Nursing Care Plan as Learning Tool Introduction
Nursing Care Plans (NCPs) are a foundational component of nursing education and practice, providing a structured approach to patient care. They reflect the nursing process, a critical thinking model that guides nurses in delivering comprehensive and individualized care. This detailed exploration of NCPs highlights their definition, impact on nursing education, historical development, and the formulation of care plans and outcomes.
What Is a Nursing Care Plan?
Nursing Care Plans are systematic frameworks used to guide the practice of nursing. They are “a written reflection of the nursing process” (Ackley & Ladwig, 2014; Gulanick & Myers, 2014, p. 3). The nursing process is a critical thinking approach that helps nurses identify and address health problems, aiming to assist clients and their families in achieving optimal health and self-efficacy (Ackley & Ladwig, 2014).
The components of the nursing process used in developing NCPs include:
- Assessment: This initial phase involves gathering subjective and objective data through health interviews, physical examinations, and medical record reviews. The goal is to obtain a comprehensive understanding of the patient’s health status to plan holistic care.
- Diagnosis: Based on the assessment, nursing diagnoses are formulated. These diagnoses are clinical judgments about individual, family, or community responses to actual or potential health problems/life processes (Herdman, 2012, p. 515).
- Planning: In this phase, nurses establish client-centered outcomes. These outcomes should be “specific, measurable, attainable, realistic, and timed” (Ackley & Ladwig, 2014, p. 7), ensuring that the goals set are achievable and clear.
- Implementation: Interventions are planned and executed based on clinical judgment and knowledge. These are actions performed by the nurse to enhance patient outcomes (Bulechek et al., 2013, p. 2).
- Evaluation: After implementing interventions, nurses evaluate the client’s responses to determine whether the expected outcomes were achieved. The NCP is revised as necessary based on this evaluation to ensure ongoing effectiveness.
Learning Impact of NCPs in Nursing Education
In nursing education, NCPs serve as a vital teaching tool that helps students grasp the dynamic nature of the nursing process. By engaging with NCPs, students learn to validate nursing diagnoses, identify related factors, and define characteristics based on assessment data. They also select, individualize, prioritize, and implement interventions, and evaluate if the outcomes were met.
Several models assist students in understanding care planning:
- Gordon’s Functional Health Patterns: This model helps students organize assessment data to identify nursing diagnoses related to common patterns of client responses (Gordon, 2010).
- Carpenito’s Bifocal Clinical Practice Model: This model distinguishes between nursing diagnoses managed with nurse-prescribed interventions and collaborative problems treated with both independent and interdisciplinary interventions (Carpenito, 2014).
- Concept or Mind Maps: These visual diagrams illustrate the relationships within the nursing process, aiding students in understanding how various aspects of care planning interconnect (Doenges, Moorhouse, & Murr, 2013; Gulanick & Myers, 2014).
- Clinical Pathways or Care Maps: These tools provide guidelines for interdisciplinary client care, incorporating NCPs to evaluate health outcomes for specific populations and monitor resource utilization (Gulanick & Myers, 2014).
NCPs also help bridge the gap between classroom learning and clinical practice by linking cognitive knowledge, such as critical thinking and clinical reasoning, with technical skills and professional attitudes.
History of NCPs in Nursing Education
The concept of Nursing Care Plans began to emerge in the 1930s. Henderson (1973) noted the importance of coordinating care through written plans, as nurses cannot provide 24/7 care alone. By the 1960s, the nursing process became a focal point in clinical care methodology, and the need for a common nursing diagnostic classification system was recognized (Gordon, 1979, p. 487).
The first National Conference on the Classification of Nursing Diagnoses in 1972 marked a significant step in defining the nursing profession (Gebbie & Lavin, 1975). The development of standardized taxonomies, such as:
- North American Nursing Diagnosis Association-I (NANDA-I): Provides a comprehensive list of nursing diagnoses (Herdman, 2012).
- Nursing Interventions Classification (NIC): Outlines specific nursing interventions (Bulechek et al., 2013).
- Nursing Outcomes Classification (NOC): Defines outcomes to be achieved through nursing interventions (Moorhead, Johnson, Maas, & Swanson, 2013).
The advent of computerized Nursing Care Plans (CNCPs) has further revolutionized nursing practice by integrating with electronic health records (EHRs). CNCPs enable the profession to mine rich databases for evaluating nursing contributions to health care. However, concerns about CNCPs include issues related to access, efficiency, care individualization, specialty deficiencies, system design, and privacy (Lee, 2005).
Formulation of Care Plans and Outcomes
As healthcare continues to evolve, nurses will play a critical role in identifying the root causes of problems, preventing reoccurrences, and promoting optimal health (Ackley & Ladwig, 2014). Nurses will partner with clients and their families to navigate complex healthcare systems and develop self-management skills.
To address emerging healthcare trends, nursing must develop innovative NCPs that incorporate new standardized diagnoses, outcomes, and interventions. This evolution creates opportunities for advancing nursing education, practice, and research.
The increasing use of technology in healthcare presents both challenges and opportunities. Nurses must be adept at utilizing various technologies for data access, care planning, and documentation (Ackley & Ladwig, 2014). Faculty must ensure that nursing students are well-practiced in using these technologies to develop effective NCP skills.
Further research is needed to evaluate the impact of technology on the nursing process, particularly regarding CNCPs and data mining in education and practice. Regardless of the resources or technologies used, it is crucial for faculty to guide students in selecting appropriate interventions, understanding their rationale, tailoring them to individual client needs, and ensuring that interventions are based on current evidence and best practice guidelines to deliver high-quality, safe nursing care.
Conclusion
Nursing Care Plans are essential tools in nursing education, offering a structured approach to patient care that integrates critical thinking, assessment, and evidence-based practice. They have evolved significantly over time, reflecting advancements in the nursing profession and healthcare technology. By understanding the historical context, learning impact, and formulation of NCPs, nursing educators and students can enhance their practice and contribute to the continuous improvement of nursing care. As technology continues to shape the healthcare landscape, ongoing research and adaptation will ensure that NCPs remain effective in meeting the needs of patients and supporting the development of future nursing professionals.