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.

Specializes in med/surg, telemetry, IV therapy, mgmt.
. . .it's a big circle, you can't understand the treatments if you don't understand the disease. . .

exactly. see the home page of this site about the nursing process:

http://home.cogeco.ca/~nursingprocess/index.htm

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I volunteer as a trainer of adults and boys in scouting. Part of our program is to teach them project planning and problem solving. The steps we teach are very similar to those taught in the care plan.

Also it is in writing my care plan that I pull all the pieces about my patient together. How do the labs, meds and orders fall into the patho.

When I work as a PCS on certain units, they have a nursing diagnosis written on the board for each patient. It helps me to do my job of assisting the nurse better because I have an idea of what her goals are.

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Specializes in Vascular Access Nurse.

i'm just absolutely thrilled and realize how very lucky i am to be in the program i'm in for my rn. we had to write care plans last year, but don't this year....hooray!!! now, our clinical instructor will ask us for a nursing dx, goal, intervention, eval every once in a while on our pt just to make sure we know how to write cps, but we do not have to write formal care plans. their goal this year (graduate in may 09) is to make sure we know how to care for our pt, what is pertinent information, how to interpret lab results and physical assessment findings, how and when to delegate and overall how to perform competently as an rn. i love this program.......definitely a new way of thinking!! they're honing our critical thinking skills and expect us to respond to the pt/situation at hand. :yeah:

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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.

I totally agree!!!! Do you know any web sites that have pre made care plans that you can cut and paste to whatever careplan form your school uses?

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Specializes in med/surg, telemetry, IV therapy, mgmt.
i totally agree!!!! do you know any web sites that have pre made care plans that you can cut and paste to whatever careplan form your school uses?

care plan books, the care plan constructor websites, are merely suggestions for care. you are so defeating the purpose of what you are supposed to be learning from writing a care plan by doing this. plus, cutting and pasting is plagiarism if you don't give credit to where you took the information. the idea of care planning is to customize the care to what is going on with that specific patient.

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Specializes in Pediatrics.
I totally agree!!!! Do you know any web sites that have pre made care plans that you can cut and paste to whatever careplan form your school uses?

Any instructo worth their salt would see through this in a minute. I can always tell when my students blatantly copy a care plan from a book, because it isn't individualized to their pt. And when this happens, they have to re-do it.

Usethat stuff as a guideline, but your care plans should be as individual as your pts.

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Specializes in Studying.
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.

I know... I have a good few people in my class who were having problems converting the medical dx into nursing dx. They just didn't get it... "So I CAN'T use use dehydration or I CAN?!"... And depending on who we talked to some instructors said you could use it in the r/t and some aid you couldn't and blah blah blah... I just do what I want now (and get good marks on it). But it took a good amount of us a while to actually unerstand how to make a care plan.

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Does anyone know of a website that can help me with my care plan?

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If you search the nursing student assistance forum you will come across lots of great info posted by Daytonite in reply to other questions.

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Specializes in med/surg, telemetry, IV therapy, mgmt.
does anyone know of a website that can help me with my care plan?

students ask for and get help with their care plans all the time on allnurses. post your questions in a new thread on either the nursing student assistance forum (https://allnurses.com/forums/f205/) or the general nursing student discussion forum (https://allnurses.com/forums/f50/). there are several sticky threads on the student forums that address care plans where questions have been answered:

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Specializes in Acute Care Psych, DNP Student.
I am also an instructor, and my thoughts on care plans are as follows.

1) NCLEX doesn't test on NANDA terminology. NCLEX questions are developed by reviewing new graduate practice (what new grads are actually doing in the first 6 months of practice), and since NCLEX finds that new grads are not using this terminology word-per-word in practice, neither do I. My students are to explain the problem in plain english, with a focus on understanding pathophysiology and nursing care.

2) If I am a patient, and not breathing well, I don't care if my nurse knows whether it is ineffective airway clearance or ineffective gas exchange, I just want him or her to recognize an emergency and take the needed steps (O2, positioning, call for help, etc) that I need them to take so I can live. There is a lot of new literature on new grads and failure to rescue. I don't EVER want my students to be unable to recognize an emergency because they spent 8 hrs a day gathering information and not actually caring for the patient.

3) So.....what do I do instead? I have students give brief oral care plans about their patients, and I ask questions. Not just knowledge based questions like "What is vtach?" but "What would you do if you found a patient with this rhythm? What would your first intervention be?" After all, if the nurse recognizes vtach, only to go sit at the nurses' station and drink coffee, that recognition of a fact is useless.

I want any grad coming through my courses to KNOW that they can apply the standards of safe care and make quick decisions. Research tells us that in rescue/emergency situations, the nurse typically makes a decision within 30-60 seconds. I want my students to think like a nurse! They also make rounds. I have them gather assessment data with another student, and they compare notes. What is the most important care for the patient right now? I've found that the old standard care plans only tell me what you COULD do, not what you are actually doing. Most students copy out of a book. I am not interested in how well my students can copy from a book, I want to know how they think. I am also right in there with the students. If the patient vomits, I am there to help clean it up, as well as to ask the student what should we do now to help them out? There are so many other assignments my students do (brief concept maps, acting as lead nurse, conference presentations, etc.) I also have them practice giving and receiving report and "calling the doctor," which I never got a chance to practice while in school.

4) I also care about my students' well-being. I wouldn't feel safe caring for a patient on 2 hours of sleep and I am an experienced nurse. There is no way I would ever ask a new student to assume care for a patient, knowing that he or she had been up most of the night preparing care plans for my class. How can I tell them to lead a balanced life if I don't model one, and make my expectations reasonable? When the do a care plan for me, it is done "on the spot"- right then and there, either a 5 minute care plan that is oral or written. I don't belittle them if they or wrong, or hover over them while they write. I just try to redirect them with questions if they are off-target. Students are the future of nursing. I have made a committment to treat them as such, and not burn them out before they ever begin to practice. So many new grads quit in the first year of nursing. I think it's because they are so unprepared for the realities of nursing as it is. We don't do them any favors by having them complete 5 care plans per rotation with 15-20 pages each.

I :redbeathe you!!!

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Specializes in Acute Care Psych, DNP Student.

I understand why we have to do care plans. It's to teach the student to think like a professional nurse. However, I believe this good idea has been tortured and beat to death.

And that's why I (((hate))) doing care plans in school. I love learning. I love learning about pathophysiology, in particular. I'm motivated. But care plans, as I've seen lately, tend to be inconsistent due to conflicting instructors' opinions and picking at the student repeatedly over minutiae.

So help me goodness, if you put "xyz" in the care plan, the instructor will say, "No, it's 'abc.'" Then another instructor will read the exact same care plan and say the opposite. Then, the next week, it's "efg." It's so entirely subjective and without consistency. I just feel picked at, and I'm sick of it. It's not that I fail to grasp the verbal reasoning aspect, PES format, or nursing knowledge. It's that I'm tired of the subjective picking aspect to it all. Pick, pick, pick.

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