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The Nursing and Midwifery Council (NMC, 2008) highlight that the care of patients must be a priority and to treat them as individuals. In order to achieve this nurses must use a systematic technique known as the nursing process when planning and delivering care. It originated in the USA and was introduced the UK in the 1970’s in an attempt to move nursing away from traditional and task oriented care, to more evidence based and holistic approach to care (Castledine, 2011).
It??was clearly defined in 1967 when Yura and Walsh published a book called The Nursing Process, which identified 4 strategic stages that nursing care, should follow (Roper at al 2000). These are assessment; planning: intervention and evaluation, each of these stages will be discussed in more depth later in this paper. In this paper the author will also aim to describe what holistic care is and how??each of these 4 stages helps the nurse to achieve holistic patient care in clinical practice. To provide holistic care in daily practice the nurse must recognise that the person that they are caring for is a unique individual with individual needs.
Berglund (2010) calls for the nurse to respect patients’ individuality and to treat them as human beings. Patients’ medical conditions are often the same or similar with the same clinical treatments, however the nurse should never assume that these patients have the same needs. Treatments or procedures that work for one patient may not necessarily work for another, therefore finding a balance between individual care and routine care is seen as a way of enhancing patients general well being, trust and quality of care (Persenius et al. 2009).
The rationale for providing holistic care is that the patient is a whole not merely a condition and holistic care embrace’s the??mind, body and spirit. It gives equal weight to each of these elements, while accepting that when either the mind, body or spirit are comprised there will certainly be an imbalance in the other elements (Lackey and Hassan, 2009). For this reason it is imperative that nurses take a holistic approach to patient care in their clinical practice and as a result of this the patient will be more likely to cooperate with the nurse and it leads to greater patient satisfaction (Castledine 2005).
Nursing models provide a framework to guide the nurse through the nursing process and they recognise the uniqueness of each individual. There are many different nursing models however the most commonly used in the UK is??Roper, Logan and Tierney’s’ activities of living model (Nazarko, 2007). Regardless of??the model used, the information from an assessment should be similar and used to identify patients’ current health status, problems and needs. It is the most crucial stage of the nursing process and it is ongoing throughout the care process (Hinchliff et al. 008). It is a key requirement in nursing care and Lukes (2010) goes so far in saying that,????” to plan and implement without assessment is like trying to furnish a room without knowing the room’s dimensions. ” The assessment is carried out with the patient, but sometimes with family members or carers. Information can also be gathered by medical records or family doctors. However it is the patient that can give you the most accurate account of; how they are feeling; any concerns they have and express what they want from nursing care.
Weaver (2007) claims that clients who have participated in their care feel empowered plus take an active role in monitoring and maintaining their condition. When assessing the nurse can communicate the risks and benefits of proposed procedures and any alternatives that are available to them, this in turn allows the patient to make an informed choice before giving consent (NMC, 2008). Assessment should take a holistic approach in that patients’ physical, psychological and social wellbeing are clearly assessed leaving no element of the ‘whole’ person unaddressed (Wright, 2005).
Having a clear aim allows the nurse to tailor the assessment to the individual and makes it more effective (Baid, 2006). In some cases the assessment process may only include a general assessment which involves getting the patients’ medical history/condition, next of kin, and so on. This can be done both objectively,??through measurement (vital signs) or subjectively through verification from the patient, such level of pain (Castledine, 2011).
However sometimes information gathered in the general assessment will lead to a more specialist assessment, for example if a person is not very mobile they may be at risk of developing pressure sores. Therefore the patient needs to be further assessed to decide what their individual care needs are (Nazarko, 2007). The information gathered in the assessment is documented and used to plan the care of the individual with their needs and preferences at the forefront of the care plan. Planning is the second stage in the nursing process.
The main objective of having individualised plans is to help and assist the client, nurse and whole multidisciplinary team??in identifying and??prioritising interventions that may prevent, reduce or resolve the patients’ problems (Leach, 2008). It can prevent potential problems from becoming real ones and solve actual problems, as well as aiming to prevent the problem from recurring again. Planning can be split into a 2 step approach, the first being setting goals and the second identifying actions to achieve these goals.
Before goals are set the nurse must first decide what problems are priority but at the same time taking a holistic approach and always being conscientious of not only the physical problems but physiological and social elements of a person also. Goal setting should be participative or mutual with the patient, as this??is more likely to motivate the client to set higher goals, as well??as achieve them (Kraus, 2006). Patient participation in goal setting??ensures that goals are both??achievable and realistic for the patient (Roper et al. 2000).
They should be clear??and specific as this is likely to avoid confusion and misinterpretation by both patients and the whole multidisciplinary team, thus helping continuity of care (Leach, 2008). He further suggests that??goals are measurable, as this is??necessary in determining whether the clients have achieved or??are working towards their goals. Wright (2005) highlights that goals need to be time limited as it gives the client and nurse motivation to succeed, but in doing so it also reveals when further interventions may be needed.
The second stage of this process is planning nursing interventions and??indicating how these goals will be achieved. These actions need to be based on the best available evidence and in doing so this provides a rationale for the care that is being considered. This stage of the planning process is stipulated by the NMC (2008) who state that care must be delivered based on the best available evidence and that nurses are personally accountable for their actions and must be able to justify their decisions.
By actively embracing evidence based practice the nurse can justify his or her actions and decisions and improve patient outcomes. Implementation is the third phase of the process of nursing. It is when the proposed nursing interventions in stage two of the process are put into action by the nurse in collaboration with the patient. Nursing interventions are numerous and varied and it is likely that for any individual that the number of nursing actions will go beyond those that are listed in the care plan (Roper et al. 2000).
Interventions should be appropriate for the individual and the nurse must use all their skills such as listening; talking: observation and empathy to help the patient achieve their goals and overcome difficult or challenging situations. Alexander et al. , (2010) claim that developing a therapeutic relationship with patients and working in partnership with??families and carers will help to gain trust and confidence in the nurse and led to more successful patient outcomes in achieving goals and maintaining optimum health.
The nurse must use critical thinking at this stage to identify risks to the patients and resolve or control problems as they arise throughout this stage of the process (Kirshbaum, 2006). By taking this approach the nurse is not only safeguarding their patients but, adhering to the NMC (2008) guidelines on managing risk and protecting and promoting the well being of those in their care. The fourth and final stage of the nursing process is evaluation. It is essential in the delivery of patient centred holistic care (Davies 2006).
The effectiveness of the planning and implementation of nursing interventions can not be justified if the outcome and benefits to patient can not be seen (Alexander et al. 2010). Nurses need to be aware that not all goals and interventions they set will be effective and that it is this stage of the nursing process that ensures the most appropriate services are being delivered to the patient (Kirshbaum, 2006). If the goals or interventions have not been met the nurse must reassess to seek why they have not worked and what alternative approaches can be taken.
Tutton (2005) highlights that evaluation gives the patient the opportunity to give feedback on their experiences and as a result this helps the future of care delivery and service provision. Weaver (2007) suggest that the frequency of monitoring is important as it identifies when change in interventions are required. Change might be necessary as a result of a change in patients’ condition, patient preferences or choices. The importance of reflection by the nurse can not be ignored when discussing evaluation.
Mindful reflection drives the nurse to a higher standard of practice and results in improved patient care (Vosit-Steller et al. 2010). It promotes a holistic approach to care as it helps the nurse recognise what they could have done better, or highlights what they did was right or wrong and therefore influences their future practice and the overall quality of patient care (Hood, 2007). Reflective practice helps the nurse to be more self aware and competent in their roles.
The nursing process is a systematic process which guides nurses in carrying out their daily clinical practice. When the purpose of the nursing process is understood and used in collaboration with a nursing framework it can help promote holistic care in the clinical setting as it keeps the nurses attention on the individual, rather than routine tasks. It highlights the individuality of a person and all that they stand for, as well as making the nurse more accountable and autonomous. Reference list
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