Care planning is an essential part of health care and an integral part of a nurse’s role in aiming to provide continuity for the patient. There is an expectation that children and their families can trust the nurse to treat them as partners, work with them to make a holistic and systematic assessment of their needs and develop a personalized plan.

Everyone involved should be made aware of what needs to be done for any given child and family. Having individualized care plans that incorporate all aspects ensures that holistic care is given and assists the child and family to know what to expect in their care. Without a specific document delineating the plan of care, important issues are likely to be neglected. Care planning therefore provides a guide that maps out interventions. To be effective and comprehensive, the care planning process must involve all disciplines that are involved in the care of a child and family.

Care planning can be considered as a process and this fits well with the well-cited ‘nursing process’. The nursing process is cited as a framework for problem solving but, more importantly, it assists the structured and logical planning of care on an individual basis. Initially, there were four distinct phases – assessment (and identifying problems), planning (setting goals), implementation of care, and evaluation of that care. The Figure outlines the nursing process as five phases with the optional addition of nursing diagnosis after assessment.

Assessment: this involves gaining information about and from the child and family in order to identify their problems that require attention and intervention. The various forms of assessment have been covered in the preceding chapters in Part 1. Assessment not only identifies problems but also leads to a nursing diagnosis, i.e. a clinical judgement about the individual. Potential problems should also be identified and considered in light of the findings from the initial assessment.

Planning: Intended outcomes and goals are set which should be realistic and achievable. These can be short-term (for example, hospital-based, emergency department) or long-term (for example, in chronic illness within the community setting). The question to ask here is, ‘What needs to be done for this child?’

Implementation: this is the action required or the delivery of care interventions planned, including those from others members of the multi-disciplinary team.

Evaluation: The final, key phase, as this is where the nurse ensures that the care given has been effective, and checks if the goals have been achieved. If they have not, then reassessment is necessary in order to reach a positive outcome. This is why the nursing process is cyclical. Evaluation of all initial goals and plans should take place within an appropriate time frame.

There are many models of nursing that can be used in conjunction with the nursing process. Used together, they are fundamental tools that serve as a framework to consider and plan the care of individual children and families. A model directs the thinking of those caring for the child in relation to the context of the health care situation. They also help direct nursing interventions and how these are given and evaluated. Three models are outlined below:

Roper et al.’s (2000) Activities of Living Model: The Roper-Logan-Tierney Model for Nursing is a theory of nursing care based on activities of living (AoLs). The theory is used as an assessment throughout the patient’s care. The theory attempts to define what living means in relation to activities of living through complete assessment leading to interventions. The AoLs should not be used as a checklist of boxes. Instead, they should be viewed as an approach to the assessment and organization of the care of the patient. A child’s and a family’s problems can be identified and considered within each AoL as appropriate to the individual case.

Casey’s (1988) Family-Centred Care Model: Casey’s Model of Nursing focuses on the nurse working in partnership with the child and his or her family. This was one of the earliest attempts to develop a nursing model designed specifically for child health nursing. The five aspects of this nursing theory are: the child, the family, health, the environment, and the nurse. Any problem identified for an individual case should include a partnership between the nurse and family, with involvement along with interaction with the child, their health and environmental needs during illness. The Figure shows how a written care plan can incorporate family intervention.

Orem’s (1991) Self-Care Deficit Model: Similar to Casey’s model, the four elements of Orem’s nursing theory are the person (child/family), health, the environment, and the nurse. The theory of self-care refers to the practice of activities or requisites that an individual initiates and performs on his or her own behalf to maintain life, health, and well-being. Universal self-care requisites are associated with life processes, as well as the maintenance of the integrity of human structure and functioning. Self-care deficits exist, however, when a person becomes ill or unable to perform these requisites and maintain optimum health. Therefore, a child’s problems are identified according to these requisites and whether they have any deficit under each one.

Finally, it must be emphasized how important accurate and ongoing documentation is in relation to care planning. Record keeping was covered in Chapter 9; an individual’s plan of care is an integral part of this. The Nursing and Midwifery Council emphasizes that nurses should ensure healthcare records for patients or clients are accurate accounts of treatment, care planning and delivery.