PERSON-CENTRED CARE AND CARE PLANNING 22/03/23.
We had a recap on the previous lesson. We further on went to the learning outcomes of this lesson, which is THE NURSING PROCESS. We discussed the nursing process that is a model or tools or techniques used in assessing a patient. That is a systematic way of integrating assessment information with care decisions, which involves considering potential nursing interventions and evaluating their effectiveness. The technique or tools can be ADPIE /ASPIRE whose original format of APIE has been modified and refined over the years.
I learnt about some of the benefits Nursing Process (N/P) are listed below:
. The N/P gives direction to the nurse when assessing the needs of the patient.
. It helps to add consistency and continuity to person-centred care (PCC), because everyone will be working with the same underpinning framework. Another benefit of person-centered care s that Health and social care professionals work collaboratively with people who uses the service.
. It also provides a framework to direct practitioners in their assessment and care planning process.
According to the RLT model, whose main focuses on activity of daily living, in a holistic and systematic way. The model proposes 12 areas that makes up daily living, they are maintaining a safe environment,
communicating,
breathing,
eating, and drinking,
controlling body temperature,
washing, and dressing,
working, and playing,
mobilizing,
eliminating,
expressing
sexuality,
sleeping,
and dying.
The RLT model aim to move away from a disease-base approach to care, to an approach that recognizes the holistic needs of the patient/services users.
Person-centered means focusing on the individual at the center not the problem. Focusing on the care needs of the individual, ensuring that their preferences, needs, and values guide clinical decisions are met. Its enables individual’s feeling to speak about what is important to them and the workforce listening and developing an understanding of what matters to people. It support people to develop the knowledge, skills, and confidence.
This model is important because its aim is to treat people with dignity, compassion, and respect and to improve on experience, quality, and outcomes.
Many people want to play a more active role in their healthcare.
The four principles of person-centred care, according to the (Health Foundation 2018) are listed below:
- Affording people dignity, compassion, and respect.
- Offering coordinated care, support, or treatment.
- Offering personalized care, support, or treatment.
- Supporting people to recognize and develop their own strengths and abilities to enable them to live an independent and fulfilling life.
Some assumption of person-centred care:
There is an established therapeutic relationship.
The patient and nurses share power and responsibilities in relation to care planned.
The patient carries responsibility for their part .
The patient must become well known to the nurse as a person, not just a patient, patient should be empowered.
There must be effective communication and effective therapeutic relationships.
The prerequisites of PCC – staff attributes, competence, skills, communication skills, values, beliefs, commitment.
The care environment – skill mix, shared decision making, sharing of power, supportive organizational system, innovation, physical environment, staff relationships.
Person-centred processes – patients’ beliefs and values, shared decision making, authentic engagement, sympathetic understanding, holistic care provision.
Person-centred outcomes – Good care experience, involvement in care, feeling of well-being, healthful culture.
I learnt about the assumptions of person-centred care that there is an established therapeutic relationship.
The patient and nurse share power and responsibilities in relation to care planned.
The patient carries responsibility for their part.
The patient must become well known to the nurse as a person, not just a patient, patient should be empowered.
There must be effective communication and an effective therapeutic relationship.
Some of the barriers to person-centred ways of working can be time,
skills,
resources (the right equipment),
experience,
knowledge,
standard ways of practice,
communication,
therapeutic relationship, and
self-awareness of staff.
I learnt about the ways of assessing person-centred care in practice. Feedback, patient survey, review, readmission, pressure sore or ulcer develops, are ways of assessing person-centred care in practice.
Criteria for setting a goal can be
SMART (Specific, measurable, Achievable, Realistic and Time),
MACROS (Measurable, Achievable, Client-centred, Realistic, Outcome-written and Short).
PRODUCT (Patient-centred, Recordable, Observable, Directive Understandable and clear, Credible and Time-related).
We looked at the barriers to individualized care planning.
Time.
Nurses often feel that the individualized care plans are ‘paper exercise’.
Resources.
Skills.
Knowledge and
Confidence.
Some importance of documentation
Document the information; it cannot be shared if it is in your head or a brief discussion
Documentation helps to improve outcomes- the bases of evaluation.
Activities that are required to reach the goals should be written in a way that leaves no room for misunderstanding.
If it is not documented, it didn’t happen.
In care planning stages:
- Identify the problem and nursing diagnosis- clearly defining what these are from the assessment information and discussion with the person.
- Establishing the goals – clearly defined benchmarks for measuring achievement of problem-solving which have been agreed with the person.
- Determining nursing interventions – listing nurses’ actions based on assessed understanding of the situation and your knowledge and expertise.
- Evaluation of care process – documenting outcomes of the care given.
- Review dates – the date on which it is expected that a change will have been made affected.
Planning care using the RLT Model:
- Purpose of
- setting goals is to solve or alleviate problems and, where possible, avoid potential problems from becoming actual problems.
- Goals should offer a short, directive statement as to the outcome of nursing care.
- If a baseline is where the service user is now in relation to the problem, then a goal represents where the service user should be because of the nursing care.
- Consider the available resources before setting the goals.
KSB ADDRESSED.
K1: Understand the code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC 2018), and how to fulfill all registration requirements.
K4: Understand the principles of research and how research findings are used to inform evidence-based practice.
K5: Understand the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care.
K6: Understand and apply relevant legal, regulatory and governance requirements, policies, and ethical frameworks, including any mandatory reporting duties, to all areas of practice.
K7: Understand the importance of courage and transparency and apply the Duty of Candour.
K8: Understand how discriminatory behaviour is exhibited.
K9: Understand the aims and principles of health promotion, protection and improvement and the prevention of ill health when engaging with people.
K10: Understand the principles of epidemiology, demography and genomics and how these may influence health and well-being outcomes.
K11: Understand the principles of epidemiology, demography, and genomics and how these may influence health and well-being outcomes.
K12: Understand the importance of early years and childhood experiences and the possible impact on life choices, mental, physical and behavioural health and well-being.
K13: Understand the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices to mental, physical and behavioural health outcomes.
K15: Understand human development from conception to death, to enable delivery of person-centred safe and effective care.
K16: Understand body systems and homeostasis, human anatomy and physiology, biology, genomics, pharmacology, social and behavioural sciences as applied to delivery of care.
K17: Understand commonly encountered mental, physical, behavioural and cognitive health conditions as applied to delivery of care.
K18: Understand and apply the principles and processes for making reasonable adjustments.
K19: Know how and when to escalate to the appropriate professional for expert help and advice.
K20: Know how people’s needs for safety, dignity, privacy, comfort and sleep can be met.
K21: Understand co-morbidities and the demands of meeting people’s holistic needs when prioritising care.
K22: Know how to meet people’s needs related to nutrition, hydration and bladder and bowel health.
K23: Know how to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity.
K24: Know how to support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain.
K25: Know how to deliver sensitive and compassionate end of life care to support people to plan for their end of life.
K26: Understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld.
K27: Understand the principles of safe and effective administration and optimisation of medicines in accordance with local and national policies.
K28: Understand the effects of medicines, allergies, drug sensitivity, side effects, contraindications, and adverse reactions.
K29: Understand the different ways by which medicines can be prescribed.
K30: Understand the principles of health and safety legislation and regulations and maintain safe work and care environments.
K33: Understand when to seek appropriate advice to manage a risk and avoid compromising quality of care and health outcomes.
K36: Understand the roles of the different providers of health and care.
K39: Understand the principles and processes involved in supporting people and families with a range of care needs to maintain optimal independence and avoid unnecessary interventions and disruptions to their lives.
K40: Understand own role and contribution when involved in the care of a person who is undergoing discharge or a transition of care between professionals, settings or services.
K41: Know the roles, responsibilities and scope of practice of different members of the nursing and interdisciplinary team, and own role within it.
SKILLS:
S1: Act in accordance with the Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC, 2018), and fulfil all registration requirements.
S2: Keep complete, clear, accurate and timely records.
S5: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).
S17: Safely demonstrate evidence-based practice in all skills and procedures required for entry to the register: Standards of proficiency for nursing associates Annex A & B (NMC 2018).
S18: Recognise when capacity has changed recognise and how a person’s capacity affects their ability to make decisions about their own care and to give or withhold consent.
S21: Monitor the effectiveness of care in partnership with people, families and carers, documenting progress and reporting outcomes.
S23: Work in partnership with people, to encourage shared decision making, in order to support individuals, their families and carers to manage their own care when appropriate.
S25: Meet people’s needs for safety, dignity, privacy, comfort and sleep.
S26: Meet people’s needs related to nutrition, hydration and bladder and bowel health.
S27: Meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity.
S28: Support people with commonly encountered symptoms including anxiety, confusion, discomfort and pain.
S30: when a person’s condition has improved or deteriorated by undertaking health monitoring, interpreting, promptly responding, sharing findings and escalating as needed.
S32: Work collaboratively and in partnership with professionals from different agencies in interdisciplinary teams.
S35: Accurately undertake risk assessments, using contemporary assessment tools.
BEHAVIOUR:
B1: Treat people with dignity, respecting individual’s diversity, beliefs, culture, needs, values, privacy and preferences.
B2: Show respect and empathy for those you work with, have the courage to challenge areas of concern and work to evidence based best practice.
B3: Be adaptable, reliable and consistent, show discretion, resilience and self-awareness.