Guest Blog From ‘KL’

KL says:

Nursing Care Plans Gone Mad

I can’t find this discussion anywhere. To me it is the elephant in the room or a case of the emperor having no clothes. The issue is the relevance of nursing care plans to good patient care in psychiatric nursing units. I don’t argue that nursing care plans are irrelevant just that nurses spend too much time caring for the chart at the cost of patient contact. I have worked on a psychiatric unit for more than 30 years (I’m sure that you guessed that I am not an RN). In the old days there was always a problem list that one charted against. For a while SOAP charting was the norm. Psychiatric care plans are perhaps an improvement but not such an improvement as to justify the enormous time investment that registered nurses spend writing and updating them.

Almost any beginning psych nursing text will say that the therapeutic relationship is the most important part of psychiatric care. Dziopa and Ahern have written about the following nine critical aspects of psychiatric nursing practice: understanding and empathy, individuality, providing support, being there/being available, being ‘genuine’, promoting equality, demonstrating respect, demonstrating clear boundaries, and demonstrating self awareness for the patient. I don’t need a care plan to practice any of these skills. A nursing instructor once told me that psychiatric care plans are a tool to teach skills or interventions, I can buy that, but the pretence on my psychiatric unit is that the psychiatric care plan drives patient care.

It would be an interesting experiment to follow registered nurses around the acute care psychiatric unit that I work at with a stop watch and measure how much time they actually spend talking to patients. Years ago nurses actually led or co-led the majority of group therapies, now this task is done by occupational therapists and unpaid interns. The nursing assessment is frequently a five minute conversation done in conjunction with taking vital signs or passing medications.

I have tried to ‘Goggle’ related topics and in an age when almost any topic generates 100,000+ hits, I find very little. Any insights would be much appreciated. Maybe the emperor’s new clothing really are an improvement, help me understand.


4 Responses to “Guest Blog From ‘KL’”

  1. I think this is a longstanding problem which used to fall under the heading ‘theory-practice divide’. People argued that rarified academic debates and initiatives were very different from day to day clinical realities. Moving nurse training into the higher education sector was supposed to help correct this problem, because student nurses were expected to take their state of the art theories directly into the workplace once they graduated.

    Unfortunately, this doesn’t seem to have worked. Many online discussions suggest that the theory-practice divide still exists, this time in the form of a separation between RMN paperwork roles and non-RMN practical care delivery. This is probably true, but the argument tends to divert from a more disturbing possibility…..

    The theories and official policies aren’t converted to effective therapies simply because they are nothing more than politically driven wish lists and propaganda. Just smoke and mirrors which disguise the embarrassing fact that little measurable progress has been made in mental health care since care in the community began.


  2. Ourselves, our body, our health….. enhancing self usage towards prevention of illnesses & promoting well-being.
    that what Nurses do 🙂

  3. Please help. I am looking for a carer or nurse with psychaitric experience in KL. to care for my brother at night. He is going through dementia process. Sometimes he can be aggressive. Any suggestion on his care management.

  4. Hi Lilian, Sorry to hear about your difficulties. Your family doctor has probably already put you in touch with the local community mental health team. Perhaps theycould re-assess the situation? Unfortunately I can’t be more specific when it’s likely that other parties are involved, but I wish you well. Best wishes, Leo

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