? about care plans

nightingale, RN · Sep 13, 2001

There are no silly questions.....

It is my view that writing, studying, and discussing care plans lays the groundwork for what you must do when you practice as a nurse. It would be nice to have this layed out but you simply do not have the time.

Making a care plan is what you do "instintively" as a nurse when you use a proactive approach for your patients. In an ideal world, we should be able to do this. Pragmatics don't always allow for a proactive approach but it is far easier to prevent a problem then fix what went bad by not initiating interventions. An obvious example would be to change surgical dressings before an infection has time to festor and your are then left with a seeping wound to care for (and yes this happens).

I also rememeber the journals from school. My teacher rejoiced when we finally "got it". She was so pleased when we finally starting thinking like a nurse. She learned this by reading about our private thoughts of concern and worry of providing the important interventions for our patients.

Good luck to you Purp. It sounds like you have what it takes to be a good nurse!

P_RN, ADN, RN · Sep 13, 2001

No honest question is ever silly.

In all honesty I believe that the long, complicated care plans required in school are pretty useless in practice. That being said these type care plans do train you in logical, critical thinking.

First you do need to know WHAT THE NEED IS. ( I hate "problems" because if you didn't have a problem then why on earth would you be hospitalized in the first place.)

After that you need to know what it will take to resolve the NEED.

It will take time to gain these skills.

After that it all comes pretty much as a matter of course.

I KNOW that everyone does not agree with me.

I KNOW that the academics LOVE the NANDA style care plans.

I also KNOW that in the real world when you don't even get to go to the bathroom, there is just no time to sit down and write a care plan.

Thunderkat · Sep 13, 2001

As a forensic nurse... I work for the State of WV..... We are required to create care plans, however ours is a multi discipline approach.... We document or chart on progress notes along with the doctors, social workers, counselors, health service techs, dietary, and others. I did not care for this approach at first, but then I realized the time saving of not flipping thru the chart for information. We all address each patient's issues/needs. Care palns have value since not all problems are self evident when you are assessing or providing care. In Pysch Nursing, you have dual diagnosis and so care plans help you meet all of the pt's needs. We were PIE charting.... (hate it) now we narrative chart and refer to the problem list as well.... I have been a nurse for 12+ years, and I have charted 7 ways to sunday....i.e..SOAP, SOAPIE, PIE, Narrative, and Flow Sheet.... and i think I prefer to narrative chart as it is more effective and care plans help me to not forget to effectively document my patients issues or needs. Hope this helps.....

prmenrs, RN · Sep 13, 2001

I agree w/PRN. As a student, doing a care plan is like programming your mind to be a good observer, have the knowledge of the diagnosis and its implications.

When you see a pt in clinical, start w/ your database, add in all hte diagnostic stuff, family stuff, teaching needs, and you have an idea of what the pt. needs, what labs are appropriate, why the doc ordered whatever, how the meds are going to help--it all starts coming together.

there will be a point @ which you go "aha!", and you begin to see the patterns. Until that point, you may have to sorta put your mind in neutral and follow the directions.

Don't be afraid to ask anything!! That's what being a student is for!! Asking here is even better! Gives us old farts something to think about!!

frustratedRN · Sep 14, 2001

im one of those kinds of people who need to write things to really learn them. i liked doing care plans in school. (i know im one of those weirdos...lol)

we only use care plans in practice on admission and discharge. of course they are supposed to be updated but theres never enough time.

if you take the time to learn while you are doing those care plans for school they will always stay in your mind. you will know what to do when you are faced with "needs" (btw...i love that there are no problems, just needs...thanks for the perspective!)

take your time with those care plans while you have it. learn from them. be creative and think about how you would respond to a patient with a particular need. then when you are faced with it you will know what to do.

they also help you learn to prioritize.

care plans are groovy...lol

delirium · Sep 14, 2001

Thanks everyone for your input. I like the idea that care plans can teach me to think like a nurse. Sometimes I feel so out of the loop. I guess that's the nature of the beast, though, what seems so glaringly obvious to a professor who has been in the nursing profession for umpteen million years is not quite so clear to little old me.

My nursing diagnosis:

Altered Perception of Student Knowledge related to Professorial Stagnation

Now that would be a care plan from hell.

And I don't think you're a weirdo for enjoying writing them :eek: . I enjoy a lot of things that most people don't (but this is not the forum for THAT).

Home Health Columnist / Guide · Sep 14, 2001

Every home care patient has a care plan created on admission. My homecare agency has whittled things down to nuts and bolts and our standard care plans are printed on just TWO pages. The RN checks off which areas are problems, adds/deletes to each problem to individualize goals. We try to focus on only up to three problems at a time, include date to acheive resolution of the goals. Our nursing note is two page checklist which includes spaces for 3 problems, goals to be acheived , outcome of teaching done +/or procedures done along with patient response.

Think Medical Diagnosis and associated disease process;

+ actual patient problems assessed/reported, health behaviors, and functional deficits;

+ complications associated with medical diagnosis that you need to observe for or actively intervene to treat/prevent;

= Nursing Diagnosis with plan of care to be actions to take to resolve/minimize above concerns.

jb224179 · Sep 18, 2001

I am still in nursing school also and I think that writing care plans is very time consuming but on the other hand I learn what I should look for in patients with different disease processes. But, at the hospital where I work they have SOC which are care plans that are already written out and you just document the date, time and your initials for the interventions that you carry out and the evaluation. I think that this is very helpful and also leads you to know what kinds of things you should watch for in your patients.

PammieRN · Sep 18, 2001

jb...

I work as a Registered Nurse Care Manager for a hybrid of home health, specifically those residents with developmental disabilities. These residents have been moved out of the larger state institutions and into private homes, usually 4-6 people per home. They are followed by a multitude of professionals. It is my job to oversee the health care concerns of these people and supervise the nursing/care giver staff. Creating care plans in this environment is imperitive for two main reasons:

1. State funding and monitoring requirements.

Oregon state sets forth strict guidelines for documentation

and record keeping for this population.

2. Staff education and guidance.

Few homes in this population have 24 hour nursing care.

The caregivers that are present are unlicensed persons

with litte formal training. They need more guidance and

"hand holding". Care plans and protocols are imperitive to

insuring the quality of care that this population is receiving.

Hang in there....work diligently on your care plans and try to see the bigger picture.

Pammie Sterling RN BSN RNCM

Quality Assurance Nurse