care plan rationale?

[shock-me-sane]

I am going into my second quarter in january and I have heard rumors that we will be required to do a care plan once a week. I don't find them horribly difficult, but I always have such an issue dealing with the rationale for my interventions.

My plan is to get some good resources saved to my computer for repeated use before the quarter actually starts so I will have less leg work once crunch time begins with school. I was hoping that someone had some good journal articles they know of for this use and could possibly share title's/author/etc. I have had such a difficult time using our library's online resources to actually come across quality information in a decent amount of time.

Thanks for any help!

EDITED TO ADD:

I am talking about needing sources that justify each intervention I plan on using, such as a study that was completed saying that semi-fowlers position is helpful in breathing facilitation. our rationale's must include a credible journal article.

[RNin2007]

We were required to buy a book that helps with this, our first term. I suggest you check out books at Barnes & Noble or a similar place, and look for a pocket sized care plan book. I have seen them on the shelves. It will be worth spending the money on, and the one I have is loaded with rationales....but mine isn't pocket sized.

~J

[Daytonite, BSN, RN]

rationale is nothing more than an explanation, justification or principle behind why you have put the particular nursing interventions on your care plans. depending on the situation the patient is in, your interventions are always going to follow the symptoms or problems the patient is having. in order to do this you need to make a list of the patient's problems that you are wanting to address. then, you need to do a little research about them using your textbooks and any other sources you might have, including the internet. don't forget to include what the doctors might want to be ordering as well as tests. by doing this, you will be able to better establish the priority of what needs to be attended to. remember that your ultimate goal is always going to bring the patient back to some sort of normalcy or acceptable level of functioning so the nursing interventions you choose are always going to ultimately be aimed to that. you will find the rationale for your interventions buried within that kind of logic. all you have to do is find that rationale in writing in order to verify that your intervention follows good principles of nursing. you have to do some of this leg work in order to develop a good rational plan of care. the various parts of the care plan then fall into place with one exception. that, for most of us, is the development of the nursing diagnostic statement which is a labor of english composition. you will need to have a current list of the nanda nursing diagnoses to refer to if that is what your instructors are requiring, or an explanation of how to write that diagnostic statement. all the rest of the nursing care plan is based on anatomy, physiology, pathophysiology and nursing care principles whose textbooks you should already have in your possession.

i also would recommend that you bookmark the following web site: family practice notebook.com. http://www.fpnotebook.com/ this is a huge database. the easiest way to find information on this site is to just do a search of that site for a particular problem (medical diagnosis) or symptom. the search box is in the upper left of the page just below their logo. play around with it while you're on vacation. do a search for some problems like diarrhea or seizure and see what comes up. sometimes it will present you with more specific links to check out. you will often end up with a page that outlines description of the problem, causes, pathophysiology of it, diagnostic tests and complications. although this site is for doctors, it is helpful for nursing because it gives us an idea of what the doctor is going to be doing for the patient and helps us tailor some parts of our care plan to those things which we may not have considered before.

also, http://www.labtestsonline.org/ -- this site has been designed as a single resource where people can find up-to-date lab testing information vital to the understanding and management of their health, or the health of someone close to them. it includes test descriptions, conditions, screening guide and current news. when looking up disease conditions, the lab tests typically ordered for them are listed with links to explanations about them. make sure to check out their site map for more information about lab services.

i also suggest that you read through the sticky's on these 3 forums: general nursing student discussion forum, nursing student assistant forum and pre-nursing student forum for all kinds of links to internet resources that you should check out during your school break. bookmark the ones you think will be helpful for you. also, post to the forum when you have a question on something. just make sure the title of your post attracts attention as to the subject involved as this one did for me.

[purplemania, BSN, RN]

Your textbook will have rationales, so you should not have to go to additional expense. Basically, just make a list of what you will do for that person and why. (Dehydrated? Start IV). Then expand on the thoughts to make it sound professional. Such as "Infuse isotonic fluids to balance electrolytes and to prevent hypovolemia". You get the idea.

[VickyRN, MSN, DNP, RN]

The rationales should also be scientific (hence the phrase scientific rationale), which means they should be based on research (evidenced-based practice) rather than personal opinion/ preference or nursing tradition ("we've always done it this way"). In our school of nursing, we require citation of source for each scientific rationale for nursing interventions. Possible sources for a scientific rationale might include a course textbook, professional journal, lecture, discussion with a reputable health care professional, or a scholarly Internet site.

http://home.hiwaay.net/~theholt1/NURS1100/careplan.htm

http://home.hiwaay.net/~theholt1/NURS1100/class4.htm

http://www.lmunet.edu/academics/undergrad/nursing/Fall04NURS/NURS%20241_242Blank_Nursing_Care_Plan.pdf

http://programs.kcc.hawaii.edu/~nursing/templates/153acute_ncp2.rtf

Evidenced-based practice:

http://www.ahcpr.gov/clinic/epcix.htm

http://evidence.ahc.umn.edu/ebn.htm

http://www.lib.uts.edu.au/information/subject_guides/nursing/?p=52

You may want to invest in a copy of Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC). These classifications were developed for use with NANDA. NIC interventions for illness treatment (e.g., Hyperglycemia, Seizure Management), illness prevention (e.g., Fall Prevention, Risk Identification) and health promotion (e.g. Exercise Promotion, Normalization Promotion). Interventions are not only for individuals, but also for families and communities (e.g., Family Integrity Promotion, Environmental

Management).

[pvjerrys]

Great posts from Daytonite & VickyRN. Loved the links! Thank you very much!

[mitchsmom]

I love this book, it has it all:

Nursing Diagnosis Handbook: A Guide to Planning Care

The sources above are awesome also, and I do use several resources when doing my work. But if I get too many going, it makes a longgggg project even longer.

[Daytonite, BSN, RN]

Yes, VickyRN is right. In my nursing classes some years ago we had to have references for the rationales of our nursing interventions. They had to be footnoted and referenced. Hence, pre-Internet era (sort of) I had a pile of supplementary textbooks and such that I used for references. You'd be surprised how much hair you lose over finding just one legitimate reference for something as easy as putting a patient into a semi-Folwer's position. I didn't want to bring that up because the OP sounded like she was just barely getting into this stuff and I didn't want to overwhelm her!

[Jo Dirt]

Here is a rationale that should cover everything, and if you have a Carpenitos handbook you will find it in there:

According to Maslow's Heirarchy of needs, (insert nursing dx here), if not managed now, will negatively affect the health status of the patient.

[shock-me-sane]

The rationales should also be scientific (hence the phrase scientific rationale), which means they should be based on research (evidenced-based practice) rather than personal opinion/ preference or nursing tradition ("we've always done it this way"). In our school of nursing, we require citation of source for each scientific rationale for nursing interventions. Possible sources for a scientific rationale might include a course textbook, professional journal, lecture, discussion with a reputable health care professional, or a scholarly Internet site.

http://home.hiwaay.net/~theholt1/NURS1100/careplan.htm

http://home.hiwaay.net/~theholt1/NURS1100/class4.htm

http://www.lmunet.edu/academics/undergrad/nursing/Fall04NURS/NURS%20241_242Blank_Nursing_Care_Plan.pdf

http://programs.kcc.hawaii.edu/~nursing/templates/153acute_ncp2.rtf

Evidenced-based practice:

http://www.ahcpr.gov/clinic/epcix.htm

http://evidence.ahc.umn.edu/ebn.htm

http://www.lib.uts.edu.au/information/subject_guides/nursing/?p=52

You may want to invest in a copy of Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC). These classifications were developed for use with NANDA. NIC interventions for illness treatment (e.g., Hyperglycemia, Seizure Management), illness prevention (e.g., Fall Prevention, Risk Identification) and health promotion (e.g. Exercise Promotion, Normalization Promotion). Interventions are not only for individuals, but also for families and communities (e.g., Family Integrity Promotion, Environmental

Management).

awesome! That is what I am talking about. I don't think I had made myself clear. We have to reference a peer reviewed journal or other credible source for EACH rationale. I haven't had a problem figuring out what good interventions are or how they are helpful, just where in god's green earth someone did a study deciding that it was a good thing to do for a patient with a particular problem.

[Indy, LPN, LVN]

The Ackley and Ladwig book is excellent! What you do, is use the index to look up your patient's condition(s). Each one lists a bunch of nursing diagnoses that might apply.

Look up the dx's in the book. Lists interventions that would be helpful and each one has a rationale. So the book would be one reference for your rationale. Then open your med-surg book and look up the condition. Between the both of them, you should be able to make sense of it and come up with a specific set of interventions and rationales in your own words to back up what you did or are going to do. Voila, you'll also automatically have two references.

It ain't easy but it works better than pulling your hair out. Of course this method will result in you having a whole bunch of books open on the floor around your desk while you type.

[mitchsmom]

The Ackley and Ladwig book is excellent! What you do, is use the index to look up your patient's condition(s). Each one lists a bunch of nursing diagnoses that might apply.

Look up the dx's in the book. Lists interventions that would be helpful and each one has a rationale. So the book would be one reference for your rationale. Then open your med-surg book and look up the condition. Between the both of them, you should be able to make sense of it and come up with a specific set of interventions and rationales in your own words to back up what you did or are going to do. Voila, you'll also automatically have two references.

It ain't easy but it works better than pulling your hair out. Of course this method will result in you having a whole bunch of books open on the floor around your desk while you type.

When I mentioned this book earlier, I forgot to specify that they do list the originial references for their rationales, so you will have journal references if their book doesn't 'qualify'.