Care Planning

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In England alone in 2011 there were 14.9 million finished patient admission episodes in National Health Service hospitals with 5.2 million being emergency admissions (The Health and Social Care Information Centre, 2012). It may seem such a large number however nurses must treat each patient in accordance with the Nursing and Midwifery Council (NMC) code of conduct which writes that nurses must treat patients as individuals (NMC, 2008). Holland, Jenkins, Solomon and Whittam (2008) claims a successful patient’s outcome is dependent on the nurse’s ability and skills to use the knowledge acquired on assessment effectively. The nursing process when adapted in practice defines the stages a nurse should follow in order to provide individualised care (Barrett, Wilson and Wollands, 2009). A nursing model then provides nurses with the structure to effectively assess patients’ needs holistically by showing how it should be done. This essay will look at how nursing knowledge contributed to the care of a chosen patient and an evaluation of the evidence base that underpins the care delivered will be carried out. I gained prior consent from the patient to include him in the essay. To maintain confidentiality the patient’s name has been changed to a pseudonym in order to conform to the NMC (2008) code of conduct. The nursing process was adapted into practice with the aim of providing better individualised patient care by the use of a systematic problem solving cycle (Crouch and Meurier, 2005). The four stage model of nursing process includes the patient’s health assessment, care planning, implementation and evaluation of the care delivered (APIE). All stages of the process are dependent on each other with accurate and relevant assessment being a good foundation for nurses to make a professional judgement of the care required (Kozier et al, 2008). Crouch and Meurier (2005) identified that a holistic patient assessment can gather large and complex data to which nurses can use a nursing model to generate relevant knowledge for the provision of individualised care. In current practice area the Roper, Logan and Tierney (RLT) model of nursing is used with the Activities of Living (ALs) considered the main component. ALs identifies twelve activities used to assess patient’s needs to ensure survival and quality of life. These activities include mobilising, eliminating and communication (Appendix 1). The model provides a framework for care provision (Roper, Logan and Tierney, 1996) which is significant because it ensures consistency among nurses in delivering a high standard of care. In practice the model is used in conjunction with APIE to ensure a holistic approach to care delivery (Holland, Jenkins, Solomon and Whittam, 2008). The RLT model of nursing moves away from the disease based model and acknowledges the importance of cultural, environmental and economic factors that influences the health and wellbeing of an individual (Barrett, Wilson and Woollands, 2009). This is significant in modern nursing with the government calling for personalised care which takes into account the bio-psychosocial influence on an individual’s health (Department of Health, 2009) and the NMC (2008) code of conduct embracing individuality of patient care. However if the activities of living are used as a “checklist” during a patient assessment, all the patient’s needs may not be incorporated in the list. Barrett, Wilson and Woollands (2009) identified that the ALs can address our daily activities of living if used as a way of categorising the information gained on assessment as the model intended. John was an 88 year old widow admitted to hospital complaining of being generally unwell. On admission to the ward my mentor and I introduced ourselves to John and gained consent for me to participate in his care under supervision in line with the NMC (2009) guidance on professional conduct for nursing and midwifery students. John consented to his daughter’s involvement...
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