How do you feel about care plans?

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I know how I feel about them:no:. How about you?

Specializes in critical care.
I hate care plans. I understand that it's a necessity and enables one to connect the dots and apply the nursing process. I'm just not sure how much it enforces those connections. It really hits home for me when I actually see the patient and the symptoms in real life. I'm sure care plans have helped to facilitate that recognition. They still suck.

Hopefully it will serve me well when I begin my career.

It does much more than you realize. You'll see!

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I ended up loving care plans by the end of school. It was like putting a puzzle together. When I started out, they used to take me hours, but as I got better, they took less and less time. There are a lot of really helpful posts here.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Thank you for your positive and relevant response. I am currently in nursing school. I am not necessarily turned off by careplans--they are necessary. It's just that the careplans I've seen in the actual hospital setting are much more simpler than the 25 pages I have to complete during clinical. It is indeed a learning process.
Lets start back at the beginning.....

Let the patient/patient assessment drive your diagnosis. Do not try to fit the patient to the diagnosis you found first. You need to know the pathophysiology of your disease process. You need to assess your patient, collect data then find a diagnosis. Let the patient data drive the diagnosis.

The medical diagnosis is the disease itself. It is what the patient has not necessarily what the patient needs. the nursing diagnosis is what are you going to do about it, what are you going to look for, and what do you need to do/look for first.

Care plans when you are in school are teaching you what you need to do to actually look for, what you need to do to intervene and improve for the patient to be well and return to their previous level of life or to make them the best you you can be. It is trying to teach you how to think like a nurse.

Think of the care plan as a recipe to caring for your patient. your plan of how you are going to care for them. how you are going to care for them. what you want to happen as a result of your caring for them. What would you like to see for them in the future, even if that goal is that you don't want them to become worse, maintain the same, or even to have a peaceful pain free death.

Every single nursing diagnosis has its own set of symptoms, or defining characteristics. they are listed in the NANDA taxonomy and in many of the current nursing care plan books that are currently on the market that include nursing diagnosis information. You need to have access to these books when you are working on care plans. You need to use the nursing diagnoses that NANDA has defined and given related factors and defining characteristics for. These books have what you need to get this information to help you in writing care plans so you diagnose your patients correctly.

Don't focus your efforts on the nursing diagnoses when you should be focusing on the assessment and the patients abnormal data that you collected. These will become their symptoms, or what NANDA calls defining characteristics. From a very wise an contributor daytonite.......make sure you follow these steps first and in order and let the patient drive your diagnosis not try to fit the patient to the diagnosis you found first.

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan: ADPIE from our Daytonite

  1. Assessment (collect data from medical record, do a physical assessment of the patient, assess ADLS, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
  2. Determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
  3. Planning (write measurable goals/outcomes and nursing interventions)
  4. Implementation (initiate the care plan)
  5. Evaluation (determine if goals/outcomes have been met)

  1. Care plan reality: The foundation of any care plan is the signs, symptoms or responses that patient is having to what is happening to them. What is happening to them could be the medical disease, a physical condition, a failure to perform ADLS (activities of daily living), or a failure to be able to interact appropriately or successfully within their environment. Therefore, one of your primary goals as a problem solver is to collect as much data as you can get your hands on. The more the better. You have to be the detective and always be on the alert and lookout for clues, at all times, and that is Step #1 of the nursing process.

Assessment is an important skill. It will take you a long time to become proficient in assessing patients. Assessment not only includes doing the traditional head-to-toe exam, but also listening to what patients have to say and questioning them. History can reveal import clues. It takes time and experience to know what questions to ask to elicit good answers (interview skills). Part of this assessment process is knowing the pathophysiology of the medical disease or condition that the patient has. But, there will be times that this won't be known. Just keep in mind that you have to be like a nurse detective always snooping around and looking for those clues.

A nursing diagnosis standing by itself means nothing. The meat of this careplan of yours will lie in the abnormal data (symptoms) that you collected during your assessment of this patient......in order for you to pick any nursing diagnoses for a patient you need to know what the patient's symptoms are. Although your patient isn't real you do have information available.

What I would suggest you do is to work the nursing process from step #1.

Take a look at the information you collected on the patient during your physical assessment and review of their medical record. Start making a list of abnormal data which will now become a list of their symptoms. Don't forget to include an assessment of their ability to perform ADLS (because that's what we nurses shine at). The ADLS are bathing, dressing, transferring from bed or chair, walking, eating, toilet use, and grooming. and, one more thing you should do is to look up information about symptoms that stand out to you.

What is the physiology and what are the signs and symptoms (manifestations) you are likely to see in the patient.

Did you miss any of the signs and symptoms in the patient? if so, now is the time to add them to your list.

This is all part of preparing to move onto step #2 of the process which is determining your patient's problem and choosing nursing diagnoses. but, you have to have those signs, symptoms and patient responses to back it all up.

Care plan reality: What you are calling a nursing diagnosis is actually a shorthand label for the patient problem.. The patient problem is more accurately described in the definition of the nursing diagnosis.

Another member GrnTea say this best......

A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(nursing diagnosis)_____ . I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics) ________________. He has this because he has ___(related factor(s))__."

"Related to" means "caused by," not something else.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Dear, goodness. Why are you making so many threads in such a short amount of time?
Possibly they have questions? Possibly they are excited? Possibly they want to make friends......we are always happy to see people interested in nursing and being a member here at AN! The largest online nursing community!
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I think they are mostly fluff but necessary. They are probably more relevant outside hospitals as LOS is so short inpatient. As an experienced nurse, most care plan goals are implied such as hemodynamic stability. When you are in school, care plans are designed to promote big picture thinking etc.

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Specializes in 15 years in ICU, 22 years in PACU.
Possibly they want to make friends......

Not if they answer the question with this: "Now, if that somehow bothers you, then dismiss yourself. Simple. Problem solved. Right? "

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Specializes in Emergency Department.
Thank you for your positive and relevant response. I am currently in nursing school. I am not necessarily turned off by careplans--they are necessary. It's just that the careplans I've seen in the actual hospital setting are much more simpler than the 25 pages I have to complete during clinical. It is indeed a learning process.

I know how I feel about doing care plans... and I'm not ashamed to say it: I absolutely despise doing them! That being said, I truly love them for what they do.

By doing care plans so often, and in so much detail, you're effectively building a recipe for providing care for a patient. In some ways, you're building multiple recipes because after a while you will have built many recipes for providing care to meet various patient needs. Later, you'll be able to pick and choose the recipes to suit the specific patient.

Your school (and mine) went into much detail because later, all you need to do is mention the kind of care needed and your mind will fill-in the detail. It's like baking: At first, when you want to bake a chocolate cake, you follow the recipe. Once you know it, when your dessert plan calls for baking a chocolate cake you just write down "chocolate cake" and you don't have to include all the steps because you know them.

Hopefully that makes sense as to why "hospital" care plans you've seen are much simpler than what you're required to do.

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Specializes in Emergency Department.

Also, I don't know how much Esme got into this, but you really shouldn't try to translate a medical diagnosis into a nursing diagnosis. Believe it or not, the "diagnosis" steps are absolutely identical, but the approach used to get there and the body of knowledge used are very different. While it is possible to figure out a way to reverse engineer the medical dx, you would have to be able to go from the diagnosis, get down into the very specific signs and symptoms for what the disease does and then you might be able to piece the data back together to form a nursing diagnosis or five... because there isn't a 1:1 relationship between a nursing dx and a medical dx. You would drive yourself crazy (not to mention waste too much time) if you tried and you wouldn't learn much. Instead, you should gather data from whatever sources necessary (H&P can be used along with your own observations) and let the data drive and guide you toward the appropriate nursing dx for your patient.

Eventually you'll see how various nursing diagnoses, medical diagnoses, nursing plans and medical plans of care will all merge together to provide good, patient specific care.

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Specializes in Pschiatry.

In my experience (short though it may be lol) they could be a useful tool if you can use them properly and if someone teaches you to do that. We were just handed the papers and told to make a care plan. Huh? The one time I tried to go beyond a textbook plan and dig deep (I used 2 meds that were known to cause C-Diff), I was reprimanded and asked "Where did you get this?'

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Specializes in HH, Peds, Rehab, Clinical.

Right there. THAT is the attitude that will make posters NOT want to answer your questions!

Again, because I'm interested. Now, if that somehow bothers you, then dismiss yourself. Simple. Problem solved. Right?
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Specializes in HH, Peds, Rehab, Clinical.

Not every nurse works in a hospital. Surely you've learned THAT in nursing school? LTC facilities have VERY detailed and lengthy careplans on most of their residents. Knowing how to write them and follow them will serve you far better than your attitude....

Thank you for your positive and relevant response. I am currently in nursing school. I am not necessarily turned off by careplans--they are necessary. It's just that the careplans I've seen in the actual hospital setting are much more simpler than the 25 pages I have to complete during clinical. It is indeed a learning process.
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Specializes in CVICU, CCRN.

love-hate relationship

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