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What is a nursing care plan?

A care plan is a document used by health care professionals to help them plan for the optimum care of an aged care resident or aged care client. 

Nursing homes and aged care services use care plans to help guide them in the care of an older person.

A good care plan should detail an individual's care needs along with specified goals and actions that carers can take to ensure optimal care is delivered.


Care plan assessment

Before a care plan can be drawn up care staff must first assess a resident or aged care client. This assessment determines how well the person can care for themselves, how much help they need with activities of daily living and if they have any specialised care needs.

A care plan assessment helps determine an individual's physical, social and emotional care needs.


What information is included in a care plan?

A care plan should provide information on:

  • Diagnosis
  • Medication regimes
  • Physical care needs (personal hygiene, toileting, mobility) 
  • Wound care
  • Specialised care (tube feeding, diabetic care, colostomy care)
  • Nutrition and dietary needs
  • Use of special lifting equipment or walking aids
  • Use of allied health (podiatry, dental, physiotherapy, optometry)
  • Continence care (use of incontinence pads, special equipment, specific routines) 
  • Social and emotional care needs
  • Spiritual needs

A good care plan allows a caregiver unfamiliar with the care needs of a person to step in at any time. Goals of a care plan should focus on supporting an individual's strengths, preferences and interests.

A care plan needs to be continually reviewed and updated to reflect an individual's current health status and care needs. A care plan should be easy to follow and understand.


How can I be involved in a loved one's care?

Family conferences are a great way to be involved in the care of a loved one. Nursing homes should have regular family conferences where a nursing care plan is read out and reviewed by everyone involved in the care of a loved one including the aged care client.

If you are a carer you can write up your own care plan. Knowing that alternative care arrangements can be made at a moments notice in case anything happens to you will put your mind at ease. It will also ensure care is consistent.

Keep a care plan in a known spot with important phone and emergency contacts. Inform all family members and carers of its whereabouts.


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Albert Mojica wrote 25 weeks 13 hours ago
wow this is a good place to be for my Grand ma, what are the other things or activities you have in there? thanks I am really interested.
GUEST wrote 49 weeks 6 days ago
I was searching the web to see who's reponsibility is it to write the care plan in an aged care facility. Im studying Cert 3 age care, and was told that only the RN writes up the Care plan with advices from Allied Health. So I was kind of thrown off from that 2nd to last paragraph? What setting would that be?
Guest wrote 1 year 2 weeks ago
As a nurse facilitator, I have seen heaps of care plans. However, there just seems to be so many bit of paper, in order to find the info, in a concise manner that we are looking for. I am trying to teach the basics of care plans, to gather info regarding residents and their needs. They have so little time in clinical, that I would prefer that they were interacting with residents on the floor. Computers an books can be found at home/ uni. Does anyone have a simplified template/ summary of all acfi documents that I could use as a tool for this unit? Cheers mickey
Guest wrote 1 year 6 weeks ago
care plan for someone who is 85 year old resident who is recovering from a cerebrovascular accident (CVA). She has left sided weaknessand swallowing difficulties.she mobilises with a walker and feels very embarrassed as she needs to wear an incontinence pad,due to urinary incontinence. She is normally able to speak slowly and clearly, but today she is having difficulty with her speech. Please identify the members of the multi disciplinary team that you would include in her recovery and outline why they would form an important part of the team.
Golden Carers wrote 1 year 25 weeks ago
There is some helpful information on the Golden Carers website including sample care plans.

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