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Background Purpose Cyclic vomiting syndrome (CVS) and cannabinoid hyperemesis syndrome (CHS) are both characterized by episodic, acute transitions from asymptomatic states to highly symptomatic states of nausea, repetitive vomiting, and often severe abdominal pain. Patients with CVS and CHS face significant challenges to abort or mitigate episodes at home and often require emergency department (ED)‐based care.This paper reviews the current treatment approach to abort acute CVS and CHS episodes at home and in ED settings. Multiple pharmacologic and nonpharmacologic interventions have been demonstrated to potentially abort CVS or CHS episodes. Systemic pharmacologic agents often used as abortive therapy include triptans, antiemetics, anxiolytics, NK‐1 receptor antagonists, antipsychotics, sedatives in general, and various analgesic / anti‐inflammatory medications. Nonsystemic, nonpharmacologic approaches include reducing external stimuli (quiet room, dim lights, etc.), and hot water bathing or the application of topical capsaicin cream. More research is needed to develop evidence‐based, individualized abortive treatment plans, as well as to determine whether the abortive treatment for CVS requires a fundamentally different approach than for CHS. When home‐based approaches fail, all patients with CVS or CHS should receive nonjudgmental, informed, and compassionate care in the ED to abort their episode. Patients with more severe forms of CVS/CHS who require more frequent ED utilization should develop care plans with their ED to assure predictable and effective treatment. [ABSTRACT FROM AUTHOR]

Indigenous American (I.A.) individuals with serious illness and their families have unmet needs. Often, this group is viewed as a minority within a minority. Numerous health challenges exist within the I.A. populations resulting in dire health care situations. Historical trauma and mistrust of the healthcare system impacts access to quality palliative care by this marginalized population. Given the range of social, spiritual, and cultural issues, the interprofessional team needs increased knowledge specific to the I.A. population to ensure holistic, culturally sensitive care. Utilizing a case study, this article reviews of the needs of I.A. individuals with serious illness and essential skills. The aim is empower palliative care clinicians the knowledge to provide culturally sensitive and congruent care to I.A. individuals with serious illness and their community. [ABSTRACT FROM AUTHOR]

Introduction: Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered. Methods: Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents' care plans and speech and language therapist recommendations. Results: Written recommendations predominantly focused on food and fluid modification. Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision. Conclusion: Care homes need to be supported to establish a safe swallowing culture to improve residents' safety and care experience. WHAT THIS PAPER ADDS: What is already known on this subject?: Dysphagia is associated with considerable morbidity and mortality and has been identified as an independent risk factor for mortality in nursing home residents.There is evidence that compensatory swallowing strategies, safe feeding advice and dietary modifications can reduce the risk of aspiration pneumonia.Care for nursing home residents at mealtimes is often task‐centred and delegated to those with limited training and who lack knowledge of useful strategies to support the nutrition and hydration needs of residents with dysphagia. What this study adds?: Written advice from speech and language therapists on safe nutrition and hydration for residents with dysphagia is focused mainly on food and fluid modification.Nurses and healthcare assistants have limited understanding of International Dysphagia Diet Standardisation Initiative levels or safe swallowing strategies and recommended practices to support safe nutrition care for residents with dysphagia are inconsistently applied especially when residents are eating in dining areas.Care homes are not aware of Royal College of Speech and Language Therapists guidance on how safe nutrition care of residents with dysphagia should be supported. What are the clinical implications of this work?: Care homes need to prioritise a safe swallowing culture that ensures that residents with swallowing difficulties are assisted to eat and drink in a way that enhances their mealtime experience and minimises adverse events that may result in hospital admission.Speech and language therapists could play an important role in training and supporting care home staff to understand and use safe swallowing strategies with residents with dysphagia.The Royal College of Speech and Language Therapists could provide more assistance to care homes to support and guide them in how to implement safe feeding routines.Care home staff have limited knowledge about how to implement safe feeding routines and need more guidance from speech and language specialists on how they can support residents with dysphagia to eat safely.Creating a safe swallowing culture within care homes could help to improve nutrition care and enhance patient safety. [ABSTRACT FROM AUTHOR]

Innovation in cancer therapy has increased childhood cancer survival rates. However, survivors are still at risk of developing late effects. In the digital transformation of the health sector, the Survivorship Passport (SurPass) can support long-term follow-up care plans. Gaps in seamless connectivity among hospital departments, primary care, combined with the time of health professionals required to collect and fill-in health data in SurPass, are barriers to its adoption in daily clinical practice. The PanCareSurPass (PCSP) project was motivated to address these gaps by a new version of SurPass (v2.0) that supports semi-automatic assembly from organizational Electronic Health Record (EHR) systems of the treatment summary data using HL7 FHIR, to create SurPass, and to link it to regional or national digital health infrastructures in six European countries. In this paper we present the methodology used to develop the SurPass technical implementation strategy with special focus on the European Health Data Space (EHDS). The recently provisionally approved EHDS regulation instruments a digital health data ecosystem with opportunities for cost-effective SurPass implementation across Europe. Moving forward, a European HL7 FHIR SurPass Implementation Guide along with synthetic data sets, and validation tools can enrich the European Electronic Health Record Exchange Format (EEHRxF) with use cases on health & wellness of childhood cancer survivors. [ABSTRACT FROM AUTHOR]

For parents providing care for people living with disabilities, future care provision is an inevitable concern. Migrant parents are often faced with "dual challenges", not only as parents of an individual living with disabilities but also as migrants, creating immediate or additional barriers to their engagement in the planning process. This study explores the impact of cultural differences and how they shape the future care plans of Korean migrant parents providing care for individuals living with disabilities. Applying a qualitative approach, this study conducted semistructured interviews with Korean migrant parents in New Zealand (n=8) and professionals working with them (n=10). The collected data were analysed using the content analysis method. The findings revealed a strong emphasis on familism and cultural barriers experienced by migrant families that negatively affect the planning process. For future care planning to take its place as a conventional care phase, some political and practical recommendations are presented. Future care provision planning is a pervasive concern for parents providing care for individuals living with disabilities; thus, it must take its place as a conventional phase of care. The impact of cultural differences and the values attached need to be taken into consideration in policy making and social work practice to elevate the level of involvement in the future care planning process among migrant families. [ABSTRACT FROM AUTHOR]

The purpose of this article is to present a scenario of a typical patient at risk of developing pressure damage and demonstrate how to complete the assessment and implement a prevention plan using the aSSKINg framework (Healthcare Improvement Scotland, 2020). By following these recommendations, healthcare professionals can demonstrate good preventative care, reduce the risk of patients developing pressure damage, and protect their organisation against any future litigation claims (Downie, 2014). [ABSTRACT FROM AUTHOR]

Abstract Background Pain is one of the most common complaints that patients present to the emergency department for; emergency medicine providers are tasked with providing appropriate pain relief while simultaneously limiting the risk of personal and societal harm that may result from opioid misuse. The Lakeland Regional Medical Center developed a medical management program that identified frequent emergency department visitors with a chief complaint of pain. Individualized care plans were developed for these patients. A retrospective review was then conducted to assess the efficacy of these care plans in reducing the number of emergency department visits for pain-related complaints by the patients entered into the medical management program. Results There were 294 patients; 65% were male, and the median age was 41 (interquartile range: 33 to 51). A total of 80% percent of the patients were white, and the payors were as follows: 53% were self-pay, 42% were government programs, and 5% had private insurance. The three most common chronic pain complaints were 39% abdominal pain, 24% back/neck pain, and 23% headache/migraine (patients could have more than one area of pain). A total of 60% of the patients had a primary care provider, and another 18% had a pain management provider in addition to primary care. Post plan admissions were significantly reduced to a median of 1 (IQR 0 to 3) with the Wilcoxon signed-rank test’s p-value of less than 0.001. Conclusion The authors describe their experience with a quality improvement initiative that identifies frequent emergency department visitors with a chief complaint of pain and provides individualized care plans to these patients. The goals of the program are to improve patient’s quality and consistency of care, through interventions that eliminate the prescribing of opioids while providing non-opioid alternatives.

Major life changes can trigger a traumatic stress response in older adults causing trauma symptoms to resurface. In 2019, the Centers for Medicare and Medicaid Services released the requirement, without specific guidance, for trauma-informed care (TIC) as part of person-centered care in long-term care. Observational, cross-sectional. A total of 722 new admissions at one nursing home in metro Atlanta between November 2019 and July 2021. We developed a "TRAUMA" framework for TIC screening based on Substance Abuse and Mental Health Services Administration resources. The admissions nurse conducted TIC screening within 48 hours of new admissions, including reported trauma and necessary modifications to care plans. Demographic information was derived from electronic records. Analysis included independent sample t-tests, binary logistic regression, and χ2 tests. All data were analyzed using SPSS v. 28. Of 722 new admissions, 45 (6.2%) indicated experiencing trauma. There was no significant association with being Black or non-White and experiencing trauma, but there was a significant association with being female and experiencing trauma (χ2 (1) = 5.206, P =.022). Only men reported child physical abuse and war trauma and only women reported adult sexual assault, child sexual assault, adult domestic violence, school or community violence, adult nonintimate partner violence, and other trauma. There was a small, significant negative association of age and trauma (β = −0.037; SE = 0.11; P <.001). The most-reported trauma category was medical trauma, including COVID-related trauma. More than half (51%) requested spiritual intervention and only 2 requested medical intervention with medication as initial interventions. Our experience suggests that knowing the patient and their trauma history allowed the admissions nurse and interdisciplinary care team to modify the person-centered care plan to best meet the patient's needs. Our results also emphasize the need for using universal trauma precautions in all interactions. [ABSTRACT FROM AUTHOR]

Background: Pain is one of the most common complaints that patients present to the emergency department for; emergency medicine providers are tasked with providing appropriate pain relief while simultaneously limiting the risk of personal and societal harm that may result from opioid misuse. The Lakeland Regional Medical Center developed a medical management program that identified frequent emergency department visitors with a chief complaint of pain. Individualized care plans were developed for these patients. A retrospective review was then conducted to assess the efficacy of these care plans in reducing the number of emergency department visits for pain-related complaints by the patients entered into the medical management program. Results: There were 294 patients; 65% were male, and the median age was 41 (interquartile range: 33 to 51). A total of 80% percent of the patients were white, and the payors were as follows: 53% were self-pay, 42% were government programs, and 5% had private insurance. The three most common chronic pain complaints were 39% abdominal pain, 24% back/neck pain, and 23% headache/migraine (patients could have more than one area of pain). A total of 60% of the patients had a primary care provider, and another 18% had a pain management provider in addition to primary care. Post plan admissions were significantly reduced to a median of 1 (IQR 0 to 3) with the Wilcoxon signed-rank test's p-value of less than 0.001. Conclusion: The authors describe their experience with a quality improvement initiative that identifies frequent emergency department visitors with a chief complaint of pain and provides individualized care plans to these patients. The goals of the program are to improve patient's quality and consistency of care, through interventions that eliminate the prescribing of opioids while providing non-opioid alternatives. [ABSTRACT FROM AUTHOR]

Background: Persons with multiple chronic conditions face complex medical regimens and clinicians may not focus on what matters most to these patients who vary widely in their health priorities. Patient Priorities Care is a facilitator-led process designed to identify patients' priorities and align decision-making and care, but the need for a facilitator has limited its widespread adoption., Objective: The aims of this study are to design and test mechanisms for patients to complete a self-directed process for identifying priorities and providing their priorities to clinicians., Methods: The study involved patients of at least 65 years of age at 2 family medicine practices with 5 physicians each. We first tested 2 versions of an interactive website and asked patients to bring their results to their visit. We then tested an Epic previsit questionnaire derived from the website's questions and included standard previsit materials. We completed postintervention phone interviews and an online survey with participating patients and collected informal feedback and conducted a focus group with participating physicians., Results: In the test of the first website version, 17.3% (35/202) of invited patients went to the website, 11.4% (23/202) completed all of the questions, 2.5% (5/202) brought results to their visits, and the median session time was 43.0 (IQR 28.0) minutes. Patients expressed confusion about bringing results to the visit. After clarifying that issue in the second version, 15.1% (32/212) of patients went to the website, 14.6% (31/212) completed the questions, 1.9% (4/212) brought results to the visit, and the median session time was 35.0 (IQR 35.0) minutes. In the test of the Epic questionnaire, 26.4% (198/750) of patients completed the questionnaire before at least 1 visit, and the median completion time was 14.0 (IQR 23.0) minutes. The 8 main questions were answered 62.9% (129/205) to 95.6% (196/205) of the time. Patients who completed questionnaires were younger than those who did not (72.3 vs 76.1 years) and were more likely to complete at least 1 of their other assigned questionnaires (99.5%, 197/198) than those who did not (10.3%, 57/552). A total of 140 of 198 (70.7%) patients responded to a survey, and 86 remembered completing the questionnaire; 78 (90.7%) did not remember having difficulty answering the questions and 57 (68.7%) agreed or somewhat agreed that it helped them and their clinicians to understand their priorities. Doctors noted that the sickest patients did not complete the questionnaire and that the discussion provided a good segue into end-of-life care., Conclusions: Embedding questionnaires assaying patient priorities into patient portals holds promise for expanding access to priorities-concordant care., (©Jody Naimark, Mary E Tinetti, Tom Delbanco, Zhiyong Dong, Kendall Harcourt, Jessica Esterson, Peter Charpentier, Jan Walker. Originally published in JMIR Formative Research (https://formative.jmir.org), 29.08.2024.)

This paper identified the flaws in preparing children with disabilities for life after institutional care living in Zimbabwe. With the utility of a qualitative paradigm and a phenomenology research design, the study discovered that institutions of care have limited choices for vocational skills training courses due to financial paucity. The paucity of financial resources has also been found to compromise the effectiveness of preparing children with disabilities for life after institutional care. The findings revealed that there are also inherent systemic weaknesses and loopholes in the design of care plans which cast a shadow of confusion on the re-integration process. Limited family support and involvement were also found to weaken the acceptability and simulation of these children into the community. Underpinned by a social model of disability and social work lenses, the study recommended immense advocacy for the participation of children with disabilities together with their families in the preparation of care plans to ensure inclusion and sustainable reintegration. Furthermore, the paper pushes for closer monitoring and evaluation of institutional care facilities to guarantee alignment and compliance of care plans with national policy frameworks that guide the placement and reintegration of youth with disabilities back into the community. [ABSTRACT FROM AUTHOR]

Implementation of survivorship care plans remain a challenge. This quality improvement initiative aims to integrate personalized treatment plans (PTP) and care plans (PCP) into the existing workflow for breast cancer (BC) patients. Methods: Phase 1 was to identify multidisciplinary team members to generate and deliver PTP and PCP. Concurrently, Phase 2 was to deliver PTP and PCP to newly diagnosed invasive BC patients at chemotherapy initiation and completion, respectively. Iterative plan, do, study, act (PDSA) cycles were applied to refine the process. The proportion of information completed for PTP and PCP generation and its delivery by the care team were measured. Patient and provider satisfaction were also assessed. Implementation Process and Results: The care transfer facilitator (CTF) was identified to complete and deliver PTP, and their data entry increased from 0% to 76%, 80%, 92% consecutively during the last 4 PDSA cycles. PTP and PCP were provided to 85% of eligible BC patients. Patients agreed that PTP helped them to actively participate in their care (88%) and communicate with the oncology care team (86%). Primary care physicians agreed that PTP and PCP had the information needed to “stay in the loop” (80%), and oncologists agreed they should be incorporated into oncology clinics (100%). Conclusions: Integrating PTP and PCP generation and delivery into existing workflow has led to an increase in uptake, sustainability and provider buy-in. With limited resources, it remains difficult to find care team members to complete the forms. A dedicated personnel or survivorship clinic is required to successfully implement PTP and PCP as the standard of care.

Resumen: Objetivo: Identificar la opinión de las enfermeras de atención primaria sobre el uso y la utilidad de los planes de cuidados y los lenguajes estandarizados tradicionales en la práctica asistencial. Diseño: Estudio descriptivo, transversal, multicéntrico. Emplazamiento: Equipos y dispositivos de atención primaria en Cataluña. Participantes: Se estimó una muestra necesaria de 1.668 enfermeras y se aplicó una técnica de muestreo consecutivo. Intervenciones: Cuestionario de acceso on-line con preguntas sobre la percepción de facilidad, utilidad y uso de los planes de cuidados y los lenguajes estandarizados tradicionales. Mediciones: Estadísticos descriptivos con proporciones, medidas de tendencia central y de dispersión. La significación estadística se estableció si p ≤ 0,05. Resultados: Se analizaron 1.813 cuestionarios. Las participantes opinaron que los planes de cuidados tienen un valor añadido medio, aunque su uso es con frecuencia incorrecto. Refirieron un nivel de conocimientos adecuado sobre los lenguajes estandarizados, y en su mayoría (81%) opinaron que son difíciles de emplear en la práctica y que son poco útiles para representar la prestación de cuidados y sus resultados (78%). Independientemente de su nivel académico y de los años de experiencia, valoraron como insuficiente la claridad (p = 0,058), facilidad de uso (p = 0,240) y utilidad de los lenguajes estandarizados (p = 0,039). Conclusiones: Las enfermeras urgen a introducir cambios en el uso de los planes de cuidados, incluyendo el cambio de lenguaje, para mejorar los datos y la información que revierta positivamente la prestación de cuidados para la mejora de los resultados de salud de las personas beneficiarias de los servicios de atención primaria. Abstract: Objective: To identify opinions of Primary Healthcare nurses on the use and usefulness of standardised nursing care plans and traditional nursing language systems in the practice settings. Design: Multicentre, observational, cross-sectional study. Setting: Primary Healthcare centres in Catalonia. Participants: Sample size was estimated at 1,668 registered nurses. Consecutive sampling was applied. Interventions: On-line survey containing questions on ease, usefulness, and use of nursing care plans and standardised nursing language systems. Measurements: Descriptive statistics, including percentages, central tendency, and dispersion measures. Statistical significance was set at P ≤ .05. Results: The final analysis included 1,813 questionnaires. Participants stated that care plans have a medium added value, however their use is frequently incorrect. They stated to have a fair level of knowledge on traditional standardised nursing languages, and most were of the opinion that these languages are difficult to use in practice (81%) and not useful to represent nursing care provision and its outcomes (78%). Regardless of their education level and years of experience, the participants assessed as insufficient the clarity (P = .058), ease of use (P = .240), and usefulness (P = .039) of these language systems in practice. Conclusions: Nurses say that urgent changes are required in the use of care plans. This includes changing the language systems, and improving data and information that positively impacts on the provision of nursing care, as well as to enhance the health outcomes of the individuals receiving Primary Healthcare services.

Healthcare providers as well as medical technologists lay a strong focus on clinical conditions for patient centric care delivery. Currently, the challenges are to (1) obtain a consolidated view of various stakeholders and pain points for the entire disease lifecycle, (2) identify interdependencies between different stages of the disease, and (3) prioritize solutions based on customer needs. A structured approach is required to address clinical needs across disease care plans tailored to different geographies and ethnicities. Innovation Think Tank (ITT) teams across multiple locations formed focus groups to elaborate the pathways of 22 global diseases, selected based on ranking of associated economic burden and threat to life. Ideation sessions were held to identify pain points and find innovative solutions. Additionally, inputs were taken from co-creation sessions at universities worldwide. The optimization and design of infographics and care plan was done based on the key information gathered—facts and figures, stakeholders, pain points and solutions. Finally, validation was obtained from clinical and technology experts globally. A disease pathway framework was created to develop pathways for 22 global diseases. Over 1,500 pain points were collected and about 1,900 ideas were proposed. The approach was applied to optimize its application to 30 product and portfolio definition projects over 2 years at Siemens Healthineers, as well as co-creation programs with universities and hospitals. The disease pathway framework provides a unique foundation for extensive collaboration among multiple stakeholders, through information sharing and delivering high-quality solutions based on the identified problems and customer needs.

• Question What are the information needs of home health aides (HHA) specific to care plans of patients living with dementia (PLWD)? • Findings In this qualitative study of 25 English and Spanish-speaking HHAs in the New York metropolitan area, HHAs highlighted challenges related to ambiguities of scope of HHA tasks related to medication management and limited details about patient's social history on the care plan. HHAs voiced high priority for the provision of person-centered care to PLWD. • Meaning HHAs are the backbone of the home healthcare workforce, essential to help PLWD age in place in the community. HHAs provide personal care and assistance with health-related tasks. Initiatives to expand dementia-related curriculum and content on care plan for HHAs are warranted. Home health aides (HHAs) are a vital workforce essential to meet the complex care needs of the persons living with dementia (PLWD) who remain at home. Care plans for PLWD in the home healthcare setting should incorporate HHAs perspectives. We sought to understand HHAs' perspectives about their information needs in caring for PLWD, from June to August 2020, semi-structured interviews telephone interviews (n = 25) with English and Spanish-speaking HHAs with limited English proficiency in the New York metropolitan area. Interviews were audio-recorded, transcribed verbatim and transcripts were analyzed using conventional content analysis. Four key themes emerged reflective of information needs of HHAs caring for PLWD: (1) ambiguities of scope of HHA tasks related to medication management; (2) clinical information needs of HHAs; (3) dementia-related concerns; and (4) going above and beyond. Findings from this research can guide efforts to develop dementia-specific care plans, and training to support the HHA workforce caring for the growing population of PLWD. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the importance of involving service users in the care planning process • To understand how care planning practice could be improved in mental health organisations • To learn about a service improvement initiative that increased service user involvement in care planning and enabled the multidisciplinary team to contribute to this process The care planning process can provide meaningful therapeutic engagement with service users, and the concept of service users being collaborators in their care plans is central to best practice. However, it has been suggested that, in practice, care planning is largely a 'paper exercise' that is usually only performed by nurses, with service users often excluded from the process. This article discusses the development and implementation of a service improvement initiative – the Four Core Care Plans – which aimed to increase service user involvement in care planning and enable the multidisciplinary team to contribute to the process. It also details the organisational outcomes that were identified after the implementation of the Four Core Care Plans across a large independent mental health organisation. [ABSTRACT FROM AUTHOR]

Background: Longitudinal care management (LCM) for high-risk patients is a cornerstone of primary care models aiming to improve quality and reduce costs. Objective: Describe the extent to which LCM was implemented in the second year of Comprehensive Primary Care Plus (CPC+), and barriers to and facilitators of implementation. Design: Mixed-methods. Participants: Quantitative: 2715 practices participating in CPC+ in 2018. Qualitative: Interviews with practitioners and staff in 23 representative CPC+ practices. Main Measures: Across all CPC+ practices, we report median percentages of empaneled patients placed in the highest-risk tiers and, of those, the median percentage receiving LCM. Across 23 CPC+ practices, we report qualitative findings on LCM implementation. Key Results: While practices reported benefits of LCM, a small proportion of patients received LCM. Practices placed 2.4% (median) of patients in the highest-risk tier; of these, 30% (median) received LCM. Practices placed 10% (median) of patients in the second-highest-risk tier; of these, 7% (median) received LCM. Interviews revealed LCM uptake across tiers was low because of insufficient care manager staffing. Other challenges included lack of practitioner buy-in to using risk stratification to identify high-risk patients, patients' reluctance to engage in LCM or change behaviors, and limited health information technology functionality for developing, maintaining, and accessing high-risk patients' care plans. Facilitators included embedding care managers within practices and electronic health record functionalities that support LCM. Conclusions: Despite substantial financial and other supports, and practices' perceived benefits of LCM, insufficient care manager staffing and other barriers have limited its potential in CPC+ to date. To expand LCM's reach, practices need additional care managers, training to overcome barriers to patient engagement, better identification of patients who might benefit from LCM, improved information technology tools for risk stratification and care plans, and more practitioner buy-in to risk stratification. [ABSTRACT FROM AUTHOR]

Clinical care plan assignments and the use of concept mapping traditionally incite critical thinking and clinical judgment skills for pre-licensure nursing students. An ongoing debate in the literature apropos the effective use of both tools, either used alone or collectively, and which tool best promotes increased critical thinking skills among nursing students. Typically, the use of both tools requires the student to complete at least some elements of the assignment outside of the clinical setting after the clinical experience concludes. Standard clinical tasks take precedence during the clinical experience leaving little to no time to complete paperwork such as care plans or concept maps. This paper reconnoiters the concepts of critical thinking and clinical judgment among pre-licensure nursing students, the techniques to enhance these critical skills, and proposes a framework to promote an innovative solution for nurse educators and students easily deployed during clinical experiences with assignment recommendations following the clinical experience. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To learn about the Recovery Star and how its use can empower patients to develop their skills and self-reliance • To understand the benefits and constraints associated with using the Recovery Star in mental health inpatient services • To consider methods you could implement in your area of practice to support frequent and appropriate use of the Recovery Star The Recovery Star is a collaborative tool used by staff to support the recovery of adults who are using mental health services, including inpatient rehabilitation services. However, staff experiences of completing this tool with patients have seldom been reported. Therefore, a service evaluation was undertaken to explore staff perspectives about the useful elements and barriers associated with using the Recovery Star, to determine whether staff believe it is an appropriate tool to use in inpatient rehabilitation services, and to understand the reasons for the tool's underuse. Semi-structured interviews were conducted with nine staff members who worked across four wards in an inpatient rehabilitation service in Leicester, England. Four main themes were identified through a thematic analysis of the interview transcripts: it is a helpful tool; it is patient-dependent; it is underused due to constraints such as lack of time; and wider issues affecting its use. Subthemes for each of these themes were also identified. Staff reported that the Recovery Star is an appropriate tool to use in mental health rehabilitation services, although they recognised some barriers to its use and amendments required to ensure the tool is used more often. [ABSTRACT FROM AUTHOR]

Abstract Background Postnatal care continually attracts less attention than other parts of the childbirth year. Many regions consistently report poor maternal satisfaction with care in the post-birth period. Despite policy recommending post-birth planning be part of maternity services there remains a paucity of empirical evidence and reported experience using post-birth care plans. There is a need to report on post-birth care plans, identify policy and guideline recommendations and gaps in the current empirical research, as well as experiences creating and using post-birth care plans. Methods This scoping review accessed empirical literature and government and professional documents from 2005 to present day to build a picture of current understanding of policy imperatives and existent published empirical evidence. The review was informed by the Arksey and O’Malley approach employing five stages. Results The review revealed that post-birth care planning is promoted extensively in health policy and there is emergent evidence for its implementation. Yet there is a paucity of practice examples and only one evaluation in the UK. The review identified four overarching themes: ‘Positioning of post-birth care planning in policy; ‘Content and approach’; ‘Personalised care and relational continuity’; Feasibility and acceptability in practice’. Conclusions Empirical evidence supports post-birth care planning, but evidence is limited leaving many unanswered questions. Health care policy reflects evidence and recommends implementation of post-birth care plans, however, there remains a paucity of information in relation to post-birth care planning experience and implementation in practice. Women need consistent information and advice and value personalised care. Models of care that facilitate these needs are focused on relational continuity and lead to greater satisfaction. It remains unclear if a combination of post-birth care planning and continuity of carer interventions would improve post-birth outcomes and satisfaction. Gaps in research knowledge and practice experience are identified and implications for practice and further research suggested.

L'institution militaire a développé une politique d'accompagnement des blessés à travers la mise en place d'un parcours de soins et d'un parcours administratif balisé, allant du dépistage du trouble stress post-traumatique (TSPT) ou des problématiques de harcèlement et de souffrance au travail (numéro vert Écoute Défense) à la reconnaissance de l'imputabilité de la blessure en service conduisant à des indemnisations (pension militaire d'invalidité, jurisprudence Brugnot, fonds de prévoyance, garanties des assurances privées), en passant par la réhabilitation du blessé avec le soutien des cellules, des blessés des différentes armées (stages de réhabilitation par le sport), jusqu'à la réintégration professionnelle (stages d'immersion en entreprise, congés de reconversion, création d'entreprises) avec le dispositif Défense Mobilité pour la reconversion professionnelle. Dans cette première partie d'entretien, le PSYHC Laurent Brulin détaille les plans d'action successifs du Service de Santé des Armées (SSA) et aborde la question de la prise en charge hospitalière des militaires blessés à l'hôpital d'instruction des armées Robert Picqué (HIARP) et en médecine physique et réadaptation (MPR). The military institution has developed a policy of supporting the wounded through the establishment of a care plan and a marked administrative path, ranging from screening for PTSD or problems of harassment and suffering at work (tall free call Écoute Défense) to the recognition of the accountability of the injury in service leading to compensation (military invalidity pension, Brugnot case law, contingency funds, private insurance guarantees, through the rehabilitation of the injured with support from injured cells of the various military Armies branches (rehabilitation training through sport) up to professional reintegration (company immersion courses, retraining leave, business creation) with the defence mobility system for professional retraining. In this first part of the interview, the PSYHC Laurent Brulin detail the successive action plans of the army health service and address the issue of the hospital and therapeutic care of soldiers wounded at the Robert Piqué Army Instruction Hospital (HIARP) and in Physical Medicine and Rehabilitation (MPR). [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the potential uses and benefits of team formulation in mental health practice • To be able to apply team formulation in your practice • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Formulation is a process of developing an understanding of what is happening for a person and why, and therefore what might be helpful for them. It involves gathering information, drawing from personal meanings and theoretical understandings to develop a coherent narrative. Traditionally, formulation is undertaken by a practitioner and a service user on an individual basis, but it can also be undertaken in a team context. This article explores team formulation, outlining its ideas, implementation and potential effects. It describes some of the evidence, outlines some techniques that can be used and reflects on team formulation in practice. However, it is not a systematic review of the evidence. It is hoped that this process will enable readers to develop an enhanced awareness of the concepts and issues involved, feel more confident engaging in team formulation and recognise the challenges and value that it can bring to clinical practice. [ABSTRACT FROM AUTHOR]

L'institution militaire a développé une politique d'accompagnement des blessés à travers la mise en place d'un parcours de soins et d'un parcours administratif balisés, allant du dépistage du trouble stress post-traumatique (TSPT) ou des problématiques de harcèlement et de souffrance au travail (numéro vert Écoute Défense) à la reconnaissance de l'imputabilité de la blessure en service conduisant à des indemnisations (pension militaire d'invalidité, jurisprudence Brugnot, fonds de prévoyance, garanties des assurances privées), en passant par la réhabilitation du blessé avec le soutien des cellules blessés des différentes armées (stages de réhabilitation par le sport), jusqu'à la réintégration professionnelle (stages d'immersion en entreprise, congés de reconversion, création d'entreprises) avec le dispositif Défense Mobilité pour la reconversion professionnelle. Dans cette seconde partie d'entretien, le PSYHC Laurent Brulin et l'assistante de service sociale Delphine Breuil évoquent le parcours administratif des blessés, les différents stages de réhabilitation par le sport et la question de la réinsertion professionnelle des militaires blessés. The military institution has developed a policy of supporting the wounded through the establishment of a care plan and a marked administrative path, ranging from screening for PTSD or problems of harassment and suffering at work (tall free call Écoute Défense) to the recognition of the imputability of the injury in service leading to compensation (military invalidity pension, Brugnot case law, contingency funds, private insurance guarantees, through the rehabilitation of the injured with support from injured cells of the various military Armies branches (rehabilitation training through sport) up to professional reintegration (company immersion courses, retraining leave, business creation) with the defense mobility system for professional retraining. In this second part of the interview, the PSYHC Laurent Brulin and social service assistant Delphine Breuil evoke the administrative path of the wounded, the various rehabilitation courses through sport and the question of the professional reintegration of injured soldiers. [ABSTRACT FROM AUTHOR]

Background: Care coordination is considered important for patients with rare conditions, yet research addressing the impact of care coordination is limited. This study aimed to explore how care coordination (or lack of) impacts on patients and carers. Semi-structured interviews were conducted with 15 patients and carers/parents in the UK, representing a range of rare conditions (including undiagnosed conditions). Transcripts were analysed thematically in an iterative process.Results: Participants described a range of experiences and views in relation to care coordination. Reports of uncoordinated care emerged: appointments were uncoordinated, communication between key stakeholders was ineffective, patients and carers were required to coordinate their own care, and care was not coordinated to meet the changing needs of patients in different scenarios. As a result, participants experienced an additional burden and barriers/delays to accessing care. The impacts described by patients and carers, either attributed to or exacerbated by uncoordinated care, included: impact on physical health (including fatigue), financial impact (including loss of earnings and travel costs), and psychosocial impact (including disruption to school, work and emotional burden). Overall data highlight the importance of flexible care, which meets individual needs throughout patients'/carers' journeys. Specifically, study participants suggested that the impacts may be addressed by: having support from a professional to coordinate care, changing the approach of clinics and appointments (where they take place, which professionals/services are available and how they are scheduled), and improving communication through the use of technology, care plans, accessible points of contact and multi-disciplinary team working.Conclusion: This study provides further evidence of impacts of uncoordinated care; these may be complex and influenced by a number of factors. Approaches to coordination which improve access to care and lessen the time and burden placed on patients and carers may be particularly beneficial. Findings should influence future service developments (and the evaluation of such developments). This will be achieved, in the first instance, by informing the CONCORD Study in the UK. [ABSTRACT FROM AUTHOR]

BackgroundImplementation of survivorship care plans remain a challenge. This quality improvement initiative aims to integrate personalized treatment plans (PTP) and care plans (PCP) into the existing workflow for breast cancer (BC) patients. Methods: Phase 1 was to identify multidisciplinary team members to generate and deliver PTP and PCP. Concurrently, Phase 2 was to deliver PTP and PCP to newly diagnosed invasive BC patients at chemotherapy initiation and completion, respectively. Iterative plan, do, study, act (PDSA) cycles were applied to refine the process. The proportion of information completed for PTP and PCP generation and its delivery by the care team were measured. Patient and provider satisfaction were also assessed. Implementation Process and Results: The care transfer facilitator (CTF) was identified to complete and deliver PTP, and their data entry increased from 0% to 76%, 80%, 92% consecutively during the last 4 PDSA cycles. PTP and PCP were provided to 85% of eligible BC patients. Patients agreed that PTP helped them to actively participate in their care (88%) and communicate with the oncology care team (86%). Primary care physicians agreed that PTP and PCP had the information needed to "stay in the loop" (80%), and oncologists agreed they should be incorporated into oncology clinics (100%). Conclusions: Integrating PTP and PCP generation and delivery into existing workflow has led to an increase in uptake, sustainability and provider buy-in. With limited resources, it remains diffcult to find care team members to complete the forms. A dedicated personnel or survivorship clinic is required to successfully implement PTP and PCP as the standard of care. [ABSTRACT FROM AUTHOR]

Formulation is a collaborative process that promotes shared understanding of a service user's narrative to ensure their care is meaningful. This article provides an overview of individual formulation in mental health practice. It explores the interaction between formulation and interventions, and how mental health practitioners can work with service users by using formulation to plan and implement care. The article also presents two models of formulation – the five-area and 5Ps models – and explains how these can be used across a wide range of clinical presentations to understand a service user's immediate problems and longer-term challenges, thus supporting the selection of appropriate evidence-based interventions. [ABSTRACT FROM AUTHOR]

Background: Care plans are an evidence-based strategy, encouraged by the Centers for Medicare and Medicaid Services, and are used to manage the care of patients with complex health needs that have been shown to lead to lower hospital costs and improved patient outcomes. Providers participating in payment reform, such as accountable care organizations, may be more likely to adopt care plans to manage complex patients. Objective: To understand how Medicare accountable care organizations (ACOs) use care plans to manage patients with complex clinical needs. Design: A qualitative study using semi-structured interviews with Medicare ACOs. Participants: Thirty-nine interviews were conducted across 18 Medicare ACOs with executive-level leaders and associated clinical and managerial staff. Approach: Development, structure, use, and management of care plans for complex patients at Medicare ACOs. Key Results: Most (11) of the interviewed ACOs reported using care plans to manage care of complex patients. All care plans include information about patient history, current medical needs, and future care plans. Beyond the core elements, care plans included elements based on the ACO's planned use and level of staff and patient engagement with care planning. Most care plans were developed and maintained by care management (not clinical) staff. Conclusions: ACOs are using care plans for patients with complex needs, but their use of care plans does not always meet the best practices. In many cases, ACO usage of care plans does not align with prescribed best practices: ACOs are adapting use of care plans to better fit the needs of patients and providers. [ABSTRACT FROM AUTHOR]

Objective: Consider whether mental health service users and carers meaningfully engage in care planning and whether care planning adds value to patient care. Conclusion: A review of the meta-analyses and systematic reviews of service users and carers identified many barriers to their meaningful engagement in care planning. No research has demonstrated any measurable benefits or positive outcomes linked to mental health care planning. [ABSTRACT FROM AUTHOR]

Oral complications arising from cancer or its treatment, such as mucositis and dry mouth, are common. In the general cancer setting, oral complications can be expected in at least 50% of patients undergoing chemotherapy or targeted therapy to treat a solid tumour. In patients with head and neck cancers and in those undergoing haematopoietic stem cell transplantation, the incidence is much higher. Oral complications can cause distress, malnutrition and/or dehydration, inability to sleep, delays to treatment, long-term complications and increased morbidity. However, they are not inevitable and a planned, proactive team approach to oral care can assist in preventing them or in reducing their incidence and severity. This article provides an overview of optimal oral care in the cancer setting, covering assessment, identification of risk factors, patient education, optimal care of the oral cavity, preventive measures and treatment options. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the importance of care planning in structuring interventions for a patient • To understand how you can use the process of care planning as an educational activity for nursing students • To count towards revalidation as part of your 35 hours of CPD, or you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Care planning for patients is an important element of the nurse's role, yet some nursing students may miss its relevance to their practice. However, they can learn many skills by care planning thoroughly in partnership with patients. They can also expand their knowledge of the wider aspects of holistic care, including the importance of empowering and educating patients. This article discusses how to structure care planning systematically and assists practice supervisors to guide nursing students working in the community in their learning, showing how to relate certain aspects of care to specific, measurable, achievable, realistic and timely (SMART) goals. The article also describes a structure for developing interventions for a care plan – professional values, assessment, treatment and education (PATE) – which nursing students can use to incorporate a chronological order into care that also encompasses health promotion. [ABSTRACT FROM AUTHOR]

Objectives: To document the current clinical practice in 2017 for assessment of supportive care needs and provision of supportive care to women with gynecological cancer and their caregivers in Australia, and to identify the main enablers and barriers to care provision.Methods: A total of 64 health professionals who care for Australian women with gynecological cancer responded to an electronic survey which explored their use of needs assessment, service-level processes and protocols for support service provision, and identified enablers and barriers to provision of care to both patients and caregivers. Eight respondents underwent an additional in-depth interview to elaborate on enablers, barriers, and gaps in the provision of supportive care.Results: Mostly, needs assessment for women and caregivers was part of current practice but done without validated tools or a checklist. Only 30% of respondents reported having documented referral pathways. Most respondents simply recorded a plan for meeting needs within the patients' medical record (63% for patients; 46% for caregivers) rather than using a formalized care plan (15% for patients; 6% for caregivers). The interviewees' comments supported survey results that having sufficient time to discuss issues was both the most important enabling factor and the greatest barrier to successful supportive care provision. The interviewees further discussed variations in needs based on age, cultural background, and phases within the cancer care continuum, and that best practice supportive care should involve a multidisciplinary team and customizable protocols.Significance Of Results: There is much room for improvement in the assessment of needs and provision of supportive care to women with gynecological cancer and their caregivers. Approaches to optimize use of consultation time (e.g., needs assessment tools and referral protocols) are necessary. Flexibility in the form and mode of delivery of support may be required to meet diverse personal preferences and incorporate caregivers. [ABSTRACT FROM AUTHOR]

Aim: To review, test and refine standardised tools for nurses to initiate treatment summaries and care plans, and identify barriers and enablers to providing them. Background: This paper reports on a pilot study informed by the development of a Survivorship Framework in South Australia. Methods: Expression of interest was sought for adult medical oncology services to pilot standardised tools within existing services and resources. A quality improvement approach was used over three months with nurse practitioners and nurse practitioner candidates to obtain feedback, refine tools and resources, and identify barriers and enablers. Quantitative and qualitative data was recorded at each site using spreadsheets, at fortnightly meetings, and at a final debriefing. Content analysis was used to identify key themes in the context of barriers and enablers. Findings: Four medical oncology clinics in South Australia participated (three metropolitan, one regional). Forty-three consultations were delivered at three sites. Barriers included time to complete documentation, perceived knowledge and skills, re-orientation of clinics and referral pathways, competing service priorities and lack of administrative support. Enablers included interrelationships within and between pilot teams, supporting resources, and increased familiarity with tools. Discussion and conclusion: There is potential for nurses to initiate treatment summaries and care plans in the treatment setting with the use of standardised tools. Further refinements are needed to make the process less time burdensome, additional specialised training is needed to improve confidence of nurses to work in a wellness model, and numerous system challenges need to be overcome to improve overall feasibility of using standardised tools to provide survivorship support to patients. Lack of systems to populate information, and lack of referral processes to support survivorship discussions with patients are likely to limit the initiation of survivorship care in treatment settings in South Australia. Further nurse-led development of tools for treatment summaries and care plans should occur in parallel with translational research designed to address system challenges. [ABSTRACT FROM AUTHOR]

This article explores best practice in co-creating recovery-orientated care plans. Recovery is a holistic experience that involves the service user beginning to regain a sense of control, alongside a reduction or absence of symptoms of mental distress. A care plan documents the needs of the service user and the interventions that will support their recovery. The history and development of care plans are explored and the benefits of care planning, involving good-practice guidelines and co-production, with service users are discussed. A case study is used to show strategies for planning care and recovery tools, and troubleshooting suggestions are provided for when there is a lack of engagement from the service user. Care planning is an important part of a mental health nurse's role, as a legal record of care given and as a therapeutic tool to encourage recovery. [ABSTRACT FROM AUTHOR]

As digitisation continues to increase across Australian health services, the nursing profession has focused on analysing and measuring the way care is provided to the patients. Focus on optimising nursing workflows and improved care delivery has presented challenges but this is now demonstrating improvements in patient care outcomes and time for care. [ABSTRACT FROM AUTHOR]

Aims: The first aim of this study was to measure the extent of care planning and support for health goals within a sample of Māori/non-Māori people with long-term conditions (LTCs). The second aim was to compare those with and without care plans, and those with and without support for health goals, with respect to health and experiences with general practice. Background: Collaborative care planning, resulting in a written care plan, and providing support for patient-identified goals are important aspects of LTC management. In the MidCentral District Health Board region, primary care practitioners have had help to achieve this through the introduction of comprehensive assessment and care-planning tools. Methods: 569 people with at least one LTC, who had recently enrolled in a local EnhancedCare+ programme or were receiving care from an LTC community clinical nurse, were recruited into the region's "Talking about Health" study, designed to explore LTC care from patient and provider perspectives. Consenting participants chose to complete a paper (by post) or electronic (email link) questionnaire, which included measures of health, healthy behaviours, experiences with doctors and nurses in general practice, patient activation, care planning/goal support and demographics. Results: People with written care plans were more active self-managers, reported better interactions with primary-care doctors and nurses, and perceived receiving more support from the general practice team than those without. Results were similar for people receiving support for their health goals, but differences in mental and physical health were also evident. More Māori than non-Māori reported having a written care plan, and support for health goals in the absence of a written care plan. A slightly broader range of benefits was evident for non-Māori than Māori, but the different sample sizes need to be taken into account when drawing conclusions. Conclusions: Written care plans and practitioner support for health goals appear to benefit people with LTCs. Support for health goals is important as, even without a written care plan, it was associated with better health and more positive ratings of practitioner interactions. Challenges for the region are to involve more people/whanau in collaborative care planning and to address system-wide barriers to embedding care-planning practices into routine care. [ABSTRACT FROM AUTHOR]

Background and purpose: Inconsistent documentation impedes communication and quality of care. Our aim was to develop and implement evidence-based standardized nursing care plans (SNCPs) for cardio-respiratory conditions encountered in community care settings. Methods: A Plan-Do-Study-Act (PDSA) model was employed to guide this quality improvement project. We developed and implemented SNCPs with nurses in Southwestern Ontario, Canada. Chart audits were used to evaluate documentation after implementation (77 charts). The user perspective was obtained through informal interviews throughout implementation. Findings: Pre-intervention chart reviews (64 charts) revealed inconsistent language and absence of nursing process components thereby establishing the need for this project. The post-intervention chart audit demonstrated improved consistency linking objective data to nursing interventions. The SNCPs were easy to use and decreased perceived documentation time. Conclusions: SNCPs are a feasible method of translating evidence- based guidelines into community care nursing practice. SNCPs comprising guideline content can be used as a clinical decision support tool, quality indicators for program evaluation, and to reduce documentation burden. [ABSTRACT FROM AUTHOR]

Lymphoma encompasses a heterogeneous group of haematological malignancies that require complex management. Patients with lymphoma experience a wide range of physical, social and emotional issues. This article summarises the diagnosis, treatment and long-term consequences of lymphoma, and outlines the role of the primary care practitioner in the lymphoma care pathway. [ABSTRACT FROM AUTHOR]

Frequent attenders to emergency departments (EDs) are a heterogeneous group who have traditionally been patched up and discharged with little support. This makes them vulnerable to over investigation and they often have a poor experience in EDs, which can cause frustration among the staff who work with them. This article reviews the literature on frequent ED attenders and explores the related issues. It also describes how a multidisciplinary team (MDT) was formed to identify people in this group, evaluate their attendances and notes to understand their individual needs and identify strategies to improve their options and care while in the ED. The rationale for the formation of the MDT, the process of selecting patients and the interventions commonly used are discussed, as well as the benefits to patients, staff and the trust. [ABSTRACT FROM AUTHOR]

Introduction: The support of families in the care of children with medical complexity (CMC) requires the integration of health care providers' (HCPs') medical knowledge and family experience. Care plans largely represent HCP information, and care maps demonstrate the family experience. Understanding the intersection between a care plan and a care map is critical, as it may provide solutions to the widely recognized tension between HCP‐directed care and patient‐ and family‐centered care (PFCC). Method: This study used qualitative methods to explore the experience and usefulness of care maps. Parents of CMC who already had a care plan, created care maps (n = 15). Subsequent interviews with parents (n = 15) and HCPs (n = 30) of CMC regarding both care maps and care plans were conducted and analyzed using thematic analysis. Results: Data analysis exploring the relationship and utility of care plans and care maps revealed six primary themes related to using care plans and care maps that were grouped into two primary categories: (a) utility of care plans and maps; and (b) intersection of care plans and care maps. Discussion Care plans and care maps were identified as valuable complementary documents. Their integration offers context about family experience and respects the parents' experiential wisdom in a standard patient care document, thus promoting improved understanding and integration of the family experience into care decision making. [ABSTRACT FROM AUTHOR]

Care plans can reduce care fragmentation for children with medical complexity (CMC); however, implementation is challenging. Mobile health innovations could improve implementation. This mixed methods study's objectives were to (1) evaluate feasibility of mobile complex care plans (MCCPs) for CMC enrolled in a complex care program and (2) study MCCPs' impact on parent engagement, parent experience, and care coordination. MCCPs were individualized, updated quarterly, integrated within the electronic health record, and visible on parents' mobile devices via an online portal. In 1 year (September 1, 2016, to August 31, 2017), 94% of eligible patients (n = 47) received 162 MCCPs. Seventy-four percent of parents (n = 35) reviewed MCCPs online. Forty-six percent of these parents (n = 16) sent a follow-up message, and the care team responded within 8 hours (median time = 7.2 hours). In interviews, parents identified MCCPs as an important reference and communication tool. MCCPs for CMC in a complex care program were feasible, facilitated parental engagement, and delivered timely communication. [ABSTRACT FROM AUTHOR]

Young people who have learning disabilities commonly have many complex and severe life-limiting conditions that result in premature death. Too often neither they nor their family and friends are prepared for end of life situations. End of life care planning is helpful in eliciting and honouring the young person's wishes, as far as possible. However, it can be challenging due to communication difficulties and limited understanding of the meaning of death and dying. This article introduces the ADVANCE toolkit featuring a values-based framework that aims to help caregivers who work with young people who have learning disabilities, including nurses, social workers and care assistants, develop their confidence and skills in end of life care planning. The ADVANCE toolkit enables insight in knowing how, when and with whom to discuss the sensitive topic of planning for end of life care. In this article, six activities are included for readers to complete with a view to enabling engagement with the material presented. [ABSTRACT FROM AUTHOR]

• Youth involved within the justice system present with a unique and complex set of needs. • Male youth in custody were more likely to require care planning related to substance, tobacco and nicotine use compared to female youth. • Youth in custody were more likely to trigger care planning related to transitions compared to other patient groups. Despite comparable rates of mental health problems, youth in custody, in- and outpatient groups typically differ with respect to experiences of trauma and expression of internalizing and externalizing behaviours. While comparisons between these groups have been made, an exploration of specific care planning needs have yet to be investigated. To compare the care planning needs identified for youth in custody and those within inpatient (e.g., mental health hospital admissions) and outpatient treatment (e.g., community mental health agencies), while controlling for age and sex differences. The sample consisted of 755 youth aged 16–19 recruited from youth justice and mental health facilities in Ontario, Canada. Semi-structured interviews using the interRAI child and youth suite of instruments were completed. Items that signify imminent risk, as well as the accompanying Collaborative Action Plans among samples of youth were compared. Male youth in custody were more likely to require care planning related to substance/tobacco/nicotine use and withdrawal symptoms than both in- and outpatient youth. They also were more likely to report harm to others, while inpatient females were most likely to report self-harm. Irrespective of case type, males were more likely to require care planning related to educational needs and communication. Youth in custody were more likely to trigger Collaborative Action Plans related to transition planning compared to patient groups. Evidence suggests that youth involved within the justice system present with a unique and complex set of needs. This research supports the need for tailored services and evidence-based intervention that may transgress the boundaries of the youth justicesetting to the community. [ABSTRACT FROM AUTHOR]