Creating Nursing Care Plans

According to the U.S. Department of Health and Human Services, there is a current need for approximately 2 million full time registered nurses in the country to provide adequate patient care. This need is anticipated to grow to 2.8 million by the year 2020 with an estimated shortage of 1 million nurses by that time. Therefore this supports the need to invest in nursing professional education, but also this highlights the importance of enhancing nursing care through innovative means of technology.

Nursing care plans are a means by which nurses continually assess, diagnose, implement and evaluate overall care and progress of a patient. In the past, documentation of the nursing care plan had been time consuming, but with the advent of computerized data systems, this process has been streamlined for nurses providing greater efficiency. This efficiency has alleviated some of the pains felt by nursing shortages, but much broader areas of potential exist as these systems become more creative.

In a study where 20 nurses were formally interviewed, various questions were posed regarding the benefits in using a computerized nursing care plan system. In addition to the expected response of streamlined care, nurses added several areas of benefit. These benefits included a reference for their memory for patient details, a learning tool for patient care, and a vehicle to easily modify care plan content. These responses highlight the creative potential for nursing care plans as IT solutions are developed.

Information included in a nursing care plan routinely involves the anticipated care that a nurse will provide for a patient, specifically identified patient problems, and a guide in assessing and evaluating the success of that care. In other words, the nursing care plan exists in an intermediary stage of the nursing process between initial evaluation and final outcome. Given its central position in patient care, it would appear obvious that a computerized nursing care plan offers great potential in many areas other than just making care more efficient.

For example, the increase in patient to nursing ratio has not only reduced the amount of time a nurse has per patient, but also increased the volume of information overall that the nurse must remember. Computerized care plans allow comprehensive storage of this information. If creative technological developments allow mobile and fluid access to this data, quality of patient care will be improved.

Additionally, a large part of quality patient care depends on preventative measures. Nursing care plans that include educational tools to teach patients preventative measures results in better long term health outcomes. Developing and adopting methods that automate these educational tools through computerized means saves nurses time, but also can be more comprehensive and thorough. Interactive tools even allow care plan documentation that patients received and understood content.

In the past, changes in the nursing care plan were more difficult to track. A change may be noted, but documentation for the change may be vague or located in other areas of the plan. This hindered continuity among nurses on different shifts or in different patient care areas. Computerized solutions could allow an improvement in this continuity of information throughout a patient’s care experience. This would include information from hospital to care facilities to even outpatient centers.

Nursing care plans provide a wealth of information about the care of a patient, and these also serve as guides to ensure optimal patient care. As greater demands on nurses evolve, it will be imperative to assist their abilities to maintain care plans accurately. Computerized solutions assist in this need through making documentation and care plan creation more efficient. In addition, however, technological solutions also provide a means to improve quality of care by making information readily accessible and by providing preventative educational tools for patients and nurses. These aspects make these creative solutions even more attractive as health care resources continue to shrink in relation to health care demand.

References:

Anderson, Beth. (2007) Care Plans: Worthwhile or Worthless? Retrieved from http://agedcareact.wordpress.com on June 10th, 2008.

Edmunds, Linda. (1982) Computer-assisted Nursing Care. Vol 82 (7): 1076-79.

Lee, Tin-ting. (2006). Nurses’ Perception of Their Documentation Experiences in a Computerized Nursing Care Plan System. Journal of Clinical Nursing. Vol 15: 1376-82.

Developing Schoolwide Vision and Implementing Strategic Plans

A key lesson learned from the decentralization experiment is the need for system-wide standards and intervention to address the challenge of student performance. The LSC (Local School Council) and its supportive network alone are not sufficient to promote educational improvement system-wide. Indeed, decentralized reform may have widened the capacity gap among schools to raise performance. Instead, districtwide leadership is needed to apply both pressure and support to schools. Such a mix of intervention strategies did not occur during the period of LSC dominance because the reform ideology with its strong antibureaucratic sentiments did not allow for the proper functioning of the central office. Taken as a whole, the post 2005 strategies of sanctions and support have improved the overall conditions that lead to better student performance across the system. Better test scores are seen not only in elementary schools but also in the more problematic high schools since 2004.

In contrast to the seemingly recentralizing tendency under integrated governance, charter school reform aims to significantly reduce regulatory control from the central administration and union agreements. Although they are labeled as public schools, charter schools are distinctive in several major aspects. The school’s charter or contract explicitly spells out the conditions and expectations for outcome-based performance. The authorizing agency can be the local school board, the state, or other legal entities (such as universities). Once established, schools enjoy substantial autonomy in setting curriculum, teacher salaries, and work conditions, although they are bound by state regulations regarding safety, health, dismissal, and civil rights. School funding follows students to the schools, which operate on a multiyear renewable contract.

Charter schools are guided by several design principles. They aim to:

• create a new structure of school autonomy based on performance contract;

• limit central office control over curriculum, instruction, and personnel decisions;

• grant parental preferences on schooling opportunities; and

• promote innovation and alternative assessment on student performance.

Since 1992, when the first two charter schools opened in Minnesota, the number of states with charter legislation and the number of schools in operation have grown steadily. Charter school advocates have identified two kinds of innovative effects: (1) charter school can create competition, maintaining a better fit with the needs of their “customerparents,” and thereby pressuring regular public schools to improve in order to maintain their share of the student “market”; and (2) enjoying substantial autonomy from the central office, schools can serve as laboratories for developing new educational ideas and practices, fostering and following through on innovative ideas from which traditional public schools in the district can learn. But are these claims supported by the knowledge base in the current literature?

Not surprisingly, the literature is split on the issue of whether charter school competition pressures public schools to improve. Most of the research has found light to moderate effects, more prevalent in smaller or mid-sized districts where the system is often more nimble and the impact of a few schools is more readily felt. Legislative compromise-capping the number of schools, cushioning the financial blow to traditional district schools, or reducing the autonomy of schools-may lessen the effects. Educational reform was also influenced by past performance and the eagerness of the district leadership to undertake change. While there is some evidence suggesting district response to competition, starting charter schools is such difficult work that a significant amount of time may be needed before producing strong, system-wide impacts on school districts. In districts where schools made an impact, districts made “piecemeal” instead of system-wide changes, and were most concerned with expanding their school day by offering new add-on programs. In short, given the mixed evidence on charter school impact, more research is needed on what works and what doesn’t in charter school as a system-wide reform.

As for schools promoting innovative practices, researchers have asked two related questions: (1) Are schools engaging in classroom innovation, with new methods of teaching? (2) Are district schools able and willing to integrate those classroom innovations into the mainstream curriculum? On both of these issues, the empirical evidence tends to be mixed. While innovations were found, many were structural, few were either freestanding or independently replicable, and no evidence of significant sharing or dissemination of practices from schools to district schools was found. Some evidence suggests that changes in organizational and institutional arrangements may prove more significant than any academic innovations. The literature remains unclear on whether charter reforms are actually “adding value” to student learning.

Conclusions

The two emerging governance models represent a continuum of institutional possibilities for urban educational reform. At one end of the continuum is integrated governance, which redefines the responsibilities and enhances the capacity of districtwide leadership. Given its strong focus on raising student performance, integrated governance reform tends to target resources on and apply pressure to low-performing schools and students. A challenge is to recruit leadership that has the vision to apply pressure and provide support to low-performing schools.

Concerns about the potential of excessive central direction have prompted some reformers to support the charter school model, which represents the other end of the institutional reform continuum. While decentralization may facilitate innovative practices and promote more efficient use of resources, the charter school model is likely to be unevenly implemented across different settings. Given schools’ autonomy, system-wide standards are not likely to be considered a high priority. Whether schools are able to recruit high-quality leaders will be a critical challenge. Equally important is the charters’ capacity for turning around low-performing schools and students.

From a broader perspective, the two emerging models call our attention to the complex challenge of reengineering low-performing schools with a particular focus on leadership and management issues. More specifically, this review of the two models raises several issues in the area of educational leadership, including: the role of states and districts in designing and implementing alternative systems of accountability; leadership qualities and management practices that are necessary for implementing the reform models at the district and school level; the kind of technical assistance that is needed to ease organizational transition and improve effective management in settings where political leaders at the state and city level have taken a more active role in education; principals’ strategies in developing school-wide vision and implementing strategic plans that are designed to raise student performance; the ability of public school leadership at the school and district levels to respond to an emerging competitive environment given the increase in the number of schools; and effective ways in which noneducators can collaborate with school professionals to turn around low-performing schools.