What EXACTLY is a care plan?

skulskcc01 · Aug 4, 2012

For me, what makes doing a care plan so long is writing up all of the meds. Names, side effects, classes, route, dose, frequency, pharmological action. At my school our care plans consist of an assessment tool for each system then we have to write up anywhere from 3-5 priority diagnosis. The write ups for each nursing diagnosis consist of at least 2 short term goals and one long term. Then we have to write what we will assess, therapeutic interventions, and finally what we will teach the client. Then if applicable a referral to a different health care professional.

Personally, I have never spent over three-four hours on a care plan. I always scored in the 90s on them. We did a care plan for each day at clinical. This started 4th week of my first semester. My advice to you buy a care plan book it will help you tremendously. Not only will it assist you in writing up diagnosis but will help you understand the why behind the interventions, teachings, etc... and why the diagnosis is appropriate.

malestunurse · Aug 4, 2012

Care plans will differ from school to school and facility to facility so there is no real way of knowing what you will have to do for them or how much work you will have to do for them until your lecturers give you your assignments.

Care plans are exactly what they are called, plans of care for the nurses. They give the nurse a guide of the care that is required for that individual patient. Care plans can be comprehensive (as they usually are at nursing school) or specific to performing a certain nursing task.

EarthhAngel2013 · Aug 5, 2012

My care plans are a worksheet we make for each patient, that helps us as students plan our care. My very first CP I ever did, took me 8 hours. I was totally stressing and freaking out over it, and that was only for one patient. My second one was stilll difficult but only took 3-4 hrs. We have to do one CPS per pt. and we have one day to do them in. (Example we take care of 5 pts, we have one night to complete 5 care plans. They are due the next morning.) since then I've started doing some things to make this easier. Make a med list on the computer. I've even done some interventions lists and rationale lists. Copy and paste. so much easier. Still takes awhile, but way easier. I try to take my Comp with me to clinical, then during post conference, bust out the computer and try to complete my CPs (care plan sheet) before I leave for the day, then I can go home and print that sucker out and I'm done!

QuarterLife88, MSN, RN, NP · Aug 5, 2012

An academic torture device.

RNintraining72 · Aug 5, 2012

For me, what makes doing a care plan so long is writing up all of the meds. Names, side effects, classes, route, dose, frequency, pharmological action. At my school our care plans consist of an assessment tool for each system then we have to write up anywhere from 3-5 priority diagnosis. The write ups for each nursing diagnosis consist of at least 2 short term goals and one long term. Then we have to write what we will assess, therapeutic interventions, and finally what we will teach the client. Then if applicable a referral to a different health care professional.
Personally, I have never spent over three-four hours on a care plan. I always scored in the 90s on them. We did a care plan for each day at clinical. This started 4th week of my first semester. My advice to you buy a care plan book it will help you tremendously. Not only will it assist you in writing up diagnosis but will help you understand the why behind the interventions, teachings, etc... and why the diagnosis is appropriate.

What care plan book would you suggest?????

alex1987 · Aug 5, 2012

At my school our care plans consist of 3 pages of physical assessment + 1 page of psychosocial assessment. Then we have to fill in 1 page with all the meds, allergies, and lab values. We have to collect as much information as we can from our patient by doing a head to toe assessment and interviewing them, and you can also get extra information checking their chart in the computer.

All that information is so important because it is your subjective and objective data which is what you need to write appropriate nursing diagnosis for that patient. Based on those diagnosis then you can start writing your "care plan" in which you'll have to develop each one of those diagnosis giving the goals that you want your patient to meet and what are you going to do to help them (nursing interventions).

It is a very interesting and long process, but I think the more you do it the easier it becomes for you.

My first care plan took me like 10 hours to finish. So far I've only completed 4 of them and the last one took me only like 4 hours to finish. So if you have a great care plan book and get a lot of useful information from your patients in clinicals then you shouldn't be taking 10+ hours to complete your care plans once you have been doing it for a while.

tyvin, BSN, RN · Aug 5, 2012

The plan of care is there to insure that all nurses give the same care 24/7 to insure the short and long term goals are achieved.

mikeicurn, ASN, RN · Aug 5, 2012

Careplans are a little different in school than in the workplace. The ones you do in school are more detailed, because you need to learn what you are doing before you start filling out the "short form" versions. They are usually meant as more of a teaching method so you learn how to use labs, medications and medical diagnoses to apply nursing diagnoses. So, of course they take longer to fill out.

You will learn in school that there are doctor's diagnoses (such as sepsis, cancer, anemia, etc...), and nursing diagnoses. The careplan is filled out by the nurse who is admitting the patient, and every nurse who assumes care afterwords reviews, and if necessary, revises the care plan. This is meant to insure consistant care is given by all nurses.

For example, if I admit an elderly patient who has orthostatic hypotension (their blood pressure drops with they stand up), they would be in danger of falling. A nursing diagnosis might be "risk of injury due to falls related to hypotension". So, then I would apply the necessary interventions to try to prevent the injury. Such as "bed alarm in place", "call button within reach", etc... This would all be called out in the care plan. So when you took over care of the patient you would review the careplan, and initial it. This stays in the patient's chart.

There is an organization called NANDA North American Nursing Diagnosis Association. They put out a list of standard nursing diagnoses. This is the standard my school used and I would imagine a lot of other schools use as well.

Good luck in school, I hope this helps.

libran1984, ASN, RN · Aug 5, 2012

I've been an LPN in a correctional setting and an ED for over 2 years now....

1. Do RNs still create care plans anymore?

2. Was school beneficial to learning the creation if a care plan if the answer to Question 1 is 'yes'?

3. When a care plan is implemented by the RN on a hospital floor (non-ED), does the MD ever disagree with decisions made by the RN?

4. Is a care plan becoming outdated in the hospital setting? Is there a certain population, like LTC, that a care plan is more productive?

5. With so many lawsuits being thrown around, should the RN even create a care plan anymore and then be prosecuted for causing what the recoving surgery patient says is undue pain because he was made to ambulate or even a differnt example with perhaps more validity? (I see enough RNs/LPNs scared to do what is perhaps "right" for fear of being viewed as "wrong" and then being sued. Let alone poor reflection of the HCAHPS b/c the pt didn't get to sleep in until 10am).

6. Is the current state of care-planning just to assist student with critical thinking skills?

When I was a correctional nurse the closest thing I ever saw to a care plan was being encouraged to use NANDA approved nursing Dx for our offenders who came to the clinic. We were then also encouraged to document the various steps of the nursing process that pertained to the offender's visit and schedule a time for evaluation and document the teachings performed. In the ED neither RN nor LPN even does something of the sort, unless its a generic check box.

mikeicurn, ASN, RN · Aug 5, 2012

1. Do RNs still create care plans anymore?

In my area everyone admitted to the hospital or LTC facility has a care plan.

2. Was school beneficial to learning the creation if a care plan if the answer to Question 1 is 'yes'?

I think so, in school you learn the process. The "why" instead of just the "how".

3. When a care plan is implemented by the RN on a hospital floor (non-ED), does the MD ever disagree with decisions made by the RN?

I have never seen this.

4. Is a care plan becoming outdated in the hospital setting? Is there a certain population, like LTC, that a care plan is more productive?

I don't think so. If John Doe comes into the hospital from a LTC with exacerbation of COPD, he will be treated for his COPD, but he also needs to be treated for all the other health problems he had at the LTC facility. If he was a fall risk there, he is gonna be a fall risk in the hospital.

5. With so many lawsuits being thrown around, should the RN even create a care plan anymore and then be prosecuted for causing what the recoving surgery patient says is undue pain because he was made to ambulate or even a differnt example with perhaps more validity? (I see enough RNs/LPNs scared to do what is perhaps "right" for fear of being viewed as "wrong" and then being sued. Let alone poor reflection of the HCAHPS b/c the pt didn't get to sleep in until 10am).

In the facilities I have worked in this isn't optional. It is part of doing an admission. The driving force for change in my hospital is not fear of lawsuits, it's fear of not getting full compensation from Medicare/Medicaid. Case management is constantly digging through charts ensuring everything is done correctly so we get full compensation. It is even more important nowadays for these interventions to be done to ensure the length of stays are reduced, core measure patients are treated correctly, and people are not being readmitted for the same diagnosis over and over again. We have to fill out separate paperwork for most of this, but it is really just an extension of the careplan in many cases in my humble opinion.

6. Is the current state of care-planning just to assist student with critical thinking skills?

Well, like I said above. Care plans in my school were much more detailed, as a means to make you use the critical thinking process. In the hospital our careplans consist of checkboxes. In school we had to write out the nursing diagnosis, the medical diagnosis it was related to, the subjective and objective data, goals, and outcome criteria. It was a learning tool.

If for instance, I get a patient in with dehydration, I don't have to to write out in my care plan that he may have poor turgor, decreased NA+, increased K+, c/o headache, and dry mucus membranes. I am a nurse, I should know that, however as a student I had to show the instructor that I knew it. I also had to detail what was objective, and what was subjective. So part of the exercise was to fill out the careplan, and part of it was to educate me on signs, symptoms, treatments and interventions. I think the careplans in school are a good exercise to tie everything together in a more "real life" manner. I also think they have some value in the hospital/LTC setting. You certainly wouldn't need one in the ER. I wasn't aware if they used them in corrections or not. You taught me something there.

Esme12, ASN, BSN, RN · Aug 5, 2012

care planning is based on determining what the patient's nursing problems are. this is done by using the nursing process which consists of 5 steps, the first of which is assessment. the entire care plan is based on everything that was discovered during assessment. that is the critical thinking or logic of care planning. this is why your instructors are counting you off for not having enough assessment data. nursing interventions are supposed to target the abnormal data that was discovered during the assessment process; that abnormal data is the evidence that supports the nursing diagnoses. all nursing diagnoses, like medical diagnoses, can be broken down into the patient's signs and symptoms to tell a story about the problem. your interventions are solutions to do something for each of those signs and symptoms because that is how you eat away at the problem in correcting it. doctors do the same thing in treating disease. the instructors can tell from the way your care plans are constructed that you are not utilizing the nursing process.

the biggest thing about a care plan is the assessment. the second is knowledge about the disease process. first to write a care plan there needs to be a patient, a diagnosis, an assessment of the patient which includes tests, labs, vital signs, patient complaint and symptoms.

the third is a good care plan book. i use ackley: nursing diagnosis handbook, 9th edition and gulanick: nursing care plans, 7th edition

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:

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)
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)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)

a care plan is nothing more than the written documentation of the nursing process you use to solve one or more of a patient's nursing problems. the nursing process itself is a problem solving method that was extrapolated from the scientific method used by the various science disciplines in proving or disproving theories. one of the main goals every nursing school wants its rns to learn by graduation is how to use the nursing process to solve patient problems.

just like you need a recipe care to make a cake from scratch. a care plan is your recipe card to caring for your patient and what to look for while you are caring for them.

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