A needs orientated approach to care

This will be discussed in detail providing evidence of strengths and weaknesses of the model. The nursing process that will be discussed will be APIE which is assess, plan, implement and evaluate. A nursing process is a systematic approach which focuses on each patient as an individual ensuring that the patients holistic needs are taken into consideration. These include physical, social, psychological, cultural and environmental factors. . The nursing process is a problem solving framework for planning and delivering nursing care to patients and their families (Atkinson and Murray 1995). When used collaboratively the nursing model and the nursing process should provide a plan of care that considers the patient holistically rather than just focusing on their medical diagnosis (Moseby’s 2009). It will also discuss an example of a care plan done for a fictional patient and evaluate and discuss how the nursing plan and the nursing process have created a plan of care and how effect ive this was or was not. Care planning is a highly skilled process used in all healthcare settings which aims to ensure that the best possible care is given to each patient. The Nursing and Midwifery council state that care planning is only to be undertaken by qualified staff or by students under supervision. The Department of health (2009) says that â€Å"Personalized care planning is about addressing an individual’s full range of needs, taking into account their health, personal, social, economic, educational, mental health, ethinic and cultural background and circumstances† with the aim of returning the patient to their previous state before they became ill and were hospitalized considering all of these needs to provide patient centered care. It recognizes that there are other issues in addition to medical needs that can impact on a person’s total health and well being’.It provides a written record accessible to all health professionals where all nursing interventions can be d ocumented. Care planning is extremely important as it enables all staff involved in the care to have access to relevant information about the patients current medical problems and how this affecting them in relation to the 12 activities of living as well as any previous medical history. Barrett et al (2009) state that taking care of an individuals needs is a professional, legal and ethical requirement. There are many different nursing models all of which have strengths and weaknesses and its up to the nurse to choose the right one for individual patient, the model which is used will vary between different speciailties depending on which is more relevant to the patient and their illness and needs. Although a vast majority of hospitals now use pre-printed care plans it is important to remember that not all the questions on them will be relevant to all patients. An example of this would be that activity of breathing may not have any impact on a healthy young adult be would be a major f actor for an elderly man with COPD. There are four stages to the nursing process which are Assess, plan, implement and evaluate (APIE) but Barrett et al state that there should be six stages to include systematic nursing diagnosis and recheck (ASPIRE) as although they are included in the nursing process they are not separate stages and could be overlooked.(Barrett et al 2009). It is important that a nursing process is used and it is set out in a logical order, the way in that the nurse would think this helps minimize omissions or mistakes. Roper, Logan and Tierney model of nursing suggests that there are five interrelated concepts which need to be taken into consideration when planning and implementing care which are activities of living, lifespan, dependence/independence continuum, factors influencing activities of living and individuality in living (Roper, Logan and Tierney 2008). Assessment Assessment is fundamental to gaining all the information required about the patient in order to give the best possible care. â€Å"Assessment is extremely important because it provides the scientific basis for a complete nursing care plan† (Moseby’s 2009). The initial assessment untaken by nurses is to gather information regarding the patients needs but this is only the beginning of assessing as the holistic needs of the patient including physical, physiological, spiritual, social, economic and environmental needs to be taken into consideration in order to deliver appropriate individualized care (Roper, Logan and Tierney 2008). When using the 12 activities of living (ALs) for assessment it gives a list a basic information required but must not just be used as a list as the patient will respond better to questions asked in an informal manner and when just part of the general conversation. RLT (2008) state that although every AL is important some are more important than o ther and this can vary between patients. It is important for nurses to obtain appropriate information through both verbal and non-verbal conversation patients are more likely to give correct information but without jumping to conclusions or putting words into their mouths. ‘Assessment is the cornerstone on which a patients care is planned, implemented and evaluated (RLT 2008). â€Å"Poor or incomplete assessment subsequently leads to poor care planning and implementation of the care plan† (Sutcliffe 1990). Information can be gained from the patient, the patients family and friends as well as any health records (Peate I, 2010) During this process of gathering information it is important to find out what the patient can do as well as what they cant. , McCormack, Manley and Garbett (2004) state that gathering the information requires a certain kind of relationship between the nurse and the patient and nurses need to be able to communicate effectively in order to be able to build this relationship. A full assessment needs to consider how the patient was before they became ill or hospitalized in relation to their medical diagnosis as well as how the patient was dealing with it, how they are now, what is the change or difference if any, do they know what is causing the change, what if anything they are doing about it, do they have any resources now or have they have in the past to deal with the problem (barrett et al). RLT (2008) state that there are 5 factors that influence the 12 activities of living which are biological, psychological, sociocultural, environmental and politicoeconomic, these may not all hav e an effect on each patient but all need to be taken into consideration.The more information gained in the assessment process the easier the other steps will follow. RLT (2008) suggest that assessing is a continuous process and that further information will be obtained through observations and within the course of nursing the patient. At the end of the initial assessment the nurse should to identify the problems that the patient has. There are limitations to using a nursing process which are the 12 als are often used as a list as part of a core care plan and are not always individualized Walsh (1998) argues that the 12 activities of living may just be used as a list which could result in vital information being missed which could be detrimental to the patient. The Nursing and Midwifery Council (NMC 2008) states a nurse is personally and professionally accountable for actions and omissions in practice and any decisions made must always be justifiable. There are many benefits to using a nursing process it is patient centered and enables individualized care for each patient. It also gives patients input into their own care and gives them a greater sense of control it is outcome focused using subjective and objective information which helps and encourages evaluation of the care given. It also minimizes any errors and omissions. When I carried out the assessing stage on mabel I did this using the 12 activities of living as suggested by Roper et al (2008) but this was used too much like a checklist. I didn’t gather enough information in order to be able to do the best plan of care possible for her although I don’t feel this could have been detrimental to the care she received it needed more information than I had. I also found it difficult deciding which information should go where so I endened up repeating information in more than one of the 12 als, Which although this wouldn’t have made a difference to the planning of the care plan there was too much irrelevant information which could mean that it wasn’t read thoroughly just skimmed over as it would take too much time. As I am inexperienced in doing this I realized when writing the care plan that there were many questions that I didn’t ask so there where many parts that could not be filled in. I also didn’t gather e nough objective data for certain parts so I didn’t have any evidence that the care had worked or how effective it had been. This is where Barrett et al (2009) state that there should be a systematic nursing diagnosis where nurses establish a nursing diagnosis rather than just a medical diagnosis. This is where the holistic needs of a patient are taken into consideration. Although nursing diagnosis differs from a medical diagnosis the two do interlink but a nursing diagnosis considers the physical, psychological and spiritual aspects of the medical diagnosis and problems that may arise from these. Another part of the systematic nursing diagnosis is to provide baselines to state where the patients are at at the present time so that a needs statement can be written in conjunction with the patient in terminology that they can understand(Barrett et al 2009). Planning The next stage of the nursing process is planning this is where all the information gained in the assessment part to plan the care of the patient. The planning stage of the process is where achievable goals need to be made through discussion with care givers and the patient or the patients representative. These goals need to contain both subjective goals and objective goals in order for them to be measurable and evaluated. The plan of care is to solve the actual problems the patient has and to prevent potential problems from becoming actual ones. It also aims to help the patient cope with their illness in a positive way and to make them as comfortable and pain free as possible (RLT 2008). Planning needs to be totally individualized and patient centered they need to feel they have a voice and part of the team. The more information gathered in assessment the easier the plan of care will be. The main objective of a nursing plan is to ‘provide the information on which systematic, i ndividualized nursing can be based and individualized nursing can be based and implemented by any nurse’ (RLT 2008). Through a detailed individualized plan of care any nurse caring for a particular patient should be able to see exactly what is required of them as all the information will be recorded in the care plan. The NMC (2008) says that nursing interventions need to be specific for that particular patient, based on best evidence, measurable and achievable. There are many different criteria for setting goals just one of these is PRODUCT which stands for, Patient centered, recordable, observable and measurable, directive, understandable and clear, credible and time related. This is just meant as a way of helping nurses to set goals (Barrett et al 2009). When planning care a great emphasis needs to be based on the dependence/independence continuum which will have been established in the assessment phase. The care to be given will encourage the patient to get back to as rea sonably possible or as close to where they were on the continuum as they were before they were admitted to hospital. Planning also needs to take into account the resources available to implement the care as they need to ensure that the care they are planning is achievable and will not be compromised by lack of resources or a shortage of nursing staff (Roper et al 2008). When I did a plan of care for mabel it quickly became evident how inexperienced I was. I didn’t gather enough information in the assessing period to be able to do an effective plan of care. I also didn’t know how achievable the goals where as I wasn’t aware of how long they would take to improve or if they where achievable or not, I also found it difficult determine which problems were interrelated and as a result tried to link anxiety in with another problem when in fact it was a problem on its own. I was able to write the needs statements effectively that were not long but on a couple of these the influencing factors were missed out which would be necessary when providing holistic care. Planning care for a patient requires a great deal of knowledge in the chosen specialty which is why it must be carried out by a qualified member of staff or a student under supervision. Implementation Implementation is the next part of the nursing process and where all the goals which were set in the planning stage are put into motion and the goals can start to be achieved through nursing and medical interventions. The main component of the implementation stage is the delivery of the care to the patient. This is done with nursing staff, the multidisciplinary team members involved in the patients care such as doctor, dieticians and physiotherapists and the patient themselves in order for the patient to be able to return to how they were previously before they were admitted to hospital. The plan of care will be specific to the particular patient and will focus on the biopsychosocial aspects of the patient (Marriner 1983).Implementation provides great emphasis on individualized care which is why it is important to establish in the previous phases where they are on the dependence/independence continuum and what they are able to do now and what they were able to do before. Individualis ed care is associated with how the patient did things before such as how the person carries out the ALs and how often they carry these out. An example of this would be when carrying out the AL of personal cleansing and dressing to individualise the care it would be necessary to have determined in the assessing stage how the patient usually did this and how often it wouldn’t be individualized if in the care plan it was stated that they got a shower every morning if at home they only did this once a week. Core care plans may be used in certain situations this can provide a greater level of care as potential problems can be foreseen if related to a certain problem on the other hand it is also important not to standardize care as patients react differently to different illnesses and treatment. (Faulkner A, 2000). The NMC (2008) state that nurses are required to ‘Make the care of people your first concern, treating them as individuals and respecting their dignity’. In order to deal with certain problems or situations people often develop coping strategies which can be either adaptive or maladaptive. Adaptive coping strategies are usually helpful to the patient whereas maladaptive ones could be detrimental to their health such as smoking or drinking, the patient may feel this helps them to deal with a present situation but it is actually causing them harm. Patients need to be discouraged from using maladaptive coping strategies this could be done by introducing them to adaptive coping strategies and encouraging them to change their maladaptive ones into adaptive ones. Diamond (2008) states that there are also legal and ethical issues when it comes to implementing care as consent needs to be gained before any care is implemented and if this is not given the care cannot be given this will obviously have an effect on how effective the care has been when evaluating the care. The Nursing and Midwifery Council (NMC) state in section 3 of the code of c onduct ‘you must obtain consent before you give any treatment or care’ (2002). During the implementation of Mabel I found that although I was able to implement the care effectively I hadn’t recognized all of the nursing interventions needed to provide holistic care and I wasn’t fully aware of timescales of the planned care. I feel I also needed to research further into Mabel’s problems in order to gain the appropriate knowledge to provide the best care available as this would ensure that are the interventions are evidence based and best practice (NMC 2008). Barrett et el (2008) state that this is where recheck should take place which would enable the health care provider to establish how effective the plan of care is before the treatment ends this would enable them to re-evaluate the plan of care while the treatment is still ongoing and adjust the goals accordingly. Evaluation Evaluation is where the care that has been given can be assessed to evaluate the care given and whether it has worked or not. Chalmers (1986) describe that it is an ongoing and continuous process and also occurs at timed points in a formal setting. Roper et al (2000) say that evaluating care also provides a basis for ongoing assessment, planning and evaluation. There are two different parts to evaluation summative evaluation and formative evaluation. Formative evaluation is done with the patient taking into account whether they feel the care given has worked when done with consideration of the dependence/independence continuum information regarding the patients previous place on the dependence/independence continuum can be obtained from the patient, their friends and relatives as well as other health care professionals in the multidisciplinary team involved in the care of the patient. Summative evaluation is when the holistic view of the patient is taken into consideration how they feel about the treatment, whether they felt that the goals were achievable. It so where all the measureable data stated in the baselines and data received after this time are analyzed to show how effective or not the treatment has been. When evaluating care consideration needs to be given to the influencing factors such as biological factors as the bodies physical ability varies according to age the physical ability of an older person is generally less efficient, therefore therefore the plan of care needs to take this into consideration so that when the evaluation takes place it its hoped to have been effective. A nurse needs to evaluate her patient’s status regularly for some patients this will be just once a day but for others it will be much more frequent depending on their illness and healthcare status. RLT (2008) says that evaluation must be individual to the specific patient and not just a standard goal that is related to a specific problem. If goals haven’t been achieved then it is up to the nursing staff to determine why. Maybe the goals set weren’t measureable or achievable. Parsley and Corrigan (1999) say that if goals haven’t been measureable or achievable then new goals need t o be set. It could also be that the nursing interventions were not successful in which case new interventions should be set. Through my evaluation of Mabel it was evident that I did not require all the information to do a comprehensive plan of care. Although I did set baselines which meant I could compare data I wasn’t experienced enough to set goals to the correct timeframe I also didn’t obtain enough measureable information in certain problems to be fully able to assess how effective or ineffective the care had been. Had I had more experience I feel that the evaluation wouldn’t be a problem. Evaluation requires checking and rechecking in order to see the effectiveness of the care delivered. It requires knowledge and expertise to be able to effectively evaluate and amend the goals and interventions set as necessary. The whole care planning process took me a long time and I still was not very good at certain aspects of it. When setting goals a lot of detailed information is required in order for the plan of care to be effective so I can now understand why it is necessary for a trained member of staff to carry out the task. Conclusion This assignment has shown that when used together the nursing process and the nursing model provide a good basis to providing care. It sets out a systematic approach to providing care. Care needs to be set out in a way that both the nurse and the patient know exactly what is happening as well as any other health care professional in the multidisciplinary team providing care for the patient. It has also shown that involving patients in their care enables them to feel they are part of the team and are more likely to help themselves with their care. Reference list Sutcliffe E 1990, Reviewing the process progress. A critical review of literature on the nursing process. Senior Nurse, 10(a), 9-13. Applying the Roper-Logan-Tierney model in practice 2008 Elsevier ltd. Roper N, Logan W, Tierney J (2008) The Roper Logan Tierney model of nursing, Churchill Livingstone:London. Dimond, B. (2008) Legal Aspects of Nursing, 4th ed. Harlow: Pearson Education. Barrett D, Wilson B, Woolands A (2009) Care planning a guide for nurses: Pearson, Essex. Faulkner A (2000) Nursing The reflective approach to adult nursing. Stanley Thornes: Cheltenham. Peate I (2010) Nursing care and the activities of living 2nd ed. Wiley-Blackwell: West Sussex. Yura H, Walsh M (1983) The nursing process: Assessment, Planning, Implementing, Evaluating. Appleton Century: Crofts Norfolk. Cook S (1995) The merits of individualized measures within routine clinical practice. . http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_093359(2009) (29/04/11 Alfaro R (2002), Applying the nursing process: Promoting collaborative care 5th ed. Lippincott: London. Moseby’s Medical Dictionary (2009), 8th ed, Elsevier. http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Accountability/[Date Accessed 11/04/2011]. McCormack B, Manley K and Garbett R (2004) Practice Development in Nursing, Blackwell Publishing, Oxford. Atkinson L Murray E, (1995), Clinical guide to care planning, McGraw, Oxford. NMC (2002), The NMC code of professional conduct, Nursing and Midwifery Council Publications A needs orientated approach to care This will be discussed in detail providing evidence of strengths and weaknesses of the model. The nursing process that will be discussed will be APIE which is assess, plan, implement and evaluate. A nursing process is a systematic approach which focuses on each patient as an individual ensuring that the patients holistic needs are taken into consideration. These include physical, social, psychological, cultural and environmental factors. . The nursing process is a problem solving framework for planning and delivering nursing care to patients and their families (Atkinson and Murray 1995). When used collaboratively the nursing model and the nursing process should provide a plan of care that considers the patient holistically rather than just focusing on their medical diagnosis (Moseby’s 2009). It will also discuss an example of a care plan done for a fictional patient and evaluate and discuss how the nursing plan and the nursing process have created a plan of care and how effect ive this was or was not. Care planning is a highly skilled process used in all healthcare settings which aims to ensure that the best possible care is given to each patient. The Nursing and Midwifery council state that care planning is only to be undertaken by qualified staff or by students under supervision. The Department of health (2009) says that â€Å"Personalized care planning is about addressing an individual’s full range of needs, taking into account their health, personal, social, economic, educational, mental health, ethinic and cultural background and circumstances† with the aim of returning the patient to their previous state before they became ill and were hospitalized considering all of these needs to provide patient centered care. It recognizes that there are other issues in addition to medical needs that can impact on a person’s total health and well being’.It provides a written record accessible to all health professionals where all nursing interventions can be d ocumented. Care planning is extremely important as it enables all staff involved in the care to have access to relevant information about the patients current medical problems and how this affecting them in relation to the 12 activities of living as well as any previous medical history. Barrett et al (2009) state that taking care of an individuals needs is a professional, legal and ethical requirement. There are many different nursing models all of which have strengths and weaknesses and its up to the nurse to choose the right one for individual patient, the model which is used will vary between different speciailties depending on which is more relevant to the patient and their illness and needs. Although a vast majority of hospitals now use pre-printed care plans it is important to remember that not all the questions on them will be relevant to all patients. An example of this would be that activity of breathing may not have any impact on a healthy young adult be would be a major f actor for an elderly man with COPD. There are four stages to the nursing process which are Assess, plan, implement and evaluate (APIE) but Barrett et al state that there should be six stages to include systematic nursing diagnosis and recheck (ASPIRE) as although they are included in the nursing process they are not separate stages and could be overlooked.(Barrett et al 2009). It is important that a nursing process is used and it is set out in a logical order, the way in that the nurse would think this helps minimize omissions or mistakes. Roper, Logan and Tierney model of nursing suggests that there are five interrelated concepts which need to be taken into consideration when planning and implementing care which are activities of living, lifespan, dependence/independence continuum, factors influencing activities of living and individuality in living (Roper, Logan and Tierney 2008). Assessment Assessment is fundamental to gaining all the information required about the patient in order to give the best possible care. â€Å"Assessment is extremely important because it provides the scientific basis for a complete nursing care plan† (Moseby’s 2009). The initial assessment untaken by nurses is to gather information regarding the patients needs but this is only the beginning of assessing as the holistic needs of the patient including physical, physiological, spiritual, social, economic and environmental needs to be taken into consideration in order to deliver appropriate individualized care (Roper, Logan and Tierney 2008). When using the 12 activities of living (ALs) for assessment it gives a list a basic information required but must not just be used as a list as the patient will respond better to questions asked in an informal manner and when just part of the general conversation. RLT (2008) state that although every AL is important some are more important than o ther and this can vary between patients. It is important for nurses to obtain appropriate information through both verbal and non-verbal conversation patients are more likely to give correct information but without jumping to conclusions or putting words into their mouths. ‘Assessment is the cornerstone on which a patients care is planned, implemented and evaluated (RLT 2008). â€Å"Poor or incomplete assessment subsequently leads to poor care planning and implementation of the care plan† (Sutcliffe 1990). Information can be gained from the patient, the patients family and friends as well as any health records (Peate I, 2010) During this process of gathering information it is important to find out what the patient can do as well as what they cant. , McCormack, Manley and Garbett (2004) state that gathering the information requires a certain kind of relationship between the nurse and the patient and nurses need to be able to communicate effectively in order to be able to build this relationship. A full assessment needs to consider how the patient was before they became ill or hospitalized in relation to their medical diagnosis as well as how the patient was dealing with it, how they are now, what is the change or difference if any, do they know what is causing the change, what if anything they are doing about it, do they have any resources now or have they have in the past to deal with the problem (barrett et al). RLT (2008) state that there are 5 factors that influence the 12 activities of living which are biological, psychological, sociocultural, environmental and politicoeconomic, these may not all hav e an effect on each patient but all need to be taken into consideration.The more information gained in the assessment process the easier the other steps will follow. RLT (2008) suggest that assessing is a continuous process and that further information will be obtained through observations and within the course of nursing the patient. At the end of the initial assessment the nurse should to identify the problems that the patient has. There are limitations to using a nursing process which are the 12 als are often used as a list as part of a core care plan and are not always individualized Walsh (1998) argues that the 12 activities of living may just be used as a list which could result in vital information being missed which could be detrimental to the patient. The Nursing and Midwifery Council (NMC 2008) states a nurse is personally and professionally accountable for actions and omissions in practice and any decisions made must always be justifiable. There are many benefits to using a nursing process it is patient centered and enables individualized care for each patient. It also gives patients input into their own care and gives them a greater sense of control it is outcome focused using subjective and objective information which helps and encourages evaluation of the care given. It also minimizes any errors and omissions. When I carried out the assessing stage on mabel I did this using the 12 activities of living as suggested by Roper et al (2008) but this was used too much like a checklist. I didn’t gather enough information in order to be able to do the best plan of care possible for her although I don’t feel this could have been detrimental to the care she received it needed more information than I had. I also found it difficult deciding which information should go where so I endened up repeating information in more than one of the 12 als, Which although this wouldn’t have made a difference to the planning of the care plan there was too much irrelevant information which could mean that it wasn’t read thoroughly just skimmed over as it would take too much time. As I am inexperienced in doing this I realized when writing the care plan that there were many questions that I didn’t ask so there where many parts that could not be filled in. I also didn’t gather e nough objective data for certain parts so I didn’t have any evidence that the care had worked or how effective it had been. This is where Barrett et al (2009) state that there should be a systematic nursing diagnosis where nurses establish a nursing diagnosis rather than just a medical diagnosis. This is where the holistic needs of a patient are taken into consideration. Although nursing diagnosis differs from a medical diagnosis the two do interlink but a nursing diagnosis considers the physical, psychological and spiritual aspects of the medical diagnosis and problems that may arise from these. Another part of the systematic nursing diagnosis is to provide baselines to state where the patients are at at the present time so that a needs statement can be written in conjunction with the patient in terminology that they can understand(Barrett et al 2009). Planning The next stage of the nursing process is planning this is where all the information gained in the assessment part to plan the care of the patient. The planning stage of the process is where achievable goals need to be made through discussion with care givers and the patient or the patients representative. These goals need to contain both subjective goals and objective goals in order for them to be measurable and evaluated. The plan of care is to solve the actual problems the patient has and to prevent potential problems from becoming actual ones. It also aims to help the patient cope with their illness in a positive way and to make them as comfortable and pain free as possible (RLT 2008). Planning needs to be totally individualized and patient centered they need to feel they have a voice and part of the team. The more information gathered in assessment the easier the plan of care will be. The main objective of a nursing plan is to ‘provide the information on which systematic, i ndividualized nursing can be based and individualized nursing can be based and implemented by any nurse’ (RLT 2008). Through a detailed individualized plan of care any nurse caring for a particular patient should be able to see exactly what is required of them as all the information will be recorded in the care plan. The NMC (2008) says that nursing interventions need to be specific for that particular patient, based on best evidence, measurable and achievable. There are many different criteria for setting goals just one of these is PRODUCT which stands for, Patient centered, recordable, observable and measurable, directive, understandable and clear, credible and time related. This is just meant as a way of helping nurses to set goals (Barrett et al 2009). When planning care a great emphasis needs to be based on the dependence/independence continuum which will have been established in the assessment phase. The care to be given will encourage the patient to get back to as rea sonably possible or as close to where they were on the continuum as they were before they were admitted to hospital. Planning also needs to take into account the resources available to implement the care as they need to ensure that the care they are planning is achievable and will not be compromised by lack of resources or a shortage of nursing staff (Roper et al 2008). When I did a plan of care for mabel it quickly became evident how inexperienced I was. I didn’t gather enough information in the assessing period to be able to do an effective plan of care. I also didn’t know how achievable the goals where as I wasn’t aware of how long they would take to improve or if they where achievable or not, I also found it difficult determine which problems were interrelated and as a result tried to link anxiety in with another problem when in fact it was a problem on its own. I was able to write the needs statements effectively that were not long but on a couple of these the influencing factors were missed out which would be necessary when providing holistic care. Planning care for a patient requires a great deal of knowledge in the chosen specialty which is why it must be carried out by a qualified member of staff or a student under supervision. Implementation Implementation is the next part of the nursing process and where all the goals which were set in the planning stage are put into motion and the goals can start to be achieved through nursing and medical interventions. The main component of the implementation stage is the delivery of the care to the patient. This is done with nursing staff, the multidisciplinary team members involved in the patients care such as doctor, dieticians and physiotherapists and the patient themselves in order for the patient to be able to return to how they were previously before they were admitted to hospital. The plan of care will be specific to the particular patient and will focus on the biopsychosocial aspects of the patient (Marriner 1983).Implementation provides great emphasis on individualized care which is why it is important to establish in the previous phases where they are on the dependence/independence continuum and what they are able to do now and what they were able to do before. Individualis ed care is associated with how the patient did things before such as how the person carries out the ALs and how often they carry these out. An example of this would be when carrying out the AL of personal cleansing and dressing to individualise the care it would be necessary to have determined in the assessing stage how the patient usually did this and how often it wouldn’t be individualized if in the care plan it was stated that they got a shower every morning if at home they only did this once a week. Core care plans may be used in certain situations this can provide a greater level of care as potential problems can be foreseen if related to a certain problem on the other hand it is also important not to standardize care as patients react differently to different illnesses and treatment. (Faulkner A, 2000). The NMC (2008) state that nurses are required to ‘Make the care of people your first concern, treating them as individuals and respecting their dignity’. In order to deal with certain problems or situations people often develop coping strategies which can be either adaptive or maladaptive. Adaptive coping strategies are usually helpful to the patient whereas maladaptive ones could be detrimental to their health such as smoking or drinking, the patient may feel this helps them to deal with a present situation but it is actually causing them harm. Patients need to be discouraged from using maladaptive coping strategies this could be done by introducing them to adaptive coping strategies and encouraging them to change their maladaptive ones into adaptive ones. Diamond (2008) states that there are also legal and ethical issues when it comes to implementing care as consent needs to be gained before any care is implemented and if this is not given the care cannot be given this will obviously have an effect on how effective the care has been when evaluating the care. The Nursing and Midwifery Council (NMC) state in section 3 of the code of c onduct ‘you must obtain consent before you give any treatment or care’ (2002). During the implementation of Mabel I found that although I was able to implement the care effectively I hadn’t recognized all of the nursing interventions needed to provide holistic care and I wasn’t fully aware of timescales of the planned care. I feel I also needed to research further into Mabel’s problems in order to gain the appropriate knowledge to provide the best care available as this would ensure that are the interventions are evidence based and best practice (NMC 2008). Barrett et el (2008) state that this is where recheck should take place which would enable the health care provider to establish how effective the plan of care is before the treatment ends this would enable them to re-evaluate the plan of care while the treatment is still ongoing and adjust the goals accordingly. Evaluation Evaluation is where the care that has been given can be assessed to evaluate the care given and whether it has worked or not. Chalmers (1986) describe that it is an ongoing and continuous process and also occurs at timed points in a formal setting. Roper et al (2000) say that evaluating care also provides a basis for ongoing assessment, planning and evaluation. There are two different parts to evaluation summative evaluation and formative evaluation. Formative evaluation is done with the patient taking into account whether they feel the care given has worked when done with consideration of the dependence/independence continuum information regarding the patients previous place on the dependence/independence continuum can be obtained from the patient, their friends and relatives as well as other health care professionals in the multidisciplinary team involved in the care of the patient. Summative evaluation is when the holistic view of the patient is taken into consideration how they feel about the treatment, whether they felt that the goals were achievable. It so where all the measureable data stated in the baselines and data received after this time are analyzed to show how effective or not the treatment has been. When evaluating care consideration needs to be given to the influencing factors such as biological factors as the bodies physical ability varies according to age the physical ability of an older person is generally less efficient, therefore therefore the plan of care needs to take this into consideration so that when the evaluation takes place it its hoped to have been effective. A nurse needs to evaluate her patient’s status regularly for some patients this will be just once a day but for others it will be much more frequent depending on their illness and healthcare status. RLT (2008) says that evaluation must be individual to the specific patient and not just a standard goal that is related to a specific problem. If goals haven’t been achieved then it is up to the nursing staff to determine why. Maybe the goals set weren’t measureable or achievable. Parsley and Corrigan (1999) say that if goals haven’t been measureable or achievable then new goals need t o be set. It could also be that the nursing interventions were not successful in which case new interventions should be set. Through my evaluation of Mabel it was evident that I did not require all the information to do a comprehensive plan of care. Although I did set baselines which meant I could compare data I wasn’t experienced enough to set goals to the correct timeframe I also didn’t obtain enough measureable information in certain problems to be fully able to assess how effective or ineffective the care had been. Had I had more experience I feel that the evaluation wouldn’t be a problem. Evaluation requires checking and rechecking in order to see the effectiveness of the care delivered. It requires knowledge and expertise to be able to effectively evaluate and amend the goals and interventions set as necessary. The whole care planning process took me a long time and I still was not very good at certain aspects of it. When setting goals a lot of detailed information is required in order for the plan of care to be effective so I can now understand why it is necessary for a trained member of staff to carry out the task. Conclusion This assignment has shown that when used together the nursing process and the nursing model provide a good basis to providing care. It sets out a systematic approach to providing care. Care needs to be set out in a way that both the nurse and the patient know exactly what is happening as well as any other health care professional in the multidisciplinary team providing care for the patient. It has also shown that involving patients in their care enables them to feel they are part of the team and are more likely to help themselves with their care. Reference list Sutcliffe E 1990, Reviewing the process progress. A critical review of literature on the nursing process. Senior Nurse, 10(a), 9-13. Applying the Roper-Logan-Tierney model in practice 2008 Elsevier ltd. Roper N, Logan W, Tierney J (2008) The Roper Logan Tierney model of nursing, Churchill Livingstone:London. Dimond, B. (2008) Legal Aspects of Nursing, 4th ed. Harlow: Pearson Education. Barrett D, Wilson B, Woolands A (2009) Care planning a guide for nurses: Pearson, Essex. Faulkner A (2000) Nursing The reflective approach to adult nursing. Stanley Thornes: Cheltenham. Peate I (2010) Nursing care and the activities of living 2nd ed. Wiley-Blackwell: West Sussex. Yura H, Walsh M (1983) The nursing process: Assessment, Planning, Implementing, Evaluating. Appleton Century: Crofts Norfolk. Cook S (1995) The merits of individualized measures within routine clinical practice. . http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_093359(2009) (29/04/11 Alfaro R (2002), Applying the nursing process: Promoting collaborative care 5th ed. Lippincott: London. Moseby’s Medical Dictionary (2009), 8th ed, Elsevier. http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Accountability/[Date Accessed 11/04/2011]. McCormack B, Manley K and Garbett R (2004) Practice Development in Nursing, Blackwell Publishing, Oxford. Atkinson L Murray E, (1995), Clinical guide to care planning, McGraw, Oxford. NMC (2002), The NMC code of professional conduct, Nursing and Midwifery Council Publications

Mind-Body Connection Essay Example | Topics and Well Written Essays - 1250 words

Mind-Body Connection - Essay Example It is also not clear how compatible these inter-relations are, if any, and how complete are in the physical world. Descriptions given by formative degree and mid-nature connections are analogous. The operational principle of mind-body connection receives rations internally. Therefore, this connection strongly depends on spirit and mental effects. To begin with, there are vital things that influence connection between people’s minds and bodies. The inter-relation may result in negative or positive response within our bodies. Proponents believe that, people’s bodies do not just respond boldly but there is an internal play connecting mind with the rest of the body. In addition to that, our physical manifestation takes place due to our thoughts and emotions (Hall, 2011). For instance, a joyous memory or emotion may make people feel lighter and relaxed. On the other hand, an upsetting moment may cause a heart to race or make someone feel clammy. The body does not think but f eels. Therefore, it is clear that actions occur when mind and body inter-connect. Furthermore, some scientists claim that there is no any connection between mind and body where else others use some facts to explain the connection. Some say that personal growth is the key to mind and body connection since it raises people’s awareness and consciousness as well (Sha, 2006). When people free and expand their minds, they condition beliefs and behavior hence what enters one’s mind contributes to some degree of body reaction. There is a way in which mind shifts. In this case, people rethink how they live and start revolving around suggestions that discovered the conduit between people’s physical and mental status. Even though it seems so odd, it is true that all boundaries and divisions matters of our actions are simply a construct of our thoughts. Those who do not see the relationship between mind and body believe that there is nothing separate in the world of quantum . Moreover, those defying the presence of mind-body connection put across that, following emerging science assumptions the word connection loses its bases without the word separation. It is through utilization of language that people get informed thus creating too much awareness about reality. However, traditional medicine specialists view both mind and body as a dualistic dichotomy. They consider mind and body as simply wholesome aspects but differing (Klein, 2007). Scientific research reveals that, the idea of critical role played by our minds and emotions is a fundamental premise within interrogative medicine. Ancient healing procedures incorporated mind and body connection to heal. In order to achieve good health there should be balanced state of mind, body, and environment. Humans’ body undergoes situations that trigger emotional stress. For example, some situations like loss of a loved through death, separating from a loved one, getting laid-off from work and even movin g to a new house may be extreme thus causing anxiety or stress. However, people overcome them by use of fight-to-fight response. In such a situation, the mind links with the body and the latter secretes a hormone called catecholamine. Examples of catecholamine are no epinephrine and epinephrine. In entering the body’s bloodstream these hormones either increases breathing rate or quickens heart hence putting someone in position to deal with the current situation such as fear. Generally, how the mind and body inter-connect is amusing.

Economics Essay Example | Topics and Well Written Essays - 1000 words - 21

Economics - Essay Example The sellers have an ‘insignificant’ market share in a perfectly competitive market, implying that each firm is acting as a price-taker. In monopolistic competition, on the other hand, has as many producers and consumers as the perfect competition. Producers enjoy a degree of control over price. The products sold and purchased in a perfectly competitive market are homogeneous, which are perfect substitutes for each other. In contrast, the products sold in the monopolistically competitive market are heterogeneous. In other words, when a large number of buyers and sellers interact to buy and sell heterogeneous products we have monopolistic competition. Thus, a monopolistically competitive market differs with a perfectly competitive market mostly because of product differentiation, i.e. products are not perfect substitutes. Monopolistic competition involves many aspects of non-price competition. Marginal Revenue (MR) =Marginal Cost (MC) = Price (P) =Average Revenue (AR) = Average Cost (AC). In short run, new firms enter the market, in case the existing firms are making supernormal profits, thereby making reallocation of resources within the market. Given demand remains unchanged, the increased output (with new firms entering the market) shifts the aggregate supply curve to the right and drives the equilibrium market price down until price equates long run average cost. Thus, long run equilibrium is established as firms having no incentives now to move in or out of the market. Hence, in the long run firms make normal profits. In perfect competition ‘allocative efficiency’ is achieved, both in short run and long run, since price equates marginal cost. Production efficiency, occurring when price is equal to average cost at its minimum, is, however, achieved only in the long run. Combining the two, it can be said in the long run optimal levels of ‘static economic efficiency’ is reached in perfect competition. MR

Constitutional Law Essay Example | Topics and Well Written Essays - 500 words - 1

Constitutional Law - Essay Example For instance, if a person has been apprehended and charged with a criminal offense, they have to be presumed culpable and should be punished for their misconduct. This theory believes the criminal justice system was developed to control criminal conduct among individuals (Levesque, 2006). On the other hand, the due process model holds that individuals charged with various crimes are generally innocent until proven otherwise. In light of this, any individual charged with an offense should be allowed to enjoy certain unalienable rights. Packer (1968) described the due process model as drawing several similarities from an obstacle in the quest for granting criminal suspects punitive treatment and or sentences. The primary aim of the due process model is that, except for cases whereby suspected criminal offenders hold the society to ransom, they should be granted freedom until they are declared culpable. The model supports the notion that the primary aim of criminal justice is to safeguard the rights of the innocent and condemn the guilty. According to Levesque (2006), crime control model upholds as credible the outcomes of police investigations, and as such, police should have sweeping powers as far as fighting crime is concerned. By handling criminal suspects under police custody as if they are culpable of criminal offense, cases could be resolved as quickly as possible. Crime control, therefore, speeds up the administration of justice. In contrast, the due process model recognizes the importance of police activity in guaranteeing justice to members of the society. However, the powers of the law enforcement officers should be restricted to avoid cases of abuse or maltreatment to criminal suspects. Due process advocates for accountability of various stakeholders in the criminal justice process, which can be achieved by

Digital Business Report Essay Example | Topics and Well Written Essays - 2000 words

Digital Business Report - Essay Example The benefits delivered by e-commerce to business organisations are often categorised into two segments including tangible benefits and intangible benefits. Tangible benefits of e-commerce are closely linked with increasing business efficiency, reducing operational costs, retaining and increasing customer base along with better automation of the process. On the other hand, intangible benefits of e-commerce to a business venture are associated with secured transaction, rapid delivery, ease and effectiveness of advertisement among others (Kuzic & et. al., 2002). In a nutshell, the e-commerce business venture idea is to set up a webstore, which will sell second-hand educational textbooks. The webstore is named as textbookpalace and its target customers will include secondary school, A-level, college and university students. The second-hand books will be acquired from libraries, schools, universities, charities, bookstores, and private individuals. However, the major supplier for the second-hand book will be the students who able to sell class notes, old tests and textbook. Contextually, certain challenges are identified with the idea of opening and operating the webstore. The most prominent challenges in this regard are associated with the security and privacy, legal aspect and customer service (Kuzic & et. al., 2002). Moreover, as a tool of project management agile methodology will be used. textbookpalace will use Shopify as an e-commerce platform for creating webstore. The rationale behind choosing Shopify is that it provides the simplest way for creating online store. This platform also provides most of the features required by small retailers while it is also extremely easy to use (IBM, 2011). Besides, it offers numerous essential features such as ease in organising products, customising storefront, accepting credit card payments, tracking and responding to customers’ orders among others (Innovation Pei,

KKK (Ku Klux Klan) Essay Example | Topics and Well Written Essays - 1000 words

KKK (Ku Klux Klan) - Essay Example It was said that the Klan's first leader is the famous general N.B. Forrest, the Calvary Confederate leader. He is called the 'Grand Wizard' or the 'Imperial Wizard'. This is the title given to the Klan's highest leader and was assisted by lower ranking officials of the group. The whole southern country was mapped, organized, and subdivided into several sectors down to the lowest ranks and individual members. 1 Later in 1869, the group became perpetrators of lawless violence and recklessness throughout the continent. Ku Klux Klan members were seen mostly at night, covered in white. They hold silent parades and covered their horses with the same white robes. People regarded the Klan as Confederate soldiers returning from the dead. The Ku Klux Klan spread terror all over the entire land. Their main targets are the blacks, the carpetbaggers, and the scalawags. They effectively kept black men from voting and from joining the electoral process, so as to control the polls, its results and politics in particular. They promote terror through whipping and lynching. And because the Klan became so powerful and uncontrollable, its leaders, headed by General Forrest, ordered and sought to disband the group. He resigned from his position as the Grand Wizard. But then, a lot of its off-shoots still functioned, and it continued on for the next few years.2 The Birth of the Second Ku Klux Klan It was 1915 when the Klan was revived, thus giving birth to the second Ku Klux Klan faction. This group was formed by William J. Simmons, who is a former minister and a popular fraternal order promoter. In October of the same year, he had prepared to reveal the campaign to form the group, together with friends of the same mindset. The second Klan is still focused on restoring the supremacy of the white race. It is promoting fundamentalism as a religion and had a hand in controlling politics during those time, although it professed that it is not a political group. Some of the Klan's noted members were elected as government officials, mostly congressmen and mayors. The Klan still continued on performing extreme measures to counter its assumed enemies, and most of these cases were unauthorized by their central leaders. 3 The most noted and remembered extreme activity undertaken by the second Ku Klux Klan is the murder of three civil rights workers in the summer of 1964, in Mississippi. It was the most horrible crime they committed in the entire regime of the second Klan - it was an execution, not merely an assassination. But in 1930, Ku Klux Klan experience a decline in its members, especially when state laws prohibited the use of masks and the propagation of secret societies. This decline of interest on its members is mainly due to the massive corruption, the wrong doings, and the amassing of wealth for personal gains by its leaders through the influence group.4 The Klan as Hate Group The major example of hate groups working with leaders of several or subsequent affiliations and at the same time working under a common name but covering a lot of distinct factions is none other than the Ku Klux Klan. The Klan was a hate group which did one too many illegal acts of intimidation and violence. The Klan was known to be responsible for the arson of the Black South Caroline Group of Churches, which is a predominantly black institution. The Klan

Patterns of Urban Growth and Development Essay Example for Free

Patterns of Urban Growth and Development Essay The growth and development of urban has consistently grown globally. This is as a result of human factor and environmental influence. Growth and development is the change to a better state compared to former state. Urbanization has increased mostly in poor countries compared to developed countries. In both poor and rich countries, there are different factors that contribute to either to growth or dominate the growth of the urban areas. Urbanization is there fore, the spreading of a city and its suburbs over the rural areas at the fringe of an urban area. Patterns of urban growth and development Industrialization is one of the factors that have contributed to urbanization. This changes the nature of economic production of any country. In both rich and poor countries, each potion of land id devoted to a certain use i. e. commercial, industrial and residential areas are separated. The sensing of growth is by allocating land to different uses. In other words large tracts of land are devoted a single use and are separated from one another by none used fields, roads or rail lines, or other barriers. This results to separation from where people go to work and where they do their shopping. Urbanization in rich countries consumes much more land compared to poor countries, on the other hand urbanization in poor countries seem to consume more land due to construction of single family homes compared to apartments build in developed countries. In rich countries more land is required to build parking because of the increasing number of automobiles compared to poor countries. The impact of low density development in poor countries where many communities are less developed or urbanized land is increasing at a faster rate than the population. The critics that arise in urban development in rich countries are health and environmental issues. Urban growth has been associated with some negative environmental and public health matters. The primary cause of these negative outcomes is that urbanization leads to people having to depend on the automobile because it will be a greater distance to travel and people will not be able to walk or ride their bicycles to their destinations. Vehicle ownership has become widespread in the rich countries, health officers recommend health benefits of suburbs due to soot and industrial fumes in the city center. However, air in modern suburbs is not necessarily cleaner than air in urban neighborhoods. In fact, the most polluted air is on crowded highways, where people in suburbs tend to spend more time. On average, suburban residents generate pollution and carbon emissions than the urban counterparts because of the higher number of driving. Urbanization in rich countries is partly responsible for the decline in socialization. Close neighborhoods can contribute to casual social interactions among neighbors, while low-density urbanization creates barriers to interaction. Urbanization tends to replace public spaces such as parks with private spaces such as fenced-in backyards. Residents of urbanized neighborhoods rarely walk for transportation, which reduces opportunities for face-to-face contact with neighbors. There is also a much concern over the housing in growth pattern in both rich and poor countries. In rich countries housing are quite expensive due to demand compared to poor countries, the housing has become a scarce commodity in most developed countries, the housing affordability compared to earning is much high. In poor countries cheaper housing is available due to reduced number of urbanization and demand Suburbs are blamed in rich countries for what they see as homogeneity of society and culture, leading to urbanization of suburb developments of people with similar race and background. (Stein, 1993). Conclusion Growth pattern in both the poor and the rich countries face similar challenges in most cases. Environmental hazards are more prone to developed countries compared to poor countries due to industrialization. Housing is come scarce in rich countries than in poor countries for more people work in urban areas where industrialization is more prone than in poor countries where most people lives in rural areas. References Stein, J. (1993). Growth Management: The planning challenge of the 1990’s. Sage Publications.