Nursing care plan

Care plans can vary considerably in content and appearance. There is no universal way of writing a care plan. They are usually designed with columns for the different sections. It is important to represent the continuity of the stages^A of the nursing process in the chosen format^B.

In the hospital setting, the patient's biographical data and nursing assessment documents are often designed as a separate document to the care plan. The care plan includes the planning, implementing and evaluating stages of the nursing process. A care plan should include space for the following:

• statements of need for nursing care (or problems)

• the expected outcomes of care

• planned interventions

• implementation of nursing interventions

• evaluation of care

Statements regarding needs, expected outcomes, planned interventions, their implementation and the evaluation of actual outcomes should be clearly linked, thus providing a total picture of care. The care plan is a dynamic working tool for nurses and others in the health team. Because human needs change, it should be easy to make additions and review the plan. From the care plan, a member of the nursing team should be able to identify the personalized care that the patient needs and which of these needs have or have not yet been met. A simplified example might look something like this:

Nursing care plan

Patient's name

Patient's needs	Objectives of planned nursing care	Implementation expected intervention	Evaluation outcomes
1. Patient's appetite is poor	1. Stimulate the patient's appetite 2. Ensure that nutritional and hydration needs of the patients are met	1.Weigh patient daily 2. Monitor patient's intake and output 3. Refer to dietician	1. Patient is gaining weigh 2. Patient is showing no signs of dehydration or malnutrition
2. Patient is short of breath	1. Stabilize the patient's breathing 2. Help to make the patient feel more comfortable	1. Administer oxygen as prescribed 2. Help patient sit upright in a comfortable position	1. Patient's respiratory status improves 2. Patient is able to return to activities without shortness of breath

Notes

^A continuity of the stages — непрерывность и преемственность этапов

^в in the chosen format — зд.: в соответствии с выбранным планом

Nursing education in russia

By the last decade of the 20^th century nursing in Russia had only one level of nursing education. These educational programs were 2 or 3 years long and were provided by nursing schools. The 2-year nursing programs accepted graduates who had completed 11 years of secondary education. The 3-year nursing programs accepted graduates who had completed 9 years of secondary education. The students of the 3-year program took general courses (math, physics, chemistry, literature, history) during the first year. The age of the graduates who entered the profession of nursing was usually about 18 years old. During this time, the only opportunity for nurses to continue or improve their education was through short courses of specialization or refresher courses that lasted from 2 weeks to 3 months.

Nursing education reform in Russia started in 1991. By the year 1996, the Ministry of Health of Russia established a multi-level system of nursing education in the country. Currently, there are 3 levels of nursing education. In total there are more than 290 nursing schools in Russia providing basic and advanced nursing education and more than 30 university-based nursing programs.

The first (basic) level is the basic level of nursing education, which is 3 years of training after 11 years of secondary education. This level of education is provided by basic nursing schools.

The second (advanced) level of nursing education is provided by nursing colleges. These programs are 4 years long and students may specialize in family nursing practice^A , school nursing^B, nursing management^C or nursing education^D. Students who have graduated from basic nursing program may return to a nursing college to receive an advanced education. The program would be of a shorter duration for these students.

The third (higher level of nursing education) level is provided by universities or higher medical schools. It is for qualified nurses^E with basic or advanced education and is aimed to prepare nurses for leadership positions in nursing education, management and research. There are full time (day) and part time (evening and distant learning) courses for those who are in practice and would like to combine their practice with continuing education. The length of university programs varies from 4 to 5 years.

The first university — based nursing program was established by Professor Galina Perfilieva at the Moscow Medical Academy. The graduates of the university programs are now working as directors of nursing^F, senior nurses in hospitals and polyclinics, nursing instructors^G or nursing officers^H. The graduates of the university programs may continue their education at post-graduate programs and conduct research. In 1999, the first nurse in Russia to defend her Candidate's dissertation in the area of public health was a graduate of the nursing program at the Moscow Medical Academy.

Notes:

^A family nursing — зд.: специализация медсестер в области семейной медицины

^в school nursing — зд.: подготовка медсестер для работы в школе

^с nursing management — менеджмент в сестринском деле

^D nursing education — медсестринское образование

^Е qualified nurses — зд.: медсестры, имеющие средне-специальное (базовое) образование

^F director of nursing — руководитель сестринской службы в учреждении здравоохранения (заместитель главного врача по работе с сестринским персоналом или главная медсестра)

^G nursing instructor — преподаватель сестринского дела (в образовательном учреждении)

^н nursing officer — специалист по сестринскому делу (в органах управления здравоохранением)