Figure 3.1 Planning care using the nursing process and nursing models
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The nursing process
Nursing has a theoretical base that has many elements including physiology, psychology, pathology, pharmacology and sociology. To deliver quality care to patients that is focused, safe and organized, it needs to be planned. Documenting the plan of care for a patient and its implementation ensures continuity of care and provides a legal document demonstrating that care has been delivered. Care can be organized using the nursing process and nursing models can help focus care to meet the specific needs of patients.
What is nursing theory?
Nursing theory is the cognitive knowledge and understanding that is used by practitioners to help them deliver the best possible care based on best evidence. Nursing theory is partly drawn from a range of interconnected subjects from the arts and sciences that can be applied to the practice of nursing (Colley 2003). This knowledge comes from experiential learning and research and is part of the rich tradition linked to the development of nursing. The importance of children’s and young people’s nurses delivering care that is underpinned by evidence-based theory is perhaps reflected in Nightingale’s famous pronouncement articulated in her notes for nursing ‘Children: they are affected by the same things [as adults] but much more quickly and seriously’ (Nightingale 1859: 72).
There are several models that are commonly used in the nursing of sick children and young people (Table 3.1). The most common are ‘activities of daily living models’ which include Henderson (1978), Roper, Logan and Tierney (1983) and Orem (Aggleton and Chalmers 2000). Additionally, a further model is applied to the care of sick children and can be used in conjunction with other models that were essentially designed for adults. Casey’s (2007) model for children’s nursing is all about partnership and has become standard practice in UK children’s units. The central premise of these activities of daily living models is that normally people maintain their own functions in these areas but in times of illness these may be compromised and require support from health care professionals. In the case of children, some activities of daily living such as keeping the body clean may be compromised simply by developmental age. This is why children’s nurses have adopted Casey’s theoretical framework based on the notion of partnership and in turn on the philosophy of children’s nursing and the notion of the indivisible family unit where parents or carers provide essential care until the child is mature enough to do it themselves. Orem’s model is sometimes called the self-care model and is orientated towards restoring an individual to a health status where self-care is possible. It is particularly useful in rehabilitation settings (e.g. after childhood head injury).
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