Every student nurse has to write care plans. (I think it's a law or something.) Care plans are simultaneously great teaching and evaluation tools. I would very much like to pick your mind(s) on this topic so that I can better help my students.
With the exception of a couple practice care plans in 1st quarter, all have been on actual patients from our clinical rotations.
What were the learning objectives for that assignment? (IOW: What was your instructor looking for?)
The objective for all of them is to create a care plan based on our assessment data. Our care plans are pretty big- usually 6 or 7 pages. We have to write up the medical diagnosis and pathophys, and how it specifically effects our patient. We have to list all relelvant orders (diet, activity, precautions, etc.)and all of the lab data (preferably as trends if there is enough data available). We have to list a lot of info about each of their medications. We have a concept map that links data, objective, diagnoses, and interventions, and outcomes. The last page is the list of diagnoses from the concept map with the rationales. We have to have 3-4 nursing diagnoses with 2-4 interventions for each.
About how much time and how many books/references did you use to complete it?
I mostly stick to my med-surg book and my drug book, but there have been a couple of times where my patients had some uncommon issues and I had to look up additional sources. I have gotten info from the CDC and NIH for the care plans.
How many do your write in a semester?
My program is on a quarter system, and we have to have 3 full care plans with passing grades (80% or higher). After that, we have to do the pathophys, medications, labs, and orders for each patient, but do not have to do the full concept map. The first few pages are completed before the first clinical day of the week, after we have selected our patient the night before. That part takes about 2 hours, and is based on the data we get from the EMR. The concept map, diagnoses, rationales are done after the first clinical day and, with the exception of our outcomes (which we fill in at the very end) has to be shown to our instructor in the morning of the second clinical day. That part takes another 2-3 hours to complete, and is based entirely on our assessment data from the first day.
What major sections make up your care plan forms. AND, finally...
Pretty much what I listed above
What did you find most challenging (difficult or confusing) about the assignment?
At first, it was difficult basing the diagnoses and interventions on the patient using only the assessment data, instead of just picking likely things from the book based on the medical diagnosis. Now, I pretty much have that down, and the most difficult thing is really just the amount of time they take. It is difficult, after a 9 hour clinical day (8 hour clinical, 1 hour post conference) to put in another 2-3 hours on paperwork.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
When I went to school. We did care plans every clinical day. We didn't have NANDA. We got our assignments. We went to the hospital after school and collected all the information on the patient. We wrote our care plans looking up every diagnosis, every symptom, every med, every lab, every treatment, every IV/foley/NGT, and every test. We had to explain what they were, why the patient had the test, what complication of every disease and the pathophys of every disease....EVERYTHING! These were pages long.
After we cared for the patient we had to decide which was being exhibited right now and how they were affecting the patient and what was most important to the patient in order of priority and Maslows. We then had to develop our nursing diagnosis without the benefit of a "list" (which I sometimes think is better).
We had clinical 2-3 days a week. I went to a ASN 2 year program at a university which actually took 2 years, not 3 like the 2 year programs now. We took all of our English, pathophys, anatomy, micro blah blah blah at the same time. Including summer
Like so many other things, I think that the way students (and faculty) think about this topic is predetermined by the language they use to discuss it. Think about the difference between these pairs:
Choose a nursing diagnosis vs. Make a nursing diagnosis
Write a care plan vs. Plan a patient's nursing care
If educators and students thought more in terms of the latter than the former, we'd go a long way to teaching/learning how to think and act like a nurse. Language matters.
Like so many other things, I think that the way students (and faculty) think about this topic is predetermined by the language they use to discuss it. Think about the difference between these pairs:
Choose a nursing diagnosis vs. Make a nursing diagnosis
Write a care plan vs. Plan a patient's nursing care
If educators and students thought more in terms of the latter than the former, we'd go a long way to teaching/learning how to think and act like a nurse. Language matters.
You make a very interesting point. I definitely feel like care plans can be made into a very artificial and awkward exercise, especially when I came back for my bridge program. Some professors were so stuck in NANDA world that I felt I had to force what comes naturally for me i.e. planning a patient's care into a seemingly arbitrary format that is very stiff and non-intuitive. This gets worse when professors are also very particular about following nursing models like Roy, Neuman etc. I feel that professors like that focused on the language and format more than the content. NANDA and nursing models are tools, a means to an end. Not the end in of itself!
I actually wrote my own care plans, especially when I saw complex patients who had heart failure, ARDS, DIC etc. that were all competing for top priority. I primarily used ABCs and Maslow for them, and I found them to be way more useful than any care plan I submitted for a grade.
Oh, please... Nursing theorists. Almost got me cashiered out of graduate school.
You will note how precise Grn Tea is about the meaning of words, and how subtle substitutions will distort communication. We as a profession should be striving for accuracy in all things. My experience is that theorists imbue words with their own meaning, or even invent new words.
We are a scientific, diagnostic, discipline. I will hand it to NANDA... they have reasons for the diagnoses they list, and they try to define and defend them.
(I'm sorry cuddles... you just gave me a flashback there.)
You make a very interesting point. I definitely feel like care plans can be made into a very artificial and awkward exercise, especially when I came back for my bridge program. Some professors were so stuck in NANDA world that I felt I had to force what comes naturally for me i.e. planning a patient's care into a seemingly arbitrary format that is very stiff and non-intuitive. This gets worse when professors are also very particular about following nursing models like Roy, Neuman etc. I feel that professors like that focused on the language and format more than the content. NANDA and nursing models are tools, a means to an end. Not the end in of itself!
I actually wrote my own care plans, especially when I saw complex patients who had heart failure, ARDS, DIC etc. that were all competing for top priority. I primarily used ABCs and Maslow for them, and I found them to be way more useful than any care plan I submitted for a grade.
Yeah, yeah, geek alert.
I try to address the nonintuitive part by giving the plain English translation, which you will see every time I try to explain nursing diagnosis to newbies here. As my new friend Episteme notes, I am particular about language, and there's a good reason for that. When people have to struggle to understand words, their cognition lags just a nanosecond while their brains pick up and handle a new one. Over the course of a greater or lesser period of time, those nanoseconds of inattention add up and eventually some other useful part of the intended input gets dropped entirely. :) Thus, I try to say it more plainly:
A nursing diagnosis statement translated into regular English goes something like this: "I think my patient has ____(diagnosis)_____________ . He has this because he has ___(related factor(s))__. I know this because I see/assessed/found in the chart (as evidenced by) __(defining characteristics)________________."
Jenngirl34RN
367 Posts
With the exception of a couple practice care plans in 1st quarter, all have been on actual patients from our clinical rotations.
The objective for all of them is to create a care plan based on our assessment data. Our care plans are pretty big- usually 6 or 7 pages. We have to write up the medical diagnosis and pathophys, and how it specifically effects our patient. We have to list all relelvant orders (diet, activity, precautions, etc.)and all of the lab data (preferably as trends if there is enough data available). We have to list a lot of info about each of their medications. We have a concept map that links data, objective, diagnoses, and interventions, and outcomes. The last page is the list of diagnoses from the concept map with the rationales. We have to have 3-4 nursing diagnoses with 2-4 interventions for each.
I mostly stick to my med-surg book and my drug book, but there have been a couple of times where my patients had some uncommon issues and I had to look up additional sources. I have gotten info from the CDC and NIH for the care plans.
My program is on a quarter system, and we have to have 3 full care plans with passing grades (80% or higher). After that, we have to do the pathophys, medications, labs, and orders for each patient, but do not have to do the full concept map. The first few pages are completed before the first clinical day of the week, after we have selected our patient the night before. That part takes about 2 hours, and is based on the data we get from the EMR. The concept map, diagnoses, rationales are done after the first clinical day and, with the exception of our outcomes (which we fill in at the very end) has to be shown to our instructor in the morning of the second clinical day. That part takes another 2-3 hours to complete, and is based entirely on our assessment data from the first day.
Pretty much what I listed above
At first, it was difficult basing the diagnoses and interventions on the patient using only the assessment data, instead of just picking likely things from the book based on the medical diagnosis. Now, I pretty much have that down, and the most difficult thing is really just the amount of time they take. It is difficult, after a 9 hour clinical day (8 hour clinical, 1 hour post conference) to put in another 2-3 hours on paperwork.