Fundamentals of Nursing and Midwifery 2e

Chapter 18 Implementing person-centred care

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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