“I” Care Plans

1. “I” Care Plans Are We Ready For Culture Change? Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 • Figure is a picture of a Medical sign

2. Objectives • To gain a new perspective on the care planning process. • To understand an “open-minded” approach to resident centered care plans. • To allow resident’s to gain a more autonomous role in their healthcare. Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008. figure is a picture of a man in a wheelchair Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

3. Types of Care Plans • Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 • Traditional Care Plans • Individualized Care Plans • “I” Care Plans Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

4. Process of Evolution in LTC • Institutional model • Resident Directed (Home Setting) Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

5. Traditional Care Plans • Difficult to read • Difficult to understand • Clinically driven and lack personalization • Difficult to formulate Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

6. Traditional Care Plans Interventions: • “Assess for impediments to mobility. • Assess the patient’s ability to perform ADL’s effectively and safely on a daily basis using an appropriate assessment tool, such as the functional independence measures.” (Gulanick/Myers, p.126, 2007) Problem: “Impaired physical mobility r/t: activity limitations imposed by current diagnosis and/or treatment plan; loss of muscle mass, tone, and strength associated with prolonged disuse and inadequate nutritional status AEB multiple occurrences of falling.” (Saunders, 2007) Goal: “Patient will be free from complications of immobility, as evidenced by intact skin, absence of thrombophlebitis, falls, and normal bowel pattern.” (Gulanick/Myers, p.126, 2007) Interventions: • “Assess for impediments to mobility. Assess the patient’s ability to perform ADL’s effectively and safely on a daily basis using an appropriate assessment tool, such as the functional independence measures.” (Gulanick/Myers, p.126, 2007) Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

7. Individualized Care Plans • The first attempt by LTC Providers to become more personalized with plans of care. • Difficult to read • Clinically driven • Easier to formulate Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

8. Individualized Care Plans Problem: Resident is at risk for falls r/t unsteady gait, use of psychotropic medications, and poor safety awareness. This resident had a fall prior to admission to the facility. He now has a body alarm when in bed and when in his wheelchair to help alert staff when he attempts to transfer alone. Goal: Resident will be free from injury related to falls for the next 90 days. Resident will be free from signs and symptoms of side effects from psychotropic medications for the next 90 days. • Intervention: • Staff are to redirect this resident when witnessing his attempts to get up without assistance. • Ensure body alarm is in place as ordered by physician. • Refer resident to therapy services as needed post falls. • Administer medications as ordered by Physician and monitor for s/s of side-effects. • Notify Physician and family of any s/s of side-effects of medications and/or any incidents of falls. Problem: Resident is at risk for falls r/t unsteady gait, use of psychotropicmedications, and poor safety awareness. This resident had a fall prior to admission to the facility. He now has a body alarm when in bed and when in his wheelchair to help alert staff when he attempts to transfer alone. Goal: Resident will be free from injury related to falls for the next 90 days. Resident will be free from signs and symptoms of side effects from psychotropic medications for the next 90 days Intervention: • Staff are to redirect this resident when witnessing his attempts to get up without assistance. • Ensure body alarm is in place as ordered by physician. • Refer resident to therapy services as needed post falls. • Administer medications as ordered by Physician and monitor for s/s of side-effects. • Notify Physician and family of any s/s of side-effects of medications and/or any incidents of falls.Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

9. “I” Care Plans • Require that more time is spent with the resident • More informative to all staff • Easier to read and understand • Easier to formulate • Tell a story • Direct the care provided by staff when readJennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

10. “I” Care Plans Problem: “I began suffering from Dementia about 3 years ago. This has been hard for me because my memory is not as good as it use to be. I have problems remembering that I can’t walk as well as I did 3 months ago. Because of this I fell at home and had to go to the hospital for treatment of a fractured left hip. My doctor started me on a medication called Aricept but it did not help my anger when I became confused. He decided I should be treated with a low dose of Depakote to assist with my anger outbursts. Of course this medication makes me dizzy and can also be a cause of my falling so often. I don’t do these things to upset you I just can’t remember to ask for help when I need to get up and go to the bathroom or change my position.”Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

11. “I” Care Plans Goals: “I will get to know my environment and trust my caregivers over the next 3 months. This will assist to decrease the number of my falls while I am participating with therapy and recovering from my hip surgery. I will develop a level of medication in my body over the next 3 months that my doctor expects. My anger and confusion will improve or at least not get worse. I will be able to take my medication without having any problems caused by the side-effects the doctor said might occur. My caregivers will learn to talk to me in a manner that will calm me when I am anxious and try to do things by myself.”Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

12. “I” Care Plans Interventions: “Please talk to me before you touch me as this will keep me from becoming upset.” “Explain to me what I have done to cause me to fall rather than scold me.” “Encourage me to attend my therapy sessions because I may tire easily and begin to not want to go.” “Give me my medication after I have eaten, if the doctor agrees, because that is how my wife has always done it.” “Please be aware of any unusual movements of my mouth, arms, legs, or fingers. Tell my wife and doctor when this happens because it could be from my medication.” “For the first few weeks I am here you can use that alarm we talked about to help me remember that I shouldn’t try to get up by myself. After about 3 weeks please look at my chart and see if it is still necessary. It may not be after my medication starts to work and I have become use to where I am.”Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

13. The Process • Takes time • Can cause some confusion at first • Can be hard to remain on track • Don’t give up!!!Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

14. The Benefit • Improved communication to staff • Improved quality of care provided to residents • Improved satisfaction of residents and family members • Allow your staff to become more familiar with your residents • Remind your staff the resident is a person not a diagnosis down the hall • Increased autonomy of the resident • Improved Survey ResultsJennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

15. What More Could We Want?Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Figure is a man giving a woman a present and a caption that says "I love it Here!“ Figure is a picture of doctors and nurses with a caption that says "We love our jobs!“ Figure is a picture of office professionals with a caption that says "What a great team. No deficiencies this year. They did it!" I love it here! What a great team. No deficiencies this year. They did it! We love our jobs! Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008

16. References Gulanick & Myers.(2007).Nursing Care Plans: Nursing Diagnosis And Intervention.6th edition. St. Louis, Missouri. Mosby & Elsevier. http://www.us.elsevierhealth.com . Saunders 2007 retrieved June 9, 2008Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008 Jennifer Wright, RN Director of Nursing: Highland Pines Nursing and Rehabilitation Longview, Texas 2008