'do' in a care plan

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i get care plans. they're not hard, per se...just sometimes tedious. we have two 'monster' care plans due this semester, and i turned one in. i have a revision on it to get full points, and can't, for the life of me, understand what i have done wrong. i am starting to work on the second one, but am getting stuck there, too...on the same darned thing.

can anyone concisely explain what the 'do' in a care plan actually is/ i don't want you to word it for me, because i need to learn whatever it is that i managed to drop out of my brain...but i need to understand what the 'do' part is.

thanks in advance for any help. i do appreciate it.

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lovin' learning

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Specializes in Neuro.

The only things I can think of are interventions and assessment to evaluate the effectiveness of your interventions.

If you could be a little more specific I might be able to help you more.

Good luck

Erin

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The only things I can think of are interventions and assessment to evaluate the effectiveness of your interventions.

If you could be a little more specific I might be able to help you more.

Good luck

Erin

Hey, Erin.

Here's what I have.

"

Goal: Patient will state reason for extra caution while using crutches; patient will demonstrate acceptable use of crutches pre-operatively, by 1330 today

1. Assess: Patient's ROM and strength. Rationale: patient's ability to maintain balance and overcome additional coordination requirements while ambulating with crutches will be affected by range of motion and strength.

2. Action: Show patient how to swaddle crutch top with towel. Rationale: Use of towels as a cushion will aid in comfortable use of crutches, and will allow patient to more fully and consistently use crutches in an appropriate manner. "

Et cetera. The action/do part, I'm told, is wrong. But I don't know why/how...and can't figure it out. I was told that was a 'teach,' not a 'do', and can't figure out how to get it worded so that it's a 'do.'

Which makes me think I don't quite understand what an 'action/do' really is...

Thanks in advance for any help...I do appreciate it.

Best-

Lovin Learning

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Specializes in med/surg, telemetry, IV therapy, mgmt.

i answer care plan questions all the time and there isn't much about care planning that i don't know. but i don't know what "do" means standing by itself other than to "do" something that wasn't done. can you give more information as to how it was used and in what context on the care plan? was it used in relation to the interventions?

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what do you mean, "do" part? the nursing interventions? the client goals? My care plans have the dx, the goals of the pt, the nursing interventions, why you chose the interventions and outcomes.

maybe I can help. also, I use a Nursing Diagnosis handbook sometimes which helps a lot

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Sorry, guys. Let me see if I can't be more concise.

In the 5 columns, there are 'Assessment', 'Diagnosis', 'Planning', 'Implementation', and 'Evaulation.' The 'do' that my instructor is speaking of is in the 'planning' column.

I have, in that column, the following:

Goal: Patient will state reason for extra caution while using crutches; patient will demonstrate acceptable use of crutches pre-operatively, by 1330 today

1. Assess: Patient's ROM and strength. Rationale: patient's ability to maintain balance and overcome additional coordination requirements while ambulating with crutches will be affected by range of motion and strength.

2. Action: Show patient how to swaddle crutch top with towel. Rationale: Use of towels as a cushion will aid in comfortable use of crutches, and will allow patient to more fully and consistently use crutches in an appropriate manner.

3. Teach...rationale

4. Document...rationale

Both 4 and 5 are filled in, I just didn't include them because there were no comments to improve on.

The comments made were:

2. Action is circled, with the note " this is a teaching focus; yhou need a 'DO' focus. You need a "DO" plan for each care plan.

That's as much as I have. Sorry if I can't be more clear, but I'm lost at the moment; I haven't got a notion as to what I need to put in there, or what a 'do' plan is; it was NOT taught to us this way.

Best-

Lovin Learning

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Specializes in med/surg, telemetry, IV therapy, mgmt.

there are 4 types of nursing interventions:

  • assess/monitor/evaluate/observe (to evaluate the patient's condition)
  • care/perform/provide/assist (performing actual patient care)
  • teach/educate/instruct/supervise (educating patient or caregiver)
  • manage/refer/contact/notify (managing the care on behalf of the patient or caregiver)

the "care/perform/provide/assist (performing actual patient care)" ones could be called "do" interventions because the nurse has to get in there and actually "do" hands on nursing care with the patient--perform actual patient care.

i looked at your goal and the intervention. the intervention must cause the goal to happen.

  • goal - patient will state reason for extra caution while using crutches; patient will demonstrate acceptable use of crutches pre-operatively
  • intervention - show patient how to swaddle crutch top with towel. i asked myself, is showing (teaching) the patient how to swaddle the top of the crutch with a towel going to be able to demonstrate acceptable use of crutches preoperatively?
    • my answer - no, how could it? you didn't "do" anything that involved the use of the crutches.

when you are introducing crutches and crutch walking to a patient there are specific things that must be done:

  • (here's a "do") fit the patient for the crutch by having him stand and extend the crutch 4" to 6" to the side and 4" to 6" in front of the feet and 1 and 1/2" to 2" below the axilla. adjust the handgrips so that the patient's elbows are flexed at a 15-degree angle when standing in an at ease position.
    • problem - it doesn't address the goal of how the crutches are going to be used postoperatively

    [*](here's another "do") with the patient standing and the crutches in place, have the patient move one crutch and the opposite foot forward simultaneously. this is followed by the opposite crutch and opposite foot, also simultaneously. this is the two-point gait. [it also gets you to your goal of the patient being able to "demonstrate acceptable use of crutches pre-operatively"]

you will need to find the rationale for this. all i have is that the twp point gait is the most natural gait because it mimics walking and alternating swinging of the arms and legs. the crutches, of course, help the patient maintain their balance. (nurse's 5-minute clinical consult: procedures)

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I get where you're coming from. All of our care plans need at least 3 interventions for each goal, 1 each of what you're going to assess, what you're going to do, and what you're going to teach.

Here are some suggestions of what to DO for this client (just off the top of my head; you'd have to find similar interventions/rationales in an approved resource):

Administer pain meds 30 minutes prior to each crutch walking session

Rationale: premedication will help client tolerate the activity

Place well-fitting, nonskid footwear on the client

Rationale: avoid slipping/falling

Pad top of crutches with towels

Rationale: make crutches more comfortable

Hope this helps, otherwise ask Daytonite (she rocks. seriously.).

--teenie

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Thanks, everyone! Got it! I appreciate your help and time very much!

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Lovin Learning

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