IMO, NDX and writing care plans
are very important learning tools for student nurses. It's not the completed careplan itself that has value- it is the processes the student goes through in writing it which are invaluable.
When I was in RN school, struggling through yet another long, tedious care plan- it suddenly hit me like a smack in the head- The problem solving and critical thinking
utilized in writing
the care plan are what's important for students- not the care plan itself.
The NDX is not the thing- it's what you do and how you are challenged to think in determining
your NDX which are important.
for example- I did a humungous care plan on a S/P CVA pt. Because of doing that care plan waaay back in the day- I learned what to do- what interventions to take to prevent complications and sequelae, and to promote recovery in such a pt.
Even if all I know about the pt is "S/P CVA"- I don't know his labs, his co-morbidies, or anything else, I will still know many things that I will need to watch for and actions I need to take w/ this pt.
S/P CVA tells me-
The pt may have difficulty swallowing- high risk for aspiration pneumonia- I need to see it the pt needs thickened liquids, a soft or pureed diet, keep his HOB elevated,
He may have sensory/motor deficits on one side of his body- I need to be aware of what side of his body is affected, and be sure to keep his call light, liquids and telephone on that side, approach him from that side-
He may have trouble speaking- I'll need to ask yes or no questions. Big fall risk, side rails up, fall precautions, risk for skin break down, keep him turned, repositioned, attend to sweating in body creases, keep his skin free of urine and stool, risk for contractures, foot drop. He will be a lot less active than he was before- skin breakdown and contractures, again. Risk for DVT, muscle wasting, bone demineralization. If he can't reach for his water himself, or has lost sensation of thirst from the CVA, he's at increased risk for dehydration, UTI, constipation, hypotension. He may be depressed- I'm sure the CVA altered his roles and his views of himself, and on and on and on.
The reason these things just automatically pop into my head when I hear CVA is because of all those "meaningless" care plans I did back in school.
As nurses, we don't need to use the language
of careplans in our work, and the care plans we write for work are likely just cursory, and there only for The State
But- what our educational careplans have taught us needs to be in our heads
, and incorprated into our way of thinking
- it is through writing those tedious careplans that we learn to think like nurses.