professors over at the university of iowa call them outcomes) and nursing interventions you can actually buy books that have them listed out for you.
- nursing outcomes classification (noc), third edition, iowa outcomes project, edited by sue moorhead, marion johnson and meridean maas
- nursing interventions classification (nic), 4th edition, by joanne mccloskey dochterman and gloria m. bulechek
the nursing professors over at the university of iowa have been working on these noc (nursing outcomes classification) and nic (nursing interventions classification) projects for some time and nanda has recognized their work. many care plan books refer to them, but don't give you the complete listings. the books containing these complete listings (see above), however, like your ackley/ladwig book are merely reference books. that's all they are. you still have to have read a nursing textbook to know and understand the principles behind nursing and why these things work. you still have to know the pathophysiology of the patient's underlying medical disease(s). you still have to know the basic principles of some of the different sciences. all this knowledge contributes to the choices you make as you think your way through a problem. the more knowledge you have, the more likely you are to make a better decision. that's one of the reasons you are in school--to learn all this stuff.
i strongly urge you to bring your student questions to either the nursing student assistance forum (http://allnurses.com/forums/f205/
) or the general nursing student discussion forum (http://allnurses.com/forums/f50/
) where you will find a lot more support and resources to help you with your school assignments, particularly care plans. it's where i hang out and i'm one of the allnurses members who answer care plan questions. you can also link into these forums by clicking on the "students" tab above.