Veterinary Nursing Journal
ISSN: 1741-5349 (Print) 2045-0648 (Online) Journal homepage: https://www.tandfonline.com/loi/tvnj20
BVNA Congress 2011 Working with nursing care
plans – Part 1. What are they?
Clare Main
To cite this article: Clare Main (2011) BVNA Congress 2011 Working with nursing care
plans – Part 1. What are they?, Veterinary Nursing Journal, 26:5, 149-151, DOI: 10.1111/
j.2045-0648.2010.00040.x
To link to this article: https://doi.org/10.1111/j.2045-0648.2010.00040.x
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CLINICAL
BVNA Congress 2011 Working
with nursing care plans- Part 1.
What are they?
cLare Main
BVetMed MRCVS
Brookside, 41 Moor Road, Banwell 8529 6EF. UK
ABSTRACT: Nursing Care Plans have been used in the human medical field for
Clare Main
BVetMed MRCVS
Clare Main graduated from the
RVC, London, in 1992 and spent
three years in mixed practice
before moving to small animal
practice. She joined Hill's Pet
Nutrition in 1998 and worked
there for five years before setting
up her own practice in 2004 as
a joint venture partnership. She
is currently working part time
in small animal practice and
volunteers at the University of
Bristol, facilitating communication
skills and undergraduate interviews.
To cite this article use either
DOl: 10.1111/j.2045-0648.201 0.00040.x or
Veterinary Nursing Journal Vol26 pp149-151
~
Figure 1: The process of nursing
a number of years and are now moving into use within the veterinary profession.
Their two key benefits are, firstly, to ensure all aspects of care are addressed by
the practice team and, secondly, to promote good case communication either
between different nurses, vets and nurses, or even different clinics. In the
author's experience, care plans are fundamental to delivering a good standard
of in-patient care. This first article in a three-part series describes the author's
personal approach in practice by looking at what we need to include in a care
plan. It will be followed by two more dealing with how to use them and how to
get started, along with case examples
It is crucial to understand at the outset
that the process of planning is more
important than the plan itself. The
communication between different team
members is vital, so that everyone
involved in the case is clear about what is
going on and what the goals are, as well
as being able to share ideas when the care
is not giving the results expected. It is a
way of organising thinking and
empowering the whole team to provide
the necessary care.
What should be included?
There have been a number of proposed
care plans based on different nursing
models, but what needs to be included
will, to some extent depend on the practice
and the type of work that is done. A firstopinion practice, for example, would not
commonly need to do a full daily
neurological assessment on every patient;
whilst for a referral centre doing spinal
surgery this might well be an important
aspect to each pet's daily care plan.
The Process of Nursing involves assessing
a patient's needs, planning how it is going
to be cared for, providing or implementing
that care, assessing the response to that
care and then planning future care and
reassessment (Figure 1).
At every stage, there can be input from
the rest of the veterinary or practice team,
whilst the input from the owner is
especially important during the
assessment stage, in order to find out
what the pet normally does at home.
It also needs to be a dynamic process
because a patient's needs change and the
speed of that change will depend on the
condition from which the pet is suffering.
This speed of change will, therefore,
determine how often the needs are
reassessed and how often the planning ~
© 2011 Blackwell PubUshing Ltd
Veterinary Nursing Joumal• VOL 26 • May 2011 • Page 149
CliNICAL
TABLE 1
Key elements to include in a nursing care plan
Section Title
1. Diet and appetite
2. Water intake and thirst
What to include
An assessment for 1] and 2] would record whether or not the patient is eating or
is able to eat, or drinking or able to drink, and if so, how much and of what diet or
solution. Other vital information such as the pet's normal diet at home and when
the patient last ate prior to admission also needs to be assessed. The plan would
then include whether or not the patient was to be offered food and water, or
whether it was to be starved, for example, prior to a general anaesthetic. This
section then needs to detail what type of diet the pet is on, how much and how
often. If the patient is being fed as per a feeding plan then this is best attached as
a separate sheet, and then referred to in the plan. This section may also detail Gl
problems such as vomiting or it may be that a separate section is used such as
one specifically for vomiting, or the 'other' section can be used.
Linked Information: Feeding chart
3. Fluid therapy
An assessment here would record whether or not the patient was on intravenous
fluid therapy, what type of fluid and the fluid rate. It may also inclu..de__cesults pf
any tests used to assess the response to that treatment. The plan would then
include what fluid type the pet is to continue on, and at what rate. It may also
include a time when this is to be re-assessed. The details of the fluid therapy i.e.
a fluid therapy chart can be appended and referred to. The plan may also have a
separate section for the IV catheter i.e. has it been flushed, when was it placed
and where, when does it need to be removed etc.
Linked Information: Fluid therapy chart
4. Urination
5. Defaecation
An assessment for 4] and 5] would record whether or not the patient is passing
urine or faeces, or is able to pass urine or faeces, and, if so, how much, and
whether there are any problems with that. Other vital information for cats would
be normal toileting arrangements at home, such as whether the cat normally
uses a litter tray and what type of litter is used. The plan would then indicate that
this needed to be monitored and if any action needs to be taken if, for example, no
urine has been passed and no bladder is palpable. This can also be used for
details of urinary catheters and volumes of urine collected from them, when they
have been flushed etc.
6. Pain assessment and pain
management
An assessment here ideally needs to include a pain score, or some detailed
description of the pain assessment so that it is more easily measured against the
next time it is re-assessed. The plan would then say what action needs to be
taken with respect to pain management, e.g. is the current pain control good
enough or do changes need to be made. Again timings or re-assessment can be
recorded and the details of the drugs used recorded on a separate sheet which is
appended to the care plan and referred to in it.
Linked Information: Medication chart
7. Exercise and physiotherapy
Assessment here would involve the patient's ability to exercise or the need for
cage rest or physiotherapy. This would often be a longer term plan as it can take
time for many patients to be able to walk or move around again after injury.
Records of a more detailed assessment, such as a full neurological examination,
can be included in the care plan or attached and referred to.
Linked Information: Neurological exam and exercise plan
8. Other drugs
Pain control drugs have been itemised separately but this section can then be
used for all other drugs. A list of medication together with an assessment of their
effectiveness is usually sufficient and then a plan to say either continue, change
or stop certain drugs. The precise details of the actual drugs, formulations,
timings, dosages etc can then be appended on a detailed medication chart.
Clinical details such as temperature, pulse, respira~ion, mwcou·s membranE?
colour etc will all be detailed on the normal hospital sheet and can be referred to
from this section or the other' section.
Linked Information: Medication chart ~
Page 150 • VOL 26 • May 2011 • Veterinary Nursing Journal
© 2011 Blackwell PubUshing Ltd
CLINICAL
TABLE 1
Key elements to include in anursing care plan (continued)
9. Owner plan and contact details
This is an important area of the care plan, especially during handover between
different staff members or different clinics. To have all the information in one
place is always useful, so transferring contact numbers for the owner from the
consent form to the care plan can save time. The care plan can then also be used
as a record of phone calls to and from the client about the patient's progress or
to record that they have visited.
Linked Information: Consent form
10. Other
Every care plan needs an 'Other' section. This is because many animals have
individual needs that would not fit a normal care plan or to save including everything
every time. So, for example, 'how many legs does the cat have?' does not need to
be included on every care plan, for every cat but for the one-eyed, three-legged
ginger cat it might be important to include these details in the care plan under
'Other·. Temperament can be included in all care plans but again, if you would
rather not then just include the 'Care· or 'Nervous· warning under 'Other·. Other
areas to consider would be grooming, sleeping, and play/normal behaviour.
is re-done. It also needs to be individual
for that pet and holistic, including all
aspects of care so that nothing is missed.
This is important in, for example, elderly
patients who have complex needs and will
rarely be suffering from just one
condition. It is also vital in trauma cases
where there are often multiple injuries
affecting more than one body system it is all too easy to focus on, say, the
fractured pelvis and forget the bladder,
which may be ruptured. This will not be
identified unless the whole patient is
regularly evaluated.
This nursing process is more effective
if guided by a Nursing Model and there
are a number of examples of these. The
Orpet and Jeffery Ability Model was
developed from human models and looks
at the '1 0 abilities' that are considered to
be the basic requirements for an animal
to function.! Ability is what the animal is
able to do or not do by itself. In this way
the abilities that the pet is not able to do
can be identified and nursing can assist.
For instance, if the animal is not able to
eat by itself then it needs to be nursed to
eat via, for example, a change in diet or
assisted feeding.
As well as considering these abilities,
each element on the care plan needs to
be, in some way, dynamic - responding
to the pet's changing needs as its
condition changes. For each section a
current assessment of the situation needs
to be followed by a plan on how to tackle
that problem as needed. The key elements
to include are shown in Table 1.
® 2011 Blackwell Publishing Ltd
''The communication between different team members is vital, so that
everyone involved in the case is clear about what is going on and what the
goals are''
How long should they be?
Care plans can be as long or as short as is
needed but to go over 'one page' makes it
harder to evaluate all the information at a
glance. Hence the idea of including more
detail on attached pages is an attractive
one (Table 1) and limiting the categories
so that they can all be included on one
page can also help to make them more
'user friendly:
Every patient or only the 'nonroutine' or 'Long stay' cases?
Most practices have some sort of protocol
in place for dealing with routine cases
and so care plans can either not be used
for routine cases (day-case neutering, for
example), or one general care plan is
written to include all the elements above
but with the same being done for each
patient. Examples might be to have a
generic care plan for cat neuters that is
displayed in the cat ward for every case.
For diet and appetite, the care plan may
read 'nil by mouth' prior to general
anaesthesia and then go on to detail the
routine for re-introducing food and water
on recovery and at home.
surgery, so that everyone knows what is
expected with these patients. They will
not, however, be individual to each patient.
Then the 'non-routine' or 'long stay' patients
can have their own individual plans.
So how do we use care plans?
There are a number of different
elements to this question and these
will be the subject of Part 2 in the series.
In summary, using nursing care plans
improves patient care, practice
communication, and adds value to
the process of veterinary nursing. II
References
1. ORPET, H. 120081 Advances in the Delivery of
Practical Nursing Care- practical examples.
World Small Animal Veterinary Association World
Congress Proceedings, 2008
Further reading
ORPET & JEFFERY 120061 Moving towards a more
holistic approach. VNJ 26151 May 2006.
JEFFERY 120061 Moving away from the medical
model VNJ 21191 September 2006.
JOINER. T. 120001 An holistic approach to nursing.
Veterinary Nursing 15141 July 2000.
JEFFERY 120081 Advances in the Delivery of Nursing
In this way, a few care plans can be put
together to cover the majority of day-case
Care- a new concept. World Small Animal Veterinary
Association World Congress Proceedings, 2008.
Veterinary Nursing Journal• VOL 26 • May 2011 • Page 151