How do I create nursing care plans?
Nursing care plans are an important part of in-patient care. Depending on the discipline that you work within, they may vary, but the fundamental ideology behind them is the same. Care plans exist to make sure care is individualised, and the patients' progress easy to asses. All good care plans are created using the formula of assessment,planning, implementation and evaluation.
The importance of care plans
Why is care planning so important? For some time now, documentation in nursing has been seen as increasingly important. Looked at in its simplest form, documented care plans are written evidence that you are carrying out the nursing process effectively. They exist to help guide staff into giving consistent care that can be evaluated on a regular basis, depending on the speed at which the patient's condition changes. Nursing care plan templates In some health care situations, it is possible to use sample nursing care plans that have been pre written. However, to give truly individualised care, particularly when working with psychiatric care plans, it is far better to tailor each care plan to the individual.
Creating a care plan
Assessment When creating a care plan you must assess the patient by talking to them, looking at their notes and using your nursing knowledge to ascertain what the patients key problems are. You will find that most people have both long term and short term issues, all of which must be adressed. Planning The planning stage is when you will commit to paper the problems that the patient has, and decide what the best approach to helping solve the patients problems is. This stage of the care planning process should be as collaberative with the patient as possible, though there may be parts of the care plan that the patient disagrees with, but that you have to implement due to your duty of care towards the patient. Implementation The implementation stage of the care planning process takes time and it is important that the interventions be carried out as planned, or there is little point in spending time creating the care plan in the first place! Evaluation Evaluating the nursing interventions, and their efficacy, is all part of evaluating the care plan. The time scale for the evaluation of the care plan will vary according to the problems that the patient has. If a patient is acutely ill, then the care plan will need to be evaluated and updated at least on a daily basis, if not more frequently. The evaluation stage gives you a chance to talk to your patient and decide if the care care plan is appropriate , or whether changes need to be made.