Fundamentals of Nursing and Midwifery 2e

Chapter 18 Implementing person-centred care

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Figure 18-1 Implementing person-centred care involves carrying out the plan of care, which is modified in response to changes in the person’s health status. Numerous variables influence the way the plan of care is implemented (see arrows)

Assessing

Identifying health problems

Evaluating care

Implementing care

Standards of care Nursing, midwifery and other healthcare

• Carry out the plan of care • Continue assessment and data collection and modify the plan of care as needed • Document care

Planning care

literature: research findings Ethical and legal influences

Available resources: staff, equipment, supplies Nurse or midwife’s creativity and repertoire of care measures

treatment regimen, nurses and midwives are concerned with how the person is responding to the plan of care in general.

Outcomes of effective person-centred care include a broad range of evidence, including: • Satisfaction with care (the person’s evaluation of care) • Involvement in care (evidence of shared decision making) • Feelings of well-being (positive care experience, feeling valued) • Creation of a therapeutic culture (collaboration, transformational leadership and innovation). Reflect back on the care that has been delivered to Claire and consider the interventions you outlined in Chapter 17. In addition to the evidence described above, what other outcomes of care might you consider as evidence of the implementation of quality person- centred care? TYPES OF NURSING AND MIDWIFERY INTERVENTIONS When nurses and midwives carry out the care interventions identified in the plan of care, they are implementing the plan of care. When this is done, they are said to be functioning independently, dependently and collaboratively, depending on the situation and the resources needed to complete the care required. Independently-initiated nursing and midwifery interventions Each legal jurisdiction, as outlined in Chapter 12, will have regulations that authorise some nurses or midwives to act independently.

Nurse and midwife as coordinator One of nursing and midwifery’s major contributions to the healthcare team is the role of coordinator. Care can easily become fragmented when a person is seen by numerous spe- cialists, each interested in a different aspect of the person. At best, patients complain that no one specialist really knows them and can talk with them about what is going on and how it all may affect them in the future. At worst, the orders of different specialists may conflict with one another and be counterproductive. Nurses and midwives care for people 24 hours a day, seven days a week. Because of this interaction with the person and the other members of the healthcare team, they are often referred to as the ‘glue’ in the system. Therefore, it is important for nurses and midwives to make daily ward consultations with other members of the health- care team. They need to read the results of consultations the person has had with specialists. They can then interpret the specialists’ findings for the person and family members, prepare the person to participate to maximum ability in the plan of care before and after discharge, and serve as a liaison among the members of the healthcare team. Nurses often have a greater understanding of the person’s overall needs in the acute healthcare setting and take on the care coordinator role in these facilities. Claire has been admitted to the emergency depart- ment. She has had a range of blood samples taken for investigation and an intravenous catheter inserted and intravenous fluids commenced. She has also been started on an insulin infusion and a schedule of continuous blood glucose monitoring.