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

HazeKomp, BSN, RN · Apr 8, 2009

RN's ...have already internalized the information
I want them to look at their pt as a whole, see how one disease process can have an effect on many areas, and be able to recognize potential problems so they can intervene before it become actual- if possible.
at some point it all clicks in their head. That is when they start to think like nurses,

I've been a nurse x 35 years. (yes, I am old!) I rarely refer to patient care plans on the unit once they are generated to the satisfaction of JACHO, et. al. I didn't even think much about them in day to day practice.

HOWEVER, now I've started teaching clinical nursing students and have come to realize that I, and many other experienced RNs, have used care plans and The Nursing Process so much it is now second nature!

When I walk into a room, I find myself now realizing how I immediately begin assessing the patient, informally and formally during assessments. I begin formulating my plan of care simultaneously. My conversations tend to end up with a significant amount of patient education. And, as I round later in the shift, I am evaluating my interventions constantly.

All those years of Nursing Care plans (aka "torture") have paid off for me, for most RNs and they will for you, too!

Haze

jjjoy, LPN · Apr 8, 2009

They are alot of busy work, but I believe they do train our brains to think outside of the box...........see a patient differently than a medical dx.

The thing is that I felt like I learned MORE about thinking outside the box of the medical diagnosis than about the medical diagnosis itself. That is, I was well trained in looking beyond the medical diagnosis to the patient's physical and psychological response to illness (anxiety, risk for skin breakdown, educational needs, etc). Patient response to illness is similar across health conditions so there was lots of reinforcement throughout school on that.

But I felt like I had only the most cursory grasp on the pathophys, treatments and medical responses. So, no problem seeing the patient as something besides a medical diagnosis. The trick was recognizing that the 80% of the nursing interventions in care plans only account for 20% of the nursing care provided. That is administering medications, monitoring for adverse effects, etc take up a majority of time while patient comfort measures & education get squeezed in as possible between everything else. In other words, the "autonomous nursing interventions" that our instructors emphasized and wanted to see lots of in our care plans often take a backseat to the "collaberative nursing interventions" that our instructors tended to gloss over.

I'm rambling and getting a bit off topic, so I'll stop now!

BriWisco · Apr 22, 2009

I've come to the conclusion that they are just another math problem, just with words, and all of the right words need to be in the right place for the problem to be solved correctly.

But more often than not I've found myself writing what I thought the instructor wanted to hear opposed to what I thought was really the right thing to put in.

nicolegrow · Apr 29, 2009

When I write a care plan I just want it to be over. Most of it comes from a care plan book not my personal thought process. I can't tell you anything about the many care plans that I have written. I can tell you about the patient care I have given. You learn interventions in lecture, and with patient experience. APA is important to know especially if you desire to further your career. Every student should easily be able to construct a paper following guidelines, this is why composition is a requirement for any degree.

Pre and Post conferences at clinicals are a nice way to discuss specific individualized care plans that you anticipated after reviewing your patient assignment and evaluate afterwards. A written care plan is just a boring and long way of doing the same thing.

I also wonder if making students write out care plans has been proven by research to be the best way to learn the process. I personally know that I learn from experiences and hands on activites(stimulation).

HazeKomp, BSN, RN · Apr 29, 2009

When I write a care plan... Most of it comes from a care plan book not my personal thought process. I can't tell you anything about the many care plans that I have written. .

too bad you got them from a book instead of thinking the process through on your own.

you would have learned more that way.

feel sorry for MY students, as I ask lots of questions when reviewing their care plans weekly with them!

if they did not know their stuff, it would get ugly quickly!!

Haze

daveintexas8 · Apr 29, 2009

Ugh. I turned this semester's major nursing care plan today (which makes it my 3rd major).

It's such a beat down! Like I've said before, it does help in the beginning, but with only a semester left before graduating, it's just time that would be better spent by students in some other learning activity.

I just think that the whole NANDA list is ridiculous. I understand the arguments for it, but it just needlessly creates a new language for nursing problems. I mean, is there no better way to word "Environmental Interpretation Syndrome, impaired" or "Spiritual Well-Being, readiness for enhanced?" What does that even mean? Instead of saying "this patient has a stomach ache," at some point there will be a new dx on the list that says something like "ineffective abdominal pain management related to ineffective bowel readiness." :)

I exaggerate, but IMHO, I think it's a joke. Anyway, it's almost over. And I'm getting up from the computer. I've got a risk for impaired skin integrity related to my chair's ineffective comfort maintenence.

Daytonite, BSN, RN · Apr 29, 2009

ugh. i turned this semester's major nursing care plan today (which makes it my 3rd major).
it's such a beat down! like i've said before, it does help in the beginning, but with only a semester left before graduating, it's just time that would be better spent by students in some other learning activity.
i just think that the whole nanda list is ridiculous. i understand the arguments for it, but it just needlessly creates a new language for nursing problems. i mean, is there no better way to word "environmental interpretation syndrome, impaired" or "spiritual well-being, readiness for enhanced?" what does that even mean? instead of saying "this patient has a stomach ache," at some point there will be a new dx on the list that says something like "ineffective abdominal pain management related to ineffective bowel readiness." :)
i exaggerate, but imho, i think it's a joke. anyway, it's almost over. and i'm getting up from the computer. i've got a risk for impaired skin integrity related to my chair's ineffective comfort maintenence.

i chalk this statement up to your newness to the profession. i really didn't get the entire concept behind critical thinking and appreciate how care planning helped to develop mine until i was probably two years out of rn school and into my working career. it is a combination of what you are seeing in patients and treating combined with the textbook knowledge and the nursing process that hones that critical thinking muscle.

i would like to remind you that you asked for help with this last care plan you just turned in (https://allnurses.com/general-nursing-student/help-care-plans-286986-page18.html#post3592005). if any changes you made based on my advice was taken favorably by your instructor, remember who suggested some of them. i constantly post advice on, and teach how to diagnose and write a, care plans.

vanity plays lurid tricks with our memory.

daveintexas8 · Apr 29, 2009

Daytonite, I am always happy for the help, and I have on more than one occasion thanked you specifically for the VAST amount of help you provide here.

I knew that my post would bring a response from you. I am very new to the profession (not even actually practicing, yet). I just have an opinion on this subject (which is shared by almost every nurse I've talked to in clinicals).

I'm sorry that my post might be taken as a slight against you or the help you provide. You have helped me, and countless other students on this forum.

My point is that in my (inexperienced) opinion, the system of using NANDA Dx just doesn't make common sense. That's all. I might be wrong.

Dave

jjjoy, LPN · Apr 29, 2009

I'm with ya, Dave. Having to write a detailed care plan can become a hindrance to students at some point, taking up a lot of time to reiterate and spell out in detail what should by now be automatic to a nursing student (immobility? consider risk for skin breakdown, consider turn Q2, assess pressure points; difficulty swallowing? consider risk for aspiration, consider appropriateness of diet).

Instead of requiring the student to physically write it all out each time they create a care plan, why not have students write more stream-lined care plans that show that a student understands WHAT needs to be done for this or that patient? Instructors could use paper-based tests to evaluate if students understand the details behind it.

For example, the care plan for a specific patient only needs to say "risk for skin breakdown, turn Q2" when appropriate for that patient. A test that everyone takes tests that all students know what assessment data would indicate a risk for skin breakdown, what measures can be taken to prevent skin breakdown, etc.

Daytonite, BSN, RN · Apr 30, 2009

i came into nursing before nursing diagnoses were used. the difference was instead of putting a nursing diagnosis on a care plan where the "problem" goes we put the signs and symptoms that the patient was having, i.e. nausea, constipation, edema, coughing, etc. all nursing diagnoses have done is allow us to group similar types of symptoms and organize them into specific problems that have now been given names (labels) that include within them a set of signs and symptoms. maybe it was because i came out of another way that care plans were done that i "get" what nanda is doing.

the fact is that the critical thinking process which is what care planning is hasn't changed. what has changed is what the profession wants us to use (the nanda diagnoses) in creating these care plans. someone else could come up with the xyz system of nursing diagnosis, give nanda a run for their money and it won't change the way we critically think. all that will change is the labels we attach to the different nursing problems which the xyz system would then say are better to use. i don't know how else to say this so you all understand this. if you learn the nursing process you can work with the nanda diagnoses or the xyz system of diagnosing. it won't matter. all that is required is that you follow the rules in using either diagnostic system. what is important is that you know the nursing process and how to use it in getting to the diagnosis.

daveintexas8 · Apr 30, 2009

i came into nursing before nursing diagnoses were used. the difference was instead of putting a nursing diagnosis on a care plan where the "problem" goes we put the signs and symptoms that the patient was having, i.e. nausea, constipation, edema, coughing, etc. all nursing diagnoses have done is allow us to group similar types of symptoms and organize them into specific problems that have now been given names (labels) that include within them a set of signs and symptoms. maybe it was because i came out of another way that care plans were done that i "get" what nanda is doing.
the fact is that the critical thinking process which is what care planning is hasn't changed. what has changed is what the profession wants us to use (the nanda diagnoses) in creating these care plans. someone else could come up with the xyz system of nursing diagnosis, give nanda a run for their money and it won't change the way we critically think. all that will change is the labels we attach to the different nursing problems which the xyz system would then say are better to use. i don't know how else to say this so you all understand this. if you learn the nursing process you can work with the nanda diagnoses or the xyz system of diagnosing. it won't matter. all that is required is that you follow the rules in using either diagnostic system. what is important is that you know the nursing process and how to use it in getting to the diagnosis.

i have thought about this quite a bit since my last posting, and i want to refine my position on the issue. it's the nanda diagnoses that i am unhappy with. i always say that i understand the point of the care plans, and what i mean by that is that i know the point is to teach critical thinking. what i wish i had said is that while care plans are a valid tool with which to teach us this concept, the taxonomy is unnecessarily burdensome. i think that care plans are so derided and hated because of this nomenclature that refuses to state the obvious.

so i guess the issue for me is who are these people that approve that list? it sure doesn't seem to be the people that use it.

Daytonite, BSN, RN · Apr 30, 2009

i think that care plans are so derided and hated because of this nomenclature that refuses to state the obvious.
so i guess the issue for me is who are these people that approve that list? it sure doesn't seem to be the people that use it.

nanda. you can find out all about them here: http://www.nanda.org/