are care plans a joke for you?

[MoopleRN]

so much emphasis was placed on them when i was a student. i enjoyed the challenges of writing individualized/relative/practical care plans back then even though i realized what was required of us to write was unrealistic in the real world. it was a just another student-hoop we had to jump through and i jumped like all the other students.

bam! real world! i work in a hospital and care plans are a pre-chewed and spit-out part of the software we use to document. there are some basic diagnoses to choose from and their complementing, basic interventions. 2nd shift is responsible for keeping them current (goal met/goal not met/continuing). other shifts may chart on them.... and of course other shifts don't.

what's your opinon on care plans/how you're required to write/document them at your facility? do they make an impact on patient care?

[pagandeva2000, LPN]

Learning them was nice, but I don't see the value of them in the real world, mainly because there is not enough staff to implement them.

[Daytonite, BSN, RN]

mooplern. . .well, you figured it out! care plans in school are to learn about critical thinking, the different diseases and how they are treated. on the job they are documentation of the problem solving process we use to address nursing problems. don't know if you are aware of this, but medicare mandates that a written nursing plan of care be present in every patient's chart. at least most facilities are making it easy for nurses by providing us with software that gives us pre-chewed and spit-out care plans or else we'd be hand writing these things from scratch for each patient like we did 30 years ago.

[Ginger45]

I remember when they were very useful. It was right after I graduated the first time (1982). We actually used cardex's and relied on the careplans. We updated them with new orders. Our problems were very specific to our pts. I found them a great tool. Then came DRGS. I went from having 5 pts to 11 on a surgical floor. Then I began to have a mix of med/surg as well so I was not only monitoring closely my post surgical pts but I was trying to keep confused elderly pts from keeping OOB and falling. We had primary nursing, no NA's. I no longer had time to do them. From a long term care setting, they are very valuable if everyone is involved and follows them. The sad part is that for the most part, the only ones who know about them are managment staff.

[JBudd, MSN]

Please keep in mind that the nursing care plans written in school are an educational tool -- to help you learn to think about client's needs, priorities, appropriate interventions, evaluation of progress, etc., and to give your instructors a way to see how you're thinking about client's needs and appropriate nursing care and give you feedback on how you're doing with that process.

There are many, many things you do in nursing school that are different from actual nursing practice in the "real world" -- that's because learning to be a nurse is different from being a nurse.

Elkhorn is right, it is a way of setting up a mindset, a way of approaching things. Short of sitting there and grilling you at the clinical site, one by one, how else is the CI supposed to know what you did to prepare, and that you are ready to take full advantage of the clinical. Some of my students were CNAs, doing clinicals on the same floor where they work; trying to get out of the task oriented outlook and onto ongoing assessments and knowing exactly why you are doing things, and what it all means was difficult. Care plans were a way of bringing out details beyond tasks.

[bookworm1]

The careplans my school requires seem to be reasonable compared to surrounding schools. They end up approximately 7-12 pages in length. They really do assist in training your brain for critical thinking, recognizing trends in symptomology, and in assessments. Our instructors are honest enough to admit that we aren't going to see them once we are done with school, but it has already changed my thought processes!

[chenoaspirit, ASN, RN]

Please keep in mind that the nursing care plans written in school are an educational tool -- to help you learn to think about client's needs, priorities, appropriate interventions, evaluation of progress, etc., and to give your instructors a way to see how you're thinking about client's needs and appropriate nursing care and give you feedback on how you're doing with that process.

There are many, many things you do in nursing school that are different from actual nursing practice in the "real world" -- that's because learning to be a nurse is different from being a nurse.

I agree. In school, I hated doing them, but they are to teach students to perform critical thinking and apply their knowledge. No we dont use them out in the real world, but imagine if you hadnt done them them, do you think you would have still learned the critical thinking skills had you not done them? I ated most doing the medications lists (listing drugs, drug action, side effects, reasons pt is taking them, etc). But that helped me to learn different drugs. I sure dont miss school! lol

[Virgo_RN, BSN, RN]

I think they're useful. When I come across an unfamiliar patient situation, I like to look at the care plan for that situation just to remind myself of what my priority assessments should be, and make sure I'm not missing anything.

[MikeyJ, RN]

Care plans are very time consuming (in school) and I will admit that I cannot stand doing them. However, they do make you think about prioritizing patient problems and what type of interventions need to be done.

In the hospital I work at as a nurse apprentice, we do paper charting, thus we need to write out our care plans. We have a book full of care plans that we can copy. However, I have found myself thinking of priority nursing diagnoses for every patient I care for (my professors would be proud! haha).

[CHATSDALE]

care plans in school are like diagraming a sentence when you were in the 6th grade..you will never diagraming a sentence in the real world but you know the part of speech and can communicate with you rfellow man

in the real world: a careplan provides a blueprint as to dx and tx

gives thtb/surveyers somewhere to start as to what care the patient is receiving

[madmominavan]

This is an age old issue... care plans whether hand written or spewed electronically or in any other form is a plan of care that eithere meets criteria or objectives for quality of care for a patient.

as a student, it was a tool to make one proganize care and l;earn about the idesase proces and rationale for the nursing porcess. The paradigms continue to this day and even new models of nursing theroy rely on these POCs.

I at ome time thought as all others who have preconceived notions and do not know other than what they hear and preconceive themselves... yes they can be a pain; yes, there are days and times I just don;t get to a POC.... I learned from working in several high profile facilites and then in two smaller hospitals and even now as a seniro level case manager for a noted insurance company, POC's are part of the nirsing process.

It might be something to think about..... Have you considered taking a moe positive stance and outlook and be proactive and make this work for you particulrly. perhaps your co-workers and NM may catch on and begin to do their part and get off the "pot" and thier routinized attitudes towards POCs. The bottom line is patient care and for any niurse who belongs to any major nuring organization such as ANA, you will find vital information about how these pratices come about or why. Research continues and documentation shows that POCs are improtant. As Cm I look at POc's rom what other Cm and UR tell me. Is the poc effective? Did the pat. meet criteria and if not why not? Were there com;lications? Was cost affected and did the pt. require additional acute days in house? Was services/referrals and procedures done in a timely manner and if not what or why was there a delay and was it becasue of an acute process or that some department didnot look at all the circumstances and decided to cut the pt. short becasue they decided an outpt. ws more improtant or the department was not covered sufficientl;y etc. So, as you can see, a patinet may suffer undue costs and time, the facility could be penalized as could thier physicians, the pt. may feel entitled when in fact they are not and did not know their poc was not followed and someone neglected to manage their care or tell them. Tehe other issue is ethical and moral and legal responsibility and accountibility to the pt. .. not the nurse's personal feelings. Duggest you take yur concerns to your NM, supervisor and DON or ADON... meet with the committe on your unit or the facilities for policy & procedures. Join the committee... and take a proactive attitude.... and think "patient" first. Outcomes second and yhour profressional training and license.

[imenid37]

How about a multi-disciplinary tx plan? Mostly the computer can spit it out. This is because in the real world, nursing, medicine, soc wk, PT, resp, etc ovelap and we need to know what each other are doing. We all need to stop being so territorial! all those care plan books are earning Mosby and their competitors TONS of $$$ from frustrated student everywhere.

[locolorenzo22, BSN, RN]

I too believe that, although a pain in the butt, care plans MAKE you think about what the problems of the client are.....You have to learn about what you would do to solve said problems, and what you would do if they were unsucessful....Also, it's a really neat trick when you talk in nursing dx's for real life.....i.e. uncontrolled excitement RT graduating nursing school AMB making sure everyone knows I"m graduating in 2 weeks!!!!