Care Planning

A guide for nurses

Barrett David, Benita Wilson, Andrea Woollands, David Barrett

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781317246022
• Edition: 3
• Topic: Medicine
• Subtopic: Nursing

This clear and intuitive introduction to care planning for nurses explains the benefits of holistic, individualised care planning from a professional and clinical perspective. Using the ASPIRE model, it guides the reader step-by-step through a problem-solving approach to care, from assessing patients and identifying their needs, to planning goals and interventions, and evaluating progress.

The book is structured to explain the theory of care planning in relation to a number of common nursing models and then show how the theory can best be put into practice. It draws on recent research to show how nurses can develop individualised care plans from scratch or use and adapt a range of 'off-the-shelf' tools.

It is written in a clear, succinct and down-to-earth writing style, which will put students immediately at their ease, and is rich with pedagogic features, including:

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• 'Stop and think' boxes to check understanding;

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• boxed 'Practice examples' to illustrate points made;

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• 'Research summary' boxes to highlight relevant and important studies;

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• 'What have you learnt so far?' features to recap on key points of discussion;

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• mini care plans;

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• regular activities to encourage the reader to apply what they have learnt to particular practice scenarios.

This is a go-to text for all pre-registration nursing students taking courses on the theory and practice of effective healthcare delivery.

Part 1

Care planning theory

Chapter 1

Care planning in context

Why this chapter matters

Imagine that you have just started work on a new ward. You have been given a verbal report for 32 patients and your head is full of jargon and abbreviations that no one has had the time to explain to you. All the regular ward staff are busy elsewhere and you have no idea what you are supposed to be doing. What would you prefer to do in this situation?

1.Continue to flounder for the rest of the shift, not quite knowing what you are doing?

2.Refer to a scrappy piece of paper from your pocket, full of hastily written notes that you made during the report, trying to work out what care each patient requires?

3.Receive a complete picture of each patient that describes their needs, the goals of care, clear instructions on the care to be given and an account of the patient’s progress?

It is likely that you have chosen option 3, a choice that gives you the information and guidance that you will need to safely and effectively care for your patients. Such a detailed and complex plan may seem an impossible ideal, but with guidance from this book it can be achieved for every patient in every setting. Just think how much easier life would be for student nurses, healthcare assistants and agency staff going to unfamiliar clinical areas if they had all of that information at their fingertips. In addition, registered nurses would know that the members of staff that they were responsible for had a clear understanding of what they were supposed to be doing for each patient.

This chapter will explore why it is so important to develop the skills to plan care and will identify the benefits of care planning for you and your patients. We will demonstrate why care planning should be considered a vital part of your clinical practice and not just an optional extra.

By the end of this chapter you will be able to:

•outline the difference between care planning and care plans;

•list two ethical, two professional and two legal reasons why you need effective care planning;

•identify two things that could improve your own record keeping;

•give two examples of when the care planning process can go wrong.

Care planning and care plans

One of the problems when discussing this subject is that the terms ‘care planning’ and ‘care plans’ are often used interchangeably. They are not interchangeable and it is important to clearly identify what we mean. Care planning is the term that is used to describe activities that nurses engage in, from the time a patient is admitted into their care, through to when they are discharged. This can be in any setting – acute inpatient, community care or specialist units – and can be for as brief a time as half an hour in an accident and emergency department to years for a patient in a care home. The stages of care planning will be explored in detail throughout this book; you may know them as assessing, planning, implementing and evaluating, sometimes referred to as APIE (Yura and Walsh, 1967). In this book, we have added two further stages, systematic nursing diagnosis and recheck, giving us an approach that we refer to as ASPIRE (see Chapter 2 for a detailed overview).

Care plans are the written records of this care planning process. There are several methods for recording care, for example individualised or personalised care plans, core (or standardised) care plans and care pathways; these will be discussed in Chapter 7. Whichever method is used, the care plan is only as good as the person who has written it, and it should be an accurate summary of the care planning that has taken place. Care plans have been criticised by many authors for a variety of reasons, including being difficult to read or understand, being difficult to use and for not providing enough information about the actual patient care (Allen, 1998; Ferguson et al., 1987; O’Connell et al., 2000). These criticisms result in nurses and nurse managers questioning the need for care plans. We believe that care plans themselves are not the problem; the issue lies in the way that they are written and used on occasions. Throughout this book, we will be suggesting ways to improve the process of care planning and the development of a care plan. Effective care planning is not an optional extra: it is a professional, legal and ethical requirement of your practice. It is for this reason that you need to develop the ability to perform this essential clinical skill. This book provides you with a step-by-step guide.

All nurses should be able to explain their practice; this includes providing an account of what they have done, an explanation as to why they have done it and an evaluation of the results of their actions. The performance of these actions needs to be documented as an appropriate written record. This is because as a registered nurse you are accountable for your practice; that is, you are held to be personally responsible for the outcome of your own professional actions (Nursing and Midwifery Council, 2015). There are different levels of accountability: you are ethically (morally) accountable to your patients to do them no harm and to do your best for them; nurses in the United Kingdom are professionally accountable to the Nursing and Midwifery Council (NMC), which expects certain levels of professional competence from you; and you are legally accountable. If you are student nurse, you have the same moral and legal accountability as a registered nurse, but your professional accountability differs in that you do not directly answer to the NMC (you are, however, accountable to your university).

Individualised or personalised means tailored to a specific patient’s needs.

The Nursing and Midwifery Council is the professional body that regulates nurses and midwives in the United Kingdom.

This book will help you to make your care planning safer and more effective. This chapter will explore the care planning process and its relationship to your professional accountability and demonstrate some of the pitfalls to be aware of when planning and recording care.

WHAT HAVE YOU LEARNT SO FAR?

•There are differences between care planning and care plans.

•Care planning encompasses all that nurses do for a patient, from being admitted into their care to when they are discharged.

•Care plans are the written records relating to care planning.

•Care planning and writing accurate care plans are not optional extras but an essential part of nursing.

•Nurses are ethically (morally), professionally and legally accountable for their actions.

Care planning and professional standards

Care planning and documenting care are essential parts of nursing. They should be considered clinical skills just like administering injections or giving a bed bath, and as such you must demonstrate proficiency in them. Before qualifying, student nurses must demonstrate that they are competent in certain areas of care, including the ability to carry out key elements of the care planning process. At the point of registration, a nurse will need to be proficient in assessing the needs of people and planning their care, taking into consideration personal circumstances and preferences of both the person and their families and carers. Nurses will also need to demonstrate the ability to implement and evaluate care in partnership with patients, their families and carers.

Of course, it’s not just about developing these skills as a student – they also must be maintained and improved throughout your career. The Code: Professional standards of practice and behaviour for nurses and midwives (Nursing and Midwifery Council, 2015) (we will refer to this as ‘the Code’), outlines the standard of professional and ethical conduct expected of you as a nurse. Within the Code, there is a clear message that nurses must be able to assess patients, identify needs and deliver evidence-based care – all core elements of care planning. The emphasis that the NMC has put on care planning demonstrates how fundamental these skills are for delivering high-quality nursing care.

So, for all nurses, care planning is identified as a core skill that you must be able to demonstrate throughout your nursing career, from student days until you retire. Student nurses must demonstrate that they have achieved the necessary standard of proficiency related to care planning to enable them to register as a nurse. Once registered, if you fail to competently carry out any part of the care planning process, then you could be in breach of your professional code. This may sound a bit dramatic, but if you read Practice example 1.1 you will see that it does happen.

Proficiency is being able to carry something out competently to a required standard.

Practice example 1.1

A registered nurse was charged by the Conduct and Competence Committee because of allegations surrounding a failure to assess patients, prepare care plans or evaluate aspects of care. The nurse had been working as an acting manager of a nursing home.

It was found that several patients did not appear to have their needs assessed when they were admitted to the nursing home. One patient, who suffered from diabetes, had a care plan that did not mention the needs related to her pressure ulcers, her diabetes, her mouth care or her pain management. Other patients had care plans that did not address their nursing needs, such as wound care or pain relief.

The committee judged that the nurse should answer for the deficiencies in care, because she was identified responsible and accountable for care planning and patient care. The decision was made to remove the nurse from the NMC register as she had been persistently neglectful over a period of time and had failed to provide adequate records (Nursing and Midwifery Council, 2003).

Accountability and care planning

We’ve highlighted there are different levels of accountability, but, essentially, it is about being open and transparent about your practice by being able to explain why you have done certain things in a specific way. You are ethically, or morally, accountable to patients to do them no harm (non-maleficence) and to do your best for them (beneficence). This links to the idea that you have a trust-based relationship with your patients and are therefore bound by ethical principles and values, such as honesty, beneficence, non-maleficence and trust (Beauchamp and Childress, 2013). You are professionally accountable to the NMC, which expects certain levels of professional competence and for you to accept the rules and regulations of the profession set out in the NMC Code. Finally, you are legally accountable – you must not break the law while practising nursing and in your personal life, as you may be answerable for your actions through the legal system (NMC, 2015).

This means that registered nurses are answerable for anything that they do (actions) or do not do (omissions) for patients and as such they must be able to explain (justify) their decisions. Good care planning and care plans can help nurses to do this, by demonstrating that decisions about the care were based on comprehensive assessment of the patient, systematic nursing diagnosis, planning of care, evidence-based implementation of care, rechecking and evaluating using a recognised framework. If the care-planning process is followed, the care delivered to patients should be improved, an idea that we will be exploring in this book. The nurse in Practice example 1.1 was removed from the register partly because she did not carry out key elements of care planning: there was no assessment of patient needs, plans for nursing care were not developed and patient progress was not evaluated. Equally, because care plans had not been written, there was no way of knowing whether the appropriate care had been given or not. We will return to some of these issues later in the chapter when we look at record keeping. The key message at is that to help account for the quality of care that you deliver, your care planning and documentation need to be effective.

It is also important to note that registered nurses are accountable not only for their own actions, but also for the actions of those that they delegate work to. Therefore, if a registered nurse gives a task to a health...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Contents
• Preface
• Part 1 Care planning theory
• Part 2 Application to practice
• Appendix A Suzy Clarke
• Appendix B George Brown
• Appendix C Shoaib Hameed
• Appendix D Mini care plans
• References and bibliography
• Index