Careplans!! please respond

MaleAPRN · Jun 29, 2005

Hello All,
It has been awhile since I last wrote--but I am glad to be back!!
Congratulations to all those that have been accepted and for those that are graduating--for me I am right in the middle--But I am beside myself thinking that I will be a SENIOR --wow!! in a matter of weeks.
To the subject at hand ---CAreplans --I am curious as to the nature, duration, quantity etc. By now you can imagine I am tired of them and feel like I am going to blow a gasket every time I have to do one for a LAP CHOLE etc.. I mean after all--who is going to go into the OR without a clue as to what they are doing the next day. We are not idiots!.. Give us some credit for what we do and don't know and let us write our careplans accordingly.
ADOBE PRofessional DOES HElp---A TON---but still?????
PLease tell me about your programs requirements and what you feel helps and what does not!
Thanx JEff

Jeff,

What is Adobe Professional? And you need this for your careplans?

I am soon to be a senior SRNA too and like you, am sick and tired of writing careplans. But, I don't think ours is THAT bad.

The school used to check and criticize every little thing on the careplans that we wrote, but this was just at the beginning months. They've since laid off our backs since we'll be seniors soon.

What particular things are you frustrated about? Most of the careplans for procedures are repetitive. The more you do it, the more it comes to you naturally when you write or formulate it on paper.

Your program must have an extensive careplan requirement. Here's what we have to write on ours:

-Brief procedure description (I mean VERY brief).

-H & P - every body system touched upon, if applicable, any anesthesia implications.

-Medications and their anesthesia implications, if any.

-Labs, if any

-Fluid, EBL, etc.

-induction plan (meds to be used)

-Induction plan (referenced from text)

-Intraoperative plan (referenced from text)

-emergence plan (referenced from text)

-PACU evaluation

That's it. Is yours similar?

Vince.

NCgirl · Jun 30, 2005

Jeff,
What is Adobe Professional? And you need this for your careplans?
I am soon to be a senior SRNA too and like you, am sick and tired of writing careplans. But, I don't think ours is THAT bad.
The school used to check and criticize every little thing on the careplans that we wrote, but this was just at the beginning months. They've since laid off our backs since we'll be seniors soon.
What particular things are you frustrated about? Most of the careplans for procedures are repetitive. The more you do it, the more it comes to you naturally when you write or formulate it on paper.
Your program must have an extensive careplan requirement. Here's what we have to write on ours:
-Brief procedure description (I mean VERY brief).
-H & P - every body system touched upon, if applicable, any anesthesia implications.
-Medications and their anesthesia implications, if any.
-Labs, if any
-Fluid, EBL, etc.
-induction plan (meds to be used)
-Induction plan (referenced from text)
-Intraoperative plan (referenced from text)
-emergence plan (referenced from text)
-PACU evaluation
That's it. Is yours similar?
Vince.

I agree, they suck. Ours are called IAP's, individualized anesthetic plan. The first page is pt info and history, all drugs and dosages, and fluid plan. The rest of it includes surgical considerations, primary comorbidity(DX), and then all secondary comorbidities. As you can imagine, this can get lengthy. Then we specifically address preop, induc, main, emer, and post op. Luckily, we have an IAP that is blank and generic, and you make copies and add things accordingly. I probably have over 75 IAP's as of now. So, if I have to do a lap chole, i just cut and paste until I have it as I need it. Then highlight my specific choices. I also have a bank of over 100 pathos that I cut and paste into the IAPs. Careplans such at the beginning of the program, but they get better as you build the bank up. Hope this helps. Our program usually let us quit with careplans about 3 months before graduation. I understand alot of other program quit alot sooner. Hope this info helps. Just know you're not alone in hating careplans.

TraumaNurse · Jun 30, 2005

I too will be a senior in a matter of weeks. I don't find care plans that bad. In the beginning it was very time consuming to do all the reading and then type in all out. But now for many cases, I can go into my Word folder, pick a care plan, edit what I need to and print. My classmates and I also e-mailed each other our care plans so we can expand our collection. You still need to read up on the case, but anything that saves me time, is okay by me! My programs expectation is that once we are seniors we do not have to have care plans for the more routine cases, only the bigger cases that we had less exposure to as juniors such as CABG, Thoracotomies, Transplants etc.

Focker, CRNA · Jun 30, 2005

I'm not an srna, just hopeful. I am just wondering how long it takes you to do your careplans, and how long you have to do them. For example, do you assess the patient the day before and only have that night to write the careplan, or do you have a few days in advance to prepare?

begalli · Jun 30, 2005

I don't know of any nurse who enjoyed writing careplans. But believe it or not, even though careplans seem tedious and just a plain pain in the azz, writing them over and over again is laying the foundation of critical thinking in nursing which will serve you well in the long run.

They are a necessary evil.

Hang in there ya'll!!!! One day soon you'll see that the end justifies the means.

:)

MaleAPRN · Jun 30, 2005

I'm not an srna, just hopeful. I am just wondering how long it takes you to do your careplans, and how long you have to do them. For example, do you assess the patient the day before and only have that night to write the careplan, or do you have a few days in advance to prepare?

In response to Focker's question:

It takes me about 20 mins to do a careplan. And we do them until the 21st month of the program.

If we have an inpatient scheduled for surgery the next day, we finish our careplan the night before (ie, history, meds, etc)

We have until the end of the week to hand in all careplans that were not turned in, since we have to update it (listing any complications during surgery, med changes, etc).

jewelcutt · Jun 30, 2005

Our program sucks! We have to do one care plan for every day in the OR with all the patho and implications, and all the other stuff mentioned in the above posters. The careplan is usually 4-6 pages long, we can cut and paste, but our instructors are really picky. Each plan has to be patient specific. In the beginning it took 3-4 hours to do a plan. Also, we had to do a careplan for every new case we had. So sometimes we were expected to do 2 or 3 plans, but you can't physically do it so I never did, screw that! In addition we have to look up every patient's info for the next day and calculate out fluids, plan, etc. It's a waste of time when you're so busy cutting and pasting that you don't learn as much.

JustJen, BSN, RN · Jun 30, 2005

I love writing care plans. Granted, they are often fiction, how I would care for a patient that I was able to follow for more than 1 or 2 clinical days. They really help me focus on the task at hand. I find that I learn a ton from researching and writing a good care plan.

Oh well, I was a "party-er in my first go around at college, guess I will be a geek this time!

Jen

amberrn · Jul 1, 2005

Jaffe and Samuels anesthesiologists manual of surgical procedures has the basic info you need for each surgery and special considerations. You might have to go to other resources but it is really helpful.

krisssy · Jul 2, 2005

Hello All,
It has been awhile since I last wrote--but I am glad to be back!!
Congratulations to all those that have been accepted and for those that are graduating--for me I am right in the middle--But I am beside myself thinking that I will be a SENIOR --wow!! in a matter of weeks.
To the subject at hand ---CAreplans --I am curious as to the nature, duration, quantity etc. By now you can imagine I am tired of them and feel like I am going to blow a gasket every time I have to do one for a LAP CHOLE etc.. I mean after all--who is going to go into the OR without a clue as to what they are doing the next day. We are not idiots!.. Give us some credit for what we do and don't know and let us write our careplans accordingly.
ADOBE PRofessional DOES HElp---A TON---but still?????
PLease tell me about your programs requirements and what you feel helps and what does not!
What exactly is Adobe professional?
Thanx JEff[/QUO

DIVER CRNA · Jul 5, 2005

Thanks for all of the replies. It is evident that we all share some common threads in careplan preparation, but it is even more interesting that there is so much variability from program to program.

We have to do five care plans per surgical day (if you have that many cases, but only have to turn in two for grading.

-all of the typical h&p info, meds, preop concerns/meds, intraop plan/concerns, emergence meds/concers, blood/fluid req, position implications etc.

- I guess my point is when do you all feel we should be expected to exercise judgement over which careplans we need to do. Of course some cut and paste, use Adobe Acrobat, or use some other means of modifying old carepalns to make them easier and less time cosuming--but that strays from my point a bit.

Part of this process (As SRNA's ) is exercising judgement and applying the necessary interventions. I feel there are certain cases in which I feel competent enough to do that without a careplan that is preformulated. In fact careplans for these types of cases are cut and paste jobs that I do to satisfy requirements.

Are careplans of this type of any value? I think not! Time is very valuable to me and I would rather be spending it doing things that are productive "like studying Morgan and Mikhail etc.

The increasing variability among programs serves as a good platform to get a concensus as to what helps and what does not within our respective programs.

Thank you all for your input

Jeff