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Chapter 18 Implementing person-centred care
afford and obtain foods rich in protein. Moreover, you need
to assess whether the person values this intervention and is
willing to make the necessary changes.
Nurse and midwife variables
Variables that influence the implementation of the plan of
care include levels of expertise, creativity (ability to match
the person’s needs with specific care strategies), willingness
to provide care and available time. In Chapter 14, the issue
of engagement is discussed and this is an important variable.
Another variable is thoughtful practice because this includes
the importance of thinking critically about intervention
strategies and reflecting on care.
Resources
The most elaborately designed plan of care cannot be fully
effective in a chronically understaffed or undersupplied
nursing or midwifery unit. Adequate staff, equipment and
supplies are all important determinants of personal care. The
financial resources of the person and adequacy of community-
based resources also influence the plan of care.
Current standards of care
All actions for implementing care must be consistent with
standards of practice. See Chapter 19 for a discussion of
these standards. All nurses and midwives are responsible for
learning the standards that dictate practice in their specialty.
Failure to practice according to these standards may result in
a disciplinary action by the registering authority, as described
in Chapter 12.
Competencies
The Nursing and Midwifery Board of Australia (NMBA),
the Nursing Council of New Zealand and the Midwifery
Council of New Zealand have developed sets of practice
competencies that all nursing and midwifery students work
towards achieving prior to registration. The competencies
inform nurses and midwives on their practice and all care
implemented must be in accordance with these competency
statements (see Chapter 1).
Research findings
Nurses and midwives concerned about improving the quality
of care use research findings to enhance their practice.
Reading professional nursing and midwifery journals and
attending continuing education workshops and conferences
are excellent ways to learn about effective new care strategies.
Many organisations now use journal clubs to help you partic-
ipate and stay abreast of research findings. Research in
practice boxes throughout this text demonstrate the difference
research can make in improving outcomes for the person.
Ethical and legal guides to practice
Nurses and midwives cannot practise excellent care if they
are ignorant of the laws and regulations that affect health-
care and the ethical dimensions of clinical practice. A
sincere motivation to benefit the person and a conscien-
tious attempt to implement orders are no longer sufficient.
You are responsible for developing knowledge and an
understanding of the ethical and legal dimensions of prac-
tice, and the moral and legal accountability that is inherent
in the practice of professional nursing and midwifery.
Chapters 11 and 12 discuss the ethical and legal dimen-
sions of practice.
CONTINUING DATA COLLECTION
AND RISK MANAGEMENT
An important intervention is the ongoing collection of data.
In every encounter, there is a need to be aware of both subtle
and dramatic changes in the person’s condition. Skilled
nurses and midwives monitor the person’s responses to
planned interventions to determine if the plan of care is
working. These assessment findings are used to update and
revise the plan of care. Awareness of how the person is
responding to these interventions and how the person is pro-
gressing towards goal achievement allows you to modify the
interventions appropriately.
Another vital intervention is ongoing risk management.
While monitoring the person’s responses to the plan of
care, you should also be alert to the development of prob-
lems that may result in the identification of new health
problems. As you get to know the person and family and
recognise clusters of significant data, you can identify
problems that might make the person more at risk and
intervene appropriately to promote health and to prevent
disease.
DOCUMENTING NURSING AND
MIDWIFERY CARE
Documenting care is a fundamental nursing and midwifery
responsibility, and if not undertaken there can be profes-
sional, legal and financial ramifications for the nurse or
midwife and the healthcare delivery system. See Chapter 20
for a description of guidelines for written documentation,
and see the plans of care at the end of each clinical chapter
for samples of documented care interventions.
FAILURE TO COOPERATE WITH THE
PLAN OF CARE
When a person fails to follow the plan of care despite the best
efforts of the nurse or midwife, it is time to reassess the strat-
egy. The first objective is to identify why the person is not
following the plan. One possibility is that the plan of care
may not be right for this person. In this event, what is needed
is not a change in the person but, rather, a change in the plan
of care. However, if it is determined that the plan of care is
