NURSING MODELS

AND CARE
PLANNING

Myerscough – Lynwood
School of
Veterinary Nursing

Lisa Mulcock
 AIMS OF THE PRESENTATION
To define the terms:

 – Medical Model
 – Nursing Model
 – Nursing Process
 To explain these terms in the context of
veterinary nursing and how the use of
nursing models and the nursing process
can shape our practice through care
planning.
WHAT IS A MEDICAL MODEL?

According to a medical model a patient is a

complex set of anatomical parts and
physiological systems
(Aggleton & Chalmers 2000)

A medical model emphasises anatomical,

physiological and biochemical malfunction as
the causes of ill health and in doing so
creates a disease orientated patient
approach.
 MOVING AWAY FROM THE
MEDICAL MODEL

It was the dissatisfaction with the medical

model in human care practice that lead to
the development of the nursing theories and
models.

In addition nurses felt that it was not a correct

focus for a nursing discipline.
&
It did not support professional recognition.
 WHAT IS A MODEL FROM A
NURSING CONTEXT?
“It is a mental or diagrammatic
representation of care which is
systematically constructed and which
assists practitioners in organising their
thinking about what they do, and in
the transfer of their thinking into
practice for the benefit of the client and
the profession’’ Crucially the focus of which is nursing
practice.

McKenna (1994)
WHAT WILL NURSING MODELS
ENABLE US TO DO?

Deliver care to our patients using a

systematic approach of assessing,,
planning ,implementing and evaluating
patient care (The nursing process)

Produce a unique body of veterinary

nursing knowledge which is evidence
based rather than that's because its
what we've always done!
 THE NURSING PROCESS

The nursing process should be divided into four

main stages

Assessment
Planning

Evaluation
Implementation
THE NURSING PROCESS CONTD.

Each stage of the nursing process is of equal

importance. If we do not give adequate
consideration to a stage it will be reflected
in the quality of the next.

This is particularly important for the

assessment stage as assessment forms the
basis for the remainder of the nursing
process. ( Kratz 1989)
 STAGE 1: ASSESSMENT
 A nursing care plan can only be as good as the
information on which it is based.
 It will set the scene for nursing the patient as a
whole and as an individual
 Collect information through communication
 Write down the information
 Start to consider both actual and potential
problems
 Identify priorities

Remember:
Wrong info = wrong/inadequate action
 PLANNING
 To solve actual identified problems
 To prevent identified potential problems
becoming actual ones
 To alleviate any problems which cannot be
rectified
 To help the patient and the owner to cope
positively with those problems which cannot
be solved or alleviated
 To prevent recurrence of a treated problem
 To maintain comfort and dignity when death
is inevitable
 SETTING GOALS
 Setting goals must be part of the planning
process.
 For each actual and potential problem a goal
must be set.
 A distinction should be made between short
term and long term goals
 Goals should be looked at as outcomes which
are able to be observed, measured or tested
so that the evaluation stage can be achieved
...........
 THE NURSING PLAN
 A plan is made of all the proposed nursing
interventions needed to achieve the goals

 The plan should be written in enough detail

that any nurse reading it would know what
the plan is.

IMPLEMENTATION is the “doing” stage of the

nursing care plan
 EVALUATION
 A crucial phase of the process
 It is the element which tests the effectiveness
of your planning and implementation
 Have your goals been partially achieved or is
more information needed to decide the next
step?
 Is the problem unchanged and should the
nursing intervention be changed or stopped
 Is there a worsening off the problem and should
the goal and nursing intervention be reviewed?
 Was the initial goal un-realistic?
 Does a new goal require additional resources?
 A CONTINUING PROCESS

 By asking these questions we are effectively

revising the nursing plan to address the
issues that have become apparent during the
evaluation.

 Re-evaluation then takes place by assessing

the patient and the whole process begins
again.
 Nursing Patient Nursing Nursing Evaluation
Assessment problem Goal Actions
Actual /
Potential

Patient Poor Improve Clear Clearing

mouth oxygenation Oxygenation secretions secretions
breathing (A) from nose stopped
due to cat Unable to Improve ever 30 mouth
flu eat and patients mins. breathing
breath at ability to and
the same breath Clean 5 improved
time (A) through its minutes oxygenation
nose. before Continue
feeding regime
smelly food
 THE NURSING PROCESS
 So as you can see,, the nursing process offers a
systematic approach to care.

But ...
 it states that nurses should assess but does not tells
them what to look for.
 it advocates planning but does not say what form the
care plan should take.
 it talks of intervention but does not specify what
might be appropriate interventions
 it call's for evaluation without specifying the
standards against which comparisons should be
made..
Angleton & Chalmers (2000)
 NURSING MODELS
This is where Nursing models come in ...

They provide a set of standards which guide

nursing actions. Nursing models are
systematically constructed, logically developed
and have scientific foundations which consider
a framework for nursing the whole patient.

The values that they set out provide excellent

consideration to a standardised and continuous
quality of care.
 MODELS OF NURSING

Roper Orem
Logan & Tierney Model
Of Nursing
(RLT Model)
 THE RLT MODEL
 The model has 5 main parts :

 –Activities of Living.
 –The patients life span.
 –Dependence-Independence continuum.
 –Factors influencing the Activities of Living.
 –Individuality in Living.
 ACTIVITIES OF LIVING
 Maintaining a safe environment
 Communiicatiion
 Breathiing
 Eating & drinking
 Elimination
 Personal cleansing & dressing(grooming)
 Controlling body temperature
 Mobilising
 Working & playing
 Expressing sexuality
 Sleeping
 Dying
 LIFE SPAN

Each animal has a natural life span from birth

to death.

Where the patient is on the life span and all

the associations that naturally occur with
each given life span should always be
considered.
 DEPENDENCE / INDEPENDENCE
CONTINUUM

Closely related to the life span

It acknowledges that there are times as part of a

natural life span when a patient will not be able
to perform some of the activities of living
independently. This should be looked at for each
activity of living.

Visual plotting of where the patient is on a scale of

dependence / independence should be carried
out.
 FACTORS WHICH INFLUENCE
ACTIVITIES OF LIVING
 Biological.

 Psychological.

 Socio-cultural.

 Environmental.

 Politico-economic
 INDIVIDUALITY IN LIVING
 The Activities of Living are the main concept
off this model and although every patient is
likely to carry out these activities each
patient may do them differently therefore
expressing themselves as an individual..#

 For example, the way in which a cat will eat

may be very different from a dog..
 OREM - THE VARIATIONS
Activities of living are called “SELF CARE
REQUISITES” divided into those which are
universal, those which are developmental
and those which are specific to the patients
condition.
Orem also considers support modalities i.e.
How we need to look to support the patient
and owner;
 Totally
 Partially
 Educative / supportive
 REFERENCES
 References Aggleton & Chalmers 2nd Edition
2000. Nursing Models & Nursing Practice.
Palgrave, Hampshire
 Forshaw K.A. 2003 The application of a
conventional nursing model in veterinary practice.
Dissertation project, University of Bristol.
 McKenna 2000. Nursing Theories & Models.
Routledge, London.
 Roper, Logan & Tierney 2000. The Roper, Logan &
Tierney Model of Nursing. Churchill Livingstone,
Edinburgh
 Walsh 1997 Models and Critical Pathways in
Clinical nursing: Conceptual Frameworks for Care
Plans.Ballierre Tyndall, London