Another thread brought to the forefront one of my biggest pet peeves about nursing. The dreaded "Care Plans". I hate them. I think they are task oriented and are simply paperwork created to satisfy the state. I attach no importance to them what so ever in my nursing theory.
I'd like to know what others think of them. I'm opening up a debate here. Please, dont be afraid to say so if you think they are significant to pt. care.
I'd also like to see if there is a difference between what younger nurses vs. vet. nurses say about care plans.
So please, give me your opinion of care plans, but classify your comments with which group you fall in. Please state your field of nursing and if you are new or vet. nurse. For the purpose of this debate, we will define new vs. vet. nurse as having more or less than five years experience. New if you are 5 years or less, vet. if you have more than five years.
Personally, I am a very good nurse, but I have never in 17 years actually written or utilized a care plan (other than in school). Today, care plans are canned, and all you have to do is check this or that to "personalize" the care plan. It's a complete joke.
I know what is needed for my patients, and I go out of my way to make sure they are cared for holistically. Care plans are obsolete, in my opinion.
For students, I think care plans are very helpful in promoting critical thinking, and in kearning what specific nursing interventions you would use in specific pt situations.
In the real world of nursing, though, I find them totally useless.
This is exactly what I was going to say.
When I was a student with NO background in medicine - I think the care plans are useful teaching tools.
But in real life - no no no.
Been a nurse in L&D, ER and med/surg (rural hospital - we wear many hats) for 10 years. Now a hospice nurse.
I can give a concise report on objective and subjective data to the oncoming nurse, to include my head to toe assessment, new orders, IV site, medications, etc.. without a care plan.
Specializes in Management, Emergency, Psych, Med Surg.
Ours are soooo easy. We use the kardex a lot and our care plans basically have everything written out, we just have to check boxes and put a date. We can provide comments if we want.
I, too, believe that care plans have a place in the academic setting, although I certainly didn't appreciate it at the time. I think that they do help develop the specific style of critical thinking skills that we need to learn as nurses.
However, in reality, what the heck difference does it make if I check off the box for "Infection control" on the pre-printed care plan section of our care plan/cardex? I still wash my hands, use sterile procedure when called for, and gown/glove/mask as is appropriate.
Now we're getting in trouble for not initialing off if the specific care plan is met prior to d/c...Excuse me, but just b/c the patient has been downgraded to medical does not mean that they are not at risk for further cardiovascular issues during their stay. Just b/c we have their CHF under control for the moment does not mean that some doc isn't going to screw with their meds or that they're not going to need a bolus for BP support that sends them back into it...as far as I'm concerned, those issues that we initiate are not actually met until the patient is well enough to go home and not be under continous medical supervision. But admin seems to think that not being able to close out specific areas of the care plan indicates that we are not making progress with the patient.
I don't do them formally, just do them in my head, basically every day with every patient. I look at the drugs they're on, and why -- the labs we're doing, and why; the orders, and why each of them were written; I look at the diagnosis, and what goes with that, and then think of the things I will do (the nursing interventions) that will additionally move the patient towards recovery; and I also include my own assessment and use critical thinking "stuff" to carry out the day. I mean -- you do it all the time, you just don't call it a "care plan." We use pathways on our floor, and they includes just about anything and everyhing we are supposed to do for our particular floor. I didn't think they were useless at all in school -- I for one needed to learn how to do one to learn how to look at a patient and think critically.
I'm working at accident and emergency department. Most of the time, we need to start a clinical pathway as an initiation for the care, no matter it is a medical or surgical cases. We will be reprimaned if we forgot to used it, or question by the ward staff. Often i found pre-templated care-plan is too rigid, mould on our thinking. Foe me it is a form of govermentality on our daily job!
I agree! Everybody hates doing huge care plans in school - and none of us ever see the value while we're doing them. It's true, they absolutely do shape your thought processes in the long run. Believe me. You do enough of them, and next thing you know you're working - get a patient and all these interventions pop up in your head automatically!!
Our hospital recently switched to handwritten "plan of care " type things. We had preprinted care plans before which all we did was initial. Now we're all scrambling to remember how to write one!! The new nurses are blowing us away. So, yes they do get used in clinical practice - in one way or another.
RNKPCE
1,170 Posts
Amen!!!
Veteran nurse