All About NCPs and Why Refuse to Die

Liane Vi Clores, RN
Three simple words. We dread them. We flinch every time our clinical
instructors mention them. We spent sleepless nights trying to make one. Four years
of struggle in nursing school wouldnt be complete without them, Nursing Care Plan.

Tracing its origins

We have spent torturous nights and days formulating nursing care plans. We
have been taught and oriented on how to make them. Countless of times we were
reminded of how important they are in nursing practice. We have heard all about
them over and over in the course of years spent in nursing school but how did it all
began and why are nursing care plans needed in the nursing profession that it has
become so important these present days?
The history of nursing care plans can be traced with the name Ellen L. Buell, a
public health nurse and nursing instructor at Syracuse University, NY in the 1930s
and 40s. In 1930 in the American Journal of Nursing, she published an article: The
Case Study: As a Method of Teaching Students and Graduates the Principles of
Public Health Nursing, which was based on home nursing and included all the
family members, their health status, socioeconomic status, housing conditions, and
nationality/citizenship status. Here, she presented the public health case study as a
way of teaching comprehensive and systematic thinking and care planning to new
nurses
Some of the nursing diagnoses she used back then are shyness and temper
tantrums (for the children). Her recommended nursing interventions were more
fresh air and play out of doors. Her public health nursing case study approach then
led to codes of nursing theory, nursing process, nursing diagnoses and the nursing
care plan. The progress of all of these took place within baccalaureate nursing
programs.
NCPs were initially measured out as higher thinking and planning potential
by BSN equipped nurses, and were also meant to direct delegation of nursing duties
to the lesser diploma-trained and LPNs. Nursing care plans actually took on a life of
their own in the 1960s and 70s in the US, and then stretched virally to other parts of
the planet. They became an established requirement within BSN programs, as a way
of indoctrinating nursing students into thinking like a nurse.

What are NCPs?

Nursing care plans are a set of actions the nurse will execute to
resolve/support nursing diagnoses identified by nursing assessment. It must have
the following characteristics in order for it to be effective:
Its focus is holistic, and is based on the clinical judgment of the nurse, using
assessment data collected from a nursing framework.
It is based upon identifiable nursing diagnoses (actual, risk or health
promotion) - clinical judgments about individual, family, or community
experiences/responses to actual or potential health problems/life processes.
It focuses on client-specific nursing outcomes that are realistic for the care
recipient.
It includes nursing interventions which are focused on the etiologic or risk
factors of the identified nursing diagnoses.
It is a product of a deliberate systematic process.
It relates to the future.
Must be thorough yet brief enough to be useful.
They must be comprehensive and individualized.
They must be up-to-date and comply with current standards of practice in
nursing care as well as state and federal regulations.

Why they refuse to die

The main purpose of nursing care plans is to make out problems of a client
and find solutions to those identified problems. Five steps are to be done in order to
achieve this: assessment, diagnosis, planning, intervention, and evaluation. In order
to have a true care plan, all five of these steps must be complete. Other purposes of
the nursing care plan, which are some reasons why they still exist even at a time
wherein technology can provide almost everything, are to:

Offer a course for individualized patient care.

Provide continuity of care for the patient with all hospital departments.
Provide documentation on patient and family needs.
Provide insight for staffing needs.
Provide reimbursement for insurance by insurance companies such as
Medicare and Medicaid.

Most nursing students feel a sense of terror making nursing care plans. Some
may think that they just add burden to their already busy school work. Some even
think nursing care plans are unnecessary, but the truth is, though nursing care
plans seem to look like tedious work, it serves two great purposes which are to
teach nursing students systematic thinking and to improve patient outcomes.

Sources:
http://www.austincc.edu/nursmods/cec/cec_lev2/rnsg_1260/nursing_care_plan_samp
le/index.php
http://www.nursetogether.com/getting-nursing-care-plans-right
http://josephineensign.wordpress.com/2011/07/13/why-nursing-care-plans-refuse-todie/