Nursing care plan helps the nurse for deciding the right approach in caring for the patient during the stay of the patient up to the time the patient is discharged. The nursing care plan becomes a written document. It is up dated from time to time, depending on the status health of the patient and incorporating any changes required. It can mean addition of some thing or elimination of some thing from the previous planned care.
Nursing practice needs thoughtful and focused planning of the care of the patient based on the laboratory investigation records and history of the patient and from time to time checking the progress made in the light of anticipated goals.
The Principle Underlying the Approach:
The basic principle about each Nursing care plan is it’s specific customization for each patient and can not be substituted by a stereotype plan of a particular disease. When there is proper nursing staff ratio in the health care set up, the nurse gets ample time to do the desk job of patient care planning and complete the records of the patient from the stage of admission to discharge of the patient followed by a home care plan based on the history, medical records, physical assessment and nursing diagnosis. The patient shall be performing care at home as suggested by the nurse either by self or with the assistance of a help.
But in practical situations, the right nurse patient ratio is never present. The night shifts are overstressing hardly any time to plan and write any thing. Writing a comprehensive nursing care plan requires lot of time. One tries to take help of the standard care plans instead of making a comprehensive nurse care plans. Standard care plans, software generated plans and plans copies from care plan books are just the resources for reference and are not substitutes for comprehensive nurse plans.
The Lacuna Needing Correction:
Comprehensive patient care planning although very vital; often is neglected as wastage of time and considered a futile exercise, thus neglecting an activity on which shall depend patient’s health. Nurse care plan is like a guide post in patient’s healthy recovery, from which all the health care workers seek guidance from time to time patient is admitted in the hospital.
The nurse care plan is left at the discretion of the nurse in-charge of the patient care. Thus other members of the health care team belonging to different disciplines get excluded. The nurse becomes overloaded with work affecting effectiveness. Patient care planning should be a joint effort in planning and executing the plan.
The patient care plan begins with correct assessing considering all the factors. When the patient is in acute condition the initial care plan should be thoroughly assessed at the time of admission and subsequently reassessment is required to be done with the changes in the status of the patient after admission till the condition of the patient gets stabilized.
Different Situations & Appropriate Plans:
When the patient requires long term care, the assessment and formulating of the nurse care plan, is based on the Minimum Data Set. In the case of home patient care nurse, uses oasis assessment plan. In other situations there are protocols on the basis of which the assessment is made and patient care plan devised and reassessment is carried out as specified in the protocol.
Having arrived at the first assessment, problems are listed, which is just simple process or one can involve Resident Assessment Protocol and minimum data set. While listing the problems one also include the strengths, the patient is having or even relations with his other family members, which are causative factors for the disease and general well being of the patient.
Finding Answers from Questioning:
The next stage is looking at the specific problem and the step poses a question in the mind of the nurse “is the problem going to be corrected or some thing can be done to reduce the intensity of the problem.” The yes answer means making a goal for resolving the problem or attempt it’s improvement during the review period, which shall be of longer duration in long term and home health care plan in comparison to acute patient’s nurse care plan . The Goal has to be specific with defined parameters of measuring the progress and achieving visible improvement.
If the problem presented by the patient has very uncertain chances of improvement, the next thoughts are can the worse progression be arrested or delayed? Such a situation is usually found in diabetic and congestive heart failure patients. The question is can an intervention minimize the problem although marginally.
Care Plan of Terminally ill Patients:
In case the problem in any manner can not be improved and the worse is imminent, what can be done to improve the quality of life till the patient is living. The examples are of Alzheimer’s disease or nutritional issue in case of terminally ill patients. The nurse care plan is till the patient is admitted in the hospital or after discharge at the home is convalescing. In case of terminally ill patients all angles and probabilities should be studied before drawing nurse care plan focusing on what comforts can be accommodated because, it is going to remain in implementation stage till the end of the life of patient.