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

Daytonite, BSN, RN · Dec 7, 2009

I think you misunderstood what I wrote, I was venting, sorry. I could do care plans all day long if they consisted of my assessment data and figure out nursing dx, outcomes, and interventions and that was it. It is all of the other stuff that takes hours to type and waste my print allotment when the actual care plan part is relatively short. I actually like that part of it (the part of it that other schools have to do). I know other schools don't have as lengthy care plans as my school. I've seen what care plans look like at other schools because of posts that I have read here and on other online forums. I'd take that any day over my 28 page, small book that I do on every single patient I have. It bothers me because if I can use the assessment data and critical thinking to get where I need to be then I don't think I should have to write 25-26 pages of everything else. The care plan is 1 to 2 pages typed so why do I need 28? That is my problem with care plans. I never miss a beat on my outcome statements, interventions or figuring out the diagnoses. Right now the care plan I am working on now has 8033 words and not finished, no one could do that in a couple of hours. My schools care plans are lengthy and you get little time to do them in. So you research and then go to clinicals and then stay after, stay up because you have to finish the care plan to implement your interventions, then you are suffering from no sleep, and that is not a good state to be in when you are giving patient care.
Why am I in nursing school?
I am in nursing school for the emotional aspect. I did not get excited when I had to memorize the bones, the muscles, the cranial nerves although I was excited after I accomplished it. During it I wasn't like cool this is my favorite nerve, this is my favorite bone or anything like that--I had class mates like that--I had class mates that hated the endocrine system while I found it interesting--- I want to educate patients on things they might not know, I want to help them in their time of need, I want to make a difference, explain to them about their disease or illness, help them achieve their goals. I really just want to be a nurse. I have been in situations where I have dealt with good and bad nurses and I feel that there is a lot of room for good nurses who are there for the right reasons.
Many times you do not get thorough explanations--I want to cover it all and make sure my patients know they can ask me anything. I am not going to get burnt out because I will have a responsibility to my patients and anytime I start to I will recall myself at my sons first surgery and remember how I felt and try to help my patients and their families as best as I can.

That 28 pages is to prove you are worthy to get your academic degree. You're in a BSN program, aren't you? When I was, we had 40 page care plans. That is what the BSN costs you. If you just want an RN go to an RN school. But you are at a college and the writing part of this is the college degree requirement. You will boast about that proudly later along with the 28 page care plans and forget the connection between them. Never forget you are being college educated here as well as being taught to be an RN.

Lillian2515 · Dec 23, 2009

Care plans are a bunch of bologna. It's a way to collect paperwork that will make it appear you are in a real "class." It gives the instructor (and I use that term loosely since most people in these positions don't "teach", they simply follow some bizarre protocol set by the program) something tangible to grade. If your students are so poor in patho then get someone who can teach patho. If your student is not able to write a silly care plan, it doesn't mean they are not prepared for clinical. It means they can't write a silly care plan. Sending a student home does nothing. APA format is another ridiculous situation. I've seen lots of APA format papers that are formatted correctly, but the content is poorly written fluff. The "teachers" don't usually understand APA and don't know basic grammar and proper punctuation. So, yes, learn APA format, but write whatever you want to write, however you want to write it....dont' forget spellcheck.....bwaaahahahaaaaa.....

If your students don't know norms for BP, temp, etc.....let them look at a chart. My daily patient care plan lists the normal parameters for each patient. Norms have a range, they are not exactly one number....like the temp is 98.6. Noooooooo.....it would be say 97-99. The people in charge of nursing programs need to get realistic. Teach that there are ranges in care and interpretations. For instance....the ND regarding constipation. That patient could have constipation related to the use of morphine....not necessarily the disease process..... :twocents:

Abishag · Jan 4, 2010

I believe you can hate something and learn to appreciate it later. I despised care plans when I started. Then toward the end it was the easiest thing in the world because I could write a care plan without using my book. I already knew so many and knew the interventions.

We had addional papers we had to do with patient info including their Hx and Dx. We had to write up the pathophysiology and all the procedures and then pre/post care interventions for each procedure, write up the labs and look up the lab/diagnostic info. By the end of nursing school some of this stuff is just second nature now. I may need to refer to the book/chart to see what the exact "norms" are but I feel confident that I know my stuff now. I would not vote to remove care plans from nursing school if I was asked.

JMHO!

slacktime · Jan 7, 2010

Folks,

I have two thoughts on care plans and APA format:

1) For me care plans were a good teaching tool as a nursing student. Tedious, but taught me to think of the pt. needs and how to address them.

2) If a nursing student has trouble with the semantics used in a care plan or APA format, they likely will not be a nursing student for long. You should have learned english before you started nursing school. Semantics used in charting are important, they are read by many different people from diverse backgrounds, they need to be clear and concise.

Lillian2515 · Jan 7, 2010

Yes, get a college degree. That proves that you can write papers and care plans. Learn how to be a nurse after you get hired as a nurse. The SOAP notes are not in APA format. The medical records are not in APA format. Be concise and precise when charting because you wouldn't want your employer to get sued. Cover everyone's a _ _ legally by charting accurately. You will not learn how to do that in school. Every nurse I've followed "cheats" on the daily charting...copies from the nurse who had the patient at the last shift....."fudges" information...but they are legally covered. That's what's important. I catch mistakes all the time when following RN's. They don't like that. Tact....that's what I've learned in school.

jjjoy, LPN · Jan 8, 2010

Yes, get a college degree. That proves that you can write papers and care plans. Learn how to be a nurse after you get hired as a nurse.

From the way some programs work, that sounds about right. You put it well!

I imagine those programs rationalize the de-emphasis on clinical training by pointing out that nursing is "so much more than just patient care tasks." All of that practical hands on bedside nursing care is just such one small part of nursing practice. You can quickly pick it up on the job, right? But who's going to teach you how to think in the language of NANDA and write a unique 20-page care plan for each patient referencing evidence for palpating a pulse? You're certainly not going to learn THAT at work, are you? (Uh, no, since no one actually does that - sigh!)

imsodizzy · Jan 11, 2010

I think that the instructors should at least have a reference/book to base how they correct their care plans so as not to create confusion among the students.

ldyjstce · Feb 9, 2010

care plans? i hate them. not because they take so much time and effort, but because i do not feel that i have been properly guided as to how to create an excellent care plan. i have the ideas in my head but cannot translate them out and make them appear all "nurse-medical-brilliant" -like. now in my final semester, i am reaping the havoc that has been created from the apathy from educators of previous semesters. deer in the headlights? yep, that is what i look like now that i am attempting to do a massive care plan (and as long as i get an 86%, it will be my last one in school). due in 3 days. 6 dx that the instructor picked for me on a patient i only had for 3 hours. honestly, i am now at wit's end. :uhoh3:

pepperanne7 · Feb 9, 2010

I know that care plans seem like torture. But they truly are an essential part of learning your nursing process and interventions. We retain 75% of what we write down. When you write a care plan , you are ingraining those simple concepts into your memory. I know that the interventions are straight forward and it seems to ridiculous to have to explain your rationale down to the cellular level, but understanding why your are doing it is so important. You never know what can happen. Things can go wrong very quickly, and when they do its those retarded care plans that come back to you. Its like a light bulb, and instead of going bonkers, those rationales will kick in and like a robot you will carry out those interventions. If you never did a care plan and explored rationales, it would be difficult to approach your care in an organized manner and even more difficult to prioritize. For me it was the care plans that pounded "prioritizing" into my brain. Because when you get out in the real world its a mad house! Remember that doctors are on the floor briefly, and then they are gone. Nurses run the hospital, we spend much more time with the patients and ultimately when a patient codes, we initiate the code. In the absolute chaos it is so very easy to spazz, but the clinical experience that new nurses lack is compensated by our knowledge and understanding of the patient condition. when that patient decides that it is going to stop breathing the clock is ticking and you have to act fast. You will be fine, care plans are you frenemy!

PN2011 · Feb 12, 2010

Im in school right now , and my care plan was not 100% after the first week of never seeing a care plan like this before , and i was pulled off the floor , and sat in a room ,and basically yelled at . because i did it the way that i thought was right ! These care plans should be shot out , shredded and burnt lol .. I understand the concept to them ,but if the important info is there , the info for care is there , why is there the need to have it made just right .. down to the stupid punctuation. As you can tell im still fustrated with them!!

Mel

jjjoy, LPN · Feb 13, 2010

Perhaps you can ask your instructor what problems in particular merited being kept from the floor. Just be very careful that the question doesn't come across as childish and whiney "Why didn't SHE get pulled from the floor? HER plan was WORSE than mine!" or "I tried SO HARD. Isn't that enough?!" or "I'm PAYING for this! It's NOT FAIR to deny me floor time!"

Instead, a calm, curious, humbly asked question might get you some useful feedback. Some instructors respond well to explicit acknowledgement of a mistake ("I made some significant mistakes") and of the importance of getting things right ("I want to make sure that I really understand what exactly was wrong so that I don't make those mistakes again.")

In this case, it may be true that you didn't have complete guidance on what was expected. You did your best and you were proud of it. Great! It wasn't a waste of time and it did serve it's purpose of getting you to think about the patient in terms of nursing care. But you didn't know *exactly* what was needed and unfortunately the instructor decided it merited being held back from the floor. You needn't interpret that as failure on your part, though. Even if seems the instructor is trying to shame you, and even outright saying "maybe you just don't have what it takes," they may be testing your mettle or trying to see how motivated you are to overcome obstacles. Do you melt down every time you get negative feedback? Do you waste a lot time arguing over why you should've gotten a better score instead of just taking what you learned and moving forward?

scholarshipboy · Feb 18, 2010

Yea, use of the proper medical jargon can get really annoying..at least from my instructor. She takes us off the floor for an hour to go over our care plans and how wrong they are and changes the wording around. I write exactly what my care plan book says and she marks it wrong!! So frustrating knowing a book is still not right for her!

a proffesor will always find the most smallest mistake in a student in order for the student to become as good as them