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