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Care Plans: Worthwhile or Worthless?

Care Plans: Worthwhile or Worthless?

Beth Anderson, RN BSN

You can find some lively debates on the value of writing care plans and using nursing diagnoses. Some argue that they are a waste of time and not very useful. Others argue that they are absolutely essential to advance the field of nursing. The bottom line is that if you are a nursing student, you need to know how to write one because chances are, you will be given care plan assignments on a regular basis.

So what do you need to know about Care Plans?

First of all, you need to know what one is. Here’s the Wikipedia definition:

“A nursing care plan outlines the nursing care to be provided to a patient. It is a set of actions the nurse will implement to resolve nursing problems identified by assessment. The creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing provision of nursing care and assists in the evaluation of that care.”

It’s basically an outline of the care you intend to give to the patient, and the rationales behind that care. It describes exactly what needs to be done for the patient and why, from a nurse’s point of view, and it does this by using the nursing process. The easiest way to begin is to break the nursing process down into a series of questions:

Assessment – What does the patient look like?

In this step you will use your assessment of the patient to describe their current state. You will describe what it is about the patient that is causing them to seek medical care, or causing them to be hospitalized. For example, if the patient is in pain, you would describe the pain in your assessment: “Patient reports pain at the incision site at 7/10 on the pain scale.”

Career and Educational Information

Diagnosis – What is the patient’s problem?

In this step you will create a nursing diagnosis for the patient. Don’t confuse the nursing diagnosis with a medical diagnosis. A nursing diagnosis describes a patient’s response to a condition, rather than naming the patient’s actual condition. For example, a medical diagnosis might be “Thrombocytopenia (or a deficiency of platelets in the bloodstream)” and a nursing diagnosis would be “At risk for bleeding.”

Plan – What are you going to do about it?

Your plan is what you intend to do for the patient. If a patient is one day post-op then the plan might be to get her out of bed to a chair two times a day. If she has pain issues then the plan would be to administer pain medication and then reevaluate her pain level.

Implementation – What did you end up doing about it?

This is where you carry out the above plan. What were your actions and how often did you do them?

Evaluation – Did your plan work?

This is where you describe your patient’s response to your intervention. Take the patient who was in pain. You might say, “Patient received 2 mg Morphine IV and patient is now reporting a pain level of 1/10 on the pain scale.”

You might be saying to yourself at this point, "This seems like a lot of documentation. Is this actually something that I will be using in the “real world?”

In a sense, the answer is yes, you will use a care plan every time you see or care for a patient. The difference between writing a care plan in school and using one in your professional practice, is that in the real world, the flow of the care plan is going to seem much more intuitive, and it will be easily integrated into your charting.

Let’s put this all together and apply it to a patient who has come to the hospital with Pneumonia. Here’s an example of what his care plan would look like:

Assessment: The patient has SOB (Shortness of Breath) on exertion.

Diagnosis: Altered Respiratory Status related to pneumonia

Plan: Administer 02 and check vital signs every 4 hours.

Implementation: The patient has been maintained on 2L NC (2 liters via nasal canula). Vital signs have been checked every four hours and have remained WNL (within normal limits).

Evaluation: Pt is able to get out of bed and sit in his chair without feeling SOB.

Mind you, this is only one aspect of his plan of care. A patient with pneumonia will probably have numerous interventions while he is in the hospital, and so you could include each of these interventions within your care plan. This may seem like a lot of work if you are a nursing student, and many nights you will find yourself staying up and writing these things before you show up for your 7AM clinical. (Hey – I didn’t invent the system- I’m just trying to help you get through it!) If you break it down into simple steps, it becomes a much easier process.


Would you like to submit a sample care plan? Please submit one or more to assist other nurses.



      

      

      
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    Sunclam

    6 months ago

    2 comments

    I've been nursing for 33 yrs and can't believe we're still having this argument. As a matter of fact, why are we still having to fight for staffing, etc. Care Plans are a necessity for nursing, but it needs to be changed. The process is excellent, but our lives are now economically as well as evidence based. We need to change our care plans to reflect what we really do and establish a economic baseline for cost and quality indicators. Nursing should be a stronger entity in hospitals, nursing homes and home health. We should have a stronger and more collaborative influence with physicians and other providers in the care of patients. I'll be honest, I've never liked care plans and have serious concerns in their use and individualization in Electronic Medical Records. Nurses should always be the leader and director in coordinating patient care, diagnostics, and other services. A good nurse is the captain of patient care. Nurses do not have to continue to prove their importance, but a economic and quality identifier to support the care plan and actual nursing actions (which we perform instinctively as we gain experience). will add value and power to our field. I love being a nurse. Judith

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    wvrn

    12 months ago

    2 comments

    In the opening paragraph written above, there is a statement that EXACTLY sums up the purpose of nursing careplans."Others argue that they are absolutley essential in advancing the field of NURSING." Really.....we are still having to argue the point of why you need a nurse to save your life! I don't have the time or patience to convince some regulatory agency why my profession is needed. I'd much rather be advancing the needs and goals of my patients. Furthermore, let's not kid ourselves that nurses aren't a part of the medical model and medical diagnosis. Physicians say "thrombocytopenia, and can charge under a DRG. I have to say"risk of bleeding." Cmon folks!!! We're both talking the same language---when will nurses be recognized as colleagues, collaborators, and executors of the medical model and plan of care? Nursing careplans are forgone conclusions.

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    Deepsea_diver

    about 1 year ago

    2 comments

    I have not seen or even heard of a nursing diagnosis or care plan since I graduated 13 years ago. Personally, I believe they are a total waste of time for nurses and nursing students. In my area of the country, nurses provide care following hospital policy and procedures based on physicians orders, not nursing diagnosis or care plans, I have worked in multiple magnet facilities none of which utilize care plans and all deliver the highest quality care. It's sad that nursing school is not evolving and changing as healthcare changes. Nurses want to be viewed as a valuable team member but our educators are still teaching concepts that have no value in the real world.

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    AILENLEIVA

    over 1 year ago

    2 comments

    I have a dual opinion: For Nursing students, an absolute must, as it helps identify problems and outline the care to be given to the patient in an organized matter. It is the way to develop critical thinking skills in future Nurses; however, once you are actually working in the field, not only are they worthless, but annoying, time-wasting and pointless; matter-of-fact, most RN's, if not all, do not pay attention to careplans or base their thinking process on them: Nursing comes from natural and learned critical thinking skills, as well as ongoing evaluations on the patient current status. Having a pre-arranged plan may work for Social Workers, but Nurses's functions on much more than a Careplan. Absolutly worthless in my opinion and the shared opinion of over 100 RN's working with me (I took the time to do my own research, to send a letter to the ANA). Hopefully in the future someone in the higher chair with a brisk of common sense will realize and eliminate yet another paperwork in the way of real, hands-on patient care.

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    lafn63

    almost 4 years ago

    16 comments

    I agree, care plans were created by nurses who needed to feel more important. I think they may be good for students, but they really are just common sense. Liability comes from the Standard of Care, which every facility has, and every nurse learns in school and on the job.

  • Owl_max50

    WiseOldOwl

    almost 4 years ago

    78 comments

    Being threatened with 'you will lose your license if you do or do not ______ (fill in the blank) is a ridiculous and inappropriate thing to use to 'scare' a student or new grad into accepting something just because it is there. It is every nurses' responsibility to know what is and what is not allowed under his or her State's Nurse Practice Act.
    That is like the 'Joint Commission requires _______ ' comments that I have heard so many times. REALITY CHECK-the Joint Commission is NOT that specific! They do not wear white cotton gloves and swipe under the patients' toilets. The surveyors look at PAPERWORK and statistics, which are always alterred to meet the requirements just before an inspection is due. In fact, if they were to show up unannounced, NO HOSPITAL in the country would pass!
    Don't let anyone scare you with such nonsense. It is bullying, unprofessional and tossed at you by people who make up their own version of the 'rules'.

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    saulsberry

    almost 4 years ago

    2 comments

    care plans are a must, how would you knowwhat to teach without a care plan? i have been nursing for 16 years, and care plans drives your care, lets keep them!!!

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    floraorr

    almost 4 years ago

    4 comments

    im a very mature first semester student . could you please send me a care plan or any other notes that might help me get on my way. Im just passing books and essays dont come easy for me. flora
    floraorr1@hotmail.com

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    fuzzybug

    almost 4 years ago

    12 comments

    Care plans are OK if only they were written in plain language. Nursing diagnoses are nonsense. I was just talking about them this morning to someone. Nursing plans are a useful guideline for treatment. Nursing diagnoses are a waste of time, as someone has already written. I agree!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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    ya_ag

    almost 4 years ago

    16 comments

    I'm a nursing student...and actually I don't see the NOs here doing care plans...but they still give good care...and they know the pt's case sheets better than anyone....I'm not saying its not important just saying what they do here...but I was wondering if one day a patient wants to take you to court does the care plans actually help you or not??

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    virginiaNM

    almost 4 years ago

    2 comments

    Nursing care plans use over-inflated language to describe what medicine has already defined using far less words. Unfortunately, less time is spent learning the hard sciences while in nursing school and more emphasis is put on justifying what is common sense. Get caught criticizing care plans & nursing diagnoses & your instructor may try to scare you with "know this or put you're license on the line" or some form of this phrase. The truth is, nurses don't lose their licenses for not memorizing the 500+ nanda babble pharses. Nurses loose their license for other such tangible stupidity... i.e. outright negligence, diverting narcs, ect.

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    Patientsarefirst1

    almost 4 years ago

    2 comments

    Nice. I like this articule because It helps to remember when I was in the Nursing School, with the difference that now make more sense to me and is more easy to understand whit the practice.

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    Account Removed

    almost 4 years ago

    Care plans are for non-medical persons who are not all that familiar with what is going on with a patient. ie., social workers, family members, administration, student interns, and so on who are legally able to access a patients medical documentation. Yeah you know what is going on but others may not. I did care plans from a medical and non medical perspective and you could see who did and didn't do what was documented. If they said they did it and the evidence shows otherwise, then you know who to begin with during investigations. There are sly foxes who know how to get around actually working like they should and document it anyway but they are usually caught up to at some point and time. Care plans are not always necessary but it keeps a system of checks and balances in place, kind of.

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    WiseOldOwl

    almost 4 years ago

    78 comments

    Mon Dieu! I had hoped that somewhere in the 21st century the 'nursing diagnosis' had died on the vine. THAT is the most foolish, useless waste of time and energy that the profession has ever dreamed up. Try calling a surgeon at 3 AM and telling him that his postop mastectomy patient has 'an alteration in comfort'. Then hold the phone waaayyyy out so that you do not yourself become 'communicably challenged' with a ruptured eardrum. PAIN is PAIN, and MDs, PAs, therapists and everyone else in the medical system uses a 1-10 scoring system to assess it.
    The handwritten care plan was necessary when we were a pencil and paper society and men went to the moon using computers which were the size of deluxe refrigerators and operated with punch cards.
    Now, the hospitals and facilities into which most RNs will work have transformed medical records AND nursing care plans/paths into electronic formats, some even by law. Remember the Stimulus Bill of 2009? There is a 140 page section which would mandate an electronic medical record NATIONAL DATABASE from birth to death. As anyone who follows this kind of thing knows, ANY computerized database can and will be 'hacked into'. Nothing is foolproof to a computer geek who is willing to sell information to the highest bidder.
    However, because nurses must work with the data and plans/paths which are already adopted by their facility and in operation, I recently made the case for a basic electronic care plan program, which could be adapted/upgraded as the courses require, for the undergraduate curriculum in that committee at the local university School of Nursing. It is the reality of healthcare now, and we must prepare future nurses to be able to work with that reality.

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    bdfoote

    almost 4 years ago

    2 comments

    I am a 2nd quarter student and would like suggestions on the best website for care plans or the most useful Careplan books. Thanks for the article...being a previous Childrens Protective Services Worker is the where I first learned first hand how care plans protect your behind from the blood sucking, ambulance chasing attorneys...and they aren't so bad for as me as student either...

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