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Care Planning Tutorial

Care Planning Tutorial. Principles of Care Planning Peter Graham: Senior Nurse Care Planning. How many care plans?. Care plan v’s Action/intervention plan. One Care Plan. MDT Assessment Outcome Interventions Interventions interventions (actions) (actions) (actions)

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Care Planning Tutorial

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  1. Care Planning Tutorial Principles of Care Planning Peter Graham: Senior Nurse Care Planning

  2. How many care plans? Care plan v’s Action/intervention plan

  3. One Care Plan MDT Assessment Outcome Interventions Interventions interventions (actions) (actions) (actions) Nurses/ OTs Social Workers Medics

  4. Collaboration Staff leading the process Service user leading the process ES Recovery

  5. Elements of a care plan • Are our care plans recovery focussed? • Language! • Issue/Problem/need….what is your problem v’s how do you usually cope with your problem. Where do we record strengths?

  6. Elements of a care plan • Goal/Outcome (what do you want to achieve?) • The outcome is usually not considered fully and is the hardest thing to articulate: road map analogy • A lack of a shared outcome = dissatisfaction with care • Interventions (how are we going to achieve it?)

  7. Actions/Interventions Remember any action/intervention is designed to remove or reduce the negative IMPACT of symptoms

  8. When considering outcomes think S.M.A.R.T • Specific • Measurable • Achievable • Realistic • Timed

  9. When considering outcomes think S.M.A.R.T • Are your goals/outcomes SMART? • How many of your care plans contain the goal of “discharge to the community functioning at the optimum level with the appropriate package of care in place”?

  10. Last admission: things to consider • Think about the last person you admitted • Did you know what the purpose of admission was? • Did you see the assessment? • Do you know what needs to happen to discharge them? (our outcome) • Do you know what the person wants from the admission? (their outcome)

  11. Last admission: things to consider • The outcome is probably the hardest thing to articulate • What involvement did they have in drawing up THEIR care plan? • …does a signature or a ticked box indicate participation? • Has the care plan been taken into the ward round/MDT meeting? • How does this care plan fit in with the overall plan of care?

  12. Why have a care plan? • One person’s experience of the care plan The first care plan I was given I did not see for six months, I was too unwell, my wife and family saw it, it helped them to understand my illness, and understand that there was not a quick fix. It would be a long journey. As I made progress I became more involved in the care plan and contributed more to the conversations with my CPN and psychiatrist, that is where I am now.

  13. Questions

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