Lets talk about care plans! Fun, right? If you don’t agree, or just the thought of writing care plans for the CPNE stirs up anxiety, then you’re in the right place.
Most students studying for their clinical weekend don’t feel confident in their care planning skills. In fact, 63.7% of the thousands of CPNE students we surveyed said they feared care plans the most. If you’re part of that number you shouldn’t feel like your fear is unique. You are not alone. Though it’s important to know that your success in the CPNE depends on them. Learning how to write a care plan according to the very specific guidelines set by Excelsior College is half the battle of passing the CPNE. Once you know how to write a care plan it’s all down hill from there.
So why do most students fear care plans? Put bluntly, they feel like there is too much “gray area” or room for interpretation from examiners on whether their care plan is acceptable or not. While I won’t disagree that there is a great deal of ambiguity in the CPNE testing guidelines, I will argue that if you know how to write a solid care plan that you can back up with practical logic, there is no room for questioning and you’ll be able to write passing care plans time after time with minimal effort. Like anything, there’s a way of doing things correctly and I’m going to help you crack that code.
Which brings me to why I’ve brought you here. You now have a unique advantage. I am going to show you some of the top questions I’ve gotten from students after grading thousands (and thousands!) of care plans from CPNE students. I hope this helps fill in some of the gray area that is keeping you from writing care plans with confidence. Don’t panic if you feel overwhelmed. It’s a lot of information so don’t try and memorize it all now. Use this as a reference as you progress through your studies.
Grab a cup of coffee because here we go…
Part 1 of 3:
- What part of the diagnostic statement has to be written word for word?
The diagnostic statement is written on the evaluation form. The Nanda label is the only thing in your Mosby’s book that must be written word for word because the label was created by NANDA-I, voted in by a panel and not allowed to be altered in any way.
- Where do you find the r/t in your Mosby’s book?
The related to is in the Mosby’s book under the specific Nanda label and the related factors heading. This is what is causing the problem or also called the etiology and this can be altered to be specific to your patient.
- Where do you find the aeb (as evidenced by) in your Mosby’s book?
The as evidenced by, or AEB, is found in the Mosby’s book under the specific Nanda label and defining characteristics heading. The aeb is a sign and symptom of the Nanda and you will not know it until you get into the room and actually see the patient. It is not required on your planning phase form but rather on your evaluation form.
- Where do you find the interventions in your Mosby’s book?
The interventions are found in the shaded boxes in the Mosby’s book under each Nanda label. Remember that even though an intervention is in the Mosby’s book, it does not make it okay to use it. (This is crucial to understand.) You cannot use an assessment for an intervention on your care plan.
- How do you prioritize for your care plans?
Tricky question. You are first basing your Nanda labels on what you are assigned and how that assignment ties into the patient’s problems based on your findings in the chart or from the primary nurse. Once you have several Nanda labels picked out, you prioritize according to Maslow’s to come up with your top two Nanda labels.
- Do you have to use a GRID?
A GRID is not necessary. We encourage it so you have all of your critical elements together in one spot. It is usually placed on a blank form in your pcs packet or some will put it on the very back of the packet.
- What is the main reason for the GRID?
The purpose of a GRID is organization and to keep you on track during your pcs. Even though your kardex is filled out with your assignments, your critical elements are not listed so how are you going to remember your critical elements when you are in the room and nervous? Mnemonics are very helpful but where are you going to write them? That is where a GRID comes into play. Keeping you organized and focused cuts down on fails.
- Can you highlight in your Mosby’s book?
Highlighting is acceptable in your Mosby’s book. It is clearly expressed in your EC study guide that you are allowed to highlight. It is not cheating when you are highlighting something that is already in print. It is considered a visual jogger.
- Can you write in your Mosby’s book?
The only thing that can be written in your Mosby’s book is your name. No notes can be written in your book. It would be considered academic dishonesty if you do and they will pick up your book and thumb through it looking for writing.
- Can you tab your Mosby’s book?
Tabbing of your Mosby’s book is allowed. The only thing you can write on your tabs is the Nanda label. No medical diagnoses on the tabs. I like to color code my tabs so any respiratory Nanda labels are blue, Circulation or Mobility and Pain labels are red, and GI, urinary, Deficient fluid volume etc. with green labels. Just an idea.
- What are good examples of a validation assessment?
Validation assessments should be one specific assessment that is clear on what you are looking for or how you are going to perform the assessment. Therefore, auscultating breath sounds and observing ability to reposition self in bed are both appropriate. Asking patient about pain is not specific enough but asking patient to rate pain using a 0-10 verbal pain scale is appropriate. Peripheral neurovascular assessment is too broad and has more than one assessment. However, if you narrow it down to something like palpate pedal pulses, that would be acceptable.
- You are assigned vital signs with 0-10 pain scale and comfort management for a patient with sickle cell who is rating pain a 6 in their legs. Which Nanda labels would you pick?
Acute pain and Impaired comfort cannot be used together on the planning phase form. A rule of thumb, if assigned comfort management you go with Impaired comfort. When pain assessment is with vital signs, they have not assigned you to manage pain. Once you are in the room, you can make a clinical decision to revise your care plan to acute pain, then you must do a revision form and fill out the box at the top of the narrative notes.
- Do Interventions have to be in Mosby’s book?
It is safer if you match up your assignments/interventions on your kardex or in your critical elements with those listed in the shaded boxes in your care plan book. What if the examiner asks you to show them where you got that intervention? Will you have something to show them if you did not find it in the book? No. So at that point, you are going to have to explain your way out of that. It can be done but they do not have to accept the intervention you chose if they don’t feel like the intervention moves the patient toward the outcome.
- Are you supposed to put the “related to” and as “evidenced by” on the planning phase form?
No. If you look at the boxes on your planning phase form it says nursing diagnoses. It does not say nursing diagnostic statement. The r/t and aeb are part of the diagnostic statement which goes on the evaluation form. It is very important that you know the forms and how to fill them out. When you have questions, always refer back to your study guide.
- Where will items like splints, trochanter rolls, traction, side rails be found on the kardex?
Those will be specific under mobility or under musculoskeletal management and the side rails would be listed under safety. When you have some extra time, pick apart your kardex and look at the areas that have lines beside the caption for something to be written on them and review that section of your study guide to see what types of things the examiners can write there.
- Why is it that we cannot use assessments for interventions?
Interventions are actions that you are going to perform that will move the patient toward the outcome. If you ask yourself “if I do this then will it move the patient toward the outcome,” your answer will always be no for an assessment therefore it cannot be used.
- Why is it that you cannot use a “risk for” care plan in the planning phase?
During the planning phase, you need to find actual problems that are occurring with this patient. Even though you have not seen the patient yet, looking in the chart and asking the primary nurse questions will lead you to knowing what problems are currently existing. Once you go into the room and perform your own assessment, you can determine if those problems still exist and make necessary adjustments to your care plans and one of your two can be changed to a risk for at that time.
- Can the r/t be the same for both care plans?
The r/t or related factors are what is causing the particular nursing problem therefore if the same thing is causing the problem for both Nanda labels then yes you can have the same r/t.
- What is not allowed to be used for a r/t?
The related to is what is causing a problem. It can be a medical diagnosis. It is best to be a nursing problem instead of a medical diagnosis but a medical diagnosis is okay. What is not okay is when you relate the problem to a surgery or surgical procedure or a person because then it sounds like you are blaming the person or the procedure and having a procedure is a good thing and a person helping you is a good thing. The r/t is the cause. So don’t blame a person or a procedure.
- If my nursing diagnosis book suggests an intervention, can I use it?
This is not a straight forward question. If the intervention is in your nursing diagnosis book that is a start but you still need to ask yourself two questions: Am I assigned this intervention on my kardex? If I perform this intervention, will it move the patient toward the outcome? If both answers are yes, then it is safe to use it. An example is saying that you want your patient to have clear breath sounds for an outcome and your intervention is to administer oxygen. How does oxygen clear the breath sounds? It does not. It helps oxygenate the blood but it has to be exchanged with the CO2 at the alveolar level in order to do so. If there is mucus or secretions in the way, how is the oxygen going to get through? Just because it is in your book does not mean it is a correct intervention
- Can I use the word “maintain” in my outcome or interventions
Maintain means to continue something without changing. An outcome needs to change for the better because a problem that exists. If you use maintain in an outcome, it means the patient is already doing it and you only have a risk for care plan which is not allowable during the planning phase. On the other hand, for an intervention, if the patient is already receiving an intervention that needs to continue and you are assigned to manage that intervention (like continuing oxygen therapy or sequential compression devices, etc.) then yes you can say “maintain” for an intervention.
Loving care plans yet? Don’t worry if you feel overwhelmed. The more practice you have with writing care plans for the CPNE, the more it will make sense to you. This is a lot of information but the more you study the principles of writing care plans the more useful these common questions will be. Any one of these tips could save you from making a costly mistake that so many students before you have made, and paid the price for. So make sure you save this page so you can refer back to it when you need it.
Ready to Get Serious? If you’re ready to get really serious about perfecting your care planning then you should definitely take advantage of this video presentation I made on how I will show you the step-by-step way to writing passing care plans for the CPNE. Just click the link below.
As always, thanks for letting ATL Clinical Workshop be part of your CPNE studies. Want to super charge your studies? Come see us in Atlanta for a CPNE workshop or join our Online CPNE Workshop for more help to pass the CPNE. We’ll get you through it. Whatever it takes. 🙂 In our next post we’ll be giving you 63 CPNE Care Plan Questions: Part 2, so stay tuned.