The purpose of this assignment is to explore a needs orientated approach to care planning, through the use of a problem solving approach to care, and a nursing model. It aims to show an understanding of what both a problem solving approach to care, and a nursing model are; and to establish how various key elements of both are implemented in practice.
The following citation by the Department of Health (DH) (2009) identifies what is intended by the process of care planning; Personalised care planning is essentially about addressing an individual’s full range of needs, taking into account their health, personal, social, economic, educational, mental health, ethnic and cultural background and circumstances.
In order for the care planning process to be effective the need for both a problem solving approach to care and a nursing model is fundamental.
The problem solving approach which will be discussed within this assignment follows the format of Assess, Plan, Implementation and Evaluation (often referred to as APIE) developed by theorists; Yura and Walsh in 1967.
APIE offers a structured, systematic approach to nursing practice through the use of the methodical care planning stages highlighted above (Barrett et al, 2009).
Nevertheless, broad literature research suggests that this process lacked effectiveness in meeting the holistic needs of the individual and so, the process was adapted to include two further stages known as; Systematic Nursing Diagnosis and Recheck to produce the acronym ASPIRE (REF). However, these amended stages will not be discussed widely within this assignment, and so the process of APIE will be referred to throughout. The nursing model developed by Roper, Logan and Tierney (RLT) in 2000, is one of several extensively criticised models commonly used in practice; to enable the facilitation of a holistic approach to care.
The purpose of a nursing model is defined by Barrett et al as; Models give direction to the nurse about the patients and their needs and define nursing roles derived from the views, beliefs and values about people, health, the environment and nursing (Barrett et al, 2009 p. 42). As previously identified, RLT are keen to adopt an holistic approach to care as oppose to other models which only take into account a patients needs from a medical perspective.
The RLT model has been acknowledged to reflect the current realities of healthcare within the United Kingdom (Barrett et al, 2009), consisting of five underlying concepts; Activities of Living, Lifespan, Independence-dependence continuum, factors influencing AL’s and individuality which (Roper et al, 2000) clearly state are interrelated with one another to emphasise the importance of holism. Pearson et al, along with many other nursing authors, highlight the significance of agreeing on a nursing model to be used together with the problem solving approach to develop an individualised care plan efficiently.
Pearson et al (2005 p. 84) indefinitely state; ‘the ‘process’ cannot happen without an agreement on nursing’ as, whilst APIE provides the systematic framework as to how the care plan should be devised, the nursing model effectively identifies what should be considered at each individual stage (REF). The Royal College of Nursing (RCN) also supports the utilisation of a nursing model alongside a problem solving approach, in identifying that; It facilitates consistent, evidenced-based nursing care, and necessitates accurate, up-to-date care documentation (RCN, 2011).
This assignment will also discuss how the RLT model and the problem solving approach are used to meet the biopsyhosocial needs of an individual, and also the strengths and limitations of using RLT’s model and a problem solving approach in relation to developing a care plan. An exploration of how the implementation of the RLT model and a problem solving approach allows the multidisciplinary teams (MDT) to use the approach to meet public health needs, will also be explored within this assignment.
To support such discussions, a range of knowledge gained throughout this module and previous programme themes, as well as a formative care plan developed for a fictional patient known as Mabel Dunn (see appendix A); will be utilised effectually. Through the exploration of each stage of the problem solving approach in turn, and how RLT is utilised alongside this process, enables an extensive in depth analysis to take place whilst using the formative care plan as reflective material to support the discussion. Assessment is the initial stage of the nursing process.
Roper et al consistently use the term ‘assessing’ to signify that it is an on-going process, and highlights its continuity throughout the patient’s episode of care (Aggleton & Chalmers, 2000). It is divided into two stages to allow for a holistic representation of the patient to be established (Barrett et al, 2009). Effective assessment allows the prompt identification of any changes in a patient’s health status, and if necessary; allows any action to be carried out immediately supporting the delivery of safe, effective care DH ().
The formulation of an accurate assessment is a fundamental skill for a student nurse as outlined by the NMC (2004), and so it is important that a holistic approach is adopted for this skill to be achieved. An holistic approach supports the consideration of…….. needs,(THEME? ) which Pearson et al (2005) accentuates that without the holistic consideration of a patient’s needs; it could lead to an inaccurate representation of the individual.
RLT portrayed their understanding of a holistic approach through the use of the 12 Activities of Daily Living (ADL’s); as they believe a patient is best understood in terms of how they carry out the ADL’s (Holland et al, 2003). The 12 actvities (AL) of daily living act as a framework in the assessment process by providing a means of categorising the information in a systematic format (ppt presentation). Barrett et al (2009, p. 45) clarifies; Each activity represents a particular type of behaviour that all of us carry out on a day to day basis, whilst interacting with each other and our environment.
The idea surrounding the ADL’s was derived from the Human Hierarchy of Needs developed by psychologist Abraham Maslow in (), by offering a representation of the common elements of everyday living that ensure human survival, and also quality of life (Barrett et al, 2009/pearson?? ). Despite the main focus of RLT’s model been holism, it has been extensively criticised in meeting the holistic needs of patients in the past, as practitioners have used the ADL’s in a checklist format (Barrett et al, 2009) even though the use of the ADL’s has been stressed to be used in a broad format, to enable a comprehensive assessment to be sought effectively.
This could potentially cause further complications…. It is for this reason as to why the proficient skill of assessment is fundamental before becoming a competent practitioner as, without a comprehensive assessment the patients’ needs will not be considered from a holistic perspective, and consequently the model will not be used for its principal purpose. Holland et al (2003) highlight that the 12 ADL’s can interrelate in many different ways and therefore potentially impact on one another encouraging an holistic account of an individual’s needs.
As a practitioner it is important to understand that the ADL’s can interrelate with one another and therefore influence on each other http://www. dh. gov. uk/en/Healthcare/Longtermconditions/DH_093359 (DOH, 2009) . A holistic approach supports that only taking into consideration the individuals physical needs during assessment as oppose to the human being as a whole; could potentially lead to an inaccurate representation of the individual and therefore lead to difficulties in meeting the patients’ needs effectively (Pearson et al, 2005).
The quality of assessment will be greatly enhanced by the participation of the client and carers to the assessment process ensuring that the client’s wishes are foremost and, wherever possible, the client’s own words are used to reflect their needs RCN It also decreases the potential for, or the severity of, chronic conditions and helps the individual to gain control over their health through self-care.
RCN The Nursing and Midwifery Council (NMC) emphasise the importance of the ability to effectively assess, plan, implement and evaluate care, forming the basis for the standards of proficiency as a student nurse (NMC, 2004). The concept of individuality is constantly emphasised by theorists as been crucial in the implementation of holistic care, and therefore stress the importance of taking a patient centred approach to care planning which will be discussed at a later stage within this assignment.
Nurses have a major role in promoting health and well-being, as well as preventing disease and Roper et al see this as been an essential factor in the model for nursing (Roper et al 2000, p. 102) cited in (Holland et al, 2003) As previously stated, the stages of APIE interrelate in a cyclical context to allow for the establishment of a holistic, needs orientated approach to care delivery. The next stage known as Systematic Nursing Diagnosis was adapted due to criticisms of the approach lacking the concept of holism; one of the main focuses of the RLT model of nursing.
Barrett et al (2009) accentuate how a nursing diagnosis differs from that of a medical diagnosis by establishing that; it places emphasis on a patients holistic needs, and so takes into consideration the physical, psychological, social and spiritual inferences of having a specific medical diagnosis. Hesook (2010, p. 200) also supports this statement in that; ‘health problems that are the referents of nursing diagnosis have been conceptualised from nursing perspectives in a variety of ways. Systematic nursing diagnosis can therefore be used resourcefully with RLT’s nursing model by allowing the nurse to reflect on the assessment stage formerly carried out, before beginning the planning stage to clarify the problems highlighted within the previous stage.
Hogston & Marjoram (2006) acknowledged the fact that the original nursing process; APIE discussed in this assignment lacks this stage, arguing that the nurse does not have time to reflect on the assessment stage of the problem solving approach which affects the thoroughness of the care planning approach which could potentially lead to…. ??? look at a limitation of SND… ADD example of Mabel Dunn… Planning Planning is the second stage of APIE and is also a multistage process which Barrett et al (2009) consider to involve the development of the care plan itself; based on information gathered within the former two stages. According to Within this stage, the nurse is accountable for setting appropriate goals and prescribing the relevant care to a patient to meet their holistic needs.