Care may be defined as “providing for physical needs, help and comfort” (Collins English Dictionary). In this assignment I will discuss the effectiveness of the Operating Department care planning process in relation to organisational factors. I will include the Roper, Logan and Tierney model of care, principles and purposes of care planning, confidentially and patients rights during the care planning process. I intend to find my information from people I work with, books, journals, I will also look on the internet.
Principles and purposes
Care plans are written for individual patients and provide, accurate, current comprehensive and concise information concerning the condition and care of the patient and associated observations. The care plan is a practical way of putting the nursing process to work. Producing a care plan involves assessing the patients needs and planning appropriate care.
A care plan has five purposes:
* It provides an assessment of the patients needs
* Nursing diagnosis
* Details of planned care
* A description of how this was implemented
* Evaluation of the outcome for the patient.
The care plan should take into account the patients background and environment, his likes and dislikes, his response to his illness and his ability to cope with his illness and with his daily life. A care plan is so individual, that it can not be used for any other patient, therefore, it is unique. (Meeker 1995)
A care plan should be a continuous use and updated as soon as changes occur. This is so it contains all relevant information and reflects accurately the patients condition at any time.
Models of Care
The NHS Trust I work in is based on the Roper, Logan and Tierney nursing model.
This model believes individuals carry out a series of daily activities that are fundamental to normal functioning. The philosophy of care is based on living, not illness. (Polit 1995)
In Roper, Logan and Tierney’s model of care it describes the 12 activities of living, which are:
* Maintaining a safe environment
* Drinking and eating
* Personal (cleansing and dressing)
* Controlling body temperature
* Playing and working
* Expressing sexuality
These activities of living are the focus of the model, and are closely related to human behaviour and in particular needs. Each activity of living has three components, biological, social and psychological with variation according to age, development, cultural and social experiences, therefore Operating Department Practitioners (ODPs) must assess whether an actual or potential problem exists in relation to the activities of daily living, taking into account the persons usual routine, therefore , the ‘nature of the man is seen in terms of the activities they perform’. (Newton 1991)
The Nursing Process
This is the first step of care planning and, without effective assessment care planning would be impossible. Assessment includes:
* Collecting information
* Interpreting information
The next step in planning care is to decide what care a patient may need. The information obtained during the admission interview, together with observations and assessment goes into the planning of care. This information will identify the patients problems or potential problems. Planning includes:
* Setting the goal (expected outcome)
* Deciding what care will meet the needs if the patient and writing the appropriate instructions.
* Deciding when to review or evaluate
Implementation of nursing instructions can only be successful if the following points are investigated:
* How instructions are communicated
* When to carry out the different instructions
* Co-ordinating all aspects of care
* Giving care
* Responsibility and accountability in giving care
Evaluation is the last phase of care planning and is essential for deciding if the care has been effective. It is a continuing process that assesses and measures the quality, suitability and degree of success of both planning care and the care that is given.
(Roper et al.1985).
Confidentiality of information
Confidentiality is the non disclosure of certain information, except to another authorised person. The dictionary uses focal words in the definition, such as ‘confide’,
‘confidence’, ‘confidential’ and they all amount to ‘trust’. “To trust another person with private and personal information about yourself in a significant matter.” (Collins English Dictionary).
Confidentiality is considered as one of the most important factors in care planning “The patient is entitled to confidentiality of the information about him. There is therefore a duty on every professional and indeed every employee of the
authority to ensure confidentiality of information” (Dimmond B. 2002)p149
As ODP’s we have access to patients information, and we should respect this at all times. During the care planning process the patient has many rights (see Appendix 1)
The implications of Organisational factors and how it effects the care planning process
The care planning process affects organisational factors in a number of ways. It can improve the way we work, but sometimes, can hinder the way we work. We can order extra equipment if needed, and certain tests can be carried out at pre-assessment stage rather than waiting until they come for their operation. This can improve things but often in the hospitals, time and money are very important and can affect patient care. Sometimes there is not enough staff and they work on a bare minimum. For example on a long procedure like a hip replacement a care plan will get filled in because the staff have more time in between operations. A gynaecological list is often a quick turnover as they are all small operations and the care plans do not get filled in.
Often lists run over their allotted time, this is due to the high demand on the NHS and the pressure put on the staff. Emergencies also put pressure on staff and sometimes take staff away from scheduled lists. The number of trained staff in theatres is often a factor and we often use agency staff who are unfamiliar with the hospital care plan system.
The care planning process is continuous throughout the patients stay and everything should be recorded on the care plan, but due to organisational factors this is not always achieved.
Whilst working on this assignment it has given me a clear insight into why we plan care.
I feel that care plans are effective as they give a clear and concise record of all the care the patient received and expected to receive, therefore the patient is given the best possible treatment, however a disadvantage of care planning is that they are not correctly filled in, and patients can suffer as a consequence, this is not a purposely caused problem, but it is often due to organisational factors, such as timing and costs.
Overall I believe care plans do improve patient care, and more emphasis should be put on the staff to correctly fill them in and I believe they should be regularly followed up to make sure the patient was fully happy with the care they received.