Personalised care plans are an important record of personalised care and decisions. They outline discussions between patients and the professionals who support them. This care planning process changes the focus of how patients are cared for by looking at their current and future needs. This creates a more helpful proactive service – centred on the needs of each individual, rather than a service that comes into effect when something goes wrong.

It helps to focus on what is important to the person and puts them on an equal footing with professionals. It goes beyond clinical treatment, taking a whole-life approach and includes things like peer and community support and support for self-management. It means professionals seeing the patient as a whole person not simply focussing on a list of conditions to be treated. It means designing their health care and support in partnership with them to help them manage their own health and live the life they want.

Questions are what is important to you? and what is important for you?

This may be something such as wearing a bra every day or missing their favourite pet to ensuring they receive the correct diet that doesn’t upset them

Clare is the neighbourhood team lead for the Gainsborough Neighbourhood team which includes John Coupland Hospital and Scotter Ward During fab change week she pledged to help us roll out personalised care and support plans and all staff had this training over the period of 2 months at our ward support sessions.

There have been issues with templates and the rollout to use the care portal to store this information has not been finalised as yet.

We haven’t fully rolled it out on the ward to every patient as yet but all staff have the training and it is evident in the staffs daily actions such as finding out more about the patient and for example printing out photos of their pets for them…..that their mindset is changing from a more medical nursing orientated care plan model to a more personalised one which is fantastic.

We are working towards all patients having one and being discharged with it .

About the Author:

Scotter Ward is a nurse led ward in a busy community hospital in Gainsborough which is part of Lincolnshire Community Health Services. We have just over 40 clinical and non clinical staff and have 23 beds 21 intermediate care and 2 palliative care. We are a team passionate about what we do and always strive to improve standards for our patients and staff

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