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Chapter 18 Implementing person-centred care
treatment regimen, nurses and midwives are concerned with
how the person is responding to the plan of care in general.
Nurse and midwife as coordinator
One of nursing and midwifery’s major contributions to the
healthcare team is the role of coordinator. Care can easily
become fragmented when a person is seen by numerous spe-
cialists, each interested in a different aspect of the person. At
best, patients complain that no one specialist really knows
them and can talk with them about what is going on and how
it all may affect them in the future. At worst, the orders of
different specialists may conflict with one another and be
counterproductive. Nurses and midwives care for people 24
hours a day, seven days a week. Because of this interaction
with the person and the other members of the healthcare
team, they are often referred to as the ‘glue’ in the system.
Therefore, it is important for nurses and midwives to make
daily ward consultations with other members of the health-
care team. They need to read the results of consultations the
person has had with specialists. They can then interpret the
specialists’ findings for the person and family members,
prepare the person to participate to maximum ability in the
plan of care before and after discharge, and serve as a liaison
among the members of the healthcare team. Nurses often
have a greater understanding of the person’s overall needs in
the acute healthcare setting and take on the care coordinator
role in these facilities.
Claire has been admitted to the emergency depart-
ment. She has had a range of blood samples taken for
investigation and an intravenous catheter inserted and
intravenous fluids commenced. She has also been started
on an insulin infusion and a schedule of continuous blood
glucose monitoring.
Outcomes of effective person-centred care include a
broad range of evidence, including:
• Satisfaction with care (the person’s evaluation of
care)
• Involvement in care (evidence of shared decision
making)
• Feelings of well-being (positive care experience,
feeling valued)
• Creation of a therapeutic culture (collaboration,
transformational leadership and innovation).
Reflect back on the care that has been delivered to
Claire and consider the interventions you outlined in
Chapter 17. In addition to the evidence described above,
what other outcomes of care might you consider as
evidence of the implementation of quality person-
centred care?
TYPES OF NURSING AND
MIDWIFERY INTERVENTIONS
When nurses and midwives carry out the care interventions
identified in the plan of care, they are implementing the plan
of care. When this is done, they are said to be functioning
independently, dependently and collaboratively, depending
on the situation and the resources needed to complete the
care required.
Independently-initiated nursing and
midwifery interventions
Each legal jurisdiction, as outlined in Chapter 12, will have
regulations that authorise some nurses or midwives to act
independently.
Assessing
Evaluating
care
Identifying
health problems
Planning care
Implementing
care
• Carry out the plan of care
• Continue assessment and
data collection and modify
the plan of care as needed
• Document care
Standards of care
Nursing, midwifery and other healthcare
literature: research findings
Ethical and legal influences
Available resources: staff, equipment, supplies
Nurse or midwife’s creativity and repertoire of
care measures
Figure 18-1
Implementing person-centred
care involves carrying out the
plan of care, which is modified
in response to changes in the
person’s health status.
Numerous variables influence
the way the plan of care is
implemented (see arrows)
