Care Plan

This care plan Is taken from a nursing template and can be tailored to the participant. The nurses can write however much they need in each section to make it clear to the support staff or other nurses how the participant wants to be supported with their care.

It should make reference to any other plans they may have e.g. speech, OT. PT etc.

Participant First Name *

Participant Last Name *

Participant Address *

Participant Date of Birth *

Full Name of person completing the Care Plan *

Email Address of person completing the Care Plan

Date that the Care Plan is being completed *

was the Care plan completed with the participant *

yesno

Why wasn't the participant included in the development of the care plan? *

Name and relationship to the participant of others involved in the development of the Care Plan

General Comments about the Care Plan

Maintaining a safe environment

To complete this section, consider the following examples of what to include:

Observations
Vision and hearing:
Mobility
Tissue Viability/Waterlow
Falls Risk

Does the Participant have any Support Requirements of Goals surrounding a safe environment *

yesno

Support Requirements for maintaining a safe environment

Goals for maintaining a safe environment

How to achieve the goal for maintaining a safe environment

Communication

To complete this section, consider the following examples of what to include:

Preferred language
Cognition
Hearing
Speech
Aids

Does the Participant have any support requirement of Goals surrounding Communication *

yesno

Support Requirements for communication

Goals for communication

How to achieve the goals for communication

Breathing

To complete this section on Breathing, consider the following:

Maintaining airway
Smoking
Past medical history
Current condition

Does the Participant have any support requirements or goals for Breathing *

yesno

Support requirements for breathing

goals for breathing

how to achieve the goals for breathing

Nutrition

To complete this section on Nutrition, consider the following:

Oral Hydration
Diet oral intake
Swallowing issues
Meal times/regime
Allergies
Religious requirements
BMI
PEG/JEG

Does the Participant have any support requirements or goals for nutrition *

yesno

Support requirements for Nutrition

Goals for Nutrition

How to achieve goals for nutrition

Elimination

To complete this section on Elimination, consider the following:

Bowels
Urination
Continence
Aids/stomas

Does the participant have any support requirement or goals for Elimination *

yesno

Support Requirements for Elimination

Goals for Elimination

How to achieve goals for elimination

Personal Care

To complete this section on Personal Care, consider the following:

Hygiene needs
Assistance
Routine

Does the participant have any support requirements or goals for Personal Care *

yesno

Support requirements for Personal Care

Goals for Personal Care

How to achieve goals for Personal Care

Maintaining Temperature

To complete this section on Maintaining Temperature, consider the following:

Ability to maintain temperature

Does the Participant have any support requirements or goals for Maintaining temperature

yesno

Support requirements for maintaining temperature

Goals for maintaining temperature

how to achieve goals for maintaining temperature

Mobilising

To complete this section on Mobilising, consider the following:

Assistance
Aids
Physiotherapy
Occupational Therapy

Does the Participant have any Support Requirements or goals for Mobilising *

yesno

Support requirements for mobilising

Goals for Mobilising

How to achieve goals for Mobilising

Work and Play

To complete this section on Work and Play, consider the following:

Employment
Socialising
Hobbies
Entertainment

Does the Participant have any support requirement or goals for Work and Play *

yesno

Support requirements for work and play

Goals for work and play

how to achieve goals for work and play

Sleeping

To complete this section on Sleeping, consider the following:

Routine
Position
Aids/medication

Does the Participant have any Support Requirement or goals for Sleeping *

yesno

Support requirements for sleeping

Goals for sleeping

how to achieve goals for sleeping

Cultural

To complete this section on Culture, consider the following:

Religion
Culture
NOK
Family/friends

Does the Participant have any support requirements or goals for culture *

yesno

support requirements for culture

Goals for culture

How to achieve goals for culture

Medication

To complete this section on Medication, consider the following:

How it is taken
Allergies
When to take
Assistance needed/which level

Does the Participant have Support Requirement or goals for medication *

yesno

Support requirements for medication

goals for medication

how to achieve goals for medication

finalisation

This care plan has been completed taking into account all available information *

Draw signature|Type signatureClear

Save and Complete Later