An Exploration of a Needs Orientated
Approach to Care Planning
The aim of this assignment is to explore a needs orientated approach to care, and use a model of nursing – Roper, Logan and Tierney (RLT) model – to formulate a care plan. The RLT model of nursing is based on 12 activities of daily living and it provides a framework for nurses to plan and deliver appropriate nursing care. By using the activities of daily living when gathering information about a patient a nurse can begin a problem solving approach to care planning, however, as suggested by Barrett et al (2009), the nursing model not only provides questions to ask during the assessment of a patient, but they offer beliefs and values and instructions to what is important and relevant during the process of care planning. “The nursing process is the tool or methodology of professional nursing that assists nurses in arriving at decisions and helps them predict and evaluate consequences.” George (2002). The RLT model was created in 1980 for educational purposes – students and teachers - and was the first UK model to be used in a variety of settings; it is now used in many parts of the world and has been translated into 8 other languages, it is also popular with UK nurses and is one of the most commonly used within the UK according to Tierney, (1998). Barrett, et al suggests it is popular in the UK as it is written by British nurses and is easily understood. RLT’s model of nursing follows the process of assessment, planning, implementation and evaluation, this is also known as APIE which enables the nurse to carry out a care plan which provides complete holistic care. RLT’s model focuses on individuality, dependence-independence continuum, progression along a life span continuum and influencing factors. Barrett (2009) have also introduced ASPIRE which includes assessment, systematic nursing diagnosis, implementation, recheck and evaluate. A care plan is included as an appendix (1) to provide an example of RLT and APIE, this will be used to make comparisons with other models and to identify weaknesses or strengths of the care plan.
“Assessment is a systematic, deliberate and interactive process that underpins every aspect of nursing care”. (Heaven & Maguire 1996). It is the collection of information and data about the health status, past and present, of the patient. It is used to make nursing diagnosis, therefore if inaccurate assessing takes place it may lead to inappropriate nursing diagnoses. One of the main aims of assessment is to identify what the current health problem/experience means to the patient, this can then lead to a diagnosis, based on information collected, on the cause of pain/problem. RLT use the word assessing as it promotes the idea of ongoing assessing whereas assessment implies that it is used once to gain information about the patient. The first assessment carried out by the nurse will provide a baseline against further information gathered, the information can then be reviewed by the nurse whose time is spent observing and talking to the patient. This not only provides the opportunity for collecting data but establishes and builds a relationship with the patient, although some patients may not be willing to disclose problems and will wait until the relationship has built gradually, and not all nurses may be able to build up relationships with all patients, as Hastings et al (2006) agree it is unlikely that you will be able to establish and maintain easy relationships with all your patients, the patients may not want to follow our suggestions and choose not to interact fully with the nurse. RLT use 12 activities of daily living to provide the framework for their assessment (appendix 1), this is to establish what the patient can and cannot do. The activities take into account physical, psychological and sociological perspectives. Each of the activities are discussed with the nurse asking...
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