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Discussion

Care Plans?

hello everyone. first off, i'm so glad i found this forum. secondly, i know this is a student forum, but i'm hoping someone can help me out here. i'm currently an lpn student, and only 2 months into the program. we've started our first clinicals (in long term care facilities..) and part of our assignment every week is to make two care plans for our patients (that we only see for 2 days, about 4 hours a day, if they don't fall asleep the whole time you're there)

i understand it's part of the learning process, but in "real life" are lpns actually making care plans for the patients? i thought that 1. if a care plan is to be made, it's by an rn and 2. isn't there ususally a care plan book that you can use to guide you in personalizing it to your patient? obviously, i'm still new to all of this, but i'm getting pretty discouraged because i'm kind of lost on the whole care plan constructing thing..

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I'm with you on the care plans. It was explained to me that usually care plans are automatically done for us at the large hospital in our area via computer.

HOWEVER! lol..

In my mind knowing how to do care plans is VERY important. We just started on them in fundamentals, and when we know how to effectively do a care plan, we're exercising the pathos we need to adopt as a nurse. We have to have a particular mindset that I admittedly don't understand yet..but part of being a nurse is a way of thinking differently than a non-health care professional.

Care plans help to keep us in that frame of mind and because of that, even though they're hard for me now, I really like them. It's a series of steps that reminds me of what my part of the continuity of care is, what my job is within the scope of the license I hope I'll be getting, and how to care for people within the guidelines set up for us as this particular part of a patient's care team. So, care plans are critical for us now, even if we won't be using them in the way that we're taught..because they keep us in the correct frame of mind and encourage us to think like nurses, which I'm now realizing is not that easy to learn.

So even if we won't be using them in the way that we're taught in whatever facility we end up working at, they're so so so valuable in terms of teaching us how to think as nurses, imo.

  • Expert

i understand it's part of the learning process, but in "real life" are lpns actually making care plans for the patients? i thought that 1. if a care plan is to be made, it's by an rn

it depends upon where you work. in many of the nursing homes that i worked in the lpns were writing the care plans. in fact, in one facility there was an lpn who was in charge of the care plans and this was her only job. whenever we had a problem come up with any patient, i.e. fever, diarrhea, fall, skin tear, or the flu we were to initiate a care plan immediately and we had some pre-made fill-in forms to help us save time. in the acute hospitals, however, lpns were not initiating the writing of care plans although in the old days when they were done in pencil i recall many rns encouraging the lpns to contribute to the care plans if they wanted to. the finalized care plan bears the signature of the
rn
.

and 2. isn't there ususally a care plan book that you can use to guide you in personalizing it to your patient?

yes, there are all kinds of care plan books available commercially. however, to personalize a care plan to your patient requires including things about the patient that are not necessarily in the care plan book. what the care plan book does is provide you with a skeletal framework of what to do for a patient with that particular medical disease or medical condition. the problem that you will sometimes encounter, and this is what makes care plan writing so frustrating when people are new at it, is that a care plan is supposed to be about solving a person's
nursing problems
--not their medical problems. some medical problems result in the same nursing problems for patients, but not always. this is why following the steps of the nursing process and, in particular, assessing patients is so very important. some people have unique situations. thus, the individualization of the care plan is essential.

i'm getting pretty discouraged because i'm kind of lost on the whole care plan constructing thing.

perhaps it would help if i tell you that care planning is problem solving. and problem solving patient's nursing problems is a responsibility that lpns and rns share. in "real life" on the job, most of this problem solving/care planning is done on the spot. we do it so fast that with experience and seasoning the thinking and reasoning part of it goes by in a blur that we don't even recognize. as students it's a bit of a painful, tedious process because all the information is still new and difficult to figure out how to put together. this learning process you must endure is kind of like assembling all the pieces of a jigsaw puzzle. it takes time and patience as you pick up each piece, examine it and try to place it where you think it fits in the main picture. sometimes you're surprised to find that a piece really fits in somewhere else you never even considered.

a formal care plan is actually a
written document
that records your problem solving process and solutions to the nursing problems of one patient. in the work place this helps to record what the nursing staff was actually doing for the patient that the charting doesn't show. for students, however, the steps involved that lead up to the writing of a care plan help to cement in learning about the patient's disease process, assessment of the patient, nursing interventions for their problems and most importantly prioritizing and decision making skills. they are also what i call the "term papers" of nursing school.

although lpns and rns are not doctors they need to know what the treatments and tests are that the doctors are going to order for many of the different kinds of diseases. the same holds true that although as lpns you are not rns you still need to know what nursing treatments the
rn
is likely to order for a patient's nursing problems and that is where the care plan is going to help out. even if you eventually end up in a job where you never write another care plan you should know what they are and how to read one.

the first few care plans we all write are ones we struggle with. do you remember what it was like when you were learning to ride a two-wheeler bike? or roller skate? or drive? learning to be a nurse, give patient care, insert foley catheters and write care plans are also skills that you need to learn. practice makes perfect. we fear the unknown. never be afraid to try something new.

there is a sticky on the general nursing student discussion forum to help students with writing care plans and i will answer care plan questions all the time.

Honestly, doing care plans was one of the reason's I didn't continue with my second quarter of the program. We didn't even "learn" how to do them until the end of our first quarter when we started clinicals. We were given very little guidance, then yelled at when we didn't do them right. We did have books though but it was a "figure it out for yourself" process. Plus we had to write out all the meds for the patient, along with side effects, dosage, and time given. I do believe it is very important to know what meds your patient is on and the side effects, but by the time I got done writing all the meds, doing care plans with four diagnosis (prioritized) on my patient, including all the labs and meds listed again, and any doctor's orders, braden scale, fall assessment sheet, plus four intervention sheets with at least 5 interventions for each diagnosis, I was staying up until 2am with a 6:45am start time the next day for clinicals.

We had to go to the hospital the day before clinical to get our patient info so that we could go home and do the care plans. But we couldn't go to the hospital until after 3pm and had to have the info by 6pm. Then consider making dinner and other family stuff before starting on the care plans, and that's why it was into the wee hours of the morning for me. I just wasn't ready to commit that kind of time.

Of course I know my particular course is doable because obviously people make it through. But in my situation, it was just more than I could handle and I don't even have any children living at home or have a job, so I can imagine how hard it is on those who have those extra duties.

I keep in touch with a girl from my class and a few people have already dropped but it's still one of the largest classes the school has had. I have the opportunity to go back for winter quarter but I'm thinking maybe I'm just not cut out for it. One great thing I did learn about the side effects of the meds is that it helps you come up with your interventions. But the vast amount of time it took me to gather up all my information and write it out was too much for me. I felt like I was doing just about as much as the RN program probably teaches and think if I go back at all it will be for RN.

I applaud everyone who keeps going because I know it's not easy.

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