Long-Term Care

Trainer’s tip: Understanding the purpose of care plans

LTC Nursing Assistant Trainer, July 29, 2010

All nursing care begins with an assessment of the resident’s needs. The nursing process is used as a model for long-term care assessment. Each step of the nursing process is equally important in the care of the residents. The steps are assessment and development of nursing diagnoses, planning, implementation of the plan, and evaluation of the resident’s care plan. The nursing process is fluid and ongoing. The care plan is the cornerstone of the resident’s care. It should be accurate and reflective of the residents’ problems, needs, and care. In most states, the nurse practice act mandates the use of the nursing process. This paragraph is from the Texas nurse practice act, but all states have comparable rules:

“The nurse shall use a systematic approach to provide individualized, goal-directed nursing care by performing nursing assessments regarding the health status of the client; making nursing diagnoses which serve as the basis for the strategy of care; developing a plan of care based on the assessment and nursing diagnosis; implementing nursing care; and evaluating the client's responses to nursing interventions.”

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

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