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

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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.

You know, the care plans are super annoying, but they train you to chart as a nurse. We are not licensed to make medical diagnoses and can be held liable if we do. If you chart the pt has constipation when they actually dont, that is technically a med error. It is training us to think, talk, and write as a RN. If you want to do more than that, then you need to become a NP. I've been chewed out for it before by an NP, so I am VERY careful about how I word something. And liability is everything...RNs or nurses in general are at the bottom of the hill, and we all know what direction $hit rolls. I have to remind myself every time I am in clinical or think about the day I graduate and am a licensed nurse that I can get sued at the drop of a dime for ANYTHING. Cover your butts, play the game, and go home with a clear mind. We all gotta do it, so we might as well make the best of it. Good luck! ;)

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I agree...a lot of my fellow students gripe hard-core about the care plans, but I learn so much more with them because it forces me to investigate on my own about the patho of a disease, and the rational for the tx, rather than have some mono-toned professor with a masters or PhD bark this stuff at me and act surprised when it doesnt stick like glue to my already frazzled brain.

I learn better by doing myself than just watching or listening, and I think most do, but a lot of people in my program have become accustomed or expect to be spoon fed.

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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!

haha.. my clinical instructor was a perfectionist person too..

instead of dismissing us 11pm.. we were dismissed 2am because she wants a perfect nurses notes..darn it.. this is our life..nurses..hoho http://icons.an-file.info/skeleton.png

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i totally agree with you!!!

Its vital as a student we need to think critically and deliver a care in a evidence base practise! Nursing care plan is there to help nursing students begin to think

like a nurse in a real clinical situation! Nurses has care plan in the head already

and student needs to look patient individually and think what should be

assess and what care those my patient needs which helps managing time management, priortise the work

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

And sorry my post is long- I'm going to try to give you the rationales of why teachers do what they do.

And I'm not an old one either, I graduated from nursing school in the early part of the 2000's, and hated doing careplans then. Didn't really get the point until I was an RN and in grad school.

And I do not waste time during clinical going over them. The students need to care for their patients! The only time I will review a careplan is if I get the feeling during report that the students didn't know what the heck was going on with their pt, then I will take them aside and try to determine if they don't know what is going on because they didn't pre-plan well (which may result in going home) or if they had a weird/ difficult pt (which will not result in going home).

One of the main reasons schools use careplans (other than it being a nursing thing) is so students can learn the material. So when you become an RN you will be able to rattle off some E0's and interventions (along with knowing why you are doing them) in your head when you get that new admit.

And for the most part RN's do not use careplans a whole lot doing day to day work, but that is because they have already internalized the information and proven their knowledge to the state board and a college (which resulted in the form of a degree). Formed care plans are a set and organized way for students to show me how much they know so I don't have to pimp them the entire time of clinical. I can leave them alone so they can do their work. My husband is an engineer, and during school he had to write a load of lab reports. He NEVER has to do this now, but he did it then to show the professor that he actually learned something and could advance in the course. Careplans are pretty much the same thing (to me anyway).

Here is what I expect (and why). I teach peds clinical, so some things are different. And for me, if a student copies a careplan straight out of a book, they are most likely going to get it wrong, because the books can't individualize care for a pt. All pt/families are different, so a care plan is individualized to the pt you are caring for.

I want my students to write every possible, actual or risk for dx, because 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.

Nursing dx: After the R/T I expect to see WHY or HOW ( such as pathologically- what is going on). For example, if it is an open appy who is on morphine. I don't want to see Constipation R/T morphine use. I want to see Constipation R/T decreased intestinal motility due to use of morphine for pain. I never want to see a medical dx, because it doesn't explain the patho. And the AEB should be physical assessment findings, labs, or pt statements that back up the use of the dx.

Why am so picky about this? Because I am eternally suprised that many nursing students are so poor in patho. How can you know what problems to expect if you don't know how and why the body is going to respond to certain diseases/meds? How are you going to explain a process you don't undertstant to a parent or patient? And I want to make sure you are doing good assessment techniques even when I am not around to watch.

Expected outcomes: I want these to be measurable and specific to the pt. I teach peds, and we get all shapes and sizes. So I want to make sure that the student knows what is normal (and what isn't) for each of the age groups we will take care of. I want it to be measurable so that we can have a black and white way to to determine if the goal was met. I started being more strict on this when I discovered that many students didn't know normal Pulse, Resp, B/P for the different age groups they were going to take care of, as well as what pain scale to use with what child. Or what to expect from which age groups.

Interventions/Rational: This is so I know that you know what you should be doing during clinical as well as a way for me to see what kind of knowledge you have as far as a child's growth and development. I once had a student write an intervention for cough and deep breathe for a newborn. Now, HOW are you going to do that?:smackingf

Yes, I hate grading paperwork during my weekend "off." But I know that it does actually have a point and that it can provide a different type of instruction. Sometimes I feel like this :banghead: because I'm just not getting through. But usually I feel like this :loveya: because at some point it all clicks in their head. That is when they start to think like nurses, and I love it!

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

Ok, sorry to be so long, but this is the type of thing that gets my panties in a wad!

Don't flame me too hard! :wink2:

That was wonderful and so brave for you to post as an instructor!! Currently care plans are the most difficult part of school for me. I struggle with them and can't wait until I have the Ahaaaa moment. I just joined the site today and was hoping to gian insite to care plans. I have come to the conclusion my instructor enjoys making my life miserable :) I have often thought it would be great to gain insite into what my instructor is thinking and you may have given me some insight. Thanks

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

And sorry my post is long- I'm going to try to give you the rationales of why teachers do what they do.

And I'm not an old one either, I graduated from nursing school in the early part of the 2000's, and hated doing careplans then. Didn't really get the point until I was an RN and in grad school.

And I do not waste time during clinical going over them. The students need to care for their patients! The only time I will review a careplan is if I get the feeling during report that the students didn't know what the heck was going on with their pt, then I will take them aside and try to determine if they don't know what is going on because they didn't pre-plan well (which may result in going home) or if they had a weird/ difficult pt (which will not result in going home).

One of the main reasons schools use careplans (other than it being a nursing thing) is so students can learn the material. So when you become an RN you will be able to rattle off some E0's and interventions (along with knowing why you are doing them) in your head when you get that new admit.

And for the most part RN's do not use careplans a whole lot doing day to day work, but that is because they have already internalized the information and proven their knowledge to the state board and a college (which resulted in the form of a degree). Formed care plans are a set and organized way for students to show me how much they know so I don't have to pimp them the entire time of clinical. I can leave them alone so they can do their work. My husband is an engineer, and during school he had to write a load of lab reports. He NEVER has to do this now, but he did it then to show the professor that he actually learned something and could advance in the course. Careplans are pretty much the same thing (to me anyway).

Here is what I expect (and why). I teach peds clinical, so some things are different. And for me, if a student copies a careplan straight out of a book, they are most likely going to get it wrong, because the books can't individualize care for a pt. All pt/families are different, so a care plan is individualized to the pt you are caring for.

I want my students to write every possible, actual or risk for dx, because 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.

Nursing dx: After the R/T I expect to see WHY or HOW ( such as pathologically- what is going on). For example, if it is an open appy who is on morphine. I don't want to see Constipation R/T morphine use. I want to see Constipation R/T decreased intestinal motility due to use of morphine for pain. I never want to see a medical dx, because it doesn't explain the patho. And the AEB should be physical assessment findings, labs, or pt statements that back up the use of the dx.

Why am so picky about this? Because I am eternally suprised that many nursing students are so poor in patho. How can you know what problems to expect if you don't know how and why the body is going to respond to certain diseases/meds? How are you going to explain a process you don't undertstant to a parent or patient? And I want to make sure you are doing good assessment techniques even when I am not around to watch.

Expected outcomes: I want these to be measurable and specific to the pt. I teach peds, and we get all shapes and sizes. So I want to make sure that the student knows what is normal (and what isn't) for each of the age groups we will take care of. I want it to be measurable so that we can have a black and white way to to determine if the goal was met. I started being more strict on this when I discovered that many students didn't know normal Pulse, Resp, B/P for the different age groups they were going to take care of, as well as what pain scale to use with what child. Or what to expect from which age groups.

Interventions/Rational: This is so I know that you know what you should be doing during clinical as well as a way for me to see what kind of knowledge you have as far as a child's growth and development. I once had a student write an intervention for cough and deep breathe for a newborn. Now, HOW are you going to do that?:smackingf

Yes, I hate grading paperwork during my weekend "off." But I know that it does actually have a point and that it can provide a different type of instruction. Sometimes I feel like this :banghead: because I'm just not getting through. But usually I feel like this :loveya: because at some point it all clicks in their head. That is when they start to think like nurses, and I love it!

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

Ok, sorry to be so long, but this is the type of thing that gets my panties in a wad!

Don't flame me too hard! :wink2:

LOVE your response! I am a student in an ADN program, so I hear nothing but negative comments about care plans all day! I am definitely the black sheep of my class because I LOVE care plans!!! I think they are an amazing resource for the student to utilize (that is if the student takes the time to construct it properly).

I also like how you mentioned that care plans are a good way for the instructor to see what the students are up too without looking over their shoulder constantly. I noticed this in the clinical setting last term. The students who copied their care plans directly out of the book, and put zero time and effort into them, were the students that the instructor was babysitting.

Care plans are critical in any nursing program....learn how to do them properly and your lives will be much easier....!!!!

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Thanks for taking time to explain scribblepnp. I do absolutely agree that care plans can be great learning tools, like the lab reports your husband had to do. And I absolutely agree that the phrase "constipation r/t morphine use" by itself isn't enough to demonstrate an understanding of that relationship.

I want to see Constipation R/T decreased intestinal motility due to use of morphine for pain.

Such awkward phraseology, though! To my ears, it kinda sounds like saying "I have a husband related to me through marriage."

Nsg Dx: Constipation --- Cause: Decreased intestinal motility due to morphine use

It's almost the exact same words but it makes so much more sense to me!!!!

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can you send me a link to an example online of a careplan? thx.

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

And sorry my post is long- I'm going to try to give you the rationales of why teachers do what they do.

And I'm not an old one either, I graduated from nursing school in the early part of the 2000's, and hated doing careplans then. Didn't really get the point until I was an RN and in grad school.

And I do not waste time during clinical going over them. The students need to care for their patients! The only time I will review a careplan is if I get the feeling during report that the students didn't know what the heck was going on with their pt, then I will take them aside and try to determine if they don't know what is going on because they didn't pre-plan well (which may result in going home) or if they had a weird/ difficult pt (which will not result in going home).

One of the main reasons schools use careplans (other than it being a nursing thing) is so students can learn the material. So when you become an RN you will be able to rattle off some E0's and interventions (along with knowing why you are doing them) in your head when you get that new admit.

And for the most part RN's do not use careplans a whole lot doing day to day work, but that is because they have already internalized the information and proven their knowledge to the state board and a college (which resulted in the form of a degree). Formed care plans are a set and organized way for students to show me how much they know so I don't have to pimp them the entire time of clinical. I can leave them alone so they can do their work. My husband is an engineer, and during school he had to write a load of lab reports. He NEVER has to do this now, but he did it then to show the professor that he actually learned something and could advance in the course. Careplans are pretty much the same thing (to me anyway).

Here is what I expect (and why). I teach peds clinical, so some things are different. And for me, if a student copies a careplan straight out of a book, they are most likely going to get it wrong, because the books can't individualize care for a pt. All pt/families are different, so a care plan is individualized to the pt you are caring for.

I want my students to write every possible, actual or risk for dx, because 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.

Nursing dx: After the R/T I expect to see WHY or HOW ( such as pathologically- what is going on). For example, if it is an open appy who is on morphine. I don't want to see Constipation R/T morphine use. I want to see Constipation R/T decreased intestinal motility due to use of morphine for pain. I never want to see a medical dx, because it doesn't explain the patho. And the AEB should be physical assessment findings, labs, or pt statements that back up the use of the dx.

Why am so picky about this? Because I am eternally suprised that many nursing students are so poor in patho. How can you know what problems to expect if you don't know how and why the body is going to respond to certain diseases/meds? How are you going to explain a process you don't undertstant to a parent or patient? And I want to make sure you are doing good assessment techniques even when I am not around to watch.

Expected outcomes: I want these to be measurable and specific to the pt. I teach peds, and we get all shapes and sizes. So I want to make sure that the student knows what is normal (and what isn't) for each of the age groups we will take care of. I want it to be measurable so that we can have a black and white way to to determine if the goal was met. I started being more strict on this when I discovered that many students didn't know normal Pulse, Resp, B/P for the different age groups they were going to take care of, as well as what pain scale to use with what child. Or what to expect from which age groups.

Interventions/Rational: This is so I know that you know what you should be doing during clinical as well as a way for me to see what kind of knowledge you have as far as a child's growth and development. I once had a student write an intervention for cough and deep breathe for a newborn. Now, HOW are you going to do that?:smackingf

Yes, I hate grading paperwork during my weekend "off." But I know that it does actually have a point and that it can provide a different type of instruction. Sometimes I feel like this :banghead: because I'm just not getting through. But usually I feel like this :loveya: because at some point it all clicks in their head. That is when they start to think like nurses, and I love it!

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

Ok, sorry to be so long, but this is the type of thing that gets my panties in a wad!

Don't flame me too hard! :wink2:

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I'm only 2.5 years late to reply to the OP, but:

It seems like your issue is with dressing up language, not with the concept of care plans. I think some of the unneeded verbiage is reflective of an historical legacy of nurses fighting to be taken seriously. Maybe somebody thought it sounded more learned to talk about auscultation rather than listening, or an upper appendage rather than an arm.

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Absolutely, Jonathank! The moderators changed the original title of the original post. I don't remember anymore what it was, it probably did need improvement, but the title they came up with sounds like I was frustrated with care plans in general as opposed to the awkward, redundant, and inefficient wording required by some instructors.

I hated having to spend so much to make sure I spelled out ad nauseum and just so all of the fairly routine care instead of being able to use that time to really dig into the underlying pathophys and various treatments. Not that we didn't have to address that in the care plan, but it would be just one small percent with the rest of the care plan reiterating all of the rationales behind whatever routine nursing care would be required by that particular patient (skin care, assistance walking, emotional support).

And getting the 'proper' wording of nursing diagnoses never helped me better understand the issues at hand. I'd first have to understand the patient issues (a very reasonable expectation) and then figure out how to say it in 'nurse speak' which nurses don't even use.

From my perspective, nursing diagnosis language looks to have been developed with the specific, intentional purpose of creating a "unique body of knowledge" for the field of nursing, to demonstrate that nursing was a profession like medicine or law. That would explain the glaringly awkward avoidance of "medical" terminology in 'nurse speak'.

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Specializes in SN - Graduating December, 2012.

Scribbler,

Thanks for your response! I am entering into our program tomorrow, and though I am excited, I have already heard and read so much about careplans that I am already a little intimidated. Your reasoning and explanations will likely live in the back of my mind for a good while to come. Thanks for your detailed response - it's already helped me reflect on what I have read up to this point.

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I am a new nursing student, though not a new human being, nor a new student. You well stated answers to some concerns I had, and clarified some things I might have. Well done. Only flames are to you as a "hot" instuctor!

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