Along with “What biology coursework is now on You Tube?” and “How can you revise when your physics book is downstairs?” Sadly my daily lecture on the benefits of a plan, to-do lists, colour pens and PostIt notes is greeted with, at best, rolling eyes and a “whatever”.
The ongoing debate about revision plans reminded me of the debate in nursing about the value of documentation.
Is it possible to start work without a plan of what you are going to do? Yet a news story last week highlighted the enormous amount of work nurses have to leave undone because of staffing levels.
One of the tasks frequently omitted was the planning and documentation of care: 47% said they failed to develop or update care plans; 33% failed to adequately document care; and 28% failed to complete care plans.
The test of a good care plan is that staff, at a glance, can identify what has been done before, if it was successful and what is planned for the future. I remember working with a ward sister who advised staff to read the care plan first and then ask questions. She believed a good care plan should save time rather than make work.
Yet many of us have a dysfunctional relationship with documentation. It is viewed as an add-on, often completed after the work is finished in the office over a cup of coffee. The quality and quantity of paperwork is a barrier to completing it and incomplete documents have little practical value for day-to-day work, so no one looks at them or trusts the content. Sadly the value of good documentation is often only realised when records are used as evidence in court.
I would argue that a patient’s written care plan is pivotal to providing personalised care and there needs to be a radical rethink of how this happens in practice.
Clinical staff must be involved in the design and content of documents so they are clinically useful. The temptation to add in another assessment or tick list to meet a new directive or target needs to be carefully considered.
Nursing documents should be owned by individual patients and the nurses caring for them. They should be dynamic description of patients’ wants and needs, how these can best be addressed and the progress patients are making. If this is the focus, nursing documentation will become a valuable and essential part of care. But if this is to happen, the most important requirement is that time is made available and staff are supported to ensure this essential part of care is completed.