Assisting people to meet health goals
In this phase of implementing person-centred care, the
nursing or midwifery team carries out the care detailed in
the plan. These actions should be carefully executed and
planned to promote personal goals achievement and the
resolution of health problems. Implementing guidelines
are listed in Box 18-1.
Because the number and skill level of staffing is a problem
in many practice settings, nurses and midwives must learn to
use their time effectively and to maximise each personal
encounter. Bathing a person can be simply that, or it can be
an opportunity to gather additional focused data, to commu-
nicate concern for what the person is experiencing and
offering support, and to teach and counsel as appropriate.
How you use the 30 minutes you are in the person’s room for
the bath determines how effective you will be in helping the
person to achieve their goals.
Variables that influence outcome achievement
When working towards achieving the goals specified in the
plan of care, remember that nothing about the plan of care is
fixed. Some of the most important variables that influence
how the plan of care is implemented follow.
Personal variables
Ideally, the person is primary in determining how interven-
tions are implemented. Care interventions should be
modified according to the person’s (1) changing ability and
willingness to participate in the plan of care, and (2) previ-
ous responses to interventions and progress towards goal
achievement (Bulechek et al., 2013). In Chapter 9, the
theory of goal attainment developed by Imogene King is
mentioned. Identifying and matching goals with personal
variables is this theory in action. It is important to ensure
that the person’s goals and those of the nurse or midwife do
not conflict. For example, the goal of a nurse caring for a
patient who has suffered a stroke may be for the patient to
become fully independent in mobility, whereas the patient
may only aim for mobility that ensures they can collect the
post each day. Other important personal variables are devel-
opmental stage and psychosocial background.
Developmental stage
Addressing the developmental needs of a person is much
more than simply identifying the person’s developmental
stage on the plan of care. The developmental tasks related to
this stage and their relationship to care seldom need to be
considered. For example, you may recommend that the
parents of a premature infant make a tape of their voices to
stimulate their infant in the neonatal intensive care unit. You
must be careful not to let stereotypes about developmental
stages and tasks influence individualised care. In nursing
homes, for example, the developmental needs of older resi-
dents are ignored when a staff member selects a radio station
that plays rock music, makes humorous comments about
‘romances’ among the residents, embarrasses some residents
by calling them cute names or putting big, bright bows in
their hair, or demeans residents by planning childish group
activities. Perhaps the worst stereotype is the belief that all
older people have to do is wait to die, and there are no devel-
opmental challenges for this age group.
Psychosocial background
The same is true of the psychosocial needs of people.
Although few nurses or midwives would claim that people
from all socioeconomic groups and cultures are the same,
some practice as if this were so. When choosing interven-
tions, you should consider and respect the person’s
background or culture. Confronted with a malnourished
person on a limited income who rents a single room in a
boarding house, you cannot simply teach the importance of
including more protein in their diet. To be effective, you
must explore the realistic issue of whether the person can
Unit III Thoughtful practice and the process of care
322
BOX 18-1 Implementing guidelines
•
When implementing care, remember to act in partnership with the person and family.
•
Before implementing any care intervention or action, reassess the person to determine whether the action is still needed.
•
Approach the person competently. Know how to perform the action, why the action is being performed and potential
adverse responses. Have all equipment and supplies ready.
•
Approach the person caringly. Explain the intervention or action using language the person understands.
Communicate genuine concern for what the person is experiencing.
•
Modify care interventions according to the person’s (1) developmental and psychosocial background, (2) ability and
willingness to participate in the plan of care, and (3) responses to previous care measures and progress towards
goal/outcome achievement.
•
Check to make sure that the care interventions selected are consistent with standards of care and within legal and
ethical practice guidelines.
•
Always question that the care intervention selected is the best of all possible alternatives. Consult colleagues and the
related literature to see if other approaches might be more successful. Evaluate the effectiveness of the intervention
chosen, noting any factors that influence the outcome either negatively or positively.
•
Develop a repertoire of skilled interventions. The more options one can choose from, the greater the likelihood of success.
