In many hospitals, nurses chart in accordance with nursing care plans. What exactly is a care plan, and how does it work? Just as it sounds, a nursing care plan is a blueprint that guides nursing care. In many facilities, care plans are also designed to guide and monitor interventions provided by other health care professionals, such as PT, OT, RT, and social workers. But, are these other professionals reading or adhering to our care plans? Should they be?

Care plans are prevalent throughout the health care industry. But, they are controversial among some health care professionals. How can the humble act of planning spark so much debate among clinicians? Let’s look at the fundamentals of a nursing care plan. Take, for instance, the issue of “nursing diagnosis” versus “problem statement.”

Like other professional planning activities (such as business or city planning), care plans start with a general assessment of the object (in our case, the patient). Based on this initial assessment, the care plan briefly lists a patient’s most pertinent problems. Some facilities require traditional, even scripted, nursing diagnoses for their care plans. One such common nursing diagnosis is “altered skin integrity.” Other facilities find the jargon of nursing diagnoses to be cumbersome and confusing. So, their care plans simply list the patient’s most important problems (e.g., “skin breakdown”).

After the problems or diagnoses are listed, each problem is assigned a general goal, along with measurable outcomes and timelines, if practical. Care plans can also be updated, as needed. Take, for instance, the patient whose original plan contains the problem, “altered level of consciousness.” It is important to update this plan if the patient is now wide awake and well oriented.

Other health professionals sometimes state that nursing plans are confusing or even redundant. Couldn’t the nurse simply follow the provider’s plan for the patient, instead of coming up with a separate plan? Why rely on complex nursing lingo, instead of using established medical terminology?

To answer this question, consider the patient who has been medically diagnosed with pneumonia. A nursing care plan might list this patient’s problem simply as “infection.” Alternately, the nurse might assign a nursing diagnosis of “impaired gas exchange.” Either approach may seem convoluted. But, remember that nursing diagnoses (and problem lists) are intended to guide NURSING care, not DOCTOR care.

In the case of pneumonia, nurses will watch for signs of impaired gas exchange by checking breath sounds, oxygen saturation rates, capillary refill times, respiratory effort and so on. They will monitor the infection by checking the patient’s temperature and lab values. Guided by the care plan, nurses will also assist patients with pulmonary hygiene (reminding them to deep breathe and cough) and with appropriate activities. Of course, nurses will also administer ordered medical interventions, such as administration of antibiotics, inhalers and incentive spirometers.

Do nursing care plans enhance or hinder communication among health care providers? I think that a well-designed care plan provides a vital blueprint for nurses to follow, as well as a useful action plan for other clinicians to consider. But, unnecessarily complex wording can confuse (and might put off) other providers. To avoid confusion, I generally state patient problems as clearly as possible, using such common terminology as “pain,” “risk for skin breakdown,” or “infection.” Of course, this simple approach may not be an option in all facilities.

Does your facility rely on traditional nursing diagnoses or more simplified problem sets in designing nursing care? Do you create your own care plans, or does your facility provide pre-designed templates? Are nursing care plans a thing of the past, or the wave of the future? Please share your thoughts.