Nursing Care Plan

It was understood that this relationship would ensure the patient received the best care possible to suit them individually. This would consist of not just the patient as a physical being but their spiritual emotional and holistic being also (Cutler, 2010). The nursing care plan has four main outcomes. It must include an assessment of the patient and their specific needs; a plan of action which must be implemented and evaluated. Moreover it is a process in which patients care is assessed and evaluated and is an imperative part of practice (Hunt & Marks-Maran, 1986).

The care plan is the mechanism in which the nurse is able to make informed decisions using the nursing process (Cutler, 2010). However care plans have also been seen as providing nurses with a clear path to assisting the patient and providing the best care possible for them individually, moreover it ensures that nurses recorded their findings which will ensure high standards of care are set and maintained (Hunt & Marks-Maran, 1986). By following the SMART guidelines this should be achieved (Williams & Wilkins 2007).

The remainder of this essay will go on to evaluate and critique a particular care plan and show the flaws and also what could have been included. In this care plan the main focus is on Mr McCue’s disrupted sleep pattern, the care plan is therefore aimed at achieving an unbroken sleep pattern. However a blatant thing which is missed from the care plan is that the nurse has not taken any observational skills. The MUST tool (RCN 2004) should have been used to assess the patients weight.

This is due to the fact that Mr Mcue is saying he is eating more processed food and doing a lot less daily meaning weight is an issue as it possibly could be affecting his sleep(Williams & Wilkins 2007). BMI is important in this case as obesity can also cause sleep disturbance. The BMI is there to provide the nurse with the patient’s body fat and to alert them to any changes. Therefore knowing the BMI can be important in indentifying health concerns and can be important in the relationship of sleep disturbance (WHO, Updated March 2011).

Furthermore Williams (2008) says that weight and sleep are linked and that even small changes in the BMI can effect sleep patterns and also says that alcohol consumption and smoking can be contributed to sleep disturbance (Williams, Tacon & Carter, 2008). Moreover Patel (2008) agrees saying that the growing obesity of the country has resulted in chronic sleep deprivation, furthermore he says that weight gain can occur through lack of physical activity and lack of motivation. Mr McCue has admitted to all of these things; he indicate he cannot be bothered looking after his children and is eating unhealthily (Patel & B. u, 2008). These factors indicate that through putting on weight he may be sleeping less and therefore becoming more depressed and sleep deprived. Moreover even though the care plan is focusing on sleep the care plan fails to address why he might not be sleeping. Hunt (1986) agrees that the assessment is a lot more than just looking at the obvious but about using the information that has been gathered and making use of it to identify the key problems the patient may have (Hunt & Marks-Maran, 1986). The care plans main aim is to help Mr McCue achieve an unbroken sleep pattern.

However In the assessment stage the nurse has clearly indicated that he is drinking a lot more. Nevertheless there has been nothing mentioned about this in the planning stage to address this factor. Vinson (2010) has shown in his journal the effects that harmful drinking has on sleep, the greater the alcohol level the worse the sleep pattern. Mr McCue says that he is drinking more often in an attempt to get a better night sleep. However Vinson (2010) believes this could hinder the patient’s sleep pattern (Vinson et al, 2010).

Furthermore he goes on to say that drink can initially help the person sleep but as the drinking becomes more intense it becomes a dependent, where restless sleep is common and trying to get back to sleep is ineffective (Vinson et al, 2010). Moreover Stein (2005) agrees and says alcohol has a massive effect on sleep and the distribution of sleep. He acknowledges that alcohol can be seen as a sedative to some. However like Vinson (2010) acknowledges the more alcohol that is being consumed insomnia is likely to become a feature in the sleep pattern.

Moreover he goes on to say that if the nursing staff is alerted to this in a timely fashion something can be done about it (Stein, 2005). In the care plan it has been shown in the assessment that he drinks alcohol to enhance sleep but nothing has been done to reduce this problem which may be linked to other factors. Moreover in the assessment it has been shown that he does not feel rested on been wakened. Stein (2005) says this can be due to the alcohol it has a greater effect on the brain and causes a dependence on the alcohol which in return disturbs sleep and can leave people to feel un-rested and moody(Stein & Friedmann, 2005).

Stein (2005) and Vinson (2010) both agree and say that implementations should be in place to improve sleep for example patients who are becoming dependent on alcohol should be encouraged to try and stay off the alcohol and this should in turn help with sleep. Van- Reen (2010) also agrees however he says it depends more on the time that the alcohol is consumed that it could start to effect sleep. Still he does agree that alcohol consumption in excess can cause sleep disturbance also. In Mr McCue’s case it is unclear from the care plan how much alcohol is being consumed.

Therefore proper documentation and assessment is imperative to ensure the right care being given (Van-Reen et al, 2010). Furthermore the planning stage of the care plan wants to implement a warm drink before Mr McCue goes to bed this is a good idea however the care plan is not specific when telling Mr McCue what to drink allowing him to interpret it to mean anything. Roehrs (2002) says that Caffeine is a substance which many people forget it is a stimulant and can have a major effect on the length a person sleeps for and the function of that sleep. Moreover he says that Laboratory studies have documented its sleep-disruptive effects.

So drinking coffee could hinder his progress and actual delay his recovery (Roehrs, 2002). This is a clear flaw in the care plan as it gives to much room for interpretation it needs to be more detailed and specific. Lloyd (2007) says if the care plan is not documented correctly with sufficient information there is little point in doing it (Lloyd,Hancock &Campbell 2007). The implementation and evaluation part of the care plan are well intentioned but again are not clear. According to smart guidelines (Williams & Wilkins 2007) the care plan needs to be measurable.

However this is impossible here as there is no time frame mentioned. The nurse simply writes “continued sleep improvement” but that leaves a lot scope for questions. It does not give an exact amount of hours Mr McCue has had so it is impossible to know how effective this care plan is. It has to be a lot more informative to be seen as effective (Cronin & Anderson 2003). In conclusion the nursing process is still a strong and systematic tool which is helping nurses devise a care plan built around the individual needs of the patient that they are caring for (Lloyd,Hancock & Campbell 2007).

The process helps the patient to feel part of the decision making when devising the care plan, making them feel included. However it is the nurses in practice needing to ensure they utilise this process correctly and try to ensure they have made the care plan detailed enough and documented correctly for the care plans to work efficiently (Cronin & Anderson 2003). Moreover it has been shown that care plans help individualise patients needs in a way that can be monitored and reviewed to ensure nursing practice remains high.