Fundamentals of Nursing and Midwifery 2e

Chapter 17 Planning person-centred care

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S T U D E N T P L A N O F C A R E 1 7 . 1

(continued)

for Mrs Jones

Problem 1 care interventions (continued)

Rationale

The more support people who have knowledge and are committed to the plan of care, the greater the probability the person will achieve their goals. New self-care behaviours are dependent on knowledge.

2. Plan teaching and learning sessions to involve family members or significant others.

You should have then recorded the clustered assessment data that led to the determination of each identified issue in the assessment findings column. Recording these data helped you to link specific defining characteristics with problem statements. Identifying health problems You identified Mrs Jones’ health problems and recorded them in the assessment findings column in a prioritised list beginning with the top-priority problem for each identified health prob- lem, a clear and concise problem statement that was followed by a statement that identifies specific contributing factors. Evaluation of care [This section requires a date for the evaluation to be undertaken.] • 9/10/20XX: Goal not met. Mrs Jones says her head is ‘too old to learn all this stuff’. Equates stroke with death. Need to re-teach content in simpler terms. Reassess learning readiness. • 9/10/20XX: Goal partially met. Mrs Jones speaks freely about how much she misses her husband and how fearful this hospitalisation makes her. When asked 3. Include in the teaching plan a description of TIA and stroke and the underlying disease process, causes, symptoms and treatment plan. 4. After the treatment plan has been developed, make sure the person and family can restate it (teaching) and value the prescribed lifestyle modification (counselling). Problem 2 care interventions 1. Each shift the assigned nurse should sit with Mrs Jones for several minutes to communicate caring and to explore with her the current stressors and the adequacy of her coping response. • Assess factors compounding her losses. • Reinforce her personal strengths and support systems; counsel her to tap into these now. • Suggest local support groups if indicated. 2. Explore with her daughter, Lisa, how her mother’s moving in with her has affected the family. Recommend support systems. 3. Refer to social worker for consultation.

Planning achievable health outcomes The plan of care column contains the expected changes in health status or in personal behaviours (i.e. goals for Mrs Jones). If achieved, these resolve the problem statement in the identified health problem. Implementing care interventions Specific care interventions are written for each rationale. These specify what care interventions are to be performed, how they are to be performed, when they are to be performed and who is to perform them. In many nursing and midwifery about living with her daughter, she becomes uncharacteristically quiet. • 9/10/20XX: Goal met. Mrs Jones talks about how everything seemed better in the past after she talked it over with her husband and God. • 9/10/20XX: Goal not met. Mrs Jones couldn’t think of anything about herself that is healthy or strong. She says that her family ‘maybe’ can help her now. • 9/11/20XX: Seen by social worker. New self-care behaviours are dependent on motivation. Unless the person is committed to stroke prevention and values this outcome, she will not follow the treatment plan. Rationale The nurse’s unhurried, attentive and caring presence communicates to the person that she is important to the nurse and that they value her well-being. It is an invitation to the person to become actively involved in their recovery. Also, it is logical to explore the adequacy of past and current coping mechanisms before suggesting new approaches. Adult children of ageing parents frequently experience overwhelming stress as they try to deal with their own and their parents’ problems. Supporting this family is supporting the person indirectly. Engaging other appropriate members of the healthcare team will enhance the planning and delivery of ongoing care.