Since she was dealing with shell shocked soldiers of the war, she implemented “formal and informal group therapy sessions with soldier casualties” (Callaway, 2002) By the later 1950’s psychoanalytic principles became the core curriculum study for the training of nurses. Peplau’s commitment to re- applying the psychoanalytic procedure of treatment, in the training of nurses cannot go unnoticed because she was emphatic that the principles of psychotherapy not only influenced but greatly complimented the procedure of nursing.
According to Peplau, “The idea of milieu as therapeutic environment, as it became popular during the 1950s and 1960s, gave recognition to the idea that the nurse-patient interactions within the milieu could be beneficial to patients”. [Peplau, 1989, p. 78]. She also stated that, “It would seem that there are many theoretically orientated nurses who, with knowledge, skill and a computer, could now address this complex task, providing insight and direction. ” [Peplau, 1989, p. 78]. The Best Model in Health Care:
In days gone by, the nursing fraternity and patient care was based only on the traditional model where the patient was looked upon as a machine having different parts. If any of these parts did not function properly or if it had broken down, it was repaired by following a fixed path with knowledge as the base. This traditional model laid emphasis only on the physical aspect of the human being where the patient had to listen to the 7 doctor and follow his instructions only. The patient had no part to play what – so – ever in the outcome of his illness.
This method however is rather out dated and with the advancement in both Science and technology linked with research by great scientists, better methods have revolutionized the field of medicine. In lieu of this, the Florence Nightingale Method would lean a great deal towards the traditional method and hence is outdated for the fact that it doesn’t suit the changing times. On the other hand, Peplau’s Method with a psychoanalytical approach using interpersonal relationships does cater partially to modern health care and definitely has good scope for better patient outcomes than the traditional method.
When analyzing the Roper – Logan – Tierney Model we come to realize that the different aspects of the patient, as well as patient care, were taken into consideration. This model is best suited because it takes care of the different health care needs while utilizing a holistic approach. This method is patient – centered, in that it allows the patient to take an active part in the treatment of his own illness. Therefore I would choose this model for the treatment of my patient since it has much wider scope for better patient outcomes while building good relationships.
Theorists: Carper’s Theory: According to theorist Carper, the nurse can come to understand how Carper (1978) identified knowing in nursing. For this, he used a prism through which he passed a shaft 8 of light. Though it was a single shaft of light, the nurse could see a rainbow of colors separating out. Carper (1978) used this example to explain how she saw knowledge within nursing. In this way, Carper (1978) identified empiric, aesthetic, personal and ethical knowing.
“None of these patterns are absolute” (Carper, 1978; Silva et al, 1995), and “none of these patterns were exhaustive of other patterns of knowing that are present or becoming visible to nurses as time moves on” (Carper, 1978; Silva et al, 1995). Benner and Wrubel’s Theory: Benner and Wrubel (1989) both describe “knowing how” as practical knowledge, and it is this knowledge of the nurse that is expressed via “… bodily intentionality and the habitual, skilled body” (Benner and Wrubel, 1989: 411). Such knowledge need not be in opposition to theoretical knowledge.
Benner’s (1984) theory is based on the “Novice to Expert” framework which describes that a gap exists between theory and practice when the nurse is a novice. As the nurse progresses through her learning and experience, she reduces this “gap” as she integrates her theory and practice. “At the expert level, where the practice and theory become a hybrid of practical and theoretical knowledge”… ((Benner, 1984; Pryjmachuk, 1996), the expert uses this integrated knowledge in different situations of health care. 9 Organization of care:
The success of any Medical or Health care Centre depends solely on the organization of its care and other facilities offered. Therefore it is vital that the organization of care plays a major role in extending its services. In organizing nursing care, the patient is assured of being taken good care which will in turn result in a more better and speedy recovery. Besides health care, one of the major public service areas is Social Care where the patient depends on a social worker or other social help groups for support either financially or otherwise.
Currently, modernizing Social services has become a national priority and many organizations have come forward to lend support to the public by helping them to achieve the minimum conditions for living in dignity. For example “Care International UK and DFID Programs help the poor and marginalized people to realize their rights, responsibilities and aspirations by supporting their efforts and encouraging them to take control of their lives. (Care International, March 2006)
The UK forum for Hospice and Palliative Care is a network of both individuals and organizations based in UK, who work in tandem with each other to develop hospice and palliative care around the world where the resource settings are poor. In addition they develop and promote the sharing of information and experience and influence Government and policy makers to include hospice and palliative care in their health policies especially in resource poor countries.
(UK Forum for Hospice and Palliative Care Worldwide) 10 Skill Mix: Skill mix is basically the amount of knowledge and skill an individual or health care team employs in their day to day work in order to maximize the effectiveness and efficiency in health care. It also refers to the different levels of expertise needed to manage the care of patients. Determining staff levels, workloads and dependency of patients have significant implications which all go to determine the numbers and skill mix of nurses.
The Department of Health has introduced a comprehensive review of skill mix and staffing methodologies through the Nursing Quality Research Program to be utilized in general nursing care. The report on this research from the Nuffield institute at the University of Leeds gives us a comprehensive understanding on “Skill Mix Tools” and “Methodologies” in addition to providing valuable information on the advantages and disadvantages of each of them while indicating where each of them would be more useful in their daily practice.
It gives a detailed description and step by step instructions on how to use them. (Department of Health Website, UK, 17th January 2003) Mounting evidence has proved that higher the number of qualified nurses, the better is the patient outcomes. But problems such as ward staffing, changing patterns in health care delivery and efficiency and effectiveness of staff in health care are issues that constantly keep cropping up. The four key elements that are needed to determine establishment and skill mix are – Competency, Dependency which includes workload, volume of patients and length of stay.