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.

[cardiacRN2006, ADN, RN]

What does "liberal" have to do with it?

Huh?

If you quote the post we might know what you're talking about.

[Me, SN]

Personally, I think NANDA didn't create enough nursing diagnoses so that they could be adapted to the patient. When I come up with a "good" diagnosis, I find that most of the time it doesn't even highlight the big issue. I'm supposed to use the ABCs, to prioritize. But when my patient is stable and the problem has been addressed beforehand, I'm stuck making it up. I know my instructor will not remember tiny details about my patient, so I forge lab results and patient responses to come up with BS! That doesn't help.

I get it now. Care plans are something evil thought up by the government as most evil necessities are. :sasq:

[amdale]

I am in peds currently and feel as if I am struggling. I think I would really appreciate a teacher like you. Part of my problem is that we have not been given clear guidelines on vitals. We had one lecture and then the next am were given pt. to care for. Up until that point nearly all of my experience was with elderly and very little from maternity. Yuck! I was terrified. My biggest fear is of doing harm. We are told not to chart abnormals but the thermometers only seem to register abnormals for axillary temps. The nurses on the floor always chart them. So then is it abnormal or regular for that pt. The info is not exactly clear. Care plans do seem to be hateful subjects in our class too. Different instructors looking for different things, some say you should never use at Risk for should always be a problem. Some students required to turn in many more from certain instructors. There seems to be no consistancy so it makes it difficult to figure out what the instructors are looking for, or to see what we have learned.

Anyway that's my rant. I'll stop now :) But did want to say thanks again. I am glad to see what you are looking for in a care plan, it might make my future plans better.

[nurse4343]

Yes, I know it's frustrating, I've been there. But after a while, it all begins to make more sence. And yes, every clinical instructor is different, all expect different things.

[nurse4343]

The point of a care plan is to get you to learn about the importance of knowing the patients history and comming up with nursing diagoses, treatments, and evaluations of treatments. Paperwork is most important in the nursing world! (in case of a lawsuit)

[psychonaut]

The point of a care plan is to get you to learn about the importance of knowing the patients history and comming up with nursing diagoses, treatments, and evaluations of treatments. Paperwork is most important in the nursing world! (in case of a lawsuit)

Hmmm, your post just caused a lightbulb to flash over my head.

How about making "care plans" more like giving report? This is a skill I had to develop on my own as I entered nursing, and even now (just about to hit the end of my first year, yay!) I am always looking to find ways of improving my hand-off technique.

So, instead of these dreaded "care plans" we all suffered through (or even worse, worthless "concept maps") students are assigned to give report on their patient to the instructor before they start their clinical day?

I remember when I finally got to my critical care clinicals, I got nailed on this by the clinical instructor. Here I was, ace student, just about all 100% on three semesters worth of care plans. So, this notoriously tough clinical instructor seeks me out towards the end of my first day in the MICU, and says, "tell me about your patient." I proceed to give a wandering narrative, intermixing social info and background, current status, previous medical history, what I had done that day, details of the pathophysiology involved ("showing off", heh), etc. When I was done, she just looked at me and said, "you need a LOT of work on giving report." I was crestfallen, and confused. Giving report was NEVER emphasized in my program. It was all care plans, concept maps, nursing dx, etc. I wasn't quite sure what she wanted, or how exactly I had failed to measure up, beyond a vague understanding that my presentation had been disorganized and inefficient.

Looking back, I can see what a vital area of "real world" nursing I was lacking. SBAR, SOAP, whatever, it all comes down to giving the oncoming nurse a concise and accurate report, so they can do their job for the patient. Is this taught anywhere in nursing education?

This just goes on my list of gripes with how divorced nursing education is from the actual skills and abilities needed to actually function as a new RN. "You'll learn that on the job," "Critical thinking is much more important," etc.

Oops, a rant of my own...sorry.

[jjjoy, LPN]

This just goes on my list of gripes with how divorced nursing education is from the actual skills and abilities needed to actually function as a new RN. "You'll learn that on the job," "Critical thinking is much more important," etc.

I agree. Of course, nursing education can't cover everything or completely prepare new nurses for every possibility out there. And critical thinking IS important. But I do think the gap between "real world" and school could be lessened and that there is room for improvement in many nursing programs. I think you make a good point about students practicing taking and giving report.

It seems like nursing education has bought into the teaching philosophy that giving students a pre-set format to follow (for giving report or writing care plans) is to be avoided at all costs. It's true that an overemphasis on pattern-following and/or rote learning can stifle critical thinking, but I think many schools may have tossed the baby out with the bathwater on this. You can give students a structure to follow AND also teach them how to alter the structure or think outside the structure when need be; to teach systems and guidelines as well as the rationales behind them and how to individualize care and not just mindlessly apply those systems and guidelines.

I griped about care plans as they are often taught and used in school, but I do agree that they CAN be a useful learning and planning tool.

[FloridaRNstudent]

okay care plans are important from a first semester student's view to guide them to what they are actually looking for on a patient, but I have to say that if you don't get it from the first semester (internalize as you say), then you shouldn't be a nurse. I just think that writing it over and over in some weird format is not the actually true guts of what you should be learning. We should be focusing on lab results, objective and subjective statements, etc., without staying up all night making sure they are on the proper forms. We, as first semester students, actually went in and asked our nurses about a nursing diagnosis and were graded "wrong" when what they told us was not what the patient had. Learning experience?? no. It just shows that nurses do the same thing that students did, learned it, got what is really useful, then tossed it right out of their heads. Nursing diagnosis are generated by a computer. And don't be so naive to think that that doesn't have something to do with payment by the insurance companies. Nurses should be trained to see the whole picture and focus on the patient, but not on the tedious paperwork that goes into the trash after some random grade at the end of a semester. I would rather focus on the patient, drugs, lab tests, what the whole picture is, not a stupid care plan that a computer is going to generate later on anyway. If you ever see the day when a Nurse runs back to the chart to see if the "care plan" is right, put THAT on this forum. Or another laugh, I mentioned telling a doctor my nursing diagnosis and my instructor said "He won't even know what you are talking about." HAH

[nkt1]

It was interesting to read about purpose of Nursing Diagnoses. But, I am still straggling with it. It is my third week in ADN program in community college. I honestly do not understand how it works. Our lecture was just some powerpoint overview, where a lot of slides were even omittied. From my understanding we need to know pathopsysiology, but we did not learn it yet. I even do not know is it supposed to be separate course, or it is part of the Health Assessment course. Our clinical instractor is good. She tries to teach us to make them on a very primitive level, like one nursing diagnose, one long term goal, two short term goals and one intervention. It is still confusing, because, I do not get what I have to do to use official NANDA diagnostic labels with etiology, or whatever comes to my mind? Our cours is based on the Orem's theory, at the same time those diagnoses based on the Gordon principles. Just huge mess. Takes a lot of time to try to figure out do I need to learn right way to write the Nursing Plan, or do I need to show my knowledge in nursing, which lately looks very problematic, since most of my free time instead of studiing I try to make those diagnosis.

[hunydew2262]

Care plans can be very frustrating. My understanding, limited though it is, is that they are to prepare us to think logically about our patient care. I'm in a BSN program and they hit on that theme daily. How else can a professor know if you understand the decision making process unless you represent your knowledge in some way, ie a care plan?

Many nurses have gone before us to fight the good fight and establish nursing as a profession in it's own right. I want that to stand. My mother was a nurse who was educated to let the MD's do the thinking. Frankly, I'm smarter than that. However, I won't have my MD and I won't be qualified to diagnose a medical condition, like saying someone has this or that. All I can do as a nurse is make a nursing diagnosis.

Finally, APA is the standard for citation in any scientific paper. It's not so different from MLA so I don't see why there is so much grumbling. We are going to be surrounded by medical professionals who understand the importance of correct grammar. Don't you want to appear literate?

That's just my two bits, but I could be wrong.

[mickey69]

true so true

[TPS360]

Care plans are to help nurses with assessment and evaluation of tx of pt....