Fundamentals of Nursing and Midwifery 2e

Unit III Thoughtful practice and the process of care

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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

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.