Nursing Care Plan and Nurses’ Philosophy Influence

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This essay aims at critically exploring the philosophies, models, and frameworks that underpin care planning. This will be demonstrated through use of a service user case scenario with a long-term complex care need. The essay begins with an overview of the identified service user and their long-term condition. Followed by, a definition of philosophy and the chosen philosophies – nursing and person-centred; an explanation of how each of these components of nursing knowledge is used in the nursing practice. 

The essay continues with further discussion of the models and frameworks, highlighting their importance in practice and an explanation of how each of these components of nursing knowledge is used in the construction of Tim’s care plan. To comply with The Code, confidentiality will be maintained throughout the essay and, as such a pseudonym will be used, and the service user will be called Tim.

Tim is 78 years of age and married with no children. Tim has a diagnosis of Locked-in Syndrome following an ischaemic infarct which left him severely disabled. He has complex care needs and he is severely disabled with a tracheostomy and RIG feed which can be challenging. The ability for his wife to provide round the clock care was demanding and Tim’s care was transferred to a specialist nurse-led in-patient neurological rehabilitation unit following hospital discharge. He is non-verbal and communicates with eye movement. His mobility, the environment, and communication were some of the key factors that affected Tim’s care delivery.

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“A structured plan is an essential foundation for the delivery of safe and effective care”. Bruce et al explain that philosophies guides practice and are a vital component to both the nurses and patients. A nurses’ philosophy influences and guide their practice, and focuses on the actions, attitudes, values, ethical behavior, aspirations, and hope of the nurses (REF). This will determine how they respond to situations and individuals. The concept of nursing philosophy is also underpinned by the knowledge that includes aesthetics, ethics, empirics and personal and critical thinking. The defining attributes are respecting, and tailoring care aligned with the values needs practices and expectations of the patient, delivering unbiased, respectful, compassionate and ethical care, and understanding. 

According to Henderson (1991 cited in) remarked “the nurse who sees herself as reinforcing the patient when he lacks will, knowledge, or strength will make an effort to know him, understand him, “get inside his skin…”’. In the same way, to apply this assertion to Tim’s care, the relevance to his care would involve giving him choices, informed consent to treatment or care despite his inability to verbally communicate. The nurse too should be skilled in her approach to communication and importantly uphold the fundamental principles of beneficence, justice, non-maleficence, and autonomy.

The philosophical approach used during Tim’s care was person-centred care. This approach looks at the person behind the condition and works around the individual’s needs and focuses on knowing the person through interpersonal relationships. Barnsteiner (2014) asserts that care offered should satisfy the needs and wishes of the individual and based on principles of respect, choices, and empowerment, the involvement of the patient in policies, information, access, and support. To apply this philosophy in practice, the nurse must take a holistic approach and see the patient as a whole and not just another person with a life limiting illness. 

When looking after Tim, the nurse should listen to his, hopes, fears and unique experiences in order to offer individualized care tailored to his needs. This would also highlight Tim’s communicable needs give consideration to the fact that Tim is unable to verbally communicate, the nurse should try to connect with Tim at all levels and in all actions both verbally and no-verbally showing respect, patience and allowing time, this would give the nurse an opportunity to form a therapeutic and trusting relationship with him . 

Through developing this relationship, the nurse was able to identify other areas of concerns unique to Tim. This helped to create a care plan to meet his specific needs, the focus is maximising his quality of lie and maintaining his spasticity. Smith argues that nurses may encounter the challenges of practicing in a holistic, person-centred there may be c it is the flexibility of this approach that enhances and accelerates the change process for patients. Danny sates that when nurses respond to clients in relevant and meaningful ways at the time of need, change is more likely to occur.

The holistic care model provides nurses with an increased understanding of patients and their needs. The model also improves the quality of life of the patient including their emotional and physical well-being. In addition, the model equips the nurse to better understand the effects of an illness on a patient’s entire life and help to identify their true needs. However, a major limitation of holistic care is that nurses lack a good understanding of the meaning of holistic care and lack familiarity with the model, this may cause neglection of the use of the model. In addition, holistic care model can be affected by such factors as inadequate time, limited knowledge, inadequate clinical control, motivational and organisational factors.      

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