I've been wondering about this for awhile. I'm finishing up my first year of nursing school and have had about 3wks of clinicals altogether. not much I admit. Anyway, the point is that at school there's alot of emphasis on care plans. But when I've been out in the real world, I haven't seen too much in the way of nursing diagnoses, setting of goals, evaluations and so on. I imagine that the new generation of nurses are supposed to bring these skills to the fore, but I've been wondering if there aren't already plenty of nurses out there doing all of this already? Perhaps the ward I'm assigned to is a bit shoddy?
I'd really appreciate some feedback on this, so please let me know what your experiences are.
This has really answered my question. I'll have to put the same question to my clinical advisor when I see her next month. We don't have JACHO over here, and the little country hospital I'm at hasn't started using electronic pt. journals yet. Progress moves slowly in socialized health systems. I'm sure they must have some sort of policy/binder or something. I'll find out.
Are you all really NOT required to update your careplans daily?
Ours are very simple. In the computer we have dozens and dozens of careplans. We just click on the one we need, for example CABG. It includes pretty much everything that a routine post-op cabg requires. We can add additional problems if we want to like if a person needs restraints, has skin issues other than the incisions, etc.
It takes a total of 4 clicks on the keyboard (after signing in) to update the plan of care nightly. JCAHO's happy and the hospital is in compliance.
We can't be the only ones doing this!?!
In LTC the nurses address the careplan issues on those weekly updates. But on our acute floor, we don't address the careplans specifically as you describe. Our charts have boxes to check with our initial assessments and then we make nurse's notes longhand for anything else that happens. How much they ate. What their pain needs are and any meds given (actually there are two places to chart this - in the nurse's notes and then on the back in a box specifically for pain (pain scale, what med and how much, relief?). Trip to xray. Physician here. Family visits. We just chart what happens. Not specifically to the careplan. We don't do computer charting. We can get a careplan from one of the careplan programs made available to us on a computer at the nurse's station or go get the big binders (I do this most of the time).
Our swing patients have to have a more extensive careplan from the computer and our DON very nicely does those for us.
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I think we internalize and implement the careplans as experienced nurses, without even thinking about them on a daily basis. Actually reading and using them, step by step, daily? Nope, not in the real world, where I work, anyhow. It's automatic after a while, and you learn to individualize care for each patient automatically, as well. Our computerized charting has them built in......but each and every item is NOT addressed each shift, or even daily. Time IS short, after all. It's a lot of squares we fill for JCAHO purposes, of course.
It Teaches You To Be A Critical Thinker. An Experienced Nurse Has All This In Her Head. When You See A Medical Diagnosis, You Know Right Away The Nursing Diagnosis, Or At Risk Fors That Go With It. When I Worked Home Health, We Had A Stupid Piece Of Paper With A Nursing Dx On It For Everything.when We Had A New Pt, We Pulled All The Dx's Related To The Medical Dx, Dated It, Individualized It And Stuffed It In The Chart. We Were Required To Update The Care Plan Daily. Re: Make Changes As The Pt Progressed Or Declined. It Really Took A Heck Of Alot Of Time To Do This, But If Your Company Wants Some Sort Of Accreditation, You Have To Have These Things In Place. I Guess It Proves You Did Your Job. It's The Old " If It's Not Charted, It Didn't Occur. I Work In A County Jail Now And They Come And Go So Fast There's No Time And Really Impossible To Carry Out Any Complicated Care Plan. You Teach, Get Them Some Meds And They Post Bond And Get Out Of Jail And Forget To Take The Meds With Them. I Don't Bother With Careplans In This Setting. I Have Enough Stuff To Write.
I think we internalize and implement the careplans as experienced nurses, without even thinking about them on a daily basis.
It's a lot of squares we fill for JCAHO purposes, of course.
Your first sentence pretty much sums it up. We don't actually look at the careplans to plan our work. And JCAHO is the only reason we have these careplans and update them daily (which takes all of a few minutes during the night shift).
With our system, we can access information from plans of care from other departments (PT, dietary). For example maybe the wound nurse will leave an explanation of how exactly to change a dressing and what to use. They are responsible for keeping their own plans updated. Sometimes they will leave a note for the RN in their plans. I think it's not a bad way to keep abreast of what other departments are doing with your patient or what their goals are for the patient. This is in addition to, and actually may duplicate any note other departments may leave in the chart.
BELIEVE me, usually all we do is click, click, click, click and we're done with it. Having to do this is just another bureaucratic system created by a bureaucracy in the name of patient care.
BUT, nursing careplans are one hallmark of the nursing profession. The nursing process is just one very simple process that justifies (I'm not sure that's the right word?) what we do. The nursing process is at least one thing that nurses across the nation have in common and the nursing process is what the licensure exam, that allows us to practice professional nursing, is all about. Even though careplans are kinda dumb and elementary, I think it's a much better representation of nurses than just saying that we "care."
I hope that makes sense. I'm certainly not pro creating more work, nor do I promote silly paperwork, but for some of the reasons I stated above, I don't think that it's a "bad" idea.
Another timewasting, useless task that we must do on admit to satisfy the stupid State and JAACHO auditors! Their philosophy is the more pointless charting, the better, all based on the doctrinal thesis of some overeducated idiot with a bunch of extra letters by her name.
I'm so sick of these out of touch people! :angryfire They are ruining bedside nursing...
It now 2008, I dont know if the posts today would be a repeat of what was posted in 2004. From these posts, i am beginning to see why at work, care plans are not done ,as i am learning by the book ,in school. I hope my conclusions are correct, learn to do care plans the way your school expects, and adapt to the reality of how things are done in the real world. The important thing is to use the nursing process automatically if not on paper. These posts sure have been a morale booster, care plans were one reason I was considering dropping out of nursing. Frank
It now 2008, I dont know if the posts today would be a repeat of what was posted in 2004. From these posts, i am beginning to see why at work, care plans are not done ,as i am learning by the book ,in school. I hope my conclusions are correct, learn to do care plans the way your school expects, and adapt to the reality of how things are done in the real world. The important thing is to use the nursing process automatically if not on paper. These posts sure have been a morale booster, care plans were one reason I was considering dropping out of nursing. Frank
Don't drop out of school because of careplans!!! They're the bane of my existence right now, but they're doable.
I figure it this way: like Tweety and Steph said, doing careplans helps you to prioritize your care. You learn the things to do and assess for a whole variety of conditions. Doing them over and over just cements it in your mind.
leslieanne
42 Posts
Thanks to all for their input.
This has really answered my question. I'll have to put the same question to my clinical advisor when I see her next month. We don't have JACHO over here, and the little country hospital I'm at hasn't started using electronic pt. journals yet. Progress moves slowly in socialized health systems. I'm sure they must have some sort of policy/binder or something. I'll find out.
thanks, les