- To explore what constitutes high quality care.
- To discuss the nursing process and the core principles of nursing that lay the foundations for good care provision.
- To highlight the findings from the Francis Report which relate to the way nurses are expected to provide care.
- To discuss the reasons for writing care plans; whilst exploring what constitutes a good care plan.
- To explore the role of the named-nurse in the delivery of care.
WHAT IS HIGH QUALITY CARE?
According to King’s College London (2008) there are “six core elements” which, when combined and followed will directly lead to the delivery of “high quality nursing care”, which means “a good experience for patients”. They are as follows:
- Taking a patient-centred and holistic approach to meeting physical, mental and emotional needs.
- Efficiency and effectiveness combined with humanity and compassion.
- Practice to be evidence-based.
- Nursing interventions to be carried out safely and promptly.
- Empowerment, support and advocacy for patients.
- Effective teamwork with other healthcare professionals.
UNCONDITIONAL POSITIVE REGARD
Who first coined this term and in what year?
In the seminal work of Rogers (1956) this concept first appeared and rapidly gained momentum as a set of values that would later help to form the bedrock of modern nursing philosophy.
It is a simple notion; the view that all patients should be treated in a non-discriminatory and fair manner, irrespective of their background, personality or other individual traits. The quality of care should not be adversely affected by the way a patient behaves or presents, even if their conduct presents challenges; the successful application of this notion to the delivery of care will reduce the likelihood of unfair or poor quality care.
PRINCIPLES OF NURSING PRACTICE
The Royal College of Nursing (2018) outlines some core principles of nursing practice, which if followed correctly can be a useful guide to aid nurses in ensuring that the care they provide is both “safe and effective”; these include the following:
- Treating everyone with “dignity and humanity”, respecting all people equally.
- Nurses to take responsibility for the care they provide.
- Nurses to “manage risk” and “keep everyone safe”.
- Promote patient-centred care which includes the patient, their families and carers in decision making processes which relate to their care and treatment.
- Communicate effectively whilst maintaining accurate records and documentation. Patient information to be handled “sensitively and confidentially”. Any complaints to be dealt with effectively and any concerns to be reported (this includes safeguarding).
- Maintain “up-to-date knowledge and skills”.
- Nursing staff to “work closely” with healthcare professionals of other disciplines to coordinate care and treatment.
- Nurses to lead by example whilst seeking to develop themselves professionally and act as a role-model and mentor to others.
GUIDANCE FROM THE NMC
The Nursing & Midwifery Council (2018) provide clear and simple guidance on how to provide good care; some of their expectations are as follows:
- Nurses will keep patients safe and listen to them.
- Nurses must show kindness and respect.
- Nurses must assist patients in making choices about their own care.
- Nurses will respect the privacy and confidentiality of their patients.
- Nurses will provide information to their patients in a way which they will be able to understand.
- Nurses must keep patients safe and prevent them from being harmed.
- Nurses will be honest and raise any concerns if they are worried about safety.
- Nurses will help their patients to access the care they need.
THE NURSING PROCESS
What are the four stages of the nursing process?
The nursing process is a cyclical process which can be broken down into four stages.
(Hayes and Llewellyn, 2010).
THE FRANCIS REPORT
After the severe failings of Mid-Staffordshire Hospital in providing safe care for their patients and the dire consequences of these failings, including the deaths of patients, a public inquiry was commissioned; evidence collected during the inquiry indicated that nurses had failed to make “adequate or proper” care plans based on thorough nursing assessments (The Francis Report, 2013a, 1.186).
Care plans provide a means of protecting the patient from the risks of inappropriate treatment by providing specified guidance on how to meet the needs of the individual (The Francis Report, 2013b, 11.46). Through the proper and correct process of assessment, planning, implementation and evaluation of care nurses can avoid the pitfalls associated with poor care delivery and minimise the risk of bad outcomes for patients.
WHY DO WE CARE PLAN?
- To act on assessment and identified needs.
- To inform patients and carers of what can be expected.
- To ensure consistency and safety of care.
- To identify interventions aimed at promoting independence and supporting/empowering the patient in having a fulfilled and meaningful life.
- To identify who is responsible for interventions and when they should be delivered.
- To identify the strengths and weaknesses of the patient.
- To identify what can be realistically achieved.
(Howatson-Jones et al., 2015)
WHAT MAKES A GOOD CARE PLAN?
- Include patient, their carer and/or their family in the care planning process, as well as other healthcare professionals.
- Individualised and patient-specific interventions.
- Care plans should be readily accessible and visible to those involved in the provision of care.
- Jargon-free and written in language which will not alienate other professionals or the patient and their carer and/or family (where possible).
(Simpson et al., 2016)
WRITING A CARE PLAN
What are the three headings under which nursing care plans are usually written?
Nursing care plans are usually written under three different headings or areas; the first describes the “problem”, the next details the “goal”, and the final one explains any “interventions” which can be used in order to meet the desired outcomes. Once a care plan has been written, it must be evaluated regularly and changed accordingly, in order to ensure that it continues to meet the needs of that patient (Barry, 2002).
According to the University of Lincoln (2010) it is also useful to consider the following acronym when writing care plans:
Can you guess what each letter of the acronym stands for?
- S – specific
- M – measurable
- A – achievable
- R – realistic
- T – time limited.
ROLE OF THE NAMED-NURSE
The main purpose of the named nurse is to co-ordinate the delivery of nursing care for the patient from the first point of contact to the point of discharge; therefore, patients are able to identify one nurse who is consistently and specifically responsible for their overall nursing care. This provides the named nurse with the opportunity to “maximise the therapeutic value of the nurse-patient relationship” and increase levels of trust and nurse-patient collaboration, whilst also developing an extensive knowledge and understanding of that patient (North East London NHS Foundation Trust, 2008).