Student Nurse Guide to Continuity of Care

Continuity care includes focusing on the experience of the patient as the patient moves through the health care system. Moving your patient through this system will require organization, incorporation and facilitation of all the events along the field.

Example: Your patient being admitted on the medical surgical unit then discharged to their home. Moving from an acute bed to a skilled bed or moving from the operating room to the ICU unit.

Continuity of care is provided by the nurse who practices using her skills and knowledge according to the established nursing practice standards. Nursing standards of practice are based on written standards, guidelines and protocols. By following community agency policies and procedures you are providing continuity of care.

Care coordination - is the responsibility for facilitating continuity of care.

Documentation is required when facilitating continuity of care and it is very important that you follow all proper guidelines of documentation. There are various types of documentation that a nurse will have to cover to make sure proper continuity of care is being implemented.

Graphic sheets - provide current retrospective listing of your patient's vital signs.

Flow sheets - lists all routine care that is being provided to your patient and will provide a graph of upon which completed care has been documented when complete.

Nurses notes - lists all the clients' response to treatments as well as any changes in your patients care. If a nurse fails to maintain a proper nurses notes and leaves out details of a patients care, then legally that care has was never provided. It is very important that a nurse maintains her nurses notes clearly and precisely without leaving out any care that was given to a patient.

Kardex - provides a quick reference to your patient's information, a list of treatments and scheduled times for treatments, any special needs and any upcoming diagnostic procedures.

Nursing Care Plans - are a written guideline and communication tool that is used to identify your patient's pertinent assessment data, problems and nursing diagnoses, goals, interventions and expected outcomes. Nursing care plans can be ever changing due to the demands and changes of a patient's problem.

Care maps - incorporate your patients day to day expected outcomes anticipated at discharge or the end of the treatment phase. These care maps also outline all clinical assessments, treatments, procedures, dietary interventions, activity therapies, patient education and discharge planning.

Communication is very important and requires commitment, focus, effort and cooperation. When dealing with people with diverse backgrounds and perspective the nurse must understand and use their communication skills to successfully coordinate their care for their patients. There are many types of ways a nurse communicates. When a nurse gives a report they must be factual, accurate, complete, organized and current.