What EXACTLY is a care plan?

[DisneyNurseGal]

There are a lot of posts on this site about care plans; however, while I can somewhat guess what they are, I was wondering if someone could explain them to me. What are they? When in Nursing School do you do them? Why are they so difficult? I have people say on this site that "if you spend 10 hours on a care plan, that's not enough" why do they take so long? What is the length of one of them?

I am sure my answers will be addressed when I start school later this month, I just like to know what's coming up!

Thanks

[skulskcc01]

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

Amazon.com: All-in-One Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric Nursing Care Plans (All-In-One Care Planning Resource: Med-Surg, Peds, Maternity, & Psychiatric Nursing) (9780323044165): Pamela L. Swearingen RN:

and this one are the two I use. But stop at barnes and noble and skim through a couple. See which ones you like.

Amazon.com: Nursing Care Plans: Diagnoses, Interventions, and Outcomes, 7e (9780323065375): Meg Gulanick, Judith L. Myers: Books

[Melissa0181]

Care plans were the end all and be all of our clinical rotations. We would go to our assigned hospital setting the day prior to clinical to pick out a patient to "work up". We would gather information on the patient's medical diagnoses and treatment plan, write down all meds (including prn's), the results of blood work and radiology testing, and what history we could find in the chart then interview the patient for additional background information. No hands on touching of the patient during this preclinical info gather session. After that the real "fun" begins. Writing a separate page on the pathophysiology, risk factors, medical management, and prognosis behind each medical diagnoses. Looking up pertinent information on each medication the patient is taking including its pharmacological class, onset/peak/duration, side effects, and appropriate interventions. Looking up reasons why lab values would be high or low and what this indicates. Looking up what abnormal radiology tests meant. This all has to be written out. From that information we could develop as many pertinent nursing diagnoses as our instructors wanted. Then you decide your interventions based on the nursing diagnoses you came up with. Each student nurse had to pick their own patient so there was no overlap. Everything is patient specific so at each step you must link the information you learned to your patient's condition. Expect this to take at least 8+ hours in the beginning and closer to 6+ hours towards the end of nursing school. It's stressful and time consuming but you learn valuable information in the process. Oh, and I think my typical care plan was right around 18-20 pages in length using 12 pont font and 1 inch page borders.

[RNsRWe, ASN, RN]

Care plans were a device designed to thoroughly acquaint the student with all aspects of the patient's care/dx/tx/etc. However, I found they bore exactly ZERO similarity to what I did eventually as an acute care hospital RN. In fact, I never once used anything remotely like the care plans I did while in school.

I believe there must be a more modern, more usable format for teaching students these same critical thinking skills, rather than antiquated care plans. Unfortunately, I don't know what that might be and obviously the nursing instructors still believe there's enough validity in using them that they do just that.

Too bad mastering the written care plan is still the focus; maybe one day students will benefit from a forward-thinking teacher who devises a more real-world plan of education for aspiring nurses.

[itsnowornever, BSN, RN]

It has gotten to the point that I can do a care plan in my sleep. I was told that the reason for the care plan is so that students who can't critically think in their head quickly, can lay it out on paper and see where the flow of care for the patient comes from. There are things called "Critical Care Pathways" that are standard care checklists for things like CHF, COPD, MI and the like, and this is where the hospital care is based. The goal of the care plan is for you to see how the CCP lines up with your patient. To double check your care plan you should literally be able to draw a line and connect the dots through your care plan. I wish we could post them here, then I"d post you one of mine so you can see what it looks like, but I think that's a copy right issue. So, I'll try to explain.

JD has hypercalcemia. What is JD's cultural background, is this something that can be linked to a cultural problem? Does he have high cholesterol (according to evidence based practice, patients with high cholesterol usually have high potassium because of the drop in fatty foods and steep increase of healthy foods in combination with medications for cholesterol that can cause high potassium). What other lab values are associated with the hyperkalemia? What risks do those values cause? What is his EKG looking like (peaked T wave)? What are the risks there? What is his past medical history? Does that relate (look at cholesterol there)? High potassium causes muscle weakness and dizziness, so he is also at risk for falls. What is the plan to decrease his potassium levels (insulin or kayexelate)? What risks do those cause? (hypoglycemia)...and so on and so forth. There should be a line that links to each subsequent box showing that you are addressing all concerns and risks. If you state that he also had a stroke three years ago (in his medical history) but didn't mention risks and actual problems related to the stroke currently, then you would get points off because you didn't finish connecting those dots, which may mean that you dont understand that the stroke adds to the fall risk, adds additional risks like neglect and aspiration potentials.

Write enough of them and in your head you can start to see all the stuff that can go wrong with your patient, all the things you need to prevent take careof and teach your patient.

They are annoying and painful, but really do help you see the larger picture of your patients, and when you dont have to write them anymore, you can see them in your head and better care for your patients.

[Elladora]

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)
   

good ol' adpie. a cold shiver just ran up my spine...

[Esme12, ASN, BSN, RN]

Good ol' ADPIE. A cold shiver just ran up my spine...

Sorry.....

[staceym]

Thanks for this... I've been really curious about care plans as well. My program begins in 4 short weeks.

[mlykateRN]

When I was in school 10+ years ago, I thought care plans would be the death of me....now y'all have a lot more technology than I did, but my trick to a quick (ie about 3hrs) careplan was to make a template on word. My care plan books came with CD's and cut and paste was my BEST friend! I would just pick the dx's that applied to my patient and go from there. Our care plans were more like maps and I just made that on my computer and cut and paste! Simple. I always made top marks on my care plans....consistancy is key. You are going to use the same dx over and over, the interventions should be somewhat the same, that's what helps you create a care plan in your mind (we don't realize we do it , but we do) when you are a nurse.

As for the drug portion, same applied copy and paste are your friend. Make yourself a template and go to town. Simple and to the point.

Hope this helps some of you.....hope care plans have not changed enough that this is outdated.

Oh yeah.....your clinical site should have ready made care plans avaliable. I can remember when I had a patient that I couldn't make a dx fit, I would look at the care plan that the nurse had used in her assessment. They are simple and probably will not be enough to get by, but they definately will give you a start. (Yep....if you work in bedside care you will be doing care plans for the REST of your life!!!!!!!!)

Good Luck!

PS....I always had fun with care plans. If anyone has any trouble, message me I would love to take a look!

MLYKATE

[Esme12, ASN, BSN, RN]

Don't forget about the nursing student assistance forum!

Many of us hang there to help with care plans. I won't do it for you....... for it is important to use it to learn how to begin that "critical thinking" and "nursing process" that you will use on every patient......even if it isn't labled as such. Show me where you are lost or what you have done....I and a few other regulars will help lead you to what you need and shed light to help you begin your thought process.

[BlueEyedGuy]

I think it's all just an academic exercise to prove you can speak the academic nursing language. People have said this, but it's really just laying the nursing process out in a formal way.

-A Nursing Dx is just a formal statement about a current or potential patient problem that you observe.

-How do you make this observation? Well, it's based on what you find in your assessment.

-Planning: I was taught goals= outcomes, so if you see these word they interchangeable. Make sure you statements include: the client, the goal, and a time frame. ie. "The client will ambulate 3 times this shift."

-Interventions: What are you as the nurse going to do?

-Evaluate: I always just took my goals and put it as a question: 'Did the client ___?' or 'How well did the client ____?'

That's essentially the care plan part of the care plan. We had a several page physical assessment sheet to fill out. Then the had a table to put all the patient meds, side effects, etc. Also, a sheet with all the labs, and we had to find a rationale why any abnormal values were abnormal.

Finally, we had the concept map, which depending on your instructor can mean any number of things.

____

Depending on where you work, patient care plan can mean a number of things. If you have electronic charting, you might just select from a list of patient needs ion the computer. I've also seen, people charting them as whatever patient problems the nurse sees, but never in the formal NANDA diagnosis way.

I'm in the second half of my BSN program, so I'm technically a senior, I guess. They streamlined the care plans for us this semester, and we don't actually do the care plan part of it; we just do SBAR, assessment, labs, meds, and a concept map. I think more emphasis on the concept map is good. It helps you think about how disease affect different body systems more, and how things are all interrelated.

EDIT:

Finally, I used the Ackley & Ludwig book, the electronic copy so it was easily searchable. I don't know if I'd use it again. I recommend just using the free resource for that book on the evolve/elsevier website. That thing almost writes the care plan for you.

[CRNBSN18]

Was a care plan book not a required book for your classes? We are required to our purchase one and it was in the booklist. I think it's ulrich or something like that. I haven't gotten mine in yet though-- should be here Monday!

[BlueEyedGuy]

nanda's are so dumb sometimes too, and it will be frustrating.

my patient is here for a gi infection. hmm... what is a good nursing dx? how about infection? oh, wait that's not in the book. so then you have to settle for risk for infection, which makes no sense, "risk for infection r/t infection as evidenced by pooping here brains out"

one of my instructors was so fed up with this whole nanda dx thing. she had us use ones that weren't in the book. here two favorite were:

-tissue injury (which is super useful if you're allowed to us it)

-ineffective tissue perfusion (which is sort of in the book

ineffective peripheral tissue perfusion or and bunch of "risk for" ones for different systems)