Care Plans an Exercise in FUTILITY??????

[Destinystar]

:uhoh21: I would like to know how many of you out there sit down and read each and every care plan on each and everyone of your residents each and every day before you start work? I am not talking about getting report, or reading the assignment board.

Yes the RN nursing practice act mandates that we formulate one, and the state and federal regulations mandate that we develop one as well. Most of the care plans just duplicate what is already built into the standards of care, & the MD orders.

Do you think that the care plans in the residents medical records have a significant impact on the way you deliver nursing care?:uhoh21:

[leslie :-D]

the ncp's were filed in the back of the pt's charts. but one year we were cited by dph as that is one of the major tools they use in following a pt's care.....

[Destinystar]

lets say nurse worse actually believed in care plans. believed without question that they were absolutly necessary to take care of residents. so, she followed them to a t. can you imagine the substandard care that would result from it. first of all some of the ones sitting in the charts i've seen have so many coffee stains and cigarette burns, that they are ilegible. my favorite goal is the one that states "staff will met all the residents needs" can you imagine nurse worse following this one like she would spend so much time taking care of all of one residents needs and would have little time to spend on anything else. or if one of the care plans stated to "keep res. clean and dry after each episode of incontinence". what if the res. vomited. nurse worse might not find the problem in the care plan and might not know what to do. seriously does any cna or licensed nurse in their right mind need a care plan to tell them what to do if a resident is incontinent, or cant do adl's independently?????? you are right. we all did learn that in school. lets face it legally we are required to do whatever is in our scope at any given time and will be held to that standard. like have you ever heard of a nurse getting disciplined because she cleaned up a resident after an episode of incontinence and it wasnt in the care plan? of course not. then there is the nurse practice act, obra and state regulations we need to know and follow. end of rant

[Destinystar]

out of curiosity what federal or state reg. were you cited under?i dont see anything in ca state reg (where i am from) or in obra that states where in the medical record you have to place them. i would have loved to have taken that citation to an informal dispute. you can place the care plans anywhere, because after we get report, there are prn meds to be given, fingersticks to be taken, emergency lights to answer, res. calling out, family members demanding, md's calling in new orders, abnormal labs that have to be reported, staff calling off etc. and absolutly no time to look at the damn things. sorry but care plans have no impact on the quality of care the residents recieve, the amount of staff that we have on hand and the acuity level does. to keep dragging them around like a security blanket just endorses dogmatic thinking.

[dhudzinski]

IN home care they are invaluable. It directs our care each and every visit and is how we get reimbursed for our services. If it is not in the care plan we don;t get paid. The nursing care plan also assists when another nurse needs to go out and see your patient.

And the nursing care plan is only as good as the nurse who writes it. Most nurses never learned how to really write an effective nursing care plan. I teach nursing students and my students know how to write a realistic nursing care plan by the end of the semester.

[Hellllllo Nurse, BSN, RN]

I teach nursing students and my students know how to write a realistic nursing care plan by the end of the semester.

In all my years, I have never seen a realistic, practical care plan.

[TiffyRN, BSN, PhD]

Here's my take; I struggled so to compose care plans in school. I have been in acute care for 11 yrs now and never had to write one from scatch, many times, just checkmarking a couple of diagnoses on a sheet that got filed somewhere. My point being; careplan writing in acute care is done for you and generally never thought about much less read after admission (admittedly I don't really know about LTC).

A couple of years ago I helped my husband go through nursing school and he of course had to learn to write care plans. As I assisted him I was simply amazed that I had NO TROUBLE writing a thorough and wonderful careplan. It's automatic, part of an experienced nurse's thought process.

I can appreciate it as a good guide, needed by less experienced nurses. I will say when I changed speciaties I did read through some careplans because there was a huge difference between adult cardiacs and neonates.

It reminds me of PBDS (performance based development system). Those scenarios some of you may have had to do in orientation. Only that was to assess one's critical thinking mostly about what medical interventions were needed.

So, I don't think we need to get rid of them but as someone else posted, God forbid we should ONLY follow the careplan because most of them don't encompass all those nuances that patients require.

[sharlynn]

Nope, I think they were thought up by someone with entirely too much time on their hands and NO bedside experience.

I have to agree with you. They have nothing to do with patient care(that you can get from listening to report) and are only there because they are required by the State. But, I do my part and update them so I can keep my job!

[Destinystar]

I agree with you that the only reason why they exist in LTC is b/c OBRA and state regs. mandate it. With there being such a shortage of direct pt. care I dont think that the amount of time and $ that they require is justified. The time and money would be better spent providing hands on care. After all there is a direct relationship between the amount of time you spend performing hands on tasks for a resident and a positive outcome. In contrast to a direct relationship between spending too much time on documentation and a negative outcome.:angryfire :stone :uhoh21: These are all the nurses at the nurses station worried sick about the residents welfare b/c they have to spend so much time away from them so they can produce a document that has no ascertainable benefits

[ham22]

IMO- Care Plans are way too long with way too much unnecessary info. But, I do think they are a good idea in general like in LTC where I work- as a refferal guide . We only look at them as needed anyway. I think they are a good idea but definately could be shortened so that they are easier to access.

[Destinystar]

company policy and procedures already at the nursing station are for. why keep duplicating the same thing over and over again. it takes time away from resident care. when you look at a residents care plan it has bits and pieces of information, with varying degrees of quality often written by lay people with no knowledge or responsbility for quality care. its got a lot of stuff written by other departments in regards to what their department is responsible for, and is nothing but a waste of time for us to have to look at. the diet orders, pt orders, dietician notes, pt notes, etc. are already in the chart if we want to read up on what they are doing for the res. as well as the md orders, nurses notes, etc. why do we have to take this same info. and repeat it in the care plan??????????? the nurses notes, dietician notes, pt notes, etc. contain a ton of info about the res. problems, then it goes on a report sheet, so why have to stick it yet in just one more place????? end of rant

:angryfire

[purplemania, BSN, RN]

Care plans is one reason RN's are paid more money than LVN's in a hospital. We (RN's) need to document how we intend to care for that person and adjust the plan to reflect the patient's change in health status. I hope you never have to defend in court one of your charts that had no care plan, or one that did not reflect the actual care performed. It is one of those necessary evils.

[FrazzledRN]

I have to agree with you. They have nothing to do with patient care(that you can get from listening to report) and are only there because they are required by the State. But, I do my part and update them so I can keep my job!

I agree with some of these posts, others I do not. Yes, care plans are very time consuming and are another place to have to document and update. Agreed. But to say they aren't a part of patient care is not true in my opinion. I know that every care plan I write is individualized and are done after a thourough assessment of that patient/resident. I include things in that POC that is useful information and in a place that is easier to find than digging through multitudes of H&P's and chart documentation etc... Who inserted Mr. Jones's Peg tube a year ago (if you need to know who to notify in case of problem, etc..).. These careplans have a summary of what and who that resident is. Especially for nurses and staff who rotate and may not know certain things about that resident and certainly do not have time to read through the chart, and reports in our building give only the basic data/bare minimum---"mrs. so and so...she was fine all night". If you have no time to read care plans how will you ever find the time to hunt things up in the charts on 30 or more residents. They should be a useful source of information to help continuity of care from all staff. I know these residents' histories as well if not better than most of the floor nurses because it is my job to pour through the H&P's, charts from cover to cover, and hospital records, call over for additional information, etc..and apply it to the care plan for everyone to benefit from. They are a useful tool if utilized as such. They help patient care, not hinder it. When I worked the floor and went through those crazy, hectic days and Mr. Jones pulled out his peg...well it would've been a time saver for me to have the MD that inserted it listed on the care plan as well as the resident's other consults at hand. Time spent digging through charts. I also put the resident's preferences, etc.. on there for staff to be aware of because again with rotating staff these things are good to know. (i.e. Mrs. so and so our little Alzheimer's resident has always feared showers and prefers bed baths...becomes agitated with showers....or Mrs J. fears men and is better with female staff, etc..) This kind of info is valuable and often difficult to find anywhere else in the charts because, again noone has a great deal of time to document thoroughly and keep that kind of info current in day to day documentation. I am an RN and I do MDS's/care plans. I also assist with IV's, admissions, call outs, treatments, whatever. But I do not feel that what I do with MDS's is a waste of time or does not apply to patient care. I don't do them for the administration or just for State ..I do them with the thoughts of continuity and helping staff too. It is and can be a valuable tool. It's unfortunate that staff is not able to use them for what they are. Thanks!! :)