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Chapter 5 Findings
In the following example the nurse documents sharing of information but it
appears to be one-way communication:
“Advised re: benefits of same.”
5.7.8 Element 7: Recognition of Past and Present Life, Which May Shape
Residents’ Wishes. Life Histories.
Recognition of hobbies and interests in past and present life was judged to be
evident where activity interests were noted and planned for, or where family and
community relationships were noted. Evidence of named care staff was deemed
part of this element if life histories, etc. were to be gathered.
Analysis of documentation revealed that 64% (n=24) of notes (Chart 5.15) had
documented the resident’s interests on admission:
“Likes to listen to music tapes.”
However, in all of these assessments there was no further reference to these
interests in the daily nursing notes or care plans. Thirty-six per cent (n=14) of
residents did not have interests or hobbies documented on admission and no
further reference to these were made. In some notes there was evidence of family
relationships:
“At times family members take Mary out for the day.”
There was some evidence of what a resident did and did not like to do. There was
very little evidence of the resident’s previous life, e.g. occupation, etc. The
examples provided here show assessments and comments but no detailed plans.