Nursing Models and Care Planning Cc Ppt
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Transcript of Nursing Models and Care Planning Cc Ppt
NURSING MODELS AND
CARE PLANNING
Myerscough – Lynwood
School of
Veterinary Nursing
Lisa Mulcock
AIMS OF THE PRESENTATION
To define the terms:
– Medical Model – Nursing Model – Nursing Process To explain these terms in the context of veterinary nursing and how the use of nursing models and the nursing process can shape our practice through care planning.
WHAT IS A MEDICAL MODEL?
According to a medical model a patient is a complex set of anatomical parts and
physiological systems (Aggleton & Chalmers 2000)
A medical model emphasises anatomical, physiological and biochemical
malfunction as the causes of ill health and in doing so creates a disease
orientated patient approach.
MOVING AWAY FROM THE MEDICAL MODEL
It was the dissatisfaction with the medical model in human care practice that lead
to the development of the nursing theories and models.
In addition nurses felt that it was not a correct focus for a nursing discipline.
&It did not support professional recognition.
WHAT IS A MODEL FROM A NURSING CONTEXT?
“It is a mental or diagrammaticrepresentation of care which is
systematically constructed and whichassists practitioners in organising their
thinking about what they do, and inthe transfer of their thinking into
practice for the benefit of the client andthe profession’’ Crucially the focus of which is
nursing practice.
McKenna (1994)
WHAT WILL NURSING MODELS ENABLE US TO DO?
Deliver care to our patients using asystematic approach of assessing,,
planning ,implementing and evaluatingpatient care (The nursing process)
Produce a unique body of veterinarynursing knowledge which is evidencebased rather than that's because its
what we've always done!
THE NURSING PROCESS
The nursing process should be divided into four main stages
Assessment
Planning
ImplementationEvaluatio
n
THE NURSING PROCESS CONTD.
Each stage of the nursing process is of equal importance. If we do not give
adequate consideration to a stage it will be reflected in the quality of the next.
This is particularly important for the assessment stage as assessment forms
the basis for the remainder of the nursing process. ( Kratz 1989)
STAGE 1: ASSESSMENT A nursing care plan can only be as good as
the information on which it is based. It will set the scene for nursing the patient
as a whole and as an individual Collect information through communication Write down the information Start to consider both actual and potential
problems Identify priorities
Remember: Wrong info = wrong/inadequate action
PLANNING To solve actual identified problems To prevent identified potential problems
becoming actual ones To alleviate any problems which cannot
be rectified To help the patient and the owner to
cope positively with those problems which cannot be solved or alleviated
To prevent recurrence of a treated problem
To maintain comfort and dignity when death is inevitable
SETTING GOALS Setting goals must be part of the
planning process. For each actual and potential problem a
goal must be set. A distinction should be made between
short term and long term goals Goals should be looked at as outcomes
which are able to be observed, measured or tested so that the evaluation stage can be achieved
...........
THE NURSING PLAN A plan is made of all the proposed
nursing interventions needed to achieve the goals
The plan should be written in enough detail that any nurse reading it would know what the plan is.
IMPLEMENTATION is the “doing” stage of the nursing care plan
EVALUATION A crucial phase of the process It is the element which tests the effectiveness
of your planning and implementation Have your goals been partially achieved or is
more information needed to decide the next step?
Is the problem unchanged and should the nursing intervention be changed or stopped
Is there a worsening off the problem and should the goal and nursing intervention be reviewed?
Was the initial goal un-realistic? Does a new goal require additional resources?
A CONTINUING PROCESS
By asking these questions we are effectively revising the nursing plan to address the issues that have become apparent during the evaluation.
Re-evaluation then takes place by assessing the patient and the whole process begins again.
NursingAssessme
nt
Patient problemActual /
Potential
Nursing Goal
NursingActions
Evaluation
Patientmouthbreathingdue to catflu
Pooroxygenation(A)Unable toeat andbreath atthe sametime (A)
ImproveOxygenation
Improvepatientsability tobreaththrough itsnose.
Clearsecretionsfrom noseever 30mins.
Clean 5minutesbeforefeedingsmelly food
ClearingsecretionsstoppedmouthbreathingandimprovedoxygenationContinueregime
THE NURSING PROCESS So as you can see,, the nursing process
offers a systematic approach to care.
But ... it states that nurses should assess but does
not tells them what to look for. it advocates planning but does not say what
form the care plan should take. it talks of intervention but does not specify
what might be appropriate interventions it call's for evaluation without specifying the
standards against which comparisons should be made..
Angleton & Chalmers (2000)
NURSING MODELSThis is where Nursing models come in ...
They provide a set of standards which guide nursing actions. Nursing models are systematically constructed, logically
developed and have scientific foundations which consider a framework for nursing the
whole patient.
The values that they set out provide excellent consideration to a standardised
and continuous quality of care.
MODELS OF NURSING
RoperLogan & Tierney
(RLT Model)
OremModel
Of Nursing
THE RLT MODEL The model has 5 main parts :
–Activities of Living. –The patients life span. –Dependence-Independence continuum. –Factors influencing the Activities of
Living. –Individuality in Living.
ACTIVITIES OF LIVING Maintaining a safe environment Communiicatiion Breathiing Eating & drinking Elimination Personal cleansing & dressing(grooming) Controlling body temperature Mobilising Working & playing Expressing sexuality Sleeping Dying
LIFE SPAN
Each animal has a natural life span from birth to death.
Where the patient is on the life span and all the associations that naturally occur with each given life span should always
be considered.
DEPENDENCE / INDEPENDENCE CONTINUUM
Closely related to the life span
It acknowledges that there are times as part of a natural life span when a patient will not be able to perform some of the activities of living independently. This should be looked
at for each activity of living.
Visual plotting of where the patient is on a scale of dependence / independence should
be carried out.
FACTORS WHICH INFLUENCE ACTIVITIES OF LIVING
Biological.
Psychological.
Socio-cultural.
Environmental.
Politico-economic
INDIVIDUALITY IN LIVING The Activities of Living are the main
concept off this model and although every patient is likely to carry out these activities each patient may do them differently therefore expressing themselves as an individual..#
For example, the way in which a cat will eat may be very different from a dog..
OREM - THE VARIATIONSActivities of living are called “SELF CARE
REQUISITES” divided into those which are universal, those which are developmental and those which are specific to the patients condition.
Orem also considers support modalities i.e. How we need to look to support the patient and owner;
Totally Partially Educative / supportive
REFERENCES References Aggleton & Chalmers 2nd Edition
2000. Nursing Models & Nursing Practice. Palgrave, Hampshire
Forshaw K.A. 2003 The application of a conventional nursing model in veterinary practice. Dissertation project, University of Bristol.
McKenna 2000. Nursing Theories & Models. Routledge, London.
Roper, Logan & Tierney 2000. The Roper, Logan & Tierney Model of Nursing. Churchill Livingstone, Edinburgh
Walsh 1997 Models and Critical Pathways in Clinical nursing: Conceptual Frameworks for Care Plans.Ballierre Tyndall, London