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Approach TO Nursing Care Essay
The nursing process is a tool that puts knowledge into practice. By utilizing this systematic problem-solving method, nurses can determine the health care needs of an individual and provide personalized care.
Write a paper (1,750-2,000 words) on cancer and approach to care based on the utilization of the nursing process. Include the following in your paper:Approach TO Nursing Care Essay
Describe the diagnosis and staging of cancer.
Describe at least three complications of cancer, the side effects of treatment, and methods to lessen physical and psychological effects.
Discuss what factors contribute to the yearly incidence and mortality rates of various cancers in Americans.
Explain how the American Cancer Society (ACS) might provide education and support. What ACS services would you recommend and why?
Explain how the nursing process is utilized to provide safe and effective care for cancer patients across the life span. Your explanation should include each of the five phases and demonstrate the delivery of holistic and patient-focused care.
Discuss how undergraduate education in liberal arts and science studies contributes to the foundation of nursing knowledge and prepares nurses to work with patients utilizing the nursing process. Consider mathematics, social and physical sciences, and science studies as an interdisciplinary research area.
You are required to cite to a minimum of four sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and relevant to nursing practice.Approach TO Nursing Care Essay
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.
This benchmark assignment assesses the following programmatic competencies:Approach TO Nursing Care Essay
2.1: Incorporate liberal arts and science studies into nursing knowledge.
3.1 Utilize the nursing process to provide safe and effective care for patients across the life span.
Contemporary nursing practice is a diverse and challenging field. Nurses are increasingly involved in complex decision-making as their roles expand in the health system (Cherry and Jacob, 2016). Underlying any care decision is the need to identify the source of the problem and then to develop a suitable approach to addressing this problem. To assist in decision-making, it is recommended that nurses adopt frameworks or models of problem-solving and care planning (Johansen and O’Brien, 2016). The assessment, planning, implementing and evaluating approach, also known as APIE (Yura and Walsh, 1967), is a commonly used approach to care planning in nursing practice. This approach encourages a systematic and rigorous approach to patient care, incorporating a holistic perspective of the care process. The aim of this paper is to evaluate the individual components of the APIE and the approach in its entirety with respect to nursing practice.Approach TO Nursing Care Essay
The first stage of the APIE is ‘assessing’, which entails a thorough analysis of the presenting complaint and the overall account of the individual patient (Hill, 2015). The assessing process is not a list of presenting problems, but a more systematic integration of quantitative and qualitative data. Quantitative data include the physiological status of the patient, including routine observations (temperature, weight, blood pressure, pulse) and more specific assessments, such as physical examination and interpretation of investigations (Lewis et al., 2016). While quantitative data alone can provide a clue as to the diagnosis of the patient, the holistic nature of nursing care demands consideration of subjective wellbeing and qualitative aspects of the patient, including ideas, expectations and concerns. These should be elicited to provide a basis for reassuring the patient or addressing emotional and psychological support needs early during the consultation (Hill, 2015).Approach TO Nursing Care Essay
The assessing process can be considered a fundamental part of patient care planning and forms the main data collection phase of the nurse-patient interaction (Lewis et al., 2016). Nurses use multiple techniques and approaches to collect data, including history taking, examination and ordering investigations, all of which may inform the decision-making process. Therefore, the initial stage of the APIE can be considered a valid approach to gathering data to inform care planning of the individual patient.
Only once a systematic and comprehensive assessment phase is complete is it possible to engage in effective care planning. Planning involves formulating suitable interventions and strategies to address the presenting problem, with consideration of the biological elements of the condition as well as the preferences of the patient (Doenges et al., 2016). Furthermore, care planning should include clear goal setting to ensure that the plan can be successfully implemented. These goals should be patient-centred, recordable, observable, directive, understandable, credible and time-related regarding available resources (Hayes and Llewellyn, 2010).Approach TO Nursing Care Essay
However, planning within the problem-solving APIE approach may be limited without consideration of additional models of nursing, including the activities of living model by Roper, Logan and Tierney (1985) and the self-care model of nursing by Orem (1985). These models provide a deeper context for applying the principles of the APIE, taking into account the necessity to generate patient-centred care planning and goals that are achievable and measurable with respect to the status of the patient (Flagg, 2015). Similarly, planning should take into consideration the ability of the patient to self-care, a crucial aspect of everyday function and wellbeing (Orem, 1985). Accordingly, nurses have a duty to support and promote patients in self-care activities and should facilitate these activities wherever possible as part of the care planning process.Approach TO Nursing Care Essay
Care plans should include highly structured and clear stages and steps that may be taken to achieving a specific goal, which may be followed by patients, nurses and other care professionals, as needed (Blais et al., 2006). Nurses may involve other members of the care team in decision-making at this point in order to maximise the potential benefits to the patient. Furthermore, a combination of personal experience and evidence-based guidance can be used to inform the optimal planning approach, suggesting that nurses need to apply critical thinking and a combination of intuition and guidelines in formulating appropriate care goals (Blais et al., 2006).Approach TO Nursing Care Essay
As with the planning phase, implementing appropriate care plans requires input not only from the nurse, but also the patient. Nurses need to ensure that the actions needed to address the patient’s needs are appropriate and practicable, including the direct delivery of interventions and referral of the patient to specialist care, as needed (Locke and Latham, 2013). However, the APIE approach focuses more precisely on the role of nurse-led interventions and overlooks the importance of supportive nursing roles during the implementation process.Approach TO Nursing Care Essay
In addition to nurse-led interventions, patients should be supported and educated to promote self-care (Wilkinson and Whitehead, 2009). Furthermore, careful consideration of available resources and support is needed to ensure that the care plan is suitable for the individual patient and their environment (e.g. hospital or community settings). Self-care ranges from the simple act of a patient managing their own medication to more complex processes, whereby patients are responsible for symptom identification and changes to lifestyle/behaviours. The Nursing and Midwifery Council (2018) publishes a code for nurses, which includes the role of the nurse in supporting self-care in a sensitive and compassionate manner. Therefore, to ensure adherence to practice standards and professional codes of conduct, the implementing process in the APIE scheme should balance the need for nurse-led therapies and strategies to promote individual wellbeing and empowerment in self-care.Approach TO Nursing Care Essay
Furthermore, the APIE problem-solving approach emphasizes the need for suitable implementation of a plan, but wider roles of nurse and the patient need to be considered to deliver personalised care. This includes the core components of respect and dignity of the patient, which should be preserved at all times, as well as the delivery of culturally-sensitive care (NMC, 2018). Indeed, nurses who are compassionate and considerate of other cultures and patient beliefs are more likely to develop strong therapeutic relationships, which have been shown to promote adherence to treatment plans and improve outcomes (Hagerty and Patusky, 2003).Approach TO Nursing Care Essay
The APIE approach culminates in an evaluation of the implementation of the care plan, which is essential in ensuring goals of care have been met, while allowing adjustment of the care plan where needs remain unmet. This evaluation process was initially conceptualised as a single assessment during patient follow-up or management review, but has developed into more extensive process of monitoring therapy and adjusting interventions over time (Barrett et al., 2014). Specific consideration needs to be made regarding the achievement of care goals and the suitability of these goals in future care episodes, based on patient factors and nurse factors.Approach TO Nursing Care Essay
However, the evaluation process is not simply a process of clinical review, but can be considered a core aspect of the overall professional development of the nurse and a key learning process (Barrett et al., 2014). Indeed, reflective practice is increasingly recognised as fundamental to the nursing profession, allowing practitioners to develop strengths and target weaknesses in patient care (Redmond, 2017). The evaluation process therefore allows practitioners to engage in personalized care planning for the patient as well as professional development based on reflection on the care delivered to date.Approach TO Nursing Care Essay
Extending and enhancing the APIE approach in practice
Although the APIE approach is a fundamental aspect of problem-solving in contemporary nursing practice, it is clear that the use of additional models and processes is essential to optimising care delivery for the individual patient. Furthermore, some authors have suggested that the APIE approach benefits from expansion of the terms and inclusion of additional areas (Hill, 2015). For instance, an extension of the APIE approach includes the use of further refinement stages and on-going follow-up of care planning, which are important additions to the problem-solving approach that recognise the importance of chronic disease management in contemporary practice.
In addition, some authors advocate the inclusion of a decision-making phase following assessing, which formalises the need to develop a plan based on all available evidence, both quantitative and qualitative (Lumbers, 2018). Achieving a suitable diagnosis also has the benefit of allowing clear communication of the nature of the planning phase across multiple professional groups and may provide the patient with guidance on their future care needs.Approach TO Nursing Care Essay
Indeed, the ASPIRE approach has largely replaced APIE and comprises assessing, systematic nursing diagnosis, planning, implementing, re-check and evaluation (Lumbers, 2018). This approach will be widely known to nurses and emphasizes the importance of a systematic approach to diagnosing and re-checking the implementation process prior to evaluation. Extensions of the APIE can be considered refinements that only serve to augment the basic structure of problem-solving inherent in the approach. Therefore, the APIE or ASPIRE approach remains a core element of clinical decision-making in contemporary nursing practice.
In summary, the APIE approach remains a commonly used and rationale approach to care planning in nursing practice. Each stage of the APIE is a justifiable component of the nursing process and can contribute to effective decision-making. However, the use of nursing models is often required to complement the APIE problem-solving approach, to ensure holistic wellbeing and a patient-centred approach to care. Therefore, the APIE can be considered a valuable tool in the context of wider nursing models to facilitate care planning and decision-making.Approach TO Nursing Care Essay
Whilst evidence can be classified in different ways, I suggest here that it is useful to make
distinctions between research and experiential evidence in the first instance and then within
research evidence to note that there are different research designs that affect the nature of
evidence presented. It may seem contentious to think of experience as a form of evidence, but in
practice it is frequently called upon as just that (e.g. Finlay, 2009; Beam et al, 2010). At its
weakest, groups of nurses develop a working impression of how patients cope, how care is
delivered and what consequences emerge if nursing is delivered in particular ways. In my
experience, nurses might refer to this as practice wisdom, a collective know how that seems to
work well with given groups of patients. Such evidence provides at best a first impression, and
overview of issues. It is enhanced where the nurse plans reflection and observation more
carefully, with reference to particular questions and focusing perhaps on case studies that allow
matters to be mapped and discussed (Leach, 2007). It increases stature, as evidence, to the
degree that information is gathered in a disciplined and organised way, and with a stated purpose
in mind. That experiential evidence is important in healthcare is important is illustrated by the
analysis of case studies in care and especially those associated with risk management (e.g.Approach TO Nursing Care Essay
Stewart, 2010). Nurses and others may analyse cases in some depth to establish what went
wrong, what was missed or misinterpreted, all with the aim of avoiding mistakes and of improving
performance in the future.
The more familiar form of evidence that most colleagues refer to when discussing evidence‐based
practice is that which emerges from research (Barker, 2009). Research produces evidence
precisely because of the disciplined way in which enquiries are arranged and the efforts made to
gather data that attend to the aims, questions or hypotheses of the research project. Designs are
influential here. Research that has been designed within the positivist tradition works assiduously
to remove the risk of researcher bias and to gather sufficient data of the right type to make claims
about a population of people. There is an emphasis upon impartial enquiry, with the researcher
arranging checks by others such as critical reviewers to ensure that assumptions are not
prematurely made about what is found (Grix, 2004).
Other research is conducted within the naturalistic or interpretive tradition (e.g. phenomenology,
grounded theory, some forms of ethnography) and here the work proceeds differently. The
researcher argues that it is more important to conduct work that is authentic to healthcare, than
to conduct a study that has excluding all possible forms of bias (Silverman, 2004). The goal of such
research is often to help others portray their experience of health, illness or care and to help
nurses understand what patients and others might need or hope for (Brotchie et al, 2010). The
researcher might suggest that it is impossible to completely disassociate themselves from
perspectives or views that could shape the line of enquiry. A third research design may be
described as critical theory (Swartz, 1997). The researcher starts with acknowledged goals to
correct inequalities in health or care and to make a case for the disadvantaged. Feminist research
for example acknowledges that the researcher will not stand dispassionately aside when
deliberating on what needs to be discovered or how evidence might support a case for change.Approach TO Nursing Care Essay
Sometimes naturalistic and critical theory research is grouped together as ‘qualitative research’
because they often produce qualitative data and in contrast to the quantitative data that
sometimes emerges from positivist research (Green and Thorogood, 2009).
What seems significant in this overview of different research designs, is that there is no
universally agreed goal of research, nor is the evidence produced all of one sort. Researchers
adopt different roles depending on the design of research used. In positivist research the role of
the researcher is typically described as dispassionate and they proceed to gather information
from outside the experience of others (it is described as ‘etic’). In naturalistic and critical theory
research the researcher often approaches their subject much more closely, intimately, for
example observing and interviewing as a participant in the situation explored (it is described as
‘emic’) (Brotchie et al, 2010). To gather authentic data the researcher permits themselves to
become involved in proceedings, to use their own experience as part of the process of
interpreting what has been witnessed. These distinctions are important if the nurse is not to use
research evidence inappropriately, as something that was never intended by the researcher,
making claims that are unsupportable. The evaluating nurse needs to understand the research
design as well as the research evidence on offer.
Evidence and practice fit
It is tempting to argue that one sort of evidence (positivist) is superior to all others and that it is
upon that which nursing should be based. This is attractive where nurses wish to highlight nursing
as a science and where precision is a key consideration in care. It is extremely attractive where
the nurse has to manage risk and defend actions, especially if litigation is a consideration. Nursing
though draws upon many different sorts of evidence and this is in large part because the nurse
works with others to make sense of health and illness (Aveyard and Sharp, 2009). If the nurse
helps the patient to decide what chronic illness means to them, and to devise coping strategies
that seem manageable, they are working to help others manage uncertainty. There can be no
single gold standard solution, because patients’ circumstances and needs are different and very
individual. It follows then that research which attends to this process, of making sense of what
has happened and what might help now is also valuable. Such research is more speculative in
nature, more tentative as regards what can be proven or claimed. Nursing then may require both
‘hard’ and ‘soft’ evidence, the first concerned with what works, what is safe and beneficial and
the second associated with process, how it feels or what it means to recover or rehabilitate for
example.Approach TO Nursing Care Essay
Proctor and Rosen (2004) describe a stepwise process for finding and evaluating research that
might contribute to evidence‐based practice (see Table 1). Importantly, the purpose of the
evaluation needs to be understood first. What outcomes is the nurse most interested in? It is
necessary to review that research which fits clearly with the identified nursing need, and for
Proctor and Rosen (2004) this is largely about demonstrating tangible improvements in care
(outcomes). In Step 2 the nurse selects from the evidence reviewed the best fitting intervention,
that which achieves the desirable outcome. In Step 3 the nurse supplements or modifies the
intervention, drawing upon their experience and knowledge. This third step can seem
contentious, but it is important where research was conducted in different contexts to the
practice considered, or where the research evidence available is incomplete or perhaps
contradictory. In Step 4 the nurse monitors and evaluates the changed practice, to make sure that
the desirable outcome is sustained.
Table 1: Developing evidence‐based practice guidelines and a nursing illustration (adapted from
Proctor and Rosen, 2004)
Step 1: Locate evidence‐based interventions
relevant to the outcomes of interest.
The nurse is interested in helping patients to
manage their asthma better. Three
interventions are located within the research
literature, one associated with group teaching,
another with the use of video training and a
third linked to coaching.Approach TO Nursing Care Essay
Step 2: Select the best fitting intervention in
view of client problems, situation and
The nurse selects the intervention that
produces the required outcome (patient
independence) and which also is affordable and
realisable given the time and expertise
available. In this example it might be group
Step 3: Supplement/modify the best
intervention, using nurse experience and
knowledge so that it fits with practice context.
Group teaching is cost effective but demanding
on the skills of the nurse, so to make this work
more easily, a teacher guidance pack is
produced, one that will lead to consistent and
well organised teaching sessions.
Step 4: Monitor and evaluate the effectiveness
of the outcome.
Over the next year the nurse monitors patients’
levels of self care and the incidence of
readmissions to hospital for asthma crises.
Expressed confidence and lower incidence of
hospital readmission are seen as indictors of
In Table 1 it is possible to imagine positivist research being used in association with Step 2 (the sort
of research that focuses upon cause and effect relationships), whilst naturalistic and possibly critical
theory research might have a part to play in Step 3. For instance, there would be a case to consider
research relating to patient experience (of asthma education) alongside that which suggested the
best way to proceed if independent living was the goal. The role of experiential evidence is much
less clear in the Proctor and Rosen (2004) approach and for some colleagues it might be seen to not
have a role at all. Nevertheless, experience of particular patients, their needs and level of
confidence, the skills of staff (in this instance as patient educators) could and perhaps should factor
in determining which intervention is used. Coaching for example requires considerable skills and
long term commitment, something that might seem less feasible here.Approach TO Nursing Care Essay
As different evidence is found, there is a need for the nurse to judge its merits (Aveyard and Sharp,
2009). Just how the evidence is judged is associated with the design of the research, or in the case of
experience, the process by which it was gathered, collated and discussed. In positivist research
judgement focuses upon the authority of the design and this is judged using three questions. First,
was the research ethical—can we reasonably draw upon this evidence? Second, whether the
research was reliable—if the study was done again, would we be likely to obtain the same or very
similar results? Third, whether the research was valid—did it ask the right questions, attend to the
correct study population and secure a viable sample? In short, did the research methods help the
researcher secure enough of the relevant information to meet the aims of the study, to answer the
questions or permit the review of hypotheses stated? Where information of this kind is missing from
the research report, or the design arrangements seem ambiguous, doubts are raised about the
validity and/or the reliability of findings. Approach TO Nursing Care Essay