Care Plan - Question - What is it?

LydiaGreen · Nov 5, 2003

Careplans... where to begin?

Careplans are based on the nursing process - Assessment, Nursing Diagnosis, Actions(Interventions), Goals(Expected Outcomes), and Evaluation.

Careplans are HUGE in nursing. Once you get farther along in your education, they let you use the standard computer careplans that you then adapt to each individual patient. Starting out, you need to do your own. My school requires a care plan for each patient before you can touch them, don't have it, you don't work because you aren't prepared and are therefore a danger to the patient.

Find yourself a book on careplans and how to design and implement them. I have Nursing Care Plans Edition 6. Wonderful book, very helpful, not too terribly expensive compared to others.

Your assessment is the subjective and objective data that leads to your nursing diagnosis (must be a NANDA nursing diagnosis). That would be something like Client diagnosed as having CVA with resulting left sided weakness. Client remains in bed at all times. Okay? So, ONE of your nursing diagnoses could be Risk for impaired skin integrity related to impaired mobility related to effects of right-sided CVA manifested by left-sided weakness. A FEW of your interventions will be turn and reposition every two hours to reduce pressure points, monitor for signs and symptoms of impaired skin integrity (warm, reddened areas over bony prominences, excoriation). ONE of your goals for this diagnosis is client will remain free of development of decubitus ulcerations for duration of hospitalization. Your evaluation is based on your assessment and reassessment and confirms that you did perform the interventions. Something like, Client turned and repositioned every two hours. Skin over bony prominences remains free of signs and symptoms of impaired skin integrity - ie. warm, reddened areas, excoriation.

This is a fairly simplistic, quick example of a careplan.

We had to do comprehensive careplans - multiple diagnoses with multiple evaluations and adaptations resulting in changes to the careplan as you go. The more care a client needs, the more lengthy and involved the careplan will be. Most comprehensive careplans are greater than 20 pages (for acute care clients).

It is not as scary as it sounds. It seems impossible when you start but once you do one good careplan, you'll be able to spit them out like crazy in your sleep. But, get a good book on careplans because the list of possibilities is endless.

Good luck to you in your studies!

kwagner_51 · Nov 5, 2003

Ours is Pass/Fail but we must get at least an 80%. It takes anywhere from 1 hr to 8hrs. depending on what all you need to do. We also have to do drug cards w ALL info on them: side effects, adverse effects, where the drug works, how it works, what system it works on, the drug classification, what it can be used for, what it usually is used for, etc.

The hardest part of the NCP [Nursing CAre Plan] is documenting the resources. We use Potter and Perry [Fundamentals of Nursing]. We MUST list P & P and the page #. THAT is what takes so long!!

Once you do a few thousand of them, it becomes really easy. I don't know about using computerized ones, as I am in my first semester and have only done 3 to this point.

Good lick and keep us posted!!

Jen2 · Nov 5, 2003

Ahhh! Careplans! I find them to be the most time consuming part of nursing school, and it's really a bummer because I'd rather be studying instead of spending my usual 5 hours on a careplan. The Careplan is the nursing process. Assessment, Diagnosis, Outcomes, Planning, Implementation, and Evaluation. The careplan includes everything about the client, meds, dev. level, med/surg history, all of your subjective and objective data, and what you as the nurse or student nurse can legally treat. http://WWW.careplans.com is a web site that you can get an idea from. I have learned some from my careplans, but I think that in order to truly understand what they are, you have to actually do one. I tried to prep myself over the summer for writing care plans and gave up, because I didn't understand. Know that I am in nursing school, I am seeing the light.

CarVsTree · Nov 6, 2003

Find yourself a book on careplans and how to design and implement them. I have Nursing Care Plans Edition 6. Wonderful book, very helpful, not too terribly expensive compared to others.

Hey Lydiagreen... whose the author???

Thanks!

SirJohnny · Nov 6, 2003

LydiaGreen & Others:

- Regarding not being able to touch/work with patient until careplans approved.

- The nursing school stated exactly the same thing during my visit there back in March.

- Essentially, we arrive at the hospital/school Fridays at noon and get our patient assignment for the weekend. Then we are supposed to work on careplans until 6pm and then hit up classes. If you are not done with careplan, you work on it after class.

- Have to turn-in careplan Sat morning before you can enter hospital.

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- The above was what I was told during their "open house" back in March. I won't be starting their program until June 2004.

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- Again, thanks for the info. I'll try to find the book that you mentioned. If you have an author/ISBN, that would help out.

- Anyone else have anything to add -- would love to hear more comments/experiences with nursing plans.

Thanks,

John Coxey

Evansville, Indiana, USA

LydiaGreen · Nov 6, 2003

Here's the info folks...

Nursing Care Plans: Guidelines for Individualizing Patient Care, Edition 6. The authors are Marilynn E. Doenges, Mary Frances Moorhouse, and Alice C. Geissler-Murr. The publisher is F.A. Davis Company. The ISBN is 0-8306-0946-9.

Also, the book comes with a cd-rom that has tons and tons of info on it.

I used this book constantly through my first two years. In our third and final year, we are required to use and alter the hospital's computerized careplans to fit the patients. We also have to have an informal plan of care when we arrive on the floor each morning. It is much easier this way. But, you have to do the hours of careplans when you are learning or you will miss something when you start using the computerized care plans... you have to KNOW what should be in the careplan before you can use the computer program for your client.

FarmgrrlRN · Nov 7, 2003

Hi John,

I am preparing to write my very first careplan this weekend! We are very fortunate in our program that we are able to write them after our clinical. Before clinical we are required to have read up on the drugs, and also complete a pre-clinical form--->researching medical diagnoses, come up with 3 potential nursing diagnoses and also state where they are according to Erickson's psychosocial theory.

The book recommended to us by a trused instructor is "Nursing Diagnosis Handbook: A Guide to Planning Care" by Ackley and Ladwig (ISBN 0-323-02551-X, Mosby). Of course, I ran out and bought it...a friend of mine picked one up published by Saunders and they look very similar. I picked mine up online from Barnes & Nobles used, for about $27 used (incl. shipping). My friend bought hers at B&N too, but at the store and paid $45! So, I would definitely shop around now while you have time! BTW, I am quite impressed with this used book of mine, I usually don't trust buying used especially when I've never seen it. Turns out this book is a from a Diploma Program's library and is in great shape! Oh yeah, if you can get your hands on your booklist ahead of time try too buy online! I saved about 15% this semester by doing that. Took some time to research (Excel spreadsheet and all) but I was incredibly anxious to start school so at least I used up some of that energy in a positive way!

SirJohnny · Nov 7, 2003

FarmRN2Be:

- I have not received any specific course information (books, equipment, etc) from the nursing school yet. In fact, am still waiting for the medical/physical forms to arrive. School said that New York revised some of the medical requirements for nursing students (school did not go into detail). Said that new forms were being drafted/printed and would go out to us in Jan 2004.

- Regarding new textbooks. I purchased some Microbiology study guides from Amazon. I looked at their "used" section and some of the books were stated to be in "like new" condition. So I took a chance and ordered two texts.

- Well, the texts look like they are absolutely brand new. None have any highlighting in them. They were like $20-$25 a piece new,a nd I got them for $10-$15 each. So am definitely a happy camper.

- Am waiting to get into University of Southern Indiana's Microbiology course -- but since I am a first time student there - I have to wait until day before classes before I can get a petition to take the class. Unfortunately, the class is usually filled. But, we both know that 2 weeks into the semester there will be plenty of empty seats available.

- So, I go and play the game.

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Thanks,

John Coxey