Stages of Care Planning Process in Health and Social Care

This report covers a case study of Natalie, 67-year-old lady sought an emergency medical care due to prolonged chest pain and the identification of stages of care planning processes with help of relevant theories and exhibiting the necessity of the person-centred approach throughout the procedure.

Health and social care.

Table of Content.
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
TASK 1............................................................................................................................................1
Referral........................................................................................................................................1
Stages of the care planning process.............................................................................................2
Assessment:..................................................................................................................................2
Diagnosis......................................................................................................................................2
Planning.......................................................................................................................................3
Implementation and Execution....................................................................................................4
Person-Centred approach.............................................................................................................4
Evidence-based practice...............................................................................................................5
Legislation and Social policies....................................................................................................6
TASK 2............................................................................................................................................7
Flow chart of the process of care planning..................................................................................7
CONCLUSION................................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
A person-centred approach is mainly focus over the elements of care, support as well as
the care treatment which can matter most of the vulnerable patients, their relatives and carers as
well. In health and social care, the care professionals can work collaboratively with the people
who can use the care services. The person-centred care can encourage the people to improve the
skills, knowledge’s as well as confidence they generally require to be more efficiently manage as
well as can make an informed decision about their own well-being and care as well. The care can
effectively help to reduce the risks of various negative, harmful, or an unfair care treatment and
neglect to the recipients of well-being and the social care services. A person is mainly put at the
centre of a care and can be able to select as well as control how they want their care and the
support to be delivered. The health need assessment is mainly a systematic approach for
visualizing the well-being problems that the population is generally facing, leading to an agreed
priority as well as the allocation of resources which will enhance the well-being and can
effectively decreases the disparities as well. In this report, it will cover a case study of Natalie,
67-year-old lady sought an emergency medical care due to prolonged chest pain and for her there
is an identification of stages of care planning processes with help of relevant theories and can
also exhibiting the necessity of the person-centred approach throughout the procedure. In
addition to this, there is also a discussion about the relevant legislations and the social policy
which can impact the process of care delivery across the health and social care (Hogston and
Simpson, 2001).
MAIN BODY
TASK 1
Referral
It will give specific information on the first step within the patient process of care
delivery referral. There is a case scenario of Natalie, 67-years-old women, generally sought an
emergency medical care due to prolonged chest pain. In the year 2015, April she had a prolonged
chest pain and at that time she sought the medical care. The patient was admitted at the
healthcare organization and is diagnosed with myocardial infarction. She had a medical history
of diabetes mellitus, hypertension, dyslipidemia and she was a smoker also.
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Stages of the care planning process.
In care planning, it is generally the procedure by which the well-being care professionals
as well as the patients can discuss, agrees as well as can review an action plan to effectively
attain the aims and goals or the specific behavioural alterations of most of the relevance towards
the patient. In this, a care plan is mainly a written document generally record the results of the
care planning process. The care planning process can involve the four main phases which are
detailed below. These such phases can be worked via in a sequential process to effectively create
a care plan with the patient such as Natalie in a single patient encounter and then effectively
managed via the follow-up. Therefore, a care plan can also be improved iteratively over a series
of encounter of her, frequently with the contribution of various well-being care providers,
through which additional information about Natalie is collected as well as considered in
processing the care plan with her as well. Ultimately, the care plan is mainly a living document,
it is continually adjusted with the Natalie as more information can become available, such as
through the follow-ups or assessment of the Natalie done by the other service providers (Nursing
Process, 2021). In this, a complete care planning procedures can also involve some care plan
management activities like encouraging her in attaining the self-management goals or can
coordinate the care for Natalie as well. In addition to this, the care planning process can involve
the stages are as detailed below:
Assessment:
It is mainly the first step in the care planning part of Natalie and can include the critical
thinking skills as well as collection of information about Natalie in both objective and subjective
manner. In this, the subjective information can include the verbal statements from the Natalie
and healthcare professional. The objective information is particularly the measurable information
about Natalie such as the vital signs, intake and output and weight and height of Natalie. Here
assessment can involve such as Natalie's physical examination of the cardiac system like
palpation, auscultation of the cardiac sounds and many more. The information can come from the
Natalie more directly or from the primary care provider who can or cannot be in direct
connection with her relatives. In this, the critical thinking skills are important to the assessment,
thus required for concept-based curriculum alterations (Acute Myocardial Infarction, 2022).
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Diagnosis
In the diagnosis stage of care planning, a care nursing diagnosis can specifically
encompass the Maslow's hierarchy of needs as well as can aid to effectively prioritize and can
plan the care mainly based on the outcomes of patient-centred. In this, the common physiological
needs should be met before the higher goals can be accomplished like self-actualization and self-
esteem. It is identified that the physiological as well as the safety requirements can give the basis
for execution of the care nursing and its effective interventions. In context with Maslow's
hierarchy of needs, it particularly lay on the foundation for both emotional and physical health
such as the basic physiological needs, security and safety, love and belonging, self-esteem and
self-actualization of the patient (Natalie as per chosen case study). In context with patient
Natalie, she has reduced cardiac output, her respiratory rate is 100 bpm, Blood pressure is about
100/60 mm Hg. The diagnosis can also involve the pulmonary assessment was normal. The heart
examination generally revealed a ++/6+ systolic sound in the atrioventricular valve region. After
her myocardial infarction, she was referred to the coronary angiography that further revealed the
presence of lesions with about 90% obstruction within the right coronary, anterior descending
and a circumflex artery. Her left ventriculography has revealed an apical akinesia with having
signs of intra-cavitary thrombus in that area. The diagnosis of electrocardiogram has displayed
the sinus rhythm, heart rate of 103 bpm, PR (onset of atrial depolarization to the onset of
ventricular depolarization) interval of 122 ms, OT interval of 367 ms, QRS (the onset of
ventricular depolarization) duration of 159 ms and corrected QT of 480 ms.
Planning
In the planning stage, it is the stage where the outcome and goals are significantly
formulated and which can directly make influence over the patient’s care based on the evidence
based practice guidelines. These such patient-specific aims as well as the attainments of such
assist in ensuring a positive result. In this, the nursing care plans are quite important in this phase
of the aim settings. The effective care plan can give a course of direction for the personalized
care mainly tailored to Natalie's unique needs. Furthermore, the whole conditions as well as co-
morbid conditions can play an essential role in the construction of an effective care plan.
Moreover, the care plan can effectively improve the communication, documentation,
reimbursement and continuity of the care within the well-being care continuum. Within the
planning stage, to plan an effective care treatment for Natalie, the goals must be specific,
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measurable or can be meaningful, attainable, outcome oriented, time oriented. In context with
patient Natalie, the care nursing planning can include the long term like after two days of an
effective intervention, Natalie will participate in the activities which can help to reduce in the
cardiac workload. The nurses can assess the conditions of Natalie, monitor her vital signs as
well. Nurses should provide effective care treatment for Natalie such as enhancing myocardial
contractility or systemic perfusion, decreasing the overload of fluid volume and provide
therapies to Natalie so that her breathing rates and blood pressure levels can become normal.
Implementation and Execution
In the implementation stage, it can involve the specific actions as well as actual carrying
out of the nursing interventions which are mainly outlined in the care plan. The implementation
stage can need the effective nursing interventions for Natalie's care such as applying a cardiac
monitor or the oxygen, both indirect and direct care, the administration of medication, the
effective standard care treatment protocols as well as the evidence-based standards. In context
with evaluation step, the termination stage of the care nursing procedure is quite crucial towards
the positive outcomes of Natalie's report. In this, whenever the well-being care provider can
significantly intervene the care, they must re-evaluate the desired results that has been met.
Furthermore, the reassessment can often be required, mainly depending over the entire
conditions of Natalie (Lister et. al., 2008). The nursing care planning can be implemented as per
the care plan, which is based on the well-being conditions of a patient and its diagnosis. The care
nurses should aware Natalie about specific daily activities so that she can able to perform well.
As performing daily physical activities in old age can help her to overcome her cardiac illness.
The care nurses should provide sessions of effective therapies such as beta blockers as it is
effective for decreasing the signs and symptoms of cardiac failure and can enhances the
functioning of cardiac system as well.
Person-Centred approach
While evaluating the care planning process, there is a highlighted discussion about the
Maslow's theory which is mainly applied within the healthcare sectors. The theory can
specifically suggest that the care nurse’s basic needs are met, their concentration will shift
towards attaining the higher level of needs, consisting their sense of belongings, the self-
actualization and self-esteem as well. In addition to this, the applications of Maslow's needs of
hierarchy will effectively propel the well-being care professionals, not merely for the survival,
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but to the restoration of the pre-illness functions of the body, mind and spirit as well. While
talking about the patient-centred care, the caring of vulnerable patient is quite central within the
nursing care practice and the nurse’s relationship with the patients are generally important to that
the experience of care of a person. In this, the role of the patient such as Natalie is one of the
partnership, instead then a passive receiver of an effective care. A person-centred relationship
can significantly encourage the self-efficacy and a self-esteem as well. Furthermore, the choices
and education are generally central to the patient-centred approach, that can be associated with
enhanced satisfaction of the Natalie. Therefore, such step from a dependent, Natalie to a
supported partner within the care needs trusting relationship in which the care nurses do not react
negatively to missed appointments or a perceived non-compliance. Rather than, the care nurses
can significantly empower Natalie to effectively express her concerns and fear, to establish a
trusting and effective relationship which can encourage her self-caring behaviours also. In
addition to this, these such humanistic aspects of respect for Natalie, her rights towards self-
determination, having mutual respect as well as understanding can specifically underpins the
person-centred care (Parker and Bradley, 2007).
Evidence-based practice
While talking about Maslow's framework, the theory mainly conceptualised the
requirements of human as a pyramid with having five levels in ascending order, mainly ranging
from physiologic needs at the base, via safety, belongings and esteem, to self-actualisation at the
apex of the pyramid. In this, the theorist mainly posited that the public are innately motivated
towards the psychological growth as well as the self-improvements. The theorist specifically
defines that the human can work to accomplish the unmet requirements at the basic lower levels
before attending to those at the top most level. In addition to this, all low-level needs are
satisfied, the next top most level needs can dwell one of the main focuses till it is satisfied. In
context with the top most level needs such as self-actualisation, it can involve becoming all that
one is capable of becoming in terms of talents, abilities and skills as well. By applying
framework to the care nursing practices can suggest that when the care nurses do not feel that
their basic environmental needs are being met, then they will not feel motivated and therefore,
less likely to progress to the higher-level functions. The care nurses had been regarded as more
than just a well-being provider because, besides their understanding in care practice, they have
increased regards for the benevolence in furnishing the care for their patients to the best of their
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capability. In addition to this, one of each care nurses involve an essential task is to effectively
look after their welfare, can attending to both the psychological as well as physiological needs
(Maslow’s Hierarchy of Needs, 2021). In context with Natalie, the cardiac rehabilitation has a
specific advantage for her with cardiac illness in terms of the physical well-being and a
psychosocial health. In the rehabilitation programmes it can comprise the well-being education,
adequate physical exercise, the psychological health, stress managements and many more. The
cardiac rehabilitation care services are broadly covered by both the public and private plans, and
the co-pays per session exhibit a financial barrier for Natalie as well. It is identified that the
cardiac rehabilitation programs can benefit her as she is having a cardiovascular risk factor with
ischaemic cardiomyopathy, with severe left ventricular systolic dysfunction. In addition to this,
the cardiac catheterization is disclosed multi-vessel coronary illness and an apical akinesis with
an intra-cavitary thrombus.
Legislation and Social policies
The relevant policies and legislations to the Natalie' care planning that is applied within
the case scenario were generally The Human Rights Act 1998 and The Health and Social Care
Act 2012. As per the Equality and human rights commission, the human rights Act 1998
generally sets out the fundamental rights as well as the freedom which every people across the
UK and is associated to the reported case scenario has been no ban on the discrimination. It is
mentioned that all the patients within the healthcare organization must be treated fairly and with
respect no matter the needs of a person concerning about the effective care treatment for diseased
patient such as in case scenario of Natalie. Over the past decades, the NHS has generally become
an internal feature of the UK, not only underpinning the nation's well-being but an illustrative
some its basic values as well as the beliefs which are held today as well. In this, the National
Health Service was significantly found on the three core principles such as to meet the needs of
every people (as per Natalie's case scenario), to remain free at the point of delivery as well as
that access to the National Health Service be specifically based on the clinical requirements,
instead of ability to pay. In this, these such basic principles can always remain the essential part
of National Health Service, yet as the years have passed, there is wide agreement which the
modernisation of the National Health Service has now become important. In context with Health
and Social Care Act 2012, whilst the crucial restructuring of the National Health Service has had
been the subject of the current attention with the enactment of the Health and Social Care Act
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2012, a mental well-being has also been highlighting of the reform within the past some years. In
addition to this, the Mental Health Act 2007 generally sought to respond towards the difficulties
mainly posed by the altering psychiatric care practices as well as the policies shift from the
healthcare-based care treatment to care within the community. The restructuring of the National
Health Service as well as the alterations generally created by the Health and Social Care Act
2012 towards the commissioning procedures will take significant duration to grow accustomed
to. From the perspectives of mental well-being, the Health and Social Care Act 2012 can
specifically offer a real potential to visualise the mental well-being brought from the margins of
the provision to feature much more salient. It can generally create the prospect for an abstract
plan of the well-being to evolve, introducing the expressly the requirements for the parity among
the physical and mental well-being (Rickel et. al., 2000).
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TASK 2
Flow chart of the process of care planning.
The below care planning chart is created for a patient name Natalia with myocardial infarction
(PLANNING PATIENT CARE, 2020).
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Primary care professional;
access the condition
A healthcare professional’s
referral is not needed.
Natalie is referred to a
specialist who can identifies
whether patient need
specialist assessment to
prevent her illness.
Healthcare professional assess
the conditions and then decide
what care treatment is suitable
for Natalie to prevent her
illness.
Healthcare professional care
treatment is required and
Natalie's priority for the care
treatment is assessed.
The priority score is such that they
are offered an effective care
treatment to reduce her
cardiovascular illness.
Natalie will receive publicly
funded care treatment to
overcome her illness
A healthcare
assessment is not
available.
The priority score of Natalie
is close to the threshold so
she is reassessed within one
months.
Following care treatment, the
patient will be returned to the
care of the professionals.
The
healthcare
professional
can continue
to care for
Natalie.
If the conditions
of Natalie
worsen, she must
visit the
healthcare
organization for
reassessment.
Natalie may be
referred for the
cardiologist
advice to prevent
her cardiac
illness
conditions.

CONCLUSION
From the above discussion, it is concluded that the specific Health and Social Care Act
2012 can presents a specific departure from a culture of the people care services provision which
the people have generally accustomed to, but does it fail the vulnerable, notably those with the
mental well-being care needs. It is identified that the patient-centred care can specifically aid to
reduce the developing risk of harmful care treatments, negative and unfair as well as neglect to
the recipients of the well-being and social care services. In addition to this, patient named Natalie
is mainly put at the centre of the care approaches and have the capability to select as well as
control how they want their care and the support to be delivered. The healthcare professionals
can work combined with Natalie in order to receive care services. It can significantly encourage
Natalie to effectively improve the skills, knowledge’s as well as the confidence they generally
require to more efficiently manage and can make an informed decision about their own well-
being and care. As per the discussion, it is also concluded that the applications of Maslow's
theory can aid motivate the well-being care professionals towards the comprehensive care of
Natalie, not just for her survival, but to fix her pre-disorders function of body, mind and spirit as
well. Furthermore, having an agreed procedures and policies relevant to the case scenario of
Natalie with myocardial infarction, can effectively give a framework in which the significant
decisions can be made. The policies can effectively aid to standardise the care clinical practices,
the test as well as enhances the care services and can accomplish a better understanding and co-
operation among the other care staff.
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REFERENCES
Books and Journals:
Aggleton, P. and Chalmers, H. (2000) Nursing Models and Nursing Practice. London:
Macmillan Press
Brotherton, G. and Parker, S. (2008) Your Foundation in Health & Social Care. London: Sage
Coulshed, V. and Orme, J. (2006), Social Work Practice (4th ed.) Basingstoke: Palgrave
MacMillan
Hinchcliff, D., Norman, S. and Schober, J. (2008), Nursing Practice and Health Care. London:
Arnold
Hogston, R. and Simpson, M. (2001) Foundation of Nurse Practice. London: Macmillan
Holland, K., Jenkins, J., Solomon, J., and Whittam, S. (2003) Applying the Roper Logan and
Tierney Mode., Edinburgh: Churchill Livingstone
Parker, J. and Bradley, G. (2007), Social Work Practice. Exeter: Learning Matters
Roper, N., Logan, W. and Tierney, A. (2000) The Roper Logan and Tierney Model of Nursing.
Edinburgh: Churchill Livingstone
Calder, M.C. and Hacket, S. (2003) Assessment for Child Care, Using and Developing
Frameworks for Practice. Lyme Regis: Russell House Publishing
Ellis, J., Rider, H. and Love, C. (2005) Managing and Coordinating Nursing Care. London:
Lippincott Williams and Wilkins
Langan, M. (2006) Welfare Needs, Rights and Risks. Oxford: Oxford University Press
Lister, S., Royal Marsden NHS Trust, Dougherty, L. (2008) The Royal Marsden Hospital
Manual of Clinical Nursing Procedures. Oxford : Blackwell
Rickel, A.U., NetLibrary, Inc. and Wise, T.N. (2000) Understanding managed care An
Introduction for Health Care Professionals, [electronic resource], eBook, Electronic
resource, New York: Karger
Online:
Maslow’s Hierarchy of Needs, 2021 [Online] Available through: <https://rnspeak.com/maslows-
hierarchy-of-needs/>
Nursing Process, 2021 [Online] Available through:
<https://www.ncbi.nlm.nih.gov/books/NBK499937/>
PLANNING PATIENT CARE, 2020 [Online] Available through: <https://drdollah.com/care-
plans/>
Acute Myocardial Infarction, 2022 [Online] Available through:
https://www.ncbi.nlm.nih.gov/books/NBK459269/
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