Fundamentals of Nursing and Midwifery 2e

Chapter 18 Implementing person-centred care

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Anticipate unexpected outcomes/ situations When you learn about new procedures and interventions, you often see a description of possible adverse effects listed. While everyone hopes never to encounter these complications, they do occur with some frequency. The skilled nurse or midwife knows what might happen if an intervention ‘goes wrong’ and is prepared to deal with the new challenge. This may be as simple as accurately assess- ing how much support a patient will need to avoid a fall when ambulating for the first time after surgery, or being prepared to respond to complaints of burning at a new intravenous site. Although most people can independently meet their basic human needs, illness and the stress of diagnostic and thera- peutic measures may interfere with a person’s usual practice of self-care. The person’s abilities to independently meet their human needs must be fully assessed. You can fail people by doing too much for them and by encouraging negative, sick-role behaviours, such as inappropriate dependence. Conversely, there is a time and a place for the ‘tender loving care’ that says to a person ‘I know you may be able to do this for yourself, but just this once, how about if I do it and we’ll talk’. Balancing the need to encourage a person’s best self-care effort with the effort to make each person feel cared for and loved is an important component of the art of caring. The plan of care should include specific instructions for any assistance the person requires to meet their basic human needs, including the need for significant encouragement to promote greater independence in functioning. When routines of self-care (or assisted self-care) are included (e.g. colostomy management), instructions should include the time of the pro- cedure, the equipment used, the process and the level of personal involvement. Continuity of care is essential to the person’s development of a comfortable routine. If the person and family want to participate actively in seeking wellness, preventing disease and illness, recover- ing health and learning to cope with altered functioning, they need to possess effective self-care behaviours. You need to be aware of the importance of people learning to direct and manage their own care, and use interactions with them for both planned and spontaneous teaching, coun- selling and advocacy. (These nursing and midwifery roles are described in Chapters 8 and 11.) For example, while caring for a child recently diagnosed as having cystic fibro- sis, the nurse works continuously with the parents and siblings, helping them to develop the knowledge and skills that will enable them to care for the child after discharge. Referring families such as this to a community support group or other resources further enhances the development of self-care behaviours. Promoting self-care: Teaching, counselling and advocacy

want to talk with visitors or watch TV). If visitors are in the room, check with the person to see if they want the visitor(s) to stay during the procedure. If the person’s carer needs to learn new skills so that care can be contin- ued at home, a teaching session should be scheduled at a time both appropriate for the person and convenient for the carer. These interventions reflect the person-centred approach because the person is being involved in the decision making throughout the implementation process. Equipment Anticipate all the equipment you will need to successfully carry out the intervention and arrange it so that it is easily accessible. Be sure to order sufficient supplies at the begin- ning of the shift for the care you expect to provide, and be considerate of colleagues who will follow you by leaving adequate supplies; for example, medication and intravenous therapy orders. Follow the healthcare facility policy when ordering supplies. It is also important to ensure your equip- ment is in working order and therefore safe to use. Nurses and midwives also have a responsibility for the care of the environment after a procedure. Equipment that is not put away properly not only may become a hazard but also detracts from the person’s environment. Environment Think through the proper environment for each intervention. Pay special attention to respecting the person’s dignity, privacy and safety needs. Privacy is routinely violated in some care settings when measures as simple as closing a door or pulling curtains are neglected. These considerations are of special importance when people share rooms. For example, if an enema is being administered, it can be embar- rassing for the person and unpleasant for the person’s roommate. With some planning, the intervention can be scheduled in a private bathroom or at a time when the room- mate is absent. Personnel Prior to implementing care, identify if you are able to carry out the planned intervention independently or if you are likely to need assistance. In Chapter 13, the issue of self- awareness is discussed and this includes an appreciation of one’s own expertise. Harm can occur either to the person or to you when interventions are attempted by an insufficient number of personnel or someone who is not competent in the procedure. For example, it is easy for a student to under- estimate the strength it takes to support a large person or the expertise that is required in changing a central venous catheter. Until experienced, it is always safer to err on the side of having too much help rather than not enough. One helpful tip for student nurses and midwives is to begin each rotation by asking ‘Who thinks they might need help today?’ The team can then plan to coordinate care so that help is available when needed.