Care Plans - What's their purpose? - What do you think of them?

Nursing Students General Students

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I saw a nursing student and her instructor reviewing a care plan today and she was reviewing something about wording of the care plan and it reminded how frustrating nursing education can be and how mixed up it can seem to be sometimes!!!

At my school, anyway, a care plan for something as post-anesthesia nausea would be grilled for the wording of the nursing diagnoses, the specific wording of the nursing interventions and goals.... to make sure that we were using impractical "nurse speak" as opposed to - oh no! - referring to a medical condition directly (eg pt constipated, possibly d/t medication side effect, keep hydrated, adm laxative as ordered, etc). Students should ideally be able to rattle off quickly the what's and why's. I think the nitpicky round-about descriptions required in nursing school make simple concepts more confusing... and end up wasting the valuable time of students.

Well, I just finished my 2nd semester of care plans. They really are a terrible time waster, but before I get flamed by the usual defenders of care plans, lemme just say this....

I understand the rationale for having students do them. I think one of the biggest challenges for nursing students is learning how to "think like a nurse." There is a tremendous amount of very difficult information to master, but I think the biggest challenge is mastering the "nursing process," i.e. learning how to anticipate issues and know what we need to be doing to keep our patients on an appropriate path of care.

I think the idea of care plans is to nurture this critical thinking model that is just hammered into us.

It is simply not an effective use of the very limited and valuable time a student has. Yes, most of it is done pre- and post- clinical, but hours of the clinical day are also used to work on these. The amount of time you have to devote to them takes time away from mastering some very important lecture concepts. For example, I know enough about acid-base and fluid-lytes to pass the tests, but will I be a better nurse by REALLY MASTERING these concepts, or spending 18 hours filling in page after page of the busy work defines care plans? At some point, you have to evaluate the bang to buck of this curriculum.

I think that maybe a semester or two (at the most) gives you the concept of how you should be thinking and planning care. The rest is a waste of time. In one year, and three hospitals I've rotated through, no one does these.

My biggest complaint with school is the rather limited time we are actually DOING procedures. It would be so much more valuable to practice and refine these procedures that we learn in skills. Oh well, off topic...sorry.

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Specializes in critical care, med/surg.

Care plans are a blueprint for pt care...that's it. No more, no less. Actually I have students verbally tell me the plan of care for a pt, dx, interventions, objectives, outcomes and then tell them to write that up and turn it in. Works for me!

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they're SUPPOSED to help you lean how to do the nursing process, starting from assessment, continuing right on down to evaluation.

but the REALITY is they are a gi-normously time consuming waste of time. and if you have to attach additional sheets with med research, pathophys, labs, and other tedious, redundant junk that are better left to reviewing without a time-wasting write-up, then they do nothing more than take away time better spent on real learning.

oh and the care plans i see at the hospital either 1) look nothing like our student care plans, 2) computer generated, or 3) collaborative, or 4) collaborative and computer generated.

bottom line: they hurt more than they help

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Specializes in critical care, med/surg.

Care plan requirements vary from school to school. I agree that after a certain point a care plan becomes a way for the instructor to lazily grade a student on material that is better assessed in post-conference or at the bedside in real time. Where I work fulltime the care plans are on a computerized template that takes maybe 10 min at most. These are ideal for the busy critical care environment and satisfies The Commission and can easily be accessed when needed. Care plans have a place in nursing school because information can easily be missed when we fly by the seat of our pants! Schools use NANDA as a guideline to ensure that what is assessed, evaluated and implemented can be quantitatively and qualitatively rationalized. I challenge you as a new nurse, student or wherever you may be in nursing to continue questioning the status quo and help create a better way to accomplish what so many in nursing feel can only be done via the care plan. Peace out!

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Specializes in med/surg, telemetry, IV therapy, mgmt.
I agree that after a certain point a care plan becomes a way for the instructor to lazily grade a student on material that is better assessed in post-conference or at the bedside in real time.
Oh, please, I beg you to respond to the threads where students ask for feedback about their care plans. It takes me several hours to read through, figure out and comment about what is going on with a care plan that a student presents. I put a lot of effort into each one I work on. I have no doubt that it isn't any different for an instructor reading over a care plan that a student has turned in. Now, why you would think that it is a way for an instructor to lazily grade a student when each care plan is unique and customized has me baffled. Maybe your instructors don't write a lot of commentary on your care plans indicating they may not have read them over thoroughly, is that it?
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Specializes in critical care, med/surg.

Some instructors feel that a care plan is the Holy Grail of nursing. The time students spend suffering through them and becoming frustrated w/o the benefit of appropriate feedback represents the worst of instructors. To merely place red marks on a care plan and not validate the process in real time nursing is laziness. I applaud your time spent on care plans if you are making it real for the student. Baby boomers and even GenExers may appreciate the laborious process of care plans, but to the millenials, care plans offer little in the way of education if all it represents is a process.

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Specializes in med/surg, telemetry, IV therapy, mgmt.
some instructors feel that a care plan is the holy grail of nursing. the time students spend suffering through them and becoming frustrated w/o the benefit of appropriate feedback represents the worst of instructors. to merely place red marks on a care plan and not validate the process in real time nursing is laziness. i applaud your time spent on care plans if you are making it real for the student. baby boomers and even genexers may appreciate the laborious process of care plans, but to the millenials, care plans offer little in the way of education if all it represents is a process.

please explain what you mean by "not validate the process in real time". what does that mean?

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Specializes in critical care, med/surg.

"not validate the process in real time". Care plans, are for the inexperienced student an abstraction of hands on patient care. When one puts to paper what is hoped will be the outcome, there is a tendency to place often unrealistic expectations, unless a concerted effort is made to individualize. Students could write care plans all day long and come up with some very creative and accurate scenarios but can they be put to real use? The challenge for the instructor is to somehow ensure that the student can see, feel, hear or touch what they are putting down on paper. It would be like the architect who drew up an elaborate blueprint for a building without ever actually visiting the site, talking with those who used the hammers and saws, or those who moved the dirt around. Do not depend on care plans to validate a students' actual ability to perform compassionate and competent care.

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Specializes in med/surg, telemetry, IV therapy, mgmt.
"not validate the process in real time". Care plans, are for the inexperienced student an abstraction of hands on patient care. When one puts to paper what is hoped will be the outcome, there is a tendency to place often unrealistic expectations, unless a concerted effort is made to individualize. Students could write care plans all day long and come up with some very creative and accurate scenarios but can they be put to real use? The challenge for the instructor is to somehow ensure that the student can see, feel, hear or touch what they are putting down on paper. It would be like the architect who drew up an elaborate blueprint for a building without ever actually visiting the site, talking with those who used the hammers and saws, or those who moved the dirt around. Do not depend on care plans to validate a students' actual ability to perform compassionate and competent care.

You know, I don't understand one thing you are saying. That may be the problem.

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Specializes in critical care, med/surg.

And that's ok, but please know that care plans should not be the last word in nursing. Merry Christmas and thank you for your responses.

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Specializes in Vascular Access Nurse.

i think i understand, perhaps because i write care plans for a living (as an lpn) and am also in nursing school for my rn. care plans that look great on paper but aren't realistic are frustrating for students to write. i'm very lucky that my program doesn't require us to write care plans this year (we had to last year) and instead concentrate on making sure we understand clinical applications instead. they make ask us verbally for a problem, goal, intervention, evaluation, but don't make us write it out. they want us to be real and show action, while some schools just want the pretty papers. i'm not even a gen-xer, but i can understand the concept of not wanting to spend hours writing a care plan that will never be used anyway. if you get the basic concept and write one if needed, but more importantly apply it, then instructors should move on to more important things, imho. plus, if you look at the care plans in acute care, most are computer generated and take up only few lines. let's focus more on understanding pathophysiology and less on if the wording for your intervention is grammatically correct...:twocents:

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i think i understand, perhaps because i write care plans for a living (as an lpn) and am also in nursing school for my rn. care plans that look great on paper but aren't realistic are frustrating for students to write. i'm very lucky that my program doesn't require us to write care plans this year (we had to last year) and instead concentrate on making sure we understand clinical applications instead. they make ask us verbally for a problem, goal, intervention, evaluation, but don't make us write it out. they want us to be real and show action, while some schools just want the pretty papers. i'm not even a gen-xer, but i can understand the concept of not wanting to spend hours writing a care plan that will never be used anyway. if you get the basic concept and write one if needed, but more importantly apply it, then instructors should move on to more important things, imho. plus, if you look at the care plans in acute care, most are computer generated and take up only few lines. let's focus more on understanding pathophysiology and less on if the wording for your intervention is grammatically correct...:twocents:

i think your program may have the smartest, most reasonable, most realistic, most bestestest nursing instructors that have ever existed.

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