University Nursing Care Planning Report: Elderly Patient Care

This report provides a comprehensive analysis of nursing care planning, focusing on the care of elderly patients within a hospital setting. It begins with an introduction to nursing models and the role of the National Health Service (NHS) in the United Kingdom, emphasizing patient-centered care. The report delves into the Mid Staffordshire NHS Foundation Trust Public Inquiry, highlighting critical failures in care planning, leadership, and patient safety. It then outlines the stages of care planning, including assessment, planning, implementation, and evaluation, and emphasizes the importance of person-centered care and multidisciplinary teams. The report addresses specific issues in elderly care, such as fall and pressure injury prevention, nosocomial infections, mental health management, and workforce inadequacies, offering practical recommendations grounded in relevant legislation and guidelines. The report emphasizes the significance of data protection, training, and the implementation of the system theory to overcome social and psychological barriers. The conclusion and recommendations provide a summary of the findings and suggest areas for improvement in nursing care planning to ensure optimal patient outcomes.

Running Head: Nursing Assignment
Nursing Care Planning
Name of the Student
Name of the University
Authors Note

1Nursing Care Planning
Table of Contents
Introduction.................................................................................................2
Discussion...................................................................................................2
Background..............................................................................................2
Stages of Care Planning...........................................................................3
Evaluation of Care Planning.....................................................................8
Conclusion...................................................................................................8
Recommendation........................................................................................9
References................................................................................................10
Appendix................................................................................................10

2Nursing Care Planning
Introduction
Nursing models and theories aim to enhance the quality of patient
centred care with the quality of life. The nursing legislatives of The
National Health Service (NHS) are also focused on serving health and
social care provision to every individual in United Kingdom. The
legislatives and policies of NHS help to ensure rights of having quality
healthcare services with nominal expenses of the common people. NHS
policies evaluate the care plan and stages of care planning which helps to
recognise the service structure of a hospital or healthcare settings. There
are different nursing care models such as Roper, Logan and Tierney
Models, Orem’s self-care model, Johnson’s Behavioural model which help
to provide better services with the person-centred treatment. Involvement
of multidisciplinary teams and different additional facilities should be
incorporated in the care provision of a healthcare setting. The essay will
focus on the recommendations of the care planning for better nursing
care provision with the reference of the Mid Staffordshire National Health
Service (NHS) Foundation Trust Public Inquiry as case study (Smith and
Chambers, 2019). The objectives of this assignment are to design a
nursing care planning with proper policies and legislation to obtain the
optimum quality of care with needs assessment and up gradation of the
skills of nursing staffs. The report focuses on the care planning of elder
care patient in a hospital care setting to avoid the similar undesired
circumstances which was recognised in the Mid Staffordshire hospital after
the enquiry was taken place (Smith and Chambers, 2019).

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Discussion
Background
In 2007, Julie Bailey started a campaign against the trustee or the
administrators of the Stafford Hospital as her mother died during the
treatment. The mortality rate in the emergency department was much
higher than the usual. A full-scale official investigation was conducted in
(2008), and due to inquiry, many loopholes in the clinical settings were
recognised. The mortality rate among the emergency patient was
elevated during 2005 to 2008. The commission of Robert Francis QC (the
commission was assigned for the investigation) detected different
negative sides of healthcare setting in Stafford Hospital. The affected
families took legal steps with Ms Bailey against the hospital. According to
the inquiry commission, the management of the hospital preferred poor
strategies for healthcare provision. The Nursing and Midwifery Council
took actions against the alleged nurses and nursing leaders of the hospital
(Hayes, 2017). As many reports such as discrimination during patient
care, carelessness during the treatment of critical patients in Intensive
Care Unit (ICU), medication errors and multiple errors related to handover
process were observed in the inquiry (Hollnagel and Braithwaite, 2019).
Poor work culture and working environment were identified as after full
length investigation. The inquiry reported that around 290
recommendations were proposed by which were failed in various aspects
of the selected healthcare system (Hollnagel and Braithwaite, 2019). The
policies failed in the leadership strategies, conundrum of culture,
management of working force and implementing multidisciplinary teams

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and maintenance of the legislative policies in the service provision to the
patients in critical care. Stafford Hospital scandal was an eye-opening
instance in the healthcare industry of United Kingdom. In this incident,
nursing plans and stages of care planning were also breached along with
the NHS policies (Powell, 2019).
Stages of Care Planning
Healthcare services can be differed according to the provision of
services such as primary, secondary and tertiary care in two different
areas of care (acute and chronic care) to check effectiveness of the care
provision (Peate, 2017). This assignment aims to design a nursing care
plan for elderly patient care in acute care setting. There are four stages in
the nursing care process such as assessment, planning, implementation
and evaluation (Stonehouse, 2017.). Every care process should involve
four core components of the nursing models which are the person, the
environment, health of the patient and nursing (Cuthbert and Quallington,
2017). The nursing care plan should involve different nursing theories to
provide better services to different patients from various healthcare
context (Kitson, 2018). The stages of care planning should involve a
logical and systematic flow from initial assessment to the final evaluation.
Purpose of the care planning underlies with the legal documentation,
showing accountability to the records of the patients and continuity of the
care plan (Ballantyne, 2016.). A successful assessment procedure involves
good communication, methodical approach of detailing and better
interpretation (Hogston and Marjoram,2011). During the assessment a

5Nursing Care Planning
patient should not be asked any question which will affect his or her
aesthetic culture and personal preferences by maintaining ethics (Östlund
et al., 2018). Patient’s detail should be collected from verbal, nonverbal
and written records. An effective planning consists determination of
problems, risks and prioritised them with analysing the physical,
psychological and social condition of that person (Howatson et al., 2015).
Initiation and termination of the shifts, duration of handovers, comparison
of care plans associated with the patients and continuous monitoring are
considered as the significant aspects of implementation of a care plan.
Evaluation of care plan combines both observational and documental
evidence. Documents for evaluation can be recorded by tools, lab reports
and regular documentation by nurses (Drummond and Simpson, 2017).
In the Mid Stafford Hospital (2008) responsibility of the nurses and
health workers was lost during provision of care and patients lay striving
for hunger and thrust, hygiene of patient’s ward was neglected
(Hutchison, 2016). Late responses from the nurses and attendants led to
some unexpected mishaps, in this assignment some issues for the elder
patient in a hospital setting will be addressed. The issues, which will be
analysed in this context, are fall and pressure injuries, nosocomial
infection, immediate admission and transfer of a patient from one unit to
another, depression among the patients, aggressive behaviours of nursing
staffs, inadequate workforce for treating critical patient, erroneous service
provision (Smith and Chambers, 2019).

6Nursing Care Planning
To prevent fall risks and pressure injuries among older patient in the
older adult wards the cause of frequent falls and injuries should be found
out with the help of surveillance camera and medical records of the
admitted patients (see Appendix)(Hoffman et al., 2017). The person
centred care approach allows patients to involve whoever they want in the
treatment procedure. This approach involves financial and psychological
aspects of the patients and therefore the patients can get better
services and provision of care. The patients are hemiplegia or
neurological disorder or have balance problems should be monitored by
attendants or assistant in Nursing (Peate and Wild, 2018). Medications
should be given to the patients as per the direction of physicians only. The
handover procedures should be checked by the nursing supervisors and
the nurses should be evaluated by the evidence of timely documentation
of the patients’ records. As an intervention proper and appropriate
training should be given to prevent fall. Data protection act, 2018
ensures the data and information of every individual of UK and Northern
Ireland. The digital data are also come under the data protection act with
general data protection regulations. The hospital authority should
understand the value of information and data of the patients with
confidentiality. The training must contain of fall prevention and NICE
clinical guidance 21 for fall prevention (www.nice.org.uk, 2020;
www.hee.nhs.uk, 2020). To reduce fall prevention, strength and balance
exercise should be provided to the patient by the help of physiotherapy,
walking, dancing and other physical activities. Physiotherapists and
physical exercise instructors can be involved (Tyson, Woodward-Nutt and

7Nursing Care Planning
Plan, 2018). Monthly audit of fall hazards rate would help the
management of healthcare setting and nursing leaders to analyse the
significance and effectiveness of the above discussed plan. On the
contrary pressure injury can be managed by regular physical assessment
of the patient and taking hygiene related initiatives in the medical wards.
The pressure injury and risk of falls can be controlled by reviewing the
medications lists. Therefore, any medications which are affecting the
health of the patient and troubles person will be eliminated immediately
(Xu et al., 2017). If pressure sores are detected at an early stage, the
management would be easier. The pressure ulcers can be cured by the
medications, changing the position of the body regularly, eating proper
diet and by debridement procedures. In management of pressure injuries,
diet is very important so that a dietician should be involved in the
multidisciplinary team of the patient (Eglseer, Hödl and Lohrmann, 2019).
Using proper cushion and bed sheets with hygiene can reduce the rate of
pressure ulcer among the patients. The patients with obesity, diabetes,
urinary incontinence should monitor by the nurses with more sincerely
(Rowe et al., 2019). The occupational therapists, physiotherapists and an
exercise physiologist can be involved in the management of pressure
ulcer.
Managing mental health of elderly patients is needed more than one
clinical assistant as the mental health is dependent on various factors of a
hospital setting. The mental health of the patient can be dependent on the
environment of hospital setting, personal relationship of the patient, and
effect of the medications on the patient (Townsend and Morgan,2017). To

8Nursing Care Planning
manage depression of a patient, psychologists, psychiatrists and social
workers can be involved in the treatment procedure with different
therapeutic approaches and the Mental Health Act(1983) and Health and
Social Care Act (2012) should be maintained by every stakeholder involve
in the care plan(www.nhs.uk ,2020 ; www.legislation.gov.uk ,2020). The
Human Right Act, 1998 sets the preliminary rights and freedoms that
every person of United Kingdom can be entitled to. There are 16 rights
which can conserve the human rights and freedom for better life of a
person with establishing the equality and regulation. The interpersonal
communication between nurses and patients with the help of personal
level of interaction and Cognitive Behavioural therapy (CBT). Family
therapy and group therapy should be given to the patients along with that
music and art therapies should be suggested to the patient. Nursing
leaders should take care of the conduct of nurses and health workers with
the patients as they sometimes behave indifferently for workload and
burnout. The standards for mental health by the Royal College of
Psychiatrists can be maintained by the nurses and the other staffs
involved in the care of a mental health patient (www.rcpsych.ac.uk, 2020).
Inadequate amount of workforce is another big problem in the
healthcare setting. To prevent the problems related to workforce,
management of that health care sector should employ staffs of various
discipline and expertise. They should be trained properly and monitored
strictly during their probation period. Properly trained and educated staffs
should be recruited and they should maintain every guideline of NMC
(Nursing and Midwifery Council), NHS (National Health Service) and NICE

9Nursing Care Planning
(National Institute for Health and Care Excellence). The system theory
explains the ways of issues related to individual patients, their families,
organisations and societies for attending the optimum effect of treatment
and any kind of interventions. The system theory. The nursing leaders
should include systems theory for better social and clinical manifestation
on the patients. During the recruitment, system theory should keep in the
mind of the nursing recruiters for overcoming different social and
psychological barriers during provision of care (Parker, 2017). Nurses
always focuses on the holistic approach of the patient care without
restricting the patient condition to a limited boundary.
Evaluation of Care Planning
The care plans are based on the different individual needs of the patient
such as psychological, social, cultural, political, spiritual, biological,
environmental and economic needs. The patients who are prone to fall
and pressure injury should be treated with the reference of Roper, Logan
and Tierney model which is developed with the reference of Maslow’s
Hierarchy of Need (Holland and Jenkins, 2019). Every nurse should
maintain this model during the treatment procedure. Patient ‘ s self-
esteem , actualization other needs can be identified by the nurses in the
context of this theory .This theory will help a nurse to understand the
theory with the sense of belongings so that they can able to understand
their necessities and achieve better level of nursing. On the contrary,
limitation of the care plan is not mentioning any self-management
procedure for the patient. Orem’s self-care model can be implemented in

10Nursing Care Planning
the care planning. Self-assessment of the patient and complementary role
of family should be addressed the controlling factors of the Orem’s model
in the care plan. Self-care, self-care demands, self-care agency with the
deficiency of the nursing agency should be maintained in the care plan
(Afrasiabifa et al., 2016).
Conclusion
In conclusion, this can be understood that a nursing care plan for
elderly patient care in acute care setting requires different professionals
and references of theories. The essay will explain the recommendations
for the care planning with better nursing care provision in the context of
the Mid Staffordshire NHS Foundation Trust Public Inquiry as case study
(Smith and Chambers, 2019). A successful assessment procedure involves
good communication, methodical approach of detailing and better
interpretation. During the assessment a patient should not ask any
question which will affect his or her aesthetic culture and personal
preferences by maintaining ethics.
Recommendation
Nursing care plans should involve the regulations of government
regulatory bodies to improve respect, dignity, compassion and
commitment to quality of care that is associated to professionals’ multi-
disciplinary team (see Appendix). The person centred care approach
should be implemented in the care plan of the patients while the
health professionals are serving aged and dis tressed patient. The
proposed care pllan includes aged adults and therefore the patient

11Nursing Care Planning
centred care should include in treatment procedure. The Equality Act
(2010) protects the individual from the unlawful discrimination. Disability,
medical condition, age ,race , religion or beliefs, sex and sexual
orientation will not restrain any person from getting their rights in
healthcare provision and legal assistances. The policies are regulated by
the Care Quality Commission (CQC) as the standard related to quality and
safety of treatments The CQC standard would help in different aspects
such as warning associated to the issues, restriction of the service,
issuing the penalty notice, suspension or cancellation of registration and
prosecution of the provider(www.cqc.org.uk, 2020). The health and social
care act, 2012 ensures that the adults for the optimum level of health
care and Clinical Commissioning Group (CCG) must take actions for
reduce inequalities with respecting them with better access for health
ability. The health watch teams are recruited in the local areas to find the
healthcare gaps in local care planning commission by The National Health
Service (NHS) (Assets.publishing.service.gov.uk, 2020).Different
regulatory bodies are associated with various ongoing procedures in the
hospitals in UK. Here the nursing care plan should maintain Nursing and
Midwifery Council along with the ambulance trusts of NHS and social
support trusts. NHS should emphasise more on the Care Bill which has
been passed in 2012 to improve the quality of care among the hospitals of
England.

12Nursing Care Planning
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Drummond, C. and Simpson, A., 2017. ‘Who's actually gonna read this?’An
evaluation of staff experiences of the value of information contained in
written care plans in supporting care in three different dementia care
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Eglseer, D., Hödl, M. and Lohrmann, C., 2019. Nutritional management of
older hospitalised patients with pressure injuries. International wound
journal, 16(1), pp.226-232.
Hayes, J.A., 2017. Values-based nursing and fitness to practice issues.
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Running Head: Nursing Assignment
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Running Head: Nursing Assignment
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Nursing care plan flow chart
Issues in the hospital setting (Elderly patients
acute care centre)
Falls and pressure injury Poor Mental Health of
Patients
Inadequate and incompetent
workforce
Assessment
Plan
Diagnosis
/intervention
Evaluation
Surveillance camera
and reports
Patient monitoring
Review of medication
Psychological therapy
MDT involvement
Hospital report and patient
retention
Recruitment of staffs
Training provision
Monitoring the staffs
Involvement of nursing leaders
Patient’s response and
report
Patient monitoring
Reviewing medication
MDT involvement
Includes NHS policies
Hygiene maintenance
Care with the reference of nursing models
Continuity of the interventions
Care with the reference of nursing models
Continuity of the interventions
Nursing leaders’ continuous surveillance
Includes NHS regulations
Patient survey, Monthly Audit, Qualitative analysis of the patient’s and their families’ reactions, Survey of the staffs,
Records of patients’
Retention, Surveillance of the maintenance of NHS regulation and Policies by record keeping.
Inclusion of mental health regulation
MDT team management
Family involvement in treatment
Care with the reference of nursing models
Continuity of the interventions
Running Head: Nursing Assignment
Appendix

Running Head: Nursing Assignment