Subject: Re;Social Model for Care
From: [email-masked] (Monica King, R.N.)
Date: 15 Aug 1994 15:09:21 GMT
Newsgroups: alt.activism,alt.agriculture.fruit,alt.california,alt.christnet

The following was sent to two listserves I am on- one on interfaith
healing
practices and one for graduate nurses.  It might be a way to look at
things
in the future... peace.

>To: [email-masked], [email-masked]

Hi Lynda,
   My husband James and I were just sitting at our kitchen table having
an
early morning "pow-wow" talking about the introduction of TQM or Total
Quality Management concepts in Boston area institutions of higher
education
and how these initial attempts at integrating academic training with
real
world or business needs were going.  The concept of applying business
management techniques ala Deming et. al. is the subject of a brief
working
paper James had brought home, where the concepts of pleasing the
consumer of
a service or product is applied to institutes of higher education.
   James and I are both products of Bostonian academia, I from Simmons
and
Harvard, he from Harvard.   Both have theological training. However one
great
strength I have brought to our current life together at Dartmouth is
the
excellent management and administrative process I learned in the 70s at
Simmons we all had hoped would revolutionize charting and empower
nursing as
an autonomous discipline, but which seems to be lost in obscurity these
days.
  The process I refer to is the nursing process which developed
tangentially
with the problem-oriented record.  My instructors at the time were most
enthused by this and I never forgot it.  I internalized the process and
found
applications beyond the traditional med-surg settings where it was, at
the
time being introduced, along with community health settings.
   I brushed it off again after a visit two years ago with James to
South
Africa where we were invited as a part of a team from foundations
across the
country looking into reivesting there once DeKlerk declared Apartheid
officially abolished.  I was there to exchange wisdom with South
African
nurses and other NGO professionals struggling at grass roots levels
with the
same problems of poverty, racism, and inadequate educational
opportunities
for the vast numbers of black South Africans living on hope and
prayers. 
     I think it may have relevance to many of us struggling not simply
to
help sick individuals, but who can see it more broadly as a process to
identify and solve problems within sick organizations which create
sickness. 
How is that for a leap?  I send this to you now as a stimulus for
innovators
who might see a similarity between Deming's "Plan, do, check, act"
cycle with
an even more comprehensive cycle; the nursing process which tells us
HOW to
plan- the first three steps outlined in the reprint below;  think about
it-
WE sisters and brothers of the healing arts are the true pioneers and
forerunners of the TQM or Wellness movement- we've been doing it all
along. 
Let's become broader in vision and apply it to  our organizations which
generate iatrogenic illnesses and needless lawsuits over inadequate and
compassionless care.  We can and DO make a difference 24 hours every
day. 
Let us take the leadership now...
Monica King, R.N.
 29 Rope Ferry Rd.
Hanover, N.H. 03755
603-643-1493
Monica [email-masked]                    October 13, 1992  
Nursing Process: An Ordered Thought  Process

	   Nursing is one of the oldest professions known to humankind.  In
the
last one hundred years it has undergone an evolution of such depth and
scope
it is truly amazing, transforming herself from a vocation primarily
characterized by apprenticeship to a distinct and separate 'ministry'
which
spans from informal mentorship in "on the ground" settings of home and
street
to the highest halls of academe where nurses in the U.S. can earn
doctorates.  
    It is safe to say nursing has evolved to its  most advanced level
in the
U.S. where women dedicated to their profession and mission have carved
out
departments and chairs in Universities across the nation.  In my
initial tour
of Southern Africa I have discovered the beginnings of doctoral work in
South
African institutes of Higher educaation, but as yet this is no doctoral
program in Zimbabwe.
	  One of the significant contributions advanced nurse practitioners
and theorists have contributed this century is the Nursing Process.  It
is an
ordered way of setting about problem solving using scientific and
artististic
skills to bring about health and or alleviate a painful condition in an
individual or group.  Nursing process is designed to be used in Problem
Oriented Records where the emphasis is on problems identified by the
client
or consumer of health care, and when properly used, facilitates
collaborative
partnership and focus on the part of the health care team which
includes
physicians, nurses, P.T., O.T., Nutrition, etc. 
	 Post exchange mission I thought it may be helpful to our team as way
of speaking a common language and using a holistic process which once
employed is very easy to apply concretely in a variety of settings,
areas of
management, and community development.  This is it:

Problem or Challenge to be Met-This is usually elicited from the client
in an
interview.  It may be general or very specific.  It is helpful
sometimes to
define in broad strokes problems, then break them down into component
parts
and apply nursing process to each specific challenge or problem.  Write
it
down first.  You can make a list.  Then, apply;
Nursing Process Thought or SOAPIE:

Subjective- What does the client or consumer of your service say about
the
challenge?  Usually in our notes we write direct quotes here. A
sentence or
two will suffice.

Objective-What other hard facts can you gather regarding this challenge
or
problem?  An example in general practice is a set of vital signs eg.
pulse,
respirations, temp. etc. In applying it holistically this set of data
could
be statistics, demographic data, or any other objective set of facts
that has
been gathered by an impartial source.  The key here is objective- what
information can you gather from factual and dispassionate sources?

Assessment-What do you think is going on, based on the two sets of data
collected?  What is your educated hunch?  The medical correlation to
this of
course is the medical diagnosis.  We also have an extensive set of
nursing
diagnoses which can be made at this juncture.  They are usually phrased
in
terms of basic alterations in normal healthy function, eg. "level of
comfort;
alteration in due to post-op pain"...

Plan-Your the clinician, what are you going to DO about it?  Nurses may
involve other disciplines here, or employ basic nursing measures to
help
regain homeostasis in the client.  The plan may be as simple as
offering
Tylenol or as complex as building a new model for health care delivery
which
is universal and problem-oriented and collaborative rather than
competitive,
profit-seeking, and heirarchically male-dominated.

Intervention- What you did do about it.  This is actually the
documentation
of your clinical care.  You gave the Tylenol, the back rub, the
presentation
to convince others of your vision etc.

Evaluation-  This again is collaborative.  Yes, you need to evaluate
whether
it worked or not, and you need to ask the client the same question. 
This is
a very important and oft neglected part of the process.  We can not
maintain
a course toward health unless we ask our clients if our interventions
were
effective.  Based on evaluations, we can go back to any part of the
process
and reassess using the same or different tools, intervene with
different
strategies etc.  Our plan and intervention may have been very
successful, and
because of this another new set of very different challenges and
problems
present themselves.  Nursing process may again be applied to the new
list. 
It is cyclical and ongoing.  It never wears out.  Try it- you may like
it!

Nursing process is easy to remember.  Think clean, think SOAP, then
lather it
up and you've got SOAPIE!
I hope you find this useful in your work.
                Sincerely and with love,
                                  Monica        

              

The Course in Miracles is the only required Course in Life- the Course
in Miracles.     Snail mail inquiries may be addressed to INEDA, P.O.
Box 932, Hanover, N.H. 03755.  INEDA- International Nursing Exchange
and Development Agency