Using the Emma Gee case study presented throughout the unit develop a discussion on how strengths-based nursing and healthcare could be implemented for Emma at any point of her journey, or across the whole of her journey (hypothetically as if Emma was to experience her healthcare journey again).

Your discussion should:

• provide an overview of how strengths-based nursing could be implemented in Emma’s nursing care to address healthcare needs raised in Emma’s case study (specifically identify which healthcare need you are addressing using evidence from Reinventing Emma),
• select at least one critical transition point (maximum three) in Emma’s journey (e.g. immediate post surgical care while Emma was unconscious, nursing care following Emma regaining consciousness, admission to rehabilitation, discharge planning from rehabilitation or ongoing community care) and present a strengths-based nursing care plan for Emma that includes a family focus and collaboration with Emma, her family and other healthcare professionals involved in Emma’s care,
• demonstrate a holistic approach,
• reflect on Emma’s experience summarising the difference between the actual healthcare experience Emma received and the nursing care practices and outcomes you would expect from implementing strengths-based nursing care complementing the medical model focus,
• make your conclusion on how SBN can help achieve patient and family empowerment, health promotion and partnerships in healthcare in Australia.

Assessment 3. ‘What is a strengths-based care plan and how can I include one in my case study?’

The focus of this topic is to help you with including in your discussion “a strengths-based (nursing) care plan for Emma that includes a family focus and collaboration with Emma, her family and other healthcare professionals involved in Emma’s care”

The conversation recorded below is based on a discussion post 2017 7:28 PM. This resource has been developed in collaboration with Jade.

Jade

Hi Linds,

I am researching the concept of a care plan for Emma in my essay. I have only ever seen a one-page document in the front of a bedside chart, with some columns. The things listed in this “care plan” are things like “to assist ADL” and “soft diet.” There was definitely no field for SBNC considerations.

My friend works in stroke rehab, and says there are weekly meetings including Medical staff and Nurse Unit Manager. Is this who would write the care plan? And would it have SBNC considerations in it? Is that something the “regular” ward nurses would have access to?

Linds

This is an excellent example of where Emma’s care is discussed by the multidisciplinary team. The specialty of rehabilitation services is at the forefront of this approach. Other staff that may be included in the meeting are the Speech Pathologist, Occupational Therapist, Art Therapist, Dietitian, Social Worker just to name a few.

Jade

I’m trying to conceptualise how such a care plan would be documented. And by whom. And where it would be. Are SBN care plans entered into the progress notes by a “regular” ward nurse?

Linds

The plan for care in response to identified issues and transition points, goals or predicted care needs is developed in the team meeting and then communicated to the various staff engaged with Emma. The means of communicating the plan for action and the style of documentation will differ depending on the facilities practices. The ‘older style’ of having a columned formal ‘care plan’ is not often seen in practice and what you may know of as a ‘nursing care plan’ is replaced by different means of communicating the agreed actions and goals of care.

Here is an excerpt from the Royal Children’s Hospital Melbourne Clinical Guidelines (Nursing) 2016, on how they plan and communicate care throughout their service:

Plan of Care

Taking into consideration the patient assessment, clinical handover, previous patient documentation and verbal communication with the patient and family the plan of care for the shift is made and documented on the Patient Care Plan. The plan should be negotiated with patients’ and their carers to ensure clear expectations of care, procedures, investigations and discharge, are set early in the shift. The plan of care should align with information on the patient journey board.

Real time Progress Notes
Documentation is captured in the patient’s progress notes in ‘real time’ throughout the shift instead of a single entry at the end of shift.
Any relevant clinical information is entered in a timely manner such as;
…

• Change in plan (Any alterations or omissions from plan of care on patient care plan) e.g.. Rest in bed, increase fluids, fasting, any clinical investigations (bloods, xray), mobilisation status, medication changes, infusions etc.
• Patient outcomes after interventions e.g.. Dressing changes, pain management, mobilisation, hygiene, overall improvements, responses to care etc.
• Family centred care e.g.. Parent level of understanding, education outcomes, participation in care, child-family interactions, welfare issues, visiting arrangements etc…

Progress note entries should include nursing content and evidence of critical thinking. That is, they should not simply list tasks or events but provide information about what occurred, consider why and include details of the impact and outcome for the particular patient and family involved.”

https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Nursing_documentation/#plan-of-care.

Jade

Can notes and plan of care be in the SOAP framework?

Linds

Great suggestion Jade. Documentation in the patient’s notes following SOAP framework is an example of how this important information is communicated to everyone involved in the care.
Interestingly, the Department of Health in Queensland (who recommend using AFSNA) recommend following SOAP and identify that:

“A number of (teams) have adopted the SOAP system for clinical documentation as follows:

S = subjective information
O = observation/objective information
A = assessment
P = plan.”

(Guidelines for allied health assistants documenting in health records, 2016, page (https://www.health.qld.gov.au/__data/assets/pdf_file/0029/144866/ahadocguide.pdf)

Following ISOBAR framework is another example, as recommended in the Royal Children’s Hospital Melbourne Clinical Guidelines (Nursing) cited above.

Jade

When the facility does not promote a strengths-based perspective, is this assignment asking how I (and only I) would use a SBNC approach with the family? How I would communicate this approach to care?

Linds

In your work Jade you can either follow a facility style if you have one you would like to use or you can demonstrate how you would care for Emma implementing a strengths-based perspective and how you could communicate this to the team. For nursing your example Jade of using a structured framework in the progress notes we discussed above is very appropriate.

Writing in the progress notes can include a Strengths-based perspective and this would be encouraged if the unit or facility adopted a strengths-based perspective. This way policy can guide practice. If the facility has not articulated a perspective to follow, then the individual can include a strengths-based perspective, which would encourage others to also embrace such an approach. Using the SOAP framework is an approach that lends itself to documenting a strengths-based approach.

Jade

Should I also include what allied health involvement I would refer Emma to? I think allied health assessments and interventions that are strengths-based is something I should work with as a nurse, and help engage her family in as well.

Linds

In a multidisciplinary team approach to care, we all should share with each other our professions perspective and actions. Different professional groups may keep separate notes that aren’t always readily available to the nursing or other staff at the bedside, but you’ll regularly see other staff reading the nursing progress notes before they engage with a client. Nursing practice should definitely continue with exercises or other activities recommended by other professions throughout the rest of the day with Emma. So finding way of communicating to each other is important and you can indicate how this may be achieved.

Thank you Jade for sharing your insights with me and allowing them to be shared with the whole group. You are demonstrating how to be thoughtful and comprehensive with considering a nursing care plan for Emma. Your questions are very insightful and well researched.

Thank you for researching ‘current practice’ and then applying what you have discovered to the assignment task.

To summarise this conversation, for this section of the assignment work you can include either a ‘formal’ care plan document similar to one that you have, or might, see in practice. The background to this could be discussed in text and the document included as an appendix. Or you can write up a brief outline of actions that you individually would include in your care or Emma along the lines of an entry that would be included in the progress notes for Emma using the framework that you know or have seen in PEP.

Jade

Thank you for your thorough reply Lindsay. Those two options seem practical. Glad I’m on the right track!

I think I may go with a more formal care plan, because I can then include multidisciplinary suggestions (such as the Speech Therapist recommending Emma’s throat to be stroked while eating to assist with Dysphagia) – which a nurse can then encourage/educate family to assist with (should Emma be OK with that, and if family want to), and monitor/evaluate the effectiveness.

Would that be OK?

Linds

A great approach Jade. One that highlights

• the multidisciplinary team approach,
• a specific transition point in the Emma Gee case i.e. re-training of the swallowing reflexes,
• collaborative engagement with the family i.e. think family approach, and
• person centred approach discussing intervention with Emma and receiving her implicit consent;

that all help to build strong relationships in practice.

I found this excerpt below from a letter to an editor interesting, as it mentions that some stroke survivors may experience

“swallowing dysfunction but no speech impediment,…that a speech pathologist (may) not be consulted, and the patient may be unnecessarily consigned to permanent…(inappropriate treatment)…— but in some of those patients, it can be restored by retraining.”

http://www.cmaj.ca/content/170/7/1079.1.full