Myerscough ² Lynwood School of Veterinary Nursing
To define the terms:
Medical Model ² Nursing Model ² 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.
.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.
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.
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.´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.
.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 should be divided into four main stages
( Kratz 1989)
.Each stage of the nursing process is of equal importance. This is particularly important for the assessment stage as assessment forms the basis for the remainder of the nursing process. If we do not give adequate consideration to a stage it will be reflected in the quality of the next.
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
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
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 . For each actual and potential problem a goal must be set. Setting
goals must be part of the planning process.......
IMPLEMENTATION is the ´doingµ stage of the nursing care plan
plan is made of all the proposed nursing interventions needed to achieve the goals plan should be written in enough detail that any nurse reading it would know what the plan is.
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?
Re-evaluation then takes place by assessing the patient and the whole process begins again.
asking these questions we are effectively revising the nursing plan to address the issues that have become apparent during the evaluation.
before feeding smelly food
Clearing secretions stopped mouth breathing and improved oxygenation Continue regime
. ability to breath Clean 5 through its minutes nose.Nursing Assessment
Patient problem Actual / Potential
Patient mouth breathing due to cat flu
Poor oxygenation (A) Unable to eat and breath at the same time (A)
Improve Clear Oxygenation secretions from nose Improve ever 30 patients mins.
So as you can see. the nursing process offers a systematic approach to care. it advocates planning but does not say what form the care plan should take. it states that nurses should assess but does not tells them what to look for..
Angleton & Chalmers (2000)
.. 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...
This is where Nursing models come in . The values that they set out provide excellent consideration to a standardised and continuous quality of care..
. Nursing models are systematically constructed.. They provide a set of standards which guide nursing actions. logically developed and have scientific foundations which consider a framework for nursing the whole patient.
Roper Logan & Tierney (RLT Model)
Orem Model Of Nursing
²Dependence-Independence continuum. ²The patients life span. ²Individuality in Living. ²Factors influencing the Activities of Living.
model has 5 main parts :
Maintaining a safe environment Communiicatiion Breathiing Eating & drinking Elimination Personal cleansing & dressing(grooming) Controlling body temperature Mobilising Working & playing Expressing sexuality Sleeping Dying
Where the patient is on the life span and all the associations that naturally occur with each given life span should always be considered.Each animal has a natural life span from birth to death.
.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.
. Biological. Environmental. Socio-cultural.
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.
How we need to look to support the patient and owner. Orem also considers support modalities i. Totally Partially Educative / supportive
.e. those which are developmental and those which are specific to the patients condition.Activities of living are called ´SELF CARE REQUISITESµ divided into those which are universal.
Hampshire Forshaw K. Logan & Tierney Model of Nursing. University of Bristol. Routledge. The Roper. Churchill Livingstone. Dissertation project. 2003 The application of a conventional nursing model in veterinary practice. Roper.Ballierre Tyndall. London
.References Aggleton & Chalmers 2nd Edition 2000. McKenna 2000. London. Edinburgh Walsh 1997 Models and Critical Pathways in Clinical nursing: Conceptual Frameworks for Care Plans. Logan & Tierney 2000.A. Nursing Theories & Models. Nursing Models & Nursing Practice. Palgrave.