Use of Nursing Care Plan In Nursing Education
What Is Nursing Care Plans
Nursing care plans (NCP) provide an organizing framework for the practice of nursing and are “a written reflection of the nursing process” (Ackley & Ladwig, 2014; Gulanick & Myers, 2014, p. 3). The nursing process is a critical thinking approach used to identify and treat problems; it provides for guidelines for care to assist clients and their families in reaching self efficacy goals and optimal health (Ackley & Ladwig, 2014) Nursing process components used to develop NCP's include:
(a) assessment
(b) diagnosis
(c) planning
(d) implementation
(e) evaluation.
During assessment, nurses gather subjective and objective data via health interviews, physical examinations, and medical record reviews to plan holistic care. Based on this assessment, nursing diagnoses are identified, which are defined as “a clinical judgment about individual, family, or community experiences/responses to actual or potential health problems/life processes” (Herdman, 2012, p. 515). In planning, client centered outcomes are decided based on mutual goals and should be “specific, measurable, attainable, realistic, and timed” (Ackley & Ladwig, 2014, p. 7).
Interventions are
“defined as any treatment based upon clinical judgment and knowledge which a
nurse performs to enhance patient/client outcomes” (Bulechek, Butcher,
Dochterman, & Wagner, 2013, p. 2). After implementation of planned
interventions, nurses evaluate client responses to determine attainment of
expected outcomes. and the NCP is revised as needed.
Learning Impact of NCP In Nursing Education
In education, NCPs are used as a teaching-learning tool to help
students understand the dynamic nursing process. Students validate their use of
nursing diagnosis by identifying the related factors (contributing) and
defining characteristics (signs and symptoms) based on assessment findings.
Students select, individualize, prioritize, and implement interventions and
evaluate if client outcomes were met to complete the process NCPs also assist
students to integrate classroom learning with clinical experiences by linking
cognitive knowledge, including critical thinking and clinical reasoning, with
technical skills and attitudes needed for professional nursing practice.
Several models are commonly used to assist nursing students to understand care planning Gordon's (2010) functional health patterns are helpful to organize assessment data to identify the nursing diagnoses associated with common patterns of client responses. Carpenito's bifocal clinical practice model (Carpenito, 2014) describes how nursing diagnoses, managed with nurse-prescribed (independent) interventions, differ from collaborative problems treated with both independent and interdisciplinary (dependent) interventions.
Concept or mind maps, which are visual diagrams of a client's medical and
nursing problems, assist students with care planning by illustrating the
relationships within the nursing process (Doenges, Moorhouse, & Murr, 2013;
Gulanick & Myers, 2014). Clinical (critical) pathways or care maps are
another method to provide guidelines for interdisciplinary client care. These
tools often incorporate NCPs and are used in practice to evaluate health care
outcomes for specific populations, monitor resource utilization, and make
comparative judgments (Gulanick & Myers, 2014).
History of NCP In Nursing Education
Although the concept of NCPs began to appear in the literature in the 1930s, Henderson (1973) noted, “Since no one can nurse a patient 24 hours a day, 7 days a week, it has always been important to coordinate the efforts of those caring for a sick person through a written plan of some sort” (p. 379). In the 1960s, the “nursing process began to be emphasized as the methodology of clinical care,” and the need for a common nursing diagnostic classification system was recognized (Gordon, 1979, p. 487).
Since the first National Conference on the Classification of Nursing Diagnoses in 1972, the use of nursing diagnoses has helped to define the profession (Gebbie & Lavin, 1975). Nursing has continued to refine and develop NCPS, adopting standardized taxonomies to provide a common language for documentation and research. These standardized taxonomies include:
(a) North American Nursing Diagnoses Association-l nursing diagnoses (Herdman, 2012)
(b) Nursing Interventions Classification (NIC: Bulechek et al, 2013)
(c) Nursing Outcomes
Classification (NOC: Moorhead, Johnson, Maas, & Swanson, 2013)
Computerized NCP (CNCPs) are becoming the norm due to the increased
use of electronic health records (EHRs). CNCPS and other information systems
utilizing dis tinct taxonomy codes of nursing enable the profession to mine
rich databases to measure the unique contributions of nursing to health care.
Despite possible advantages, Lee (2005) documented nurses' concerns related to
CNCPs which included inconvenient access, reduced efficiency, inability to
individualize care, nursing specialty deficiencies, poor system design, and
privacy and legal issues.
Formulation of Care Plan and Outcomes
As health care is restructured, nurses will play a key role in assisting providers to determine the underlying cause of a problem (root cause thinking) to prevent re-occurrences, prevent readmission, and promote optimal health (Ackley & Ladwig, 2014) clients and their families will partner with nurses to navigate increasingly complex health care systems and learn self-management skills needed for health promotion, as well as acute and chronic care (Gulanick & Myers, 2014).
To address these health care trends, nursing will need to develop innovative NCP's using new standardized nursing diagnoses, outcomes, and interventions, creating exciting opportunities for nursing education, practice, and research.Nurses will continue to experience expanded uses of technology to access data, plan care, and facilitate documentation (Ackley & Ladwig, 2014). Faculty will need to ensure nursing students have ample practice using various technologies to develop NCP skills.
Further research is needed to assess the effects of technology on the nursing process, especially the use of CNCPS and data mining in nursing education and practice. Regardless of which NCP resource or technology is used, faculty must help students determine the appropriateness of interventions, understand the underlying rationales, tailor the interventions to meet individual client needs, and stress that interventions must be based on current evidence and best practice guidelines to provide high quality, safe nursing care.
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