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.

[taalyn_1, CNA]

this an old post, but since i just started the program it was an interesting read. I understand why instructors want you to do careplans, i really do, but i do not understand why EVERY nurse outside of school I talk to says "yeah you won't ever have to do that in REAL life". So, if we never will have to do that in real life why waste the time in school when we could be learning more skills and techniques and the things we WILL use in real life? Care Plans just don't make sense to me and they are long, tedious and ... well, HELL IMO. I know we have to know the pathophys of the disease and the ins and outs of disease process, so lets focus on that and not the concept mapping/careplanning/13 nrsg dxs with 20 interventions apiece etc etc.. I mean come on. BUT I know my opinion on the matter makes no difference whatsoever so I plan on just struggling through, hopefully passing. To be honest, the paperwork of nursing school is what makes me want to quit everyday. I can do the skills fine, I can take care of patients fine, I can even understand pharm and the disease process fine its just formulating these long LONG drawn out careplans/concept maps that frustrates me. O well, nursing school sucks. Just hope I find a job that I will actually like so this doesnt seem all for naught.

[studentinnursing]

I just started level 2, and my clinical instructor said we can use medical dx for r/t; can someone comment on this for me...it's easier so didn't wanna complain, but the whole class was like, huh? And she said forget what you learned in level 1; I am worried about this, though; what do I need to use for r/t so in real-world experiences it helped me learn what I need to know to be an exceptional nurse, not juist good; I want critical care at this point and thought it'd be betteer to know down to trhe cell level; any instructors out there or RNs that cpuld take a few minutes...thank you so much!

I am of course doing my clinical prep how she wants it, but shpuldnt I at least be looking at what's going on at the cell level while I'm writing up my care plan?

For examle, we are in med-surg, and for fx a lot of us had something lik impaired physical mobility r/t disruption of bone, nerves, skin secondary to R intertrochanteric hip fx and total hip replacement, and she wants the r/t to just be fracture...please advise if this even matters for the real world and if medical dx is okay? Or to stick with cell level when working this prep up. Tx for your time!

Please excuse typos, on phone, just too tiny today LOL, care plan killin me this week, keepin my proofin eyes for that.

[4gtfl1]

Wow! I just looked at this post for the first time.

Finishing up second semester of an ADN program - I have two comments that hopefully some instructor with influence will see and take to heart. (Pleeeeeease!!!)

1.) If someone had taken the five minutes to explain, in first semester, whatscribblerpnp did in the beginning of this thread, it would probably have "clicked" for a lot more students a heck of a lot faster. When you're so bogged down with everything at the beginning (just figuring out what's needed for which class is overwhelming, much less learning assessment, values, etc. etc) it's really tough to figure out this "foreign language" and understand why you're being asked to fill out these forms for interminable hours.

2.) One of the most frustrating things about it, in my experience anyway, is that not only are the instructors not all on the same page, but some of them don't understand the concept themselves! Once it started to click with me, I started realizing how inept a couple of them actually were. I'm talking about the ones with Master's degrees in nursing, too. It's hard for somebody who is just learning to be able to understand it when they're being sent on wild goose chases through NANDA codes and constantly having contradictory feedback.

I really believe that it would be much easier for us students if these two things were different! Coherent explanation from the get-go, and instructors knowing what they're trying to accomplish.

Now I feel better. Til next Care Plan, anyway ;/

[greenfile]

I work as RN in longterm elderly care and love it. We use a 16 page LTCP. Pain in the butt to write but dont know how else information could be shared between staff. Would make it a very long handover LOL

[Brittpitt]

They are good to help you critically think but they dont use them in the real world

[baldee]

At my first hospital clinical, the RN's would just write down 5 or 6 random laundry list to do items: period. Nothing more. Of course RN's were just med admins and little else there.

The hospital did not care and was going for the cheapest labor, and the cheapest labor was doing the least possible in return or maybe that is all they knew. Good RN's would pay off (not LPN's or imported RN's who did not know English or other things very well).

And Hospitals are where everyone wants to work? Wherever I go, hopefully they will listen to a value engineer break down revenues, cost, and overhead. But sometimes the skin-flints don't know anything, so they hope to get ahead by not spending any money at all. It works for a little while anyway.

I'm not saying the care plans are good or bad. But if there are only so many available, why reinvent the wheel every one? Implementation may never take place if you complete them after the Pt is gone! But don't get me started on the lack of human factor engineering in Nur teaching plans and instructional effectiveness. Its all about 'JOB SECURITY'. We have only ONE Dr. that I know of in our whole school: one of the nursing directors. She carries a heavy burden, and after mid semester to the end, all the life looks sucked out of her. Poor thing. I hope she gets paid well.

I had a poor start this semester since I just figured out some of the instructors are repeatedly posting (lies) in ratemyprofessor.com! And then mysteriously, the computer network crashed when instructor reviews were due (for a limited time, only when the computer was crashed on the surveys). IF I could only wake up!

[Jensenn]

To ScribblerPNP,

I have thought about the purpose of care plans quite a bit every time that I have had to do one in the past year of nursing school and that seems to be the best explanation i have heard so far. My instructors stress the importance of critical thinking all the time and it is evidenced in the way that they grade our care plans. If each care plan, clinical prep sheet, and patho is not specific to the patient we can count on it being hammered away at until we think about other career fields. Thank you for taking the time to put a wonderful explanation up that helps to bring understanding to the confused such as me who love to help people and can't always see the purpose behind the madness.

[Bhavana]

Care plans are a pain in the butt, but they do serve a purpose - to get you thinking about diagnosis and to drum the NURSING PROCESS into your head. The nursing process is what it is all about, and we have to know it, understand it.

Once you actually start working, care plans will be standardized and can be pulled up in the computer - and most of the stuff will just become instinctual. To think of the HOURS I spent working on care plans when the average nurse completes them in 20 seconds! But, those hours were not wasted, I learned a lot.

[Lillian2515]

Thank God there is not ONE direct....and I emphasize direct...question about care plans on the NCLEX-RN!!!!

Of course you have to be able to recognize how different systems interact and how everything is connected to patient outcome, etc., etc.

[Bhavana]

Thank God there is not ONE direct....and I emphasize direct...question about care plans on the NCLEX-RN!!!!

Of course you have to be able to recognize how different systems interact and how everything is connected to patient outcome, etc., etc.

maybe no direct careplan questions, but COUNTLESS questions on the steps of the nursing process, which is what careplans are based on.

[Lillian2515]

that's what I was saying Bhavana....

[hsienko]

Oh, and the APA stuff. Yeah, if you are going to graduate with a college degree, you need to know how to write on a professional level. That is why the APA is a big thing. EVERY profession with at least a bachelor's degree has to learn to write on a professional level, even if you will never use it. Comes with the territory of getting a college diploma.

APA is a defective academic standard. Even amongst the experts, the pHD majors, and the journalism majors, there's so much discrepency in how to inline citate. I wish the American Psychological Association would focus on people with mental issues and leave the english stuff to the professional organization of english majors (POEM) or some other standard that when they release a style book they don't have to back track and say "what we meant was...." 1 months later. APA truly sucks. and this, no matter how high or great I climb the ladder as a nurse, will never change. Ever.

Period. Dot.