NURSING CARE PLAN

Marianne greefhorts
Senior lecturer of NHL university of applied science Netherland
Lecture 1. The care plan.
Literature: Manual of nursing diagnosis by Marjory Gordon, Handbook of nursing Diagnosis
by Lynda Juall Carpenito-Moyet, Nursing, concept of practice by Dorothea E. Orem
Part A:
1. View, theory and model.
A view is what can be seen in a range of vision. View may also be used as a synonym of
point of view. Based on a view you write down observations, make choices and perform.
Out of a view a Theory can rise and develop.
Theory can be defined as an internally consistent group of relational statements
( concepts, definitions and propositions) that present a systematic view about a
phenomenon and which is useful for description, explanation, prediction and control.
Nursing theories can be used to describe, develop, circulate and use present knowledge in
nursing. Nursing theories can provide a framework for nurses to systematize their nursing
actions and get a wider view about the patient. Question that can be answered by a theory
are: what to ask, what to observe, what to focus and what to consider.
Theory based practice can provide better care for patients. The already existing theories
provide information to develop new theories and look critical to the current knowledge.
Nursing theories help to describe, explain, predict and prescribe.
For example: describe properties of a nurse. Explain how the properties are related and
how nurses functions. The predictive theory predicts what the outcome
might/could/should be the prescriptive theory does an appeal to nursing therapeutics
And the consequences of interventions.
Nursing models are constructed by theories and views. They include methods to help
nurses assess, plan and implement ;patient care by a framework that shows how to give
appropriate patient care. It draws a line how to give uniformity and consistent care .
Models can be used to crate a care plan. It gives structure and leads to systematic thinking
and purposeful working.
Dorothea Orem:
The Orem Model is based upon the philosophy that all patients wish to care for
themselves. According to Orem, care is the same as professional assistance to people with
a deficiency in their self care. Through this deficiency in self care human beings can not
be responsible to take care for themselves.
Self care is under different circumstances and in different stages of life to take care
Of yourself and / of your own environment.

Orem assumes a humanistic approach. She mentions that care has to do with activities..
These activities are based on the idea how people react on their own care needs. These
care needs have a purpose. They are for every human being different and contribute each
of them to a healthy life. Besides self care Orem describes the derivative of self care. We
know this as family care.
Orem describes self care requisites and classified them as:
- Universal self care requisites, the needs that relate to development of the individual.
For example: need of air, water and food.

Developmental self care requisites, those needs that relate to development of the
individual in their stage of life.
Health deviation requisites, the needs that arise as a result of a patients condition. For
example: how to deal and manage with my handicap.

Orem finds it important that nurses speak the same language. Without a language nursing
is invisible. She developed 11 functional health patterns. The patterns are relevant across
cultures, nursing specialism, age groups and levels of acuity. Individuals, families and
communities can be assessed and problems and strengths identified.
There are 11 functional health patterns. They can be divided in
- Health seeking behaviour
Definition: Active seeking ( by a person in stable health) of ways to alter personal health
habits and/or the environment to move to a higher level of health.
- Inability to identify basic health practices, manage own health, or seek help to
maintain health.
The 11 functional health patterns are:
1. Health-Perception-Health-Management Pattern
Describes the clients perceived pattern of health and well being and how health is
managed. Includes the individuals perception of health status and its relevance to current
activities and future planning. Also includes the individuals health risk management and
general health care behaviour, such as safety practices and adherence to mental and
physical health promotion activities, medical or nursing prescriptions and follow up care.
2. Nutritional-Metabolic pattern
Describes pattern of food and fluid consumption relative to metabolic need and pattern
indicators of local nutrient supply. Includes the individuals pattern of food and fluid
consumption: daily eating times, the type and quantity of food and fluids consumed,
particular food preferences, and the use of nutrient or vitamin supplements. Describes
breastfeeding and infant feeding patterns. Includes reports of any skin lesions, ability to
heal and measures of body temperature, height and weight. General appearance of well
being and condition of skin, hair, nails, mucous membranes and teeth are included.
3. Elimination Pattern
Describes patterns of excretory function ( bowel, bladder and skin)

Includes the individuals perceived regularity of excretory function, use of routines of

laxatives for bowel elimination and any changes of disturbances in time pattern, mode of
excretion, quality, or quantity of elimination. Also included are any devices used to
control excretion.
4. Activity-exercise Pattern
Describes patterns of exercise, activity, leisure and recreation. Includes activities of daily
living requiring energy expenditure, such as hygiene. Cooking, shopping, eating, working
and home maintenance. Also included are the type, quantity and quality of exercise,
including sports, that describe the typical pattern for the individual. Leisure patterns are
also included and describe the activities the client undertakes as recreation either with a
group or as an individual. Emphasis is on the activities of high importance or significance
and any limitations. Factors that interfere with desired or expected activities for the
individual ( such as neuromuscular deficits and compensations, dyspnea, angina, or
muscle cramping on exertion, and cardiac/pulmonary classification if appropriate) are
included.
5. Sleep-Rest Pattern
Describes patters of sleep, rest and relaxation. Includes patters of sleep, rest and relaxation
during the 24 hour-day. Includes the perception of quantity and quality of sleep and rest,
perception of energy level after sleep, and any sleep disturbances. Also includes are aids to
sleep such as medication or night time routines that the individual uses.
6. Cognitive-Perceptual Pattern
Describes sensory-perceptual and cognitive pattern. Includes the adequacy of sensory
modes, such as vision, hearing, taste, touch and smell, and the compensation of prostheses
currently used. Reports of pain perception and how pain is managed are included when
appropriate. Also included are cognitive functional abilities such as language, memory,
judgement and decision making.
7. Self-Perception-Self-Concept Pattern
Describes self concept pattern and perceptions of mood state. Includes the individuals
attitude about self perception of abilities ( cognitive, affective or physical body image,
identity general sense of worth and general emotional pattern. Body posture and
movement, eye contact, voice and speech pattern are included.
8. Role-Relationship Pattern
Describes patterns of role engagements and relationships. Includes the individuals
perception of the major roles and responsibilities in current life situation. Satisfaction or
disturbances in family, work or social relationships and responsibilities related to these
roles are included.
9. Sexuality-Reproductive Pattern
Describes patterns of satisfaction or dissatisfaction with sexuality; describes reproduction
pattern. Includes the individuals perceived satisfaction or reports of disturbances in his or
her sexuality. Includes is also the females reproductive stage. ( pre menopause or post
menopause.

10. Coping-Stress-Tolerance Pattern

Describes general coping pattern and effectiveness of the pattern in terms of stress tolerance. Includes the individuals reserve of capacity to resist challenge to self integrity
modes of handling stress, family or other support systems, and perceived ability to manage stressful situations.
11. Value-Belief Pattern.
Describes patterns of values, goals, beliefs ( including spiritual) that guide choices or
decisions. Includes what is perceived as important in life, quality of life and any perceived
conflicts in values, beliefs or expectations that are health related.
Orem developed The Manual of Nursing Diagnosis. The diagnosis are approved by
NANDA international.( North American nursing diagnosis association)
Workshop:
Functional health patterns.
Describe the health patterns of one of your patents.
Lecture 2. The patient care plan
Part B
Field: Care
Role: nursing professional
Director
Tasks related to the profession.
a. Patient related tasks:
1. Decides what care is needed (based on the functional health patterns of Gordon)
2. Planning of the nursing care.
3. realisation of the nursing care.
4. evaluation of the nursing care.
8 steps in the nursing process:
1. Collecting valid en relevant information ( significance of data, evaluation of data)
2. Nursing Diagnosis ( based on PES. Problems, Etiology or related factors, Signs and
Symptoms.
3. prognosis decision ( in relation with age, sex, medical problems)
4. Nursing Outcome criteria ( based on RUMBA criteria)
5. Nursing intervention criteria
6. Nursing interventions
7. Evaluation of the results
8. stop -------modification
b. professional related tasks:
1. improvement of own profession
2. quality in nursing
3. professional status of the profession of the nurse
9. Organisation related tasks:
a. management of the institute and organisation unit

b. span of control
c. teamwork

The difference between care and cure.

Care: the domain that the nurse is responsible for
Cure: the domain within the nurse works together with other professionals.
RUMBA means:
- Realistic
- Understandable
- Measurable
- Acceptable

Workshop: start of the patient file. History of the patient.

Background, family, school, relations, health and health problems.
Treatment of other professionals.