Person-Centred Care Planning

Outline

Review current care planning practices in the different branches of nursing

Examples from practice Consider care planning within models of

nursing and care philosophies Person-centred approaches Reflection

Exercise A

List the types of care plans you have used in practice: Name them Write down any known theory or philosophy

behind them Describe them

Exercise B

List the elements you think are important for a ‘good’ care plan (explain why)

Discussion Issues

Different client groups within the health service and voluntary sectors

Can one model fit all? Who should be involved in the care planning

process? Care collaboration – the way forward or a case

of too many cooks? (consistency v multi-perspective)

Care Planning Philosophy

Why worry about models of nursing and philosophies of care when care planning?

Care Planning Philosophy

Philosophies of care and nursing models provide: structure and an evidence base for the care

planning process context within contemporary mental health care

so that care practices match current trends in theory and philosophy

consistency between care providers

Philosophies of Care

Name some philosophies of care that drive nursing (past and present)

What models of nursing have influenced care for people with mental health problems and learning disabilities?

Nursing Process

Assessment (of patient's needs) Diagnosis (of human response needs that

nursing can assist with) Planning (of patient's care) Implementation (of care) Evaluation (of the success of the implemented

care)

Models of Nursing

Roper, Logan & Tierney (1980) Activities of Daily Living (Holistic)

Roy’s Adaptation Model

Roper, Logan & Tierney (1980):Activities of Daily Living

Maintaining a safe environment

Communication Breathing Eating and drinking Elimination Washing and dressing

Thermoregulation Mobilisation Work and play Expressing Sexuality Sleeping Death and dying

Roper, Logan & Tierney (1998):Activities of Daily Living

Bio-psychosocial model of medicine Useful for assessing older people, people with

mental health problems and chronic diseases Focuses on the functional status of the person

Roy’s Adaptation Model

Biological

Psychological Social

•Sees individual as a set of interrelated systems:

Roy’s Adaptation Model

Individual tries to maintain balance between the 3 systems and the outside world

Because there is no absolute balance we adapt to a level we find acceptable

Roy’s Model in Practice

Patton (2004) examined use of the model in acute psychiatric nursing:

Acknowledges the potential (has clear scientific & philosophical basis)

Needs more research-based evidence as to it’s efficacy

Focuses on the continuous process of change inherent in people

Aims to empower people to reclaim control of their lives using 3 domains of self, world and others

Self domain – where person feels their world of experience

World domain – where people hold their story

Others domain – relationships (past, present & future)

Have to believe the following: that recovery is possible that change is inevitable - nothing lasts that ultimately, people know what is best for them that the person possesses all the resources they need to

begin the recovery journey that the person is the teacher and the helpers are the

pupils that the helper needs to be creatively curious, to learn

what needs to be done to help the person, now!

The Ten Commitments

1. Value the voice - the person's story is paramount 2. Respect the language - allow people to use their own language 3. Develop genuine curiosity - show interest in the person's story 4. Become the apprentice - learn from the person you are helping 5. Reveal personal wisdom - people are experts in their own story 6. Be transparent - both the person and the helper 7. Use the available toolkit - the person's story contains valuable information

as to what works and what doesn't 8. Craft the step beyond - the helper and the person work together to

construct an appreciation of what needs to be done 'now' 9. Give the gift of time - time is the midwife of change 10. Know that change is constant - this is a common experience for all people

Comparisons

All these models take an holistic approach Activities of Daily Living is generally more

medically orientated Roy’s & Tidal models see the uniqueness of

the person Roy’s is more scientifically based but less

applicable than the Tidal model

Recovery Orientated Planning

Individual and collaboratively developed Identifying hopes, goals and ambitions May consider triggers and coping strategies Identifies resources, may include within and

outside of services. Resources may be personal and environmental

Move beyond focus of treating illness to promoting health & wellbeing

But ….Could be frightening process , thinking about

traumatic experiences and taking back responsibility

Application to practice

1) Think about your own recovery orientated plan. What would you want to include?

2) In pairs identify someone you worked with on your last placement. What would you include in a recovery orientated care plan?

Key elements

The trusting relationship between the named person and the service user.

Allowing and facilitating the service user to contribute their own feelings and views to the care they are receiving.

Strengths Model (Rapp, 1984)

– Emphasis is on the client’s strengths, interests and abilities NOT upon weaknesses, deficits and pathology.

– People with mental health problems can learn, grow and change.

– The client is viewed as the director of the helping process.– The client/care co-ordinator relationship becomes the

foundation for the mutual collaboration.– The community is viewed as a potential resource rather

than an obstacle.

Care Pathways

• Current trend in healthcare and used in both residential and acute/treatment settings.

• Pathways form the central part of multi-disciplinary healthcare records.

• Can be used as guides to what interventions/work you may want to implement with service users.

• It should be used in partnership with service users.

Risk Management

Risk assessment and risk management are a key consideration in working with individuals experiencing mental health problems.

You will see a range of care plans used in clinical settings based around risk management e.g. CPA level 2 risks assessments and ‘zoning’.

Current Practice

Personal Plans: Emphasis on client involvement Helps build therapeutic relationship

What happens if you identify an area you feel should be documented. Is this your own personal view on what the client should be working towards or is this a risk issue?

Current Practice

Risk Assessment Plans: Essential for addressing areas not highlighted by

service user Still discuss the risk management plan with the

service user even if they don’t agree Therapeutic risk taking – important to be care

planned and owned by the whole multi-disciplinary team

Evaluation of Care Plans

• Evaluation of care plans is completed according to the time frame of the care plan and in collaboration with service user (this is often reviewed in individual clinical supervision)

Acute/Treatment Ward Settings

Care pathway documentation You will find some variation in care planning

documentation used. Standardised care plans around observation

levels (high, intermittent and low.) Standard Trust care plan which can be used

through either a personal plan or risk management approach