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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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  • Demetrice_029

    cuttie

    over 4 years ago

    1044 comments

    I agree, It does teach you how to think like a nurse.

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    jevwl

    over 4 years ago

    26 comments

    Care plans teach you to think like a nurse.

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    lynnmorgan0916

    over 4 years ago

    2 comments

    This is just another piece of paper that has to be filled out and waste time and money doing so. No one pay attention to the care plans.

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    kbugaj

    over 4 years ago

    4 comments

    As a nursing instructor, my first comment is: "Wikipedia, " is NOT a valid resource for a definition of a nursing care plan! Try beginning with a reputable resource. Second, whether a nursing care plan is written on paper, or entered into a computer, unfortunately, even those of you who answered I ahve "never used them," actually do. There is NO nursing care provided that cannot be directed back to a care plan. Why? Because insurance companies, medicaid and medicare will not reimburse you to do ANYTHING that is not in a plan of care. JCHAO and most Health Dept. regulations mandate them to comply with federal medicare requirements. The method of teaching them may be what is not current and "not used." However, all nurses use them because if you don't, it may cost you your nursing license. If you think you aren't using them? Ask your Nurse Manager, or QA/QI person if you do! Do you ever care for a patient in isolation? Do you have to wear gloves and a gown? Why????? Because the patient has "Infection, related to: adverse side effect of antibiotics, As evidenced by: C-difficile in stool specimen. Expected Outcome; Patient will be free of C-difficile by discharge. Nursing Interventions: 1) Post sign outside door notifying of precautions Rationale: to prevent any unknowing transmission of spores outside of patient room. 2) Wear gloves and gown whenever entering patient room. Rationale: to prevent uniform from being contaminated and spreading spores to other patient rooms. 3) Wash hands with soap and water before exiting room, do not use alcohol based hand sanitizers Rationale: Spores can only be killed by sterilization. Alcohol sanitizers help spores to stick to the hands. The best way to eliminate spores is to cause emulsification with soap so they easily slide off the hands and down the drain.
    Now, if you have EVER cared for a patient with C-difficile, you HAVE used a nursing care plan. If you don't recognize it as such, well, then you either had poor professors, or you were a poor student, or both.

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    jwilson7873

    over 4 years ago

    2 comments

    The most pointless, worthless things in the world. They were created by nurses who felt inferior to physicians, so they created these to make themselves feel better. There is no legitimate research done that indicates these things have significant effects on patient outcomes. What an absolute waste of time.

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    pittrn

    over 4 years ago

    6 comments

    We teach our students that they must have a rationale to explain the reason why they are implementing a certain procedure. This gives them more insight into the purpose for their particular plan of care. They must also document their reference source.

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    mvsclan5

    over 4 years ago

    10 comments

    as a nurse of 30yrs. care plans may seem like a waste of time but in a court of law you are covered because of your care plan and when it was resolved.

  • Avatar_blue_butterfly_max50

    PaganDeva2000

    over 4 years ago

    6 comments

    I think they are useless. No one else reads them but other nurses. Physicians look at them as gibber-gabber, don't refer to the contribution made by nurses or even respect them. I think they are helpful for school, but otherwise, no.

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    Account Removed

    over 4 years ago

    Very helpful article! Thanks a lot!

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    Emmatol

    about 5 years ago

    186 comments

    'The true identity of a scientific nurse is the effective use of Nursing care plans'

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    Andrea00

    about 5 years ago

    6 comments

    I am a beginning nursing student, and this article helped out alot. I just had a test on Nursing Dx yesterday, and it is very hard to not put a medical dx in it. With a little more practice, this process should become nomal for me. Thanks for all the helpful comments!

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    saspeedster

    about 5 years ago

    4 comments

    They are useless....pie in the sky stuff. In my fifteen plus years of nursing I have never refered to them once. I have worked ER, ICU, TELE, and Med Surg, "nuff said"

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    rosanski

    about 5 years ago

    4 comments

    You cannot use a medical diagnosis as the R/T in a nursing diagnosis. "A nursing diagnosis focuses on patient response, whereas medical diagnoses focus on the disease process" (Newfield, Hinz, Tilley, Sridaromont, Maramba, 2007)

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    Fracas

    about 5 years ago

    2 comments

    You can use a true medical diagnosis if it has been made so by a doctor. This should actually be a three part diagnosis for example Altered respiratory status related to pneumonia evidenced by pt's shortness of breath(SOB). The pneumonia is an actual medical diagnosis and for it to be measurable you can objectively see if a person is SOB or he can also verbally state it to support the diagnosis further. Care plans can seem like a pain but I have seen care plans work as fast as 3 or 4 hours in some medical scenes if the plan is implemented and followed through.

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    marieowe

    about 5 years ago

    2 comments

    Care plans help us to outline care for our patients. Simply put nursing dx is the actual or potential problem; the plan identifies what you want to do about the problem; the interventions list your action to resolve the problem and the evaluation identify if your actions work.
    A key component : you have to know about the disease process and how it presents in the patient in order to develop a plan of care.

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