Developing Nursing Care Plans

CONTINUING PROFESSIONAL CPD DEVELOPMENT Developing nursing care plans

NS832 Ballantyne H (2016) Developing nursing care plans. Nursing Standard. 30, 26, 51-57. Date of submission: August 31 2015; date of acceptance: October 16 2015.

Abstract Aims and intended learning outcomes This article aims to enhance nurses’ understanding of nursing care plans, This article aims to enable you to develop reflecting on the past, present and future use of care planning. This a comprehensive understanding of nursing involves consideration of the central theories of nursing and discussion care plans so that you may begin to of nursing models and the nursing process. An explanation is provided of critique, adjust, develop and adapt them how theories of nursing may be applied to care planning, in combination to suit the requirements of different contexts with clinical assessment tools, to ensure that care plans are context of care. After reading this article and specific and patient centred. completing the time out activities you should be able to: Author  Outline the concepts and processes of planning care that enable you to use nursing Helen Ballantyne Staff nurse, Transplant Continuing Care Unit, care plans effectively. Papworth Hospital NHS Foundation Trust, Cambridge, England.  Discuss how nursing models and the nursing Correspondence to: [email protected] process relate to nursing care plans.  Describe how nursing care plans can benefit Keywords patients and nurses. care bundles, care pathways, care plan, care planning, critical thinking,  Identify potential problems with nursing models of care, nursing process, nursing theory, patient-centred care care plans in practice.  Outline the advantages and Review disadvantages of using nursing care plans in practice. All articles are subject to external double-blind peer review and checked for plagiarism using automated software. Introduction Revalidation Nursing care plans are based on nursing Prepare for revalidation: read this CPD article, answer the questionnaire theory, which is taught throughout nurse and write a reflective account. www.rcni.com/revalidation education, but is seldom revisited thereafter. Nursing care plans are complex, involving Online many aspects of nursing theory and practice. Therefore, nurses may find it difficult to For related articles visit the archive and search using the keywords above. understand how these aspects relate to care To write a CPD article: please email [email protected] planning in practice. Guidelines on writing for publication are available at: The terms ‘care planning’ and ‘care plan’ journals.rcni.com/r/author-guidelines. are often used interchangeably. This contributes to misunderstanding of the theory of care plans, encouraging some nursing staff to dismiss them as irrelevant to practice. ‘Care planning allows a nurse to identify a patient’s problems and select interventions that will help solve or minimize these problems’ (Matthews 2010), and ‘Care plans are the written records of this care planning process’ (Barrett et al 2012). Essentially, care planning is the action, while a care plan is a record of that action.

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Evolution of planning nursing care nurses to identify with the patient’s potential and In 1978, the planning of nursing care was actual health problems (Aggleton and Chalmers becoming a common topic for discussion in the 2000). Assessment may be considered the first nursing profession (Clarke 1978). In contrast, stage in the planning of nursing care, since it starts a nurse job analysis in 1953 did not recognise the process of gathering information to make or include care planning as a nursing task decisions about suitable interventions. (Goddard 1953). Reflecting on past ways of In general, planning nursing care is working, Lelean (1973) observed that nursing the process of setting goals that provide care was often dictated by ward routine. benchmarks for evaluating care. These goals It was a functional, activity-based method of may be adapted after the nursing intervention nursing where patients became names on a list has been implemented. Modifications to this according to the procedures they required. process may be used, depending on factors There are anecdotal stories of care being such as the culture of nursing, the context or provided by word of mouth, via bath books, the patient. A nursing diagnosis stage may be TPR (temperature, pulse, respiration) books, inserted between the assessment and planning dressing books and work lists. This reflected stages. Carpenito-Moyet (2009) stated: ‘a a task-based system of nursing, where the nursing diagnosis is a clinical judgment about emphasis was on the activity rather than the individual, family or community responses patient. However, by implication, there was to actual or potential health problems/life planning of care using these lists, since care processes.’ Therefore, a nursing diagnosis was provided and patients’ needs were met. acknowledges the actual or potential health The aim now is to provide individualised care, problem and labels it. ‘A nursing diagnosis is with emphasis on the patient’s unique needs. commonly referred to as a diagnostic statement This evaluation of care planning in nursing or identification of problem or need’ (Matthews history does not make the assumption that 2010). This stage is not often used explicitly nursing in the 1960s and 1970s was poor in the UK. However, it may be argued that and nursing in the present day is better, nor it is used implicitly throughout the nursing does it reflect the level of care given or the process since patient needs are identified and outcomes experienced. Nurses have always addressed. For example, consider a patient planned, carried out and documented that handover, where nursing diagnoses are often care, albeit in varying levels of detail. It is the made after a formal assessment, and several method of planning care that has changed over nursing diagnoses, for example, anxiety, risk time (Walsh 1998). For example, consider a of impaired skin integrity and disturbed sleep dressing change. In the 1970s, the care was pattern, may be used routinely. planned in the dressing book, the task ticked If one applies the nursing process to a off once completed and plans made to repeat familiar life activity, such as buying a house, the care if required, with a further entry in it is possible to understand its usefulness. A the dressing book. One can speculate that family plans to move house; the assessment care plans may be required now more than consists of a list of needs, for example a garden, ever, given the increased complexity of care, a primary school nearby and three bedrooms. access to information and changing healthcare The process is planned; visiting estate agents environments. or using online tools. The intervention is when the family moves in. Evaluation of the situation The nursing process is continuous, as the family assesses the house, 1 Make a note of all The development of the nursing process lives in it, adapts it, reassesses and possibly the nursing models you (Yura and Walsh 1967) may be considered the moves out once their needs change. can think of. Consider most influential change in approaches to thinking Complete time out activity 1 them individually and about nursing care. The nursing process is a clear try to remember the and straightforward cyclical model, consisting of Other nursing models basic principles of each. four concepts of nursing: assessment, planning, The next aspect of nursing theory to consider, Is there any particular implementation and evaluation. The central while keeping the nursing process in mind, is model which you believe consideration of the nursing process is that it nursing models. These models offer a range of applies best to your looks first at the patient and then thinks about the beliefs and values to guide nurses through the place of work? Discuss care that is required, rather than deciding what stages of problem-solving and provide direction this with a colleague to care the patient needs and then looking at the regarding that which is relevant and important find out if you agree. patient and how this might be implemented. The (Barrett et al 2012). Walsh (1998) described the emphasis is on patient assessment, encouraging nursing process as a tool to provide structure to

52 fDownloadedebruary 24 from:: vol RCNi.com 30 no 26 by:: 2016${individualUser.displayName} on May 18, 2017. For personal use only. NoNURSING other uses without STANDARD permission. Copyright © 2017 RCN Publishing Company Ltd care delivery and models of nursing as tools to example, a patient with a supportive family, instruct us on how care should be given. no comorbidities and an effective relationship Several definitions of nursing models refer with their GP may recover more quickly from to their use in the nursing process. They often a myocardial infarction than a patient who provide detail to be used in conjunction with is recently divorced and has type 2 diabetes the nursing process to facilitate care. Many and a history of missed GP appointments. In nursing models fit into one or more of the this model, nursing is required when the line four stages of the nursing process. However, of resistance has been diminished and can no several nursing models were published before longer protect a person. The emphasis is on the nursing process was formalised. This lends preventive health to ensure that the patient is validity to the nursing process, since it indicates well-equipped to resist any stressors that may that the process was in use informally before it arise as a result of their diagnosis. was formally documented. Each of these models of nursing has different Models of nursing can be abstract and priorities. By including selective aspects of difficult to measure, yet are practised daily, each of the models, it is possible for the nurse to usually without a formal label. Different develop patient centred, context-specific care models prioritise different aspects of care and plans that enable high quality care planning reflect the care priorities of the nurse. Nurses and comprehensive documentation. For in different environments provide care in a example, a care plan encompassing aspects of structured and detailed way, but their priorities the Roper-Logan-Tierney, King and Neuman and action points differ. For example, the models might adopt a holistic approach to the priority in a critical care unit is to manage patient to ensure physical symptoms are assessed the needs that patients are unable to manage and self-care goals are set, and to initiate a themselves, while the emphasis in an outpatient therapeutic relationship to facilitate interventions clinic may be on assisting patients with self-care and further assessment as required. and self-medication. Despite their long history, models of nursing Certain models of nursing prompt nurses to are still debated. Bakker and Mau (2012) stated ensure they are assessing the whole patient and that it is essential to incorporate the opinions nursing holistically. The Roper-Logan-Tierney of the main partners in care to develop a model of nursing based on activities of daily model of nursing that best reflects professional living is frequently used in assessment and nursing practice. This approach encourages admission documentation (Roper et al 2000). the development of models of nursing, where King (1981) developed a model that emphasised patients and the multidisciplinary team are the importance of therapeutic relationships, the consulted. Care pathways are one application ability of all humans to interact meaningfully of this theory. with one another in pursuit of a common goal. This led to a shift from the four-stage nursing Care pathways process towards developing a goal-oriented Care pathways were first used in the 1990s in nursing record. King (1981) identified the the United States and have been employed in the importance of communication and information NHS in a range of clinical settings since 1992. sharing when setting goals, since without They were introduced as a means of assisting communication, goals are unlikely to be met. healthcare professionals to deliver high quality, Therefore, King’s (1981) model emphasises the evidence-based and cost effective care (Kozier importance of excellent communication skills et al 2008). Walsh (1998) explained that in to establish a beneficial interaction to achieve developing a care pathway, all professionals the goals of care, rather than a checklist of involved in patient care are bought together aspects to cover in the patient assessment. and come to a consensus about the standards of The Neuman systems model focused on the care and expected outcomes for selected patient person as consisting of a core of resource, with groups within an agreed time frame. several lines of resistance or defence (Neuman Care pathways stimulate debate and and Fawcett 2010). The model suggests that discussion. Some patients meeting certain these lines of resistance fluctuate according to criteria will require the same general treatment. physiological, sociocultural, psychological, These treatments may be pharmaceutical, for spiritual and developmental variables. A person example pain relief or they may be clinical, such experiencing an extreme level of any of these as the placement of an intravenous cannula. The variables may find it difficult to resist their effects care pathway provides a stimulus to deliver and and may experience symptoms of ill health. For record such interventions. The idea of all patients

receiving the same treatments contradicts the the nursing process. Nurses plan their care, concept of holistic patient-centred care that gathering equipment and thinking it through; nurses are encouraged to deliver. However, intervene, performing the care; and continually if patients meet relevant criteria, standard evaluate, ensuring the patient remains stable. interventions can be performed, freeing up time In this way, the care bundle is applied to the for individual care in other areas. intervention aspect of the nursing process, linking specialist clinical knowledge with Clinical assessment tools fundamental nursing theory. Clinical assessment tools are often used National Service Frameworks are extensions as a part of the nursing process and care of the care bundle. They have been developed pathways. They may be considered as a at government level to address high priority, modern addition to nursing models that high mortality diseases. They directly affect the enable the nursing process. Clinical tools, care provided since they set clear requirements for example the Glasgow Coma Scale (www. for care based on the best available evidence glasgowcomascale.org), aim to ensure that (Kozier et al 2008). Moreover, they provide care is consistent, considered and appropriate guidance and support for organisations to to each patient. Using clinical assessment enable them to achieve these requirements. tools also provides a baseline from which Complete time out activity 2 to measure variation, improvement or deterioration in the patient’s health status as Critical thinking care progresses. There are many useful tools and models that Assessment skills may vary widely between assist in the planning of nursing care and staff and clinical tools provide guidance and consequently the production of useful, patient objectivity to counter instinctual assessment. centred, contextual care plans. To date, the A patient with a normal blood pressure, heart development of standardised care plans for rate and respiratory rate may still feel unwell, individual nursing diagnoses or conditions and the nurse should be able to reassure the has been the next step in the process of care patient and perform an assessment based on planning. Not every model or clinical tool will different priorities. The nurse may perhaps be used in each care plan. Equally, every patient question the feelings of the patient; are they is different. Critical thinking skills should always scared, confused or anxious? be applied to practice to ensure that nurses do not make assumptions or work unquestioningly. Care bundles Price and Harrington (2016) described The use of care pathways is a departure from a critical thinking as a process in which patient-specific nursing care plan. This may be information is gathered, sifted, synthesised redressed in part by including definite clinical and evaluated, to understand a subject or issue. instructions for specific problems. Care bundles They applied this in practice, explaining that were created by the Institute for Healthcare critical thinking enables the nurse to function Improvement (2016a) to meet this requirement. as ‘a knowledgeable doer, someone who A care bundle is a group of evidence-based selects, combines, judges and uses information best practices related to a disease or set of to proceed in a professional manner’. Nurses 2 Refer to the symptoms that result in improved outcomes cannot apply standard care plans to all patients Institute for Healthcare when they are implemented together than and, therefore, critical thinking ensures that Improvement (2016b) when they are implemented individually care is patient centred and adapted document on using (Norman 2010). For example, the Institute for as necessary. care bundles to Healthcare Improvement (2012) developed an Complete time out activities 3 and 4 improve health care. evidence-based list of interventions that were In particular, source linked to reductions in ventilator-associated statistics on how care pneumonia in patients in intensive care units. Role of nursing care plans bundles have improved These interventions included positioning of When applying critical thinking to nursing care patient outcomes for the patient’s head, regular assessment for plans, it should not be assumed that care plans aspects of acute care. extubation, oral care and daily sedation breaks. are always beneficial because they have been Discuss with a colleague Care bundles promote efficiency and patient around for years. Kaufman (2012) described how you could improve safety, establish high quality care, and are cost nursing care plans as the common language of patient outcomes in effective and reason based, thus contributing nurses, indicating a clear familiarity with them your clinical area. to improved patient outcomes (Norman 2010). and potential reliance on them. However, this They are usually used in conjunction with should not prevent nurses questioning the use

54 fDownloadedebruary 24 from:: vol RCNi.com 30 no 26 by :: 2016${individualUser.displayName} on May 18, 2017. For personal use only. NoNURSING other uses without STANDARD permission. Copyright © 2017 RCN Publishing Company Ltd of nursing care plans and their role in clinical Lastly, and perhaps most controversially, a practice. When asking: ‘What is the role of the nursing care plan allows care to be measured. nursing care plan in practice?’ there are three The requirement to measure care and main answers: ensure that it meets essential standards and 1. To facilitate standardised, evidence-based, benchmarks may be seen by some nursing holistic care. staff as time-wasting. Historically, nursing 2. To record care. has been seen as a vocational act, noble and 3 Nursing and 3. To measure care. self-sacrificing. The requirement to assess Midwifery Council A nursing care plan can facilitate holistic care the care given may sometimes be seen as (NMC) revalidation, for patients, when used by nurses throughout an affront to the experience, expertise, which comes into their career. A nursing care plan can be used disposition and personality of a nurse. effect on April 1 2016, as a learning tool (Kaufman 2012), whereby a However, measurement of care is essential encourages nurses to novice nurse may rely on such a plan to guide to ensure that patients are receiving the consult their code of their practice. Experienced staff may rely same level of care, despite being cared for conduct and reflect more on their experience. However, providing by different nurses with different levels of on how it links to nursing care is challenging and there are several education and experience, and with different their professional potential barriers to care. priorities and models of working. practice. Read The Shorter lengths of patient stay, higher patient One important criticism of nursing care Code: Professional acuity and technological advances are factors plans is the difficulty in maintaining their Standards for Practice that may restrict the amount of time available relevance as patient needs change. LaDuke and Behaviour for to care for patients (Norman 2010). Other (2008) remarked: ‘Today’s nurse continually Nurses and Midwives issues that may affect patient care include receives and analyzes new data, rapidly (NMC 2015). Which staffing levels and an increasing number of transforming them into action amid crushing parts of The Code may complex patients with multiple comorbidities. workloads. Any care planning document that be directly related to A useful and relevant nursing care plan requires constant manual revision to reflect the use of nursing care may help a member of the nursing team to this changing information is a problem, not plans? Reflect on how acknowledge these barriers and work around a solution.’ LaDuke (2008) concluded that your practice adheres to them. Moreover, such barriers mean that the nursing care plans belong in nurse education these parts of The Code. standard of care cannot always be relied on; and should not be used in clinical practice Compare your answers omissions may be made and human error is unless they can be guaranteed to provide to the points mentioned more likely. A documented care plan can offer real-time information with test results and later in this article. guidance and clarity and may also provide specific instructions for implementation. justification for using nursing time to ensure a Care Planning in the Treatment of Long Term 4 Nurses are required thorough patient assessment. Conditions: Final Report of the CAPITOL to keep a portfolio of Nursing care plans can also be used to Project (Department of Health (DH) 2012a) evidence for revalidation. record the care that has been given. This provided interesting insights. The report Planning activities and allows nursing staff to acknowledge the acknowledged that: ‘Care plans are designed to identifying development care provided, share it to ensure continuity provide a record of agreements between patient aims is an essential and reassess its effects and patient needs and professional about goals and preferences, part of preparing for as required. This documentation enables and to help to organise services around the needs revalidation. Using a nurses to demonstrate that they are working of individual patients and ensure that needs are nursing care plan or within the professional standards of practice regularly reviewed’ (DH 2012a). The report nursing process format, outlined by the NMC (2015). The Code: was designed with the aim of assessing the write a plan for the Professional Standards of Practice and implementation and outcomes of nursing care upcoming year. Assess Behaviour for Nurses and Midwives (NMC plans within the NHS. The DH (2012a) report your development needs, 2015) states: ‘nurses must keep colleagues found that there were so few care plans in place plan goals, and include informed when sharing the care of individuals that part of the CAPITOL project was shifted courses you might like with other healthcare professionals and staff’. to focus on identifying the perceived and actual to participate in, and the It requires registered staff to keep ‘clear and barriers that prevented care plans being put in people you might need to accurate records relevant to their practice’ place, rather than evaluating their usefulness. speak to, to realise your and states that this documentation should be The DH (2012a) report identified plans. Use the document contemporary, kept secure and attributed to ambivalence concerning the effectiveness and throughout the year to the professional in question. A comprehensive relevance of care plans and a lack of clarity monitor your progress nursing care plan that has documented care on how the care plan should be structured, and re-evaluate the skills meets these requirements, and may protect especially in relation to comorbidities and and knowledge you need the nurse in the case of a complaint or the contributions of multidisciplinary staff to acquire. disciplinary action. at separate locations. Where limited time

was available, the report established that It is difficult to reach a conclusion on the care plans were given lower priority when benefits of nursing care plans. The evidence is compared with other markers of care. For contradictory and differences in the information example, there was increased understanding and structure between healthcare organisations of the Quality and Outcomes Framework make direct comparisons difficult. Perhaps we (QOF) programme (Health and Social Care are attempting to standardise aspects of nursing Information Centre 2016) – a voluntary care that cannot be standardised. Considering programme that awards achievement points the 6Cs of nursing: care, compassion, to GPs when managing long-term conditions competence, communication, courage and such as asthma or diabetes. When combined commitment (DH 2012b) as a set of goals for with incentives, the QOF was used more nursing, is it possible to equate a clear, accurate readily. The DH (2012a) report demonstrated nursing care plan with a compassionate and that the effects of effective care plans and caring nurse? Comprehensive nursing care plans care planning were unclear and that further may not compensate for the absence of beneficial 5 Design a nursing work was required to improve levels of care personality traits that patients would like to see care plan using the 6Cs planning which may result in patient benefits. in nursing staff. of nursing as a basic Complete time out activity 5 Complete time out activity 6 framework for a group of patients you are familiar with. Try to ensure Discussion Conclusion that all their needs are Keogh (2015) stated that the essence of Nursing care plans may be used as a tool accounted for. professionalism is being able to describe the to promote holistic care. The care services you provide and define how well you planning process is central to patient-centred 6 Critique a nursing do it. A clear, accurate and contemporary care, enabling nursing staff to plan the care plan that you use nursing care plan should enable nurses interventions and, where possible, discuss in practice. Attempt to to achieve this, maintaining professional them with the patient. However, health care identify its strengths integrity while providing excellent is complex. Different groups of patients and limitations. Does it evidence-based care. require different interventions and different provide patient-centred There are many unanswered questions care goals. A care plan for one patient may care? Is there anything regarding care plans. Further investigation not suit another, even if they have the same missing? Is the format is required to determine if wards that are needs. Therefore, care plans should be used easy to use? How would failing to deliver basic care use care plans with consideration. you change it? routinely. Radcliffe (1999) observed that Nurses should continually question the care care plans for children under five years have they provide and evaluate their plan of care. 7 Now that you have been held in their home with their parents for Selective use of tools by nurses, for example care completed the article, many years. This ‘red book’ has documented plans, care bundles, care pathways, and clinical you might like to write nursing care, providing healthcare goals, assessment tools, can result in a patient-centred a reflective account as guidelines and care notes. Therefore, would care plan that facilitates the delivery of care, part of your revalidation. optimum care planning be achieved when ensures that nothing is forgotten, and records Guidelines to help you patients are able to write their own care plan and measures the quality of care, to the benefit are on page 62. with the help of the nurse, read it at the end of of the patient and the nurse NS their care and evaluate it for themselves? Complete time out activity 7

References Aggleton P, Chambers H (2000) for Nurses. Second edition. Department of Health (2012a) Vision and Strategy. The Stationery Nursing Models and Nursing Routledge, Abingdon. Care Planning in the Treatment Office, London. Practice. Second edition. Palgrave of Long Term Conditions: Final Macmillan, Basingstoke. Carpenito-Moyet LJ (2009) Report of the CAPITOL Project. Goddard H (1953) The Work Nursing Care Plans and hrep.lshtm.ac.uk/publications/ of Nurses in Hospital Wards: Bakker D, Mau J (2012) The Documentation: Nursing Diagnosis Care%20planning_final_ Report of a Job Analysis. nursing model of care: don’t and Collaborative Problems. Bower%20et%20al_7%20 Nuffield Provincial Hospitals forget the patient perspective. Fifth edition. Lippincott Williams Mar%2013.pdf (Last accessed: Trust, London. Nursing Management. 43, 10, and Wilkins, Philadelphia PA. January 19 2016.) 8-11. Health and Social Care Information Clarke M (1978) Planning nursing Department of Health (2012b) Centre (2016) Quality and Outcomes Barrett D, Wilson B, Woollands A care: recent past, present and Compassion in Practice: Nursing, Framework. www.hscic.gov.uk/qof (2012) Care Planning: A Guide future. Nursing Times. 74, 5, 17-20. Midwifery and Care Staff. Our (Last accessed: January 19 2016.)

56 fDownloadedebruary 24 from:: vol RCNi.com 30 no 26 by :: 2016${individualUser.displayName} on May 18, 2017. For personal use only. NoNURSING other uses without STANDARD permission. Copyright © 2017 RCN Publishing Company Ltd Institute for Healthcare Keogh B (2015 ) NHS England Matthews E (2010 ) Nursing Care Students . Third edition. Learning Improvement (2012 ) How-to Guide: Opinion: Health and High Quality Planning Made Incredibly Easy! Matters, Exeter . Prevent Ventilator-Associated Care for All, Now and for Future Lippincott Williams and Wilkins, Pneumonia . www.ihi.org/resources/ Generations . www.england.nhs.uk/ Philadelphia PA . Radcliff e M ( 1999) Don’t let the pages/tools/howtoguidepreventvap. oped-bruce-keogh/ (Last accessed: notes grind you down. Nursing aspx (Last accessed: January 19 2016.) Neuman B , Fawcett J (2010 ) Times . 95 , 48 , 27 . January 19 2016.) The Neuman Systems Model . King IM ( 1981 ) A Theory for Nursing: Fifth edition. Prentice Hall, Roper N , Logan W , Tierney AJ Institute for Healthcare Systems, Concepts, Process . Delmar Upper Saddle River NJ. (2000 ) The Roper Logan and Improvement (2016a ) What is a Thomson Learning , Florence KY . Tierney Model of Nursing: Based Bundle? www.ihi.org/resources/ Norman B (2010 ) An Ounce on Activities of Living . Churchill Pages/ImprovementStories/ Kozier B , Erb G , Berman A , of Prevention: Best Practice Livingstone, Edinburgh . WhatIsaBundle.aspx (Last accessed: Snyder S , Lake R , Harvey S (2008 ) Bundles . www.amsn.org/sites/ January 19 2016.) Fundamentals of Nursing: default/fi les/private/medsurg- Walsh M (1998 ) Models and Concepts, Process and Practice . matters-newsletter-archives/ Critical Pathways in Clinical Institute for Healthcare Improvement Pearson Education, Harlow . marapr10.pdf (Last accessed: Nursing: Conceptual (2016b ) Using Care Bundles to January 19 2016.) Frameworks for Care Planning . Improve Health Care Quality. LaDuke S (2008 ) Death to nursing Second edition. Baillière www.ihi.org/resources/Pages/ care plans! The American Journal of Nursing and Midwifery Council Tindall, Edinburgh . IHIWhitePapers/UsingCareBundles. Nursing. 108 , 6 , 13 . (2015 ) The Code: Professional aspx (Last accessed: Standards of Practice and Yura H , Walsh MB ( 1967 ) January 19 2016.) Lelean S (1973 ) Ready for Report Behaviour for Nurses and Midwives . The Nursing Process: Assessing, Nurse? A Study of Nursing NMC , London . Planning , Implementing and Kaufman C (2012 ) Designing a Communication in Hospital Evaluating. Catholic University nursing care plan for a lifetime. Wards. Royal College of Nursing, Price B , Harrington A (2016 ) Critical of America School of Nursing, Nursing. 42 , 7 , 54 - 60 . London . Thinking and Writing for Nursing Washington DC.

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1. Care planning enables nurses to: 7. Which of the following do UK How to use this assessment a) Identify a patient’s problems ❏ National Service Frameworks This self-assessment questionnaire (SAQ) b) S elect interventions that will help address? will help you to test your knowledge. Each ❏ solve a patient’s problems a) H igh priority, high mortality week you will find ten multiple-choice c) S elect interventions that will help disease ❏ questions that are broadly linked to the minimise a patient’s problems ❏ b) High priority, low mortality CPD article. Note: there is only one d) All of the above ❏ disease ❏ correct answer for each question. c) L ow priority, low mortality 2. Which is not a concept in the disease ❏ You could test your subject knowledge nursing process? d) Low priority, high mortality by attempting the questions before a) Implementation ❏ disease ❏ reading the article, and then go back over them to see if you would answer b) Evaluation ❏ any differently. c) Discharge ❏ 8. Critical thinking ensures that: d) Assessment ❏ a) Nurses make assumptions You might like to read the article to safely ❏ update yourself before attempting 3. Which is prioritised in King’s b) C are is patient-centred and the questions. ❏ nursing model? adapted as necessary When you have completed your a) Therapeutic relationships ❏ c) Individual judgement is self‑assessment, add it to your professional b) Individual resources ❏ unnecessary ❏ portfolio. You can record the amount of c) Activities of daily living ❏ d) Alternatives are not considered ❏ time it has taken. Space has been provided d) Preventive health ❏ for comments. 9. Which of the following is not a 4. Care pathways: function of nursing care plans? You might like to consider writing a a) A pply to all patients with a a) T o assist standardised reflective account, see page 62. given condition ❏ evidence-based holistic care ❏ b) Involve standard interventions ❏ b) To co-ordinate multidisciplinary c) Involve clinical interventions care ❏ Report back only ❏ c) To measure care ❏ This activity has taken me _____ hours to d) Involve pharmaceutical d) To record care ❏ complete. interventions only ❏ Other comments: 10. What is the main purpose of 5. Care bundles: measuring care? a) A pply to the evaluation phase a) T o ensure all patients receive the of the nursing process ❏ same level of care ❏ b) A re a group of evidence-based b) To identify staff training needs ❏ best practices that result in c) To justify staffing levels ❏ improved outcomes when d) T o ensure all staff are competent Now that I have read this article and implemented individually ❏ to practice ❏ completed this assessment, I think c) P romote efficiency and patient my knowledge is: safety ❏ This self-assessment questionnaire Excellent ❏ d) A re based on specialist clinical was compiled by Beth Knight Good ❏ knowledge ❏ Satisfactory ❏ The answers to this questionnaire Unsatisfactory ❏ 6. Clinical assessment tools: will be published on March 9 Poor ❏ a) Are subjective ❏ As a result of this I intend to: b) P rovide a baseline from which to The answers to SAQ 830 on measure variation, improvement discharging patients from acute care, or deterioration ❏ which appeared in the February 10 c) D epend on the level of skill of issue, are: the nurse ❏ 1. d 2. a 3. c 4. b 5. d d) Depend on the nurse’s intuition ❏ 6. c 7. b 8. b 9. a 10. c

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