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

[jjjoy]

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.

[mpccrn, BSN, RN]

scribblerpnp.....a rare instructor indeed you must be! i applaude your expectations, your way of going about things and your ability to see that clinical time can be extremely beneficial to your students. i don't see that often these days. it would be a pleasure to work with you and your students. kudos to you! keep up the good work.

[cariboujenny]

Scribblerpnp,

Thanks so much for the detailed explanation of the purpose and value of careplans. I too felt that they were most likely a waste of time when I was in nursing school. In fact, I really felt that nursing diagnosis language was created to skirt any medical diagnosis language and not tread into that sacred territory. It does make sense to me that it is a descriptive statement to intervene in pathobiological processes. Perhaps if other instructors could take a few moments to reinforce this concept then students will value the learning path of careplans. As it stand now, I believe most students believe it is ritualistic torture. :chuckle

On a side note, what do you think of critical pathways?

[*LadyJane*]

Oh, if only students could have an instructor explain the reasoning behind the careplans like you just explained, Scribbler! There would be a large reduction in the amount of whining and complaining about careplans, and people would be able to participate more in their own depth of learning!

I appreciate you explaining it here in this thread, because now I understand why these are important and what needs to happen. I expect that my whole attitude about them will be positive now, even though I may still consider them to be tedious about the queer and stilted type of wording that is required.

ALSO, you must be an awesome instructor if you enjoy reading your reviews at ratemyprofessor.com!

Thanks again for this explanation, and I'll keep it in mind as I write my careplans starting this fall!

[TLCinCICU]

Ugh....clinical pathways...the least favorite part of my workday. To me, they aren't anything even approaching a valid "care plan". They are a checklist to make sure we do the things that a) get us the maximum reimbursement for the patient's LOS and b) keep us from getting "dinged" by the powers-that-be for something potentially overlooked.

We're in the process of changing from paper documentation to computerized. I can't wait until our charting is a series of mouse clicks and free text boxes.

[Daytonite, BSN, RN]

jjjoy. . .when you talk about instructors being so fanatical about grilling students about 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'" then I know you are in a BSN program. These are concerns of professors who are thinking about preparing students who just may be going on into Master's programs, a goal of all BSN courses. They are also reaffirming that you understand and know how to use the NANDA taxonomy. Much of the work on the NANDA diagnoses has come out of university-based research. NOC and NIC research was done at the nursing school of the University of Utah grad program. This is part of the collegiate experience. You won't be dealing with this when you are a working nurse. Wouldn't it be fun to work for a hospital that is closely affiliated with a nursing school that is heavily into researching nursing diagnoses, NOCs or NICs? Wouldn't you love to work for a place that employs Ms. Carpenito or Ms. Moorhouse? :smackingf Can you imagine what that would be like?

Honestly, once you are done with school, you'll be able to write a care plan using whatever directions and parameters they give you. Think of NANDA as a piece of equipment, a tool. It can be changed to something else (a whole different set of nursing diagnoses by another company, or just one word symptoms), but the outcome, a plan of care (problem solving), is still the same. If you can use NANDA and nursing language you can use any other system and it's rules that an employer or agency sets down in front of you and instructs you to follow. That, kiddo, is the difference between a collegiate education and a vocational/technical job training.

I am always trying to get that point across, but it is difficult for students to see that far ahead because you are still trying to learn this stuff. I learned care plans before nursing diagnosis. We only used symptoms to describe the patient problems. You can still do that. It's just that what has overwhelmingly evolved in academia today is the nursing diagnosis. However, there is no law that says that in the work place that nursing diagnoses have to be the only choice for use on care plans. We didn't always use them on LTC nursing care plans. We sometimes used a medical diagnosis to describe a nursing problem ().

[Daytonite, BSN, RN]

Gahhhhh! Nursing instructor here- Please don't flame me! :sofahider

I have been answering care plan questions on the student forums for about the last 2 years, maybe more. I have posts on the stickys there. I won't give answers to questions where students ask for nursing diagnoses for a patient with some medical disease. I take hours to explain the nursing process and how assessment is the foundation of care planning which is actually problem solving. I have a document which details what assessment involves which I copy and paste into my replies all the time and it isn't just doing a physical assessment of the patient. I tell them it involves "knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. This includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. If this information is not known, then you need to research and find it." I discourage the use of care plan books. Yet there are students who will always step in and post to get a care plan book or suggest nursing diagnoses. I know these kids have no clue about critical thinking which is what I'm trying to stimulate. Some get it; some do not. I will work with those who are open to learning because I have the time.

[HeartsOpenWide, RN]

can we get scribblerpnp post as a sticky?

[Dianacabana]

Thank you ScribblerPNP. I am starting school in Sept. and these tips are important to help me. I hope I find you at my school!

[scribblerpnp]

I have been answering care plan questions on the student forums for about the last 2 years, maybe more. I have posts on the stickys there. I won't give answers to questions where students ask for nursing diagnoses for a patient with some medical disease. I take hours to explain the nursing process and how assessment is the foundation of care planning which is actually problem solving. I have a document which details what assessment involves which I copy and paste into my replies all the time and it isn't just doing a physical assessment of the patient. I tell them it involves "knowing the pathophysiology, signs/symptoms, usual tests ordered, and medical treatment for the medical disease or condition that the patient has. This includes knowing about any medical procedures that have been performed on the patient, their expected consequences during the healing phase, and potential complications. If this information is not known, then you need to research and find it." I discourage the use of care plan books. Yet there are students who will always step in and post to get a care plan book or suggest nursing diagnoses. I know these kids have no clue about critical thinking which is what I'm trying to stimulate. Some get it; some do not. I will work with those who are open to learning because I have the time.

Ahhhh, I person after my own heart. Were you one of my teachers in nursing school?

I have always found that once I tell a student what I want, how I want it, and WHY I want it, they seem to get the bigger picture!

Also trying to teach them that critical thinking and assessment skills are more important to focus on than trying to get a chance at an IV stick or a catheter placeent, is a bit of a hard sell. What sepparates us from the "others" meaning technicians is that the technician knows HOW to do something, but nurses know WHY. Truthfully we teach parents how to st cath kids all the time, so OBVIOUSLY you don't need a degree to do that.

[Logan]

Hi,

If nothing else, you must be commended for the following:

And my students must too because on ratemyprofessor, I have great positive comments. I love checking in there to see what my students write!

Such openess and approachability is refreshing to see in a teacher.

As you can probably imagine, I had some really difficult teachers. Don't get me wrong, technically and theoritically they were more than proficient... but their method left a lot to be desired.

thanks,

Matthew

[BBFRN, BSN, PhD]

I agree. These liberal educators need some help. As a student I want to learn and be prepared to take the NCLEX, so I can pass it, not drilled about wording and APA format.

How do you know they're 'liberal,' and what does that have to do with APA format?

All undergrad programs have some form of standards they require for writing papers, whether it's MLA, APA, CMS, etc. Most medically based programs require APA. Be glad you didn't have to learn multiple formats like I did in undergrad. Makes for some interesting problems, when writing papers for multiple classes.

[jjjoy, LPN]

I do think the basic concept of a care plan is valuable. Care plans should help clarify nursing actions and goals. Students can expand on them by adding rationales that practicing nurses needn't explicitly state. But as care plans are often taught in school, they make the whole process more cumbersome than they need be, taking time and energy away from useful learning and application.

Instead of having students incorporate the why into a cumbersome nursing dx that instructors may disagree on how best to word, why not just have the student list the problem, the cause, the indications, etc? And why not just test the students directly on important concepts? Eg A known side effect of morphine is constipation. Why is that? A) It acts as a diuretic. B) It decreases intestinal motility C) It decreases the urge to defecate D) It acts as a laxative. But that's not NCLEX in style.