Transcript Systematic approaches to care delivery

Systematic approaches to care
delivery
Prof Sue Frost
The nursing process provides a
logical and rational way for the
nurse to solve problems and
make decisions so that the care
given is appropriate and effective
Susan Leddy 98
Decision making models
• Organisational processes
(systems)
• Vested interest
• Rational models
Scientific Processes
• Scientific method
Recognise problem
Collect data
Form hypothesis
Select plan
Test hypothesis
Analyse results
Evaluate findings
• Nursing process
Assessment
Diagnose
 Plan
 Implement
 Evaluate
The nursing process - background
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Introduced in 1970’s in the GNC syllabus
Moved away from task allocation
Client/patient centered approach to nursing
5 stage process
Systematic approach to care delivery
Problem solving approach
Emphasises the relationship between nurse
and client
• Is a continuum and cyclic
Nursing assessment:
a process of data collection to
determine the health problems to
be addressed and the strength of
the client patient to manage this
with and without support
Assessment
• Systematic and continuous collection of
data
• Purpose of the assessment is related to
systematic planning of care delivery
• Client centered
• Various models
• Draws on nurse-client relationship
• Assessment is not “care” or “therapy”
Assessment process
• Collect data: observe, examine, interview,
test, record, review records
• What is relevant to the current situation
• What is a priority/urgent
• Triangulate
• Summarise
Diagnosis
• Analysis of data to identify needs/patterns
• Carpenito’s model of diagnosis (has been
argued is reductionist)
• Differential approaches
• Nursing approaches to taxonomy
• Problem oriented
Diagnosis
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Order and categorise information
Identify patterns, trends
Refer to norms/clinical evidence
Explore joint values, expectations
define problems
organise problems
Planning
• Identifying the programme of care/support
• Restoration/maintenance/promotion models
• temporal - may be short, medium or long
term
• joint processes with clients and families
• Managing continuity of care programme
• Organising activity
• Identify responsibilities
Planning...
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Identify outcomes to be achieved
Identify priorities
Short/medium long term goals
Identify things to be done
Organise and allocate tasks, functions, roles
Implementation
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Care delivery systems
Health care systems
Partnerships with client
Role of carers
cross agency
multidisciplinary
Implementation
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Skills
Knowledge
Attitudes
Care delivery approaches
Records
Joint working
Evaluation
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Clinical governance
Making clinical judgements
systematic, continuous process
comparing outcomes, goals with client
needs
• cyclic into reassessment
Evaluation
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Systematically review goals and outcomes
Adjust plans
Identify new needs/problems
Evaluate speed of progress
Audit and evidence
Nursing process benefits
• Orderly & systematic
• enhances efficiency by standardising
practice
• Unity of language
• Good documentation
• Increases quality of care
• Stresses independent functions of nurses
(Leddy & Pepper)
Nursing process criticism
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Linear process not fitting real world
Focuses on problems
Nurse power based
Time consuming and jargonistic
Reductionist & labeling
Antithetical to holism
Inhibits intuition and diversity
? Ritualistic
Developing models - a look
ahead
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Clinical Judgement
Using evidence
Adapting processes and approaches
Quality and assurance
New partnerships
Health based services
Some questions
• Is the nursing process appropriate in any,
some or all instances?
• What is working well?
• What is not working at all?
• How does the nursing process link with care
delivery systems?
• How do differing disciplines use systematic
approaches?