Blech. I've written 3 care plans this year, one for each of my clinical rotations. They are essentially full-sized research papers worth a huge chunk of my final grade.

Care plans are fickle creatures. We never had a proper care-plan-class, which really irritates me. I mean, I had to take English (again) to ostensibly learn how to write papers, but I don't have to take a care plan class to learn how to write care plans? Especially when I have never seen a care plan in my life and said care plan has the same impact on my final grade as any research paper had?

So because the learning curve was kind of steep (last semester we were briefly introduced to the nebulous concept of writing a care plan, and all of a sudden this semester we were told to Write A GOOD One Because It's Worth 30%), I had a lot of self-learning to do. Something I do frequently, it seems...

As part of the framework required to write the care plan, my school assigned the following guidelines:

• Patient's age, gender, marital status, religion, allergies, admission date, diet, activity, code status
• Current medical diagnoses including pathophysiology
• Past medical hx and health problems
• Applicable surgical/other procedures and their most common complications
• The patient's context of health, including (my personal favorite... lol) ye olde Determinants of Health and the principles of Primary Health Care
• The patient's developmental and social hx, including family and their influences on the pt's health
• Ordered tests, treatments, and interventions, including agency protocols and policy
• Recent diagnostic tests and results
• The teaching/learning needs of the pt
• How other members of the interdisciplinary team are involved in pt care
• Strengths & capacities of the pt
• Ordered medications including rationale, classification, side effects, and nursing considerations specific to the patient
• And, finally, 3 primary patient needs to address in the care plan. Each must include:
• Nursing diagnosis (NANDA stem, etiology, and manifestations)
• NOC labels 'SMART' goals (specific, measurable, appropriate [person-centred], realistic, & time limited
• Nursing interventions (NIC labels)
• Rationale
• Evaluation

Physical environments. “The physical environment is an important determinant of health. At certain levels of exposure, contaminants in our air, water, food and soil can cause a variety of adverse health effects, including cancer, birth defects, respiratory illness and gastrointestinal ailments (Public Health Agency of Canada, 2003).” Jane has lived in Alberta for her entire life. The urban health regions have a much lower mortality rate for all causes of death for females from 2006 to 2008. Calgary has 419.43 deaths per 100,000 population and Edmonton has 427.59. The mean for Alberta is 443.65 (Alberta Health and Wellness, 2009). Jane’s physical location is positively impacting her health simply by virtue of health accessibility and active living opportunities.

I also got very detailed with my NANDA-specific nursing diagnoses (this was the first of 3):

Priority need. Ineffective coping related to loss of vision, personal vulnerability, perception of inadequate control, impaired adaptive behaviors, and problem solving skills, as evidenced by flat affect, social isolation, inability to meet role expectations, poor self-esteem, uncertainty about choices, and deference in decision-making. Jane’s history of dependent behavior is making it a challenge for her to adjust to life as a visually impaired person. It is easier for her to surrender decision-making responsibility to John and rely on him to perform the roles of partner, guide, and caregiver than to accept her blindness and find ways to manage with it and go on with her life. Jane instead copes by isolating herself and being the passive member of their relationship.

Apparently it paid off, because I scored 18.9/20 on it. I was floored. I NEVER expected that kind of mark on the last paper of the year. Yay, me!

If you struggle as much as I do with writing care plans, I STRONGLY recommend investing in a good care plan book. I really, really like Gulanick & Myers' Nursing Care Plans: Nursing Diagnosis and Intervention. The book was very well rated on Amazon and with good reason. It has the NANDA, NIC and NOC labels for all included care plans as well as oodles of online resources and plenty of interventions and rationales. I am very happy with it. So is everybody who keeps 'borrowing' it every time a care plan comes due. At $40 it has been way more valuable to me than the freakin APA guide I spent an embarrassing amount of money on in first year.

Also keep in mind that your campus library, hospital library, and often hospital unit have really good (and really specific, in the case of on-unit material) references available. That's how I found specifically psychiatric care plans such as the one I used for my 'Ineffective Coping' diagnosis.

Another really good free online source I found is the Care Plan Constructor which I have linked on my Resources list. It's not as detailed as a book would be, but it gives you some more interventions and rationales to cite. It's also faster to navigate than a book, IMO, so it can be really handy to peruse for diagnosis ideas.

If I think of any other good things to add, I will. If you need help with your care plan I'd be happy to try. If you have any questions, fire away!