Eating Too Much Meat Will Kill You Essay

Bill Cosby once stated, â€Å"Did you ever see the customers in health-food stores? They are pale, skinny people who look half dead. In a steak house, you see robust, ruddy people. They’re dying, of course, but they look terrific.† On average, Americans consume about 8 oz. of meat a day, twice the amount as the rest of the world; about one-sixth of the total meat consumed, U.S being less than one-twentieth of the population. Meat is generally delicious, contains rich sources of proteins and minerals. Some nutritional diet programs like the Atkins Diet have linked certain types of meat-based diets to weight loss. On the contrary, eating too much meat has been linked to certain type of cancers, high cholesterol and an increased risk of contracting a foodborne illness. Americans need to recognize that diets high in meat increases the cancer risk and other health issues. Evidence suggested that consuming meat could damage the body. In a country known for its love for hambur gers and steak, consumers need to cut down on their meat for a healthy life. Consumers also need to understand grilling meat increase the risk of cancer. Part of the solution is eating healthy, but consumers also should be aware of what they’re eating. The big issue in America is quantity. Eating meat and fast-food meat on a daily basis for seven days a week, 365 days a year, is a big reason why the risk for cancer and other health diseases is dangerously high in U.S. United States slaughters more than 10 billion land animals every year (Freston 802), and the market research firm Packed Facts stated Americans spends 142 billion dollar on beef, chicken, pork, lamb at market retails. Eating too much red meat has been linked to increased risk of death from cancer and heart disease, according to a study from American Cancer Society, the more red meat you eat will increase the risk for cancer. A Journal published by the American Medical Association reported a 20-year study of nearly 149,000 adults between the ages of 50 and 74. Researchers examine the risk according to how much red meat, poultry, or fish the people had eaten. Researchers looked at how many people develop colon cancer after the study. The results were 30% to 40% are more likely to develop cancer in the lower part of the colon. People who ate the most processed meats were 50% more likely to develop colon cancer (Parish 6). Eating just three ounces meat a day increases the consumer’s chance of dying by 13 percent, and 20 percent increase if eating processed meat, like bacon and hot dogs. But it doesn’t mean we should completely cut out meat in our diet; these statistics demonstrates that the less meat you eat, the better. Consuming meat damages the body. According to Dr. Oz, from the Dr. Oz Show, eating a steak dinner can take two to three days to get out of your intestines (par. 3). Red meat takes more than 24 hours to completely digest. In the mean time, it is in your intestine rotting at 98 degrees, sending toxins through the body. Eating any food that does not completely digest will ruin your health. What happens is that the human stomach acids are not made to break meat down efficiently because of its high fat and protein contents. The body lacks the enzymes that digest proteins in the stomach. Protein digestion mainly takes place in the first section of the small intestines where the pancreas secretes the types of digestive enzymes to help break down nutrients into energy and allow the nutrients molecules enter the bloodstream. Hence, meat takes longer as it has to pass into the stomach and the intestines, opposed to carbohydrates, which are broken down easily by saliva and the stomach. Although red meat is digestible than any other food sources such as rice and vegetable, it remains in the digestive system for a longer period of time, leaving the meat to rot in your intestines. Dr Klein believes that animal protein is the primary cause for the inflammation of the intestines because meat rots in your stomach (4). It explains why eating animal protein for a long period of time can increase the risk of colon cancer. Also the kidneys work to remove excess protein from your body. Eating too much protein can stress out the kidney, leading to kidney damage. Grilling meat is a method that most people are familiar with. Grilling is part of American culture; it brings family and friends together for the holidays like Independence Day. Grilling is a method of cooking food hot and fast on your grill. Burgers, poultry, beef, seafood are typically grilled. Grilling is actually a much healthier option than frying food because it is low fat and you can grill food without adding oil on them. But unfortunately, grilling food may potentially introduce the risk for cancer. Those juicy hamburgers, especially the charred ones contains cancer causing chemical called carcinogen. When you grill meat, some of the fat drips down to the charcoal or flame and the smoke carry the carcinogen known heterocyclic amines (HCA ) and polycyclic armomatic hydrocarbons (PAH) to form. These compounds have been shown to affect our DNA and might cause cancer. PAH is the same smoke from forest fires, coal burning, car exhaust and smoking. Exposure to high amounts of PAH is dangerous to your health and long term exposure increase the risk of cancer. According to 2007 study in Epidemiology, women with high intakes of grilled, barbecued or smoked meats over their lifetime had a 74 percent chance of developing breast cancer (373). It is also important to not that these women has low intake of fruits and vegetables. Most people are not aware of the carcinogen when they are grilling the meat. But let’s face it, grilled meat taste good and people should not give up on their grass fed steak or burgers from the grill. There are couple ways to grill safely and reducing carcinogen. 1. Marinating meats for at least several hours that contains herb and spices can dramatically reduce HCA. Herbs/spices is highly potent antioxidant that helps prevent HCA formation. 2. Pre-cook the meat in either the oven or microwave and finish it on the grill to decrease the amount of the carcinogen. 3. Pick leaner cuts like skinless chicken, lean beef or pork; it decreases the fat from dripping down on the open flame. It also important to remember that well-done meat has a higher concentration of carcinogen. Medium-rare, or medium cook is healthier choice than well done. These tips to reduce and prevent carcinogen is a safe way to consume grilled meat, but what about restaurants that serves grilled meats? Unfortunately, the meat holds carcinogens. Study shows restaurant meat such as burgers, ribs, and chicken carry substantial amounts of carcinogen. Few years ago, KFC calls their new Grilled Chicken â€Å"the better-for-you chicken for health- conscious customers.† But a PCRM a test shows the grilled chicken contains a high level of carcinogen (Sullivan 12). Consumers eating grilled chicken from popular restaurant chains are exposed to substantial level of carcinogen. A study published in Nutrition and Cancers show that an independent laboratory examined one hundred samples from seven popular restaurants, and Phip, a carcinogen, was found in all the samples (33). These findings clearly show that eating grill chicken can potentially cause cancer. Consumers deserve to know what they’re eating is just as worse as a greasy high-fat fried chicken. It misleads consumers to think grilled chicken is healthy diet but in actuality a grilled chicken salad can increase the risk of breast cancer, prostate cancer, and other dangerous health disease. If that the case, shouldn’t the government or chain restaurant provide warning labels on their product? Since Tobacco Company labels their pack with a warning that cigarette causes cancer; restauran ts serving cancer-causing meat should do the same. When parents cook chicken for their children, they try to be health conscious. If people knew there were high levels of carcinogens in their grilled chicken, they may not choose it as a healthy alternative. Meat is part of American culture; Western men often forge a strong link between eating meat and masculinity. Eating too much meat is a common problem in American Society. I believe most Americans don’t realize that they’re eating too much meat. When comparing the size of the burger we’re eating today to the past decades, our burger has gotten bigger. Bacon is a big part of American culture today. It brings child-hood memories of how mothers cooked bacon for their children. It is also a common breakfast food and is often associated with family gatherings. But, eating bacon every single day of your life has life threatening repercussion to your health. Most processed meat like bacon or hot dogs contains sodium nitrate. Sodium nitrate is a food additive used in m any processed meats. It increases shelf life, gives any meat a fresh appearance, improves the smoky flavors of bacon, and slows the rate of the foul smell, and reduces bacteria (Kortboyer 5). It seems sodium nitrate is a great additive but it is widely regarded as a toxic ingredient. It is a highly carcinogenic chemical and once it enters the human digestive system; it release toxin to a number of internal organs including liver and pancreas. USDA tried to ban sodium nitrate in the 1970’s but was vetoed by food manufacturers who complained that they are trying to ban bacon from America and insisted the additive was safe. The sodium nitrate is found in almost every meat package. It’s listed right on processed meat products like bacon, turkey, hot dogs, and meats in canned soups. If it’s so dangerous, why does food manufactures use it? It sells more meat products because it makes the meat appear fresh and vibrant. Consumers are often influenced by the appearance of the meat, and sadly they will buy meat that looks fresh because of the additives, but in reality, the meat could be months old. A proven strategy to help combat sodium nitrates is to consume large doses of vitamin C and E before your meal. Another safe alternative is purchasing nitrite-free meat to reduce the exposure to sodium nitrate. But, meat without nitrates is prone to spoilage. I believe meat industry uses the saturated fat argument to distract consumers from real issues like cancer. Fruits with high saturated fat like coconut juice wont increase a person risk of cancer to jump up 50%. The real issue is what’s added to the meat during processing and packaging. While eating too much meat can be dangerous, the solution is to consume less. Meat is rich in protein and the body needs protein to maintain cellular tissue. Reducing meat intake benefits the bones. According to Dr. Campbell of Cornell University, animal sourced proteins extract more calcium from the bones, causing the bone to weaken (par. 4). Another good benefit of cutting back on meat is it that makes the consumer eat more nutritious foods. A study from American Journal of Clinical Nutrition reported that participants who were served a meal with less meat ate more vegetables (Rolls 916). Eating small portions of good quality meat can help curb meat cravings and will not jeopardize the health. Many health education websites like Meatless Mondays offer idea of cutting back on meat consumptions. Another healthy alternative is replacing meat with non-meat sources of protein. Small red beans, black beans, legumes, dairy products are all good source of protein. While fish and seafood are technically meats, they do not carry the same risks as red meat, chicken, and pork because they contain low saturated fat and cholesterol. Non-meat protein not only has low saturated fat and cholesterol, they contain healthy fats, vitamins and minerals the body needs. Besides, the average person only needs about eight grams of protein per 20 lbs of body weight. Make no mistake, Americans love eating meats. Meat is essential part of a healthy diet, but over consumption of meat will kill you. America spends hundred of billion dollars on meat and it’s no wonder why cancer is epidemic in United States. Meat is considered a luxury in other country’s, but meat in America is readily available anywhere and consumers need to learn self-restraint. Meat like hot dogs and bacon is part of American culture, but consumers need to understand that meat industry’s uses dangerous additives like sodium nitrate and eating it for a long period of time will have repercussion to your health. Strong evidence claims that not only the harmful sodium nitrate harms the body, but also eating meat in general will damage the body. There are other healthy options like non-meat protein. But the solution to the problem is consumers need to be aware of what they’re eating and learn self-restraint.

A needs orientated approach to care

This will be discussed in detail providing evidence of strengths and weaknesses of the model. The nursing process that will be discussed will be APIE which is assess, plan, implement and evaluate. A nursing process is a systematic approach which focuses on each patient as an individual ensuring that the patients holistic needs are taken into consideration. These include physical, social, psychological, cultural and environmental factors. . The nursing process is a problem solving framework for planning and delivering nursing care to patients and their families (Atkinson and Murray 1995). When used collaboratively the nursing model and the nursing process should provide a plan of care that considers the patient holistically rather than just focusing on their medical diagnosis (Moseby’s 2009). It will also discuss an example of a care plan done for a fictional patient and evaluate and discuss how the nursing plan and the nursing process have created a plan of care and how effect ive this was or was not. Care planning is a highly skilled process used in all healthcare settings which aims to ensure that the best possible care is given to each patient. The Nursing and Midwifery council state that care planning is only to be undertaken by qualified staff or by students under supervision. The Department of health (2009) says that â€Å"Personalized care planning is about addressing an individual’s full range of needs, taking into account their health, personal, social, economic, educational, mental health, ethinic and cultural background and circumstances† with the aim of returning the patient to their previous state before they became ill and were hospitalized considering all of these needs to provide patient centered care. It recognizes that there are other issues in addition to medical needs that can impact on a person’s total health and well being’.It provides a written record accessible to all health professionals where all nursing interventions can be d ocumented. Care planning is extremely important as it enables all staff involved in the care to have access to relevant information about the patients current medical problems and how this affecting them in relation to the 12 activities of living as well as any previous medical history. Barrett et al (2009) state that taking care of an individuals needs is a professional, legal and ethical requirement. There are many different nursing models all of which have strengths and weaknesses and its up to the nurse to choose the right one for individual patient, the model which is used will vary between different speciailties depending on which is more relevant to the patient and their illness and needs. Although a vast majority of hospitals now use pre-printed care plans it is important to remember that not all the questions on them will be relevant to all patients. An example of this would be that activity of breathing may not have any impact on a healthy young adult be would be a major f actor for an elderly man with COPD. There are four stages to the nursing process which are Assess, plan, implement and evaluate (APIE) but Barrett et al state that there should be six stages to include systematic nursing diagnosis and recheck (ASPIRE) as although they are included in the nursing process they are not separate stages and could be overlooked.(Barrett et al 2009). It is important that a nursing process is used and it is set out in a logical order, the way in that the nurse would think this helps minimize omissions or mistakes. Roper, Logan and Tierney model of nursing suggests that there are five interrelated concepts which need to be taken into consideration when planning and implementing care which are activities of living, lifespan, dependence/independence continuum, factors influencing activities of living and individuality in living (Roper, Logan and Tierney 2008). Assessment Assessment is fundamental to gaining all the information required about the patient in order to give the best possible care. â€Å"Assessment is extremely important because it provides the scientific basis for a complete nursing care plan† (Moseby’s 2009). The initial assessment untaken by nurses is to gather information regarding the patients needs but this is only the beginning of assessing as the holistic needs of the patient including physical, physiological, spiritual, social, economic and environmental needs to be taken into consideration in order to deliver appropriate individualized care (Roper, Logan and Tierney 2008). When using the 12 activities of living (ALs) for assessment it gives a list a basic information required but must not just be used as a list as the patient will respond better to questions asked in an informal manner and when just part of the general conversation. RLT (2008) state that although every AL is important some are more important than o ther and this can vary between patients. It is important for nurses to obtain appropriate information through both verbal and non-verbal conversation patients are more likely to give correct information but without jumping to conclusions or putting words into their mouths. ‘Assessment is the cornerstone on which a patients care is planned, implemented and evaluated (RLT 2008). â€Å"Poor or incomplete assessment subsequently leads to poor care planning and implementation of the care plan† (Sutcliffe 1990). Information can be gained from the patient, the patients family and friends as well as any health records (Peate I, 2010) During this process of gathering information it is important to find out what the patient can do as well as what they cant. , McCormack, Manley and Garbett (2004) state that gathering the information requires a certain kind of relationship between the nurse and the patient and nurses need to be able to communicate effectively in order to be able to build this relationship. A full assessment needs to consider how the patient was before they became ill or hospitalized in relation to their medical diagnosis as well as how the patient was dealing with it, how they are now, what is the change or difference if any, do they know what is causing the change, what if anything they are doing about it, do they have any resources now or have they have in the past to deal with the problem (barrett et al). RLT (2008) state that there are 5 factors that influence the 12 activities of living which are biological, psychological, sociocultural, environmental and politicoeconomic, these may not all hav e an effect on each patient but all need to be taken into consideration.The more information gained in the assessment process the easier the other steps will follow. RLT (2008) suggest that assessing is a continuous process and that further information will be obtained through observations and within the course of nursing the patient. At the end of the initial assessment the nurse should to identify the problems that the patient has. There are limitations to using a nursing process which are the 12 als are often used as a list as part of a core care plan and are not always individualized Walsh (1998) argues that the 12 activities of living may just be used as a list which could result in vital information being missed which could be detrimental to the patient. The Nursing and Midwifery Council (NMC 2008) states a nurse is personally and professionally accountable for actions and omissions in practice and any decisions made must always be justifiable. There are many benefits to using a nursing process it is patient centered and enables individualized care for each patient. It also gives patients input into their own care and gives them a greater sense of control it is outcome focused using subjective and objective information which helps and encourages evaluation of the care given. It also minimizes any errors and omissions. When I carried out the assessing stage on mabel I did this using the 12 activities of living as suggested by Roper et al (2008) but this was used too much like a checklist. I didn’t gather enough information in order to be able to do the best plan of care possible for her although I don’t feel this could have been detrimental to the care she received it needed more information than I had. I also found it difficult deciding which information should go where so I endened up repeating information in more than one of the 12 als, Which although this wouldn’t have made a difference to the planning of the care plan there was too much irrelevant information which could mean that it wasn’t read thoroughly just skimmed over as it would take too much time. As I am inexperienced in doing this I realized when writing the care plan that there were many questions that I didn’t ask so there where many parts that could not be filled in. I also didn’t gather e nough objective data for certain parts so I didn’t have any evidence that the care had worked or how effective it had been. This is where Barrett et al (2009) state that there should be a systematic nursing diagnosis where nurses establish a nursing diagnosis rather than just a medical diagnosis. This is where the holistic needs of a patient are taken into consideration. Although nursing diagnosis differs from a medical diagnosis the two do interlink but a nursing diagnosis considers the physical, psychological and spiritual aspects of the medical diagnosis and problems that may arise from these. Another part of the systematic nursing diagnosis is to provide baselines to state where the patients are at at the present time so that a needs statement can be written in conjunction with the patient in terminology that they can understand(Barrett et al 2009). Planning The next stage of the nursing process is planning this is where all the information gained in the assessment part to plan the care of the patient. The planning stage of the process is where achievable goals need to be made through discussion with care givers and the patient or the patients representative. These goals need to contain both subjective goals and objective goals in order for them to be measurable and evaluated. The plan of care is to solve the actual problems the patient has and to prevent potential problems from becoming actual ones. It also aims to help the patient cope with their illness in a positive way and to make them as comfortable and pain free as possible (RLT 2008). Planning needs to be totally individualized and patient centered they need to feel they have a voice and part of the team. The more information gathered in assessment the easier the plan of care will be. The main objective of a nursing plan is to ‘provide the information on which systematic, i ndividualized nursing can be based and individualized nursing can be based and implemented by any nurse’ (RLT 2008). Through a detailed individualized plan of care any nurse caring for a particular patient should be able to see exactly what is required of them as all the information will be recorded in the care plan. The NMC (2008) says that nursing interventions need to be specific for that particular patient, based on best evidence, measurable and achievable. There are many different criteria for setting goals just one of these is PRODUCT which stands for, Patient centered, recordable, observable and measurable, directive, understandable and clear, credible and time related. This is just meant as a way of helping nurses to set goals (Barrett et al 2009). When planning care a great emphasis needs to be based on the dependence/independence continuum which will have been established in the assessment phase. The care to be given will encourage the patient to get back to as rea sonably possible or as close to where they were on the continuum as they were before they were admitted to hospital. Planning also needs to take into account the resources available to implement the care as they need to ensure that the care they are planning is achievable and will not be compromised by lack of resources or a shortage of nursing staff (Roper et al 2008). When I did a plan of care for mabel it quickly became evident how inexperienced I was. I didn’t gather enough information in the assessing period to be able to do an effective plan of care. I also didn’t know how achievable the goals where as I wasn’t aware of how long they would take to improve or if they where achievable or not, I also found it difficult determine which problems were interrelated and as a result tried to link anxiety in with another problem when in fact it was a problem on its own. I was able to write the needs statements effectively that were not long but on a couple of these the influencing factors were missed out which would be necessary when providing holistic care. Planning care for a patient requires a great deal of knowledge in the chosen specialty which is why it must be carried out by a qualified member of staff or a student under supervision. Implementation Implementation is the next part of the nursing process and where all the goals which were set in the planning stage are put into motion and the goals can start to be achieved through nursing and medical interventions. The main component of the implementation stage is the delivery of the care to the patient. This is done with nursing staff, the multidisciplinary team members involved in the patients care such as doctor, dieticians and physiotherapists and the patient themselves in order for the patient to be able to return to how they were previously before they were admitted to hospital. The plan of care will be specific to the particular patient and will focus on the biopsychosocial aspects of the patient (Marriner 1983).Implementation provides great emphasis on individualized care which is why it is important to establish in the previous phases where they are on the dependence/independence continuum and what they are able to do now and what they were able to do before. Individualis ed care is associated with how the patient did things before such as how the person carries out the ALs and how often they carry these out. An example of this would be when carrying out the AL of personal cleansing and dressing to individualise the care it would be necessary to have determined in the assessing stage how the patient usually did this and how often it wouldn’t be individualized if in the care plan it was stated that they got a shower every morning if at home they only did this once a week. Core care plans may be used in certain situations this can provide a greater level of care as potential problems can be foreseen if related to a certain problem on the other hand it is also important not to standardize care as patients react differently to different illnesses and treatment. (Faulkner A, 2000). The NMC (2008) state that nurses are required to ‘Make the care of people your first concern, treating them as individuals and respecting their dignity’. In order to deal with certain problems or situations people often develop coping strategies which can be either adaptive or maladaptive. Adaptive coping strategies are usually helpful to the patient whereas maladaptive ones could be detrimental to their health such as smoking or drinking, the patient may feel this helps them to deal with a present situation but it is actually causing them harm. Patients need to be discouraged from using maladaptive coping strategies this could be done by introducing them to adaptive coping strategies and encouraging them to change their maladaptive ones into adaptive ones. Diamond (2008) states that there are also legal and ethical issues when it comes to implementing care as consent needs to be gained before any care is implemented and if this is not given the care cannot be given this will obviously have an effect on how effective the care has been when evaluating the care. The Nursing and Midwifery Council (NMC) state in section 3 of the code of c onduct ‘you must obtain consent before you give any treatment or care’ (2002). During the implementation of Mabel I found that although I was able to implement the care effectively I hadn’t recognized all of the nursing interventions needed to provide holistic care and I wasn’t fully aware of timescales of the planned care. I feel I also needed to research further into Mabel’s problems in order to gain the appropriate knowledge to provide the best care available as this would ensure that are the interventions are evidence based and best practice (NMC 2008). Barrett et el (2008) state that this is where recheck should take place which would enable the health care provider to establish how effective the plan of care is before the treatment ends this would enable them to re-evaluate the plan of care while the treatment is still ongoing and adjust the goals accordingly. Evaluation Evaluation is where the care that has been given can be assessed to evaluate the care given and whether it has worked or not. Chalmers (1986) describe that it is an ongoing and continuous process and also occurs at timed points in a formal setting. Roper et al (2000) say that evaluating care also provides a basis for ongoing assessment, planning and evaluation. There are two different parts to evaluation summative evaluation and formative evaluation. Formative evaluation is done with the patient taking into account whether they feel the care given has worked when done with consideration of the dependence/independence continuum information regarding the patients previous place on the dependence/independence continuum can be obtained from the patient, their friends and relatives as well as other health care professionals in the multidisciplinary team involved in the care of the patient. Summative evaluation is when the holistic view of the patient is taken into consideration how they feel about the treatment, whether they felt that the goals were achievable. It so where all the measureable data stated in the baselines and data received after this time are analyzed to show how effective or not the treatment has been. When evaluating care consideration needs to be given to the influencing factors such as biological factors as the bodies physical ability varies according to age the physical ability of an older person is generally less efficient, therefore therefore the plan of care needs to take this into consideration so that when the evaluation takes place it its hoped to have been effective. A nurse needs to evaluate her patient’s status regularly for some patients this will be just once a day but for others it will be much more frequent depending on their illness and healthcare status. RLT (2008) says that evaluation must be individual to the specific patient and not just a standard goal that is related to a specific problem. If goals haven’t been achieved then it is up to the nursing staff to determine why. Maybe the goals set weren’t measureable or achievable. Parsley and Corrigan (1999) say that if goals haven’t been measureable or achievable then new goals need t o be set. It could also be that the nursing interventions were not successful in which case new interventions should be set. Through my evaluation of Mabel it was evident that I did not require all the information to do a comprehensive plan of care. Although I did set baselines which meant I could compare data I wasn’t experienced enough to set goals to the correct timeframe I also didn’t obtain enough measureable information in certain problems to be fully able to assess how effective or ineffective the care had been. Had I had more experience I feel that the evaluation wouldn’t be a problem. Evaluation requires checking and rechecking in order to see the effectiveness of the care delivered. It requires knowledge and expertise to be able to effectively evaluate and amend the goals and interventions set as necessary. The whole care planning process took me a long time and I still was not very good at certain aspects of it. When setting goals a lot of detailed information is required in order for the plan of care to be effective so I can now understand why it is necessary for a trained member of staff to carry out the task. Conclusion This assignment has shown that when used together the nursing process and the nursing model provide a good basis to providing care. It sets out a systematic approach to providing care. Care needs to be set out in a way that both the nurse and the patient know exactly what is happening as well as any other health care professional in the multidisciplinary team providing care for the patient. It has also shown that involving patients in their care enables them to feel they are part of the team and are more likely to help themselves with their care. Reference list Sutcliffe E 1990, Reviewing the process progress. A critical review of literature on the nursing process. Senior Nurse, 10(a), 9-13. Applying the Roper-Logan-Tierney model in practice 2008 Elsevier ltd. Roper N, Logan W, Tierney J (2008) The Roper Logan Tierney model of nursing, Churchill Livingstone:London. Dimond, B. (2008) Legal Aspects of Nursing, 4th ed. Harlow: Pearson Education. Barrett D, Wilson B, Woolands A (2009) Care planning a guide for nurses: Pearson, Essex. Faulkner A (2000) Nursing The reflective approach to adult nursing. Stanley Thornes: Cheltenham. Peate I (2010) Nursing care and the activities of living 2nd ed. Wiley-Blackwell: West Sussex. Yura H, Walsh M (1983) The nursing process: Assessment, Planning, Implementing, Evaluating. Appleton Century: Crofts Norfolk. Cook S (1995) The merits of individualized measures within routine clinical practice. . http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_093359(2009) (29/04/11 Alfaro R (2002), Applying the nursing process: Promoting collaborative care 5th ed. Lippincott: London. Moseby’s Medical Dictionary (2009), 8th ed, Elsevier. http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Accountability/[Date Accessed 11/04/2011]. McCormack B, Manley K and Garbett R (2004) Practice Development in Nursing, Blackwell Publishing, Oxford. Atkinson L Murray E, (1995), Clinical guide to care planning, McGraw, Oxford. NMC (2002), The NMC code of professional conduct, Nursing and Midwifery Council Publications A needs orientated approach to care This will be discussed in detail providing evidence of strengths and weaknesses of the model. The nursing process that will be discussed will be APIE which is assess, plan, implement and evaluate. A nursing process is a systematic approach which focuses on each patient as an individual ensuring that the patients holistic needs are taken into consideration. These include physical, social, psychological, cultural and environmental factors. . The nursing process is a problem solving framework for planning and delivering nursing care to patients and their families (Atkinson and Murray 1995). When used collaboratively the nursing model and the nursing process should provide a plan of care that considers the patient holistically rather than just focusing on their medical diagnosis (Moseby’s 2009). It will also discuss an example of a care plan done for a fictional patient and evaluate and discuss how the nursing plan and the nursing process have created a plan of care and how effect ive this was or was not. Care planning is a highly skilled process used in all healthcare settings which aims to ensure that the best possible care is given to each patient. The Nursing and Midwifery council state that care planning is only to be undertaken by qualified staff or by students under supervision. The Department of health (2009) says that â€Å"Personalized care planning is about addressing an individual’s full range of needs, taking into account their health, personal, social, economic, educational, mental health, ethinic and cultural background and circumstances† with the aim of returning the patient to their previous state before they became ill and were hospitalized considering all of these needs to provide patient centered care. It recognizes that there are other issues in addition to medical needs that can impact on a person’s total health and well being’.It provides a written record accessible to all health professionals where all nursing interventions can be d ocumented. Care planning is extremely important as it enables all staff involved in the care to have access to relevant information about the patients current medical problems and how this affecting them in relation to the 12 activities of living as well as any previous medical history. Barrett et al (2009) state that taking care of an individuals needs is a professional, legal and ethical requirement. There are many different nursing models all of which have strengths and weaknesses and its up to the nurse to choose the right one for individual patient, the model which is used will vary between different speciailties depending on which is more relevant to the patient and their illness and needs. Although a vast majority of hospitals now use pre-printed care plans it is important to remember that not all the questions on them will be relevant to all patients. An example of this would be that activity of breathing may not have any impact on a healthy young adult be would be a major f actor for an elderly man with COPD. There are four stages to the nursing process which are Assess, plan, implement and evaluate (APIE) but Barrett et al state that there should be six stages to include systematic nursing diagnosis and recheck (ASPIRE) as although they are included in the nursing process they are not separate stages and could be overlooked.(Barrett et al 2009). It is important that a nursing process is used and it is set out in a logical order, the way in that the nurse would think this helps minimize omissions or mistakes. Roper, Logan and Tierney model of nursing suggests that there are five interrelated concepts which need to be taken into consideration when planning and implementing care which are activities of living, lifespan, dependence/independence continuum, factors influencing activities of living and individuality in living (Roper, Logan and Tierney 2008). Assessment Assessment is fundamental to gaining all the information required about the patient in order to give the best possible care. â€Å"Assessment is extremely important because it provides the scientific basis for a complete nursing care plan† (Moseby’s 2009). The initial assessment untaken by nurses is to gather information regarding the patients needs but this is only the beginning of assessing as the holistic needs of the patient including physical, physiological, spiritual, social, economic and environmental needs to be taken into consideration in order to deliver appropriate individualized care (Roper, Logan and Tierney 2008). When using the 12 activities of living (ALs) for assessment it gives a list a basic information required but must not just be used as a list as the patient will respond better to questions asked in an informal manner and when just part of the general conversation. RLT (2008) state that although every AL is important some are more important than o ther and this can vary between patients. It is important for nurses to obtain appropriate information through both verbal and non-verbal conversation patients are more likely to give correct information but without jumping to conclusions or putting words into their mouths. ‘Assessment is the cornerstone on which a patients care is planned, implemented and evaluated (RLT 2008). â€Å"Poor or incomplete assessment subsequently leads to poor care planning and implementation of the care plan† (Sutcliffe 1990). Information can be gained from the patient, the patients family and friends as well as any health records (Peate I, 2010) During this process of gathering information it is important to find out what the patient can do as well as what they cant. , McCormack, Manley and Garbett (2004) state that gathering the information requires a certain kind of relationship between the nurse and the patient and nurses need to be able to communicate effectively in order to be able to build this relationship. A full assessment needs to consider how the patient was before they became ill or hospitalized in relation to their medical diagnosis as well as how the patient was dealing with it, how they are now, what is the change or difference if any, do they know what is causing the change, what if anything they are doing about it, do they have any resources now or have they have in the past to deal with the problem (barrett et al). RLT (2008) state that there are 5 factors that influence the 12 activities of living which are biological, psychological, sociocultural, environmental and politicoeconomic, these may not all hav e an effect on each patient but all need to be taken into consideration.The more information gained in the assessment process the easier the other steps will follow. RLT (2008) suggest that assessing is a continuous process and that further information will be obtained through observations and within the course of nursing the patient. At the end of the initial assessment the nurse should to identify the problems that the patient has. There are limitations to using a nursing process which are the 12 als are often used as a list as part of a core care plan and are not always individualized Walsh (1998) argues that the 12 activities of living may just be used as a list which could result in vital information being missed which could be detrimental to the patient. The Nursing and Midwifery Council (NMC 2008) states a nurse is personally and professionally accountable for actions and omissions in practice and any decisions made must always be justifiable. There are many benefits to using a nursing process it is patient centered and enables individualized care for each patient. It also gives patients input into their own care and gives them a greater sense of control it is outcome focused using subjective and objective information which helps and encourages evaluation of the care given. It also minimizes any errors and omissions. When I carried out the assessing stage on mabel I did this using the 12 activities of living as suggested by Roper et al (2008) but this was used too much like a checklist. I didn’t gather enough information in order to be able to do the best plan of care possible for her although I don’t feel this could have been detrimental to the care she received it needed more information than I had. I also found it difficult deciding which information should go where so I endened up repeating information in more than one of the 12 als, Which although this wouldn’t have made a difference to the planning of the care plan there was too much irrelevant information which could mean that it wasn’t read thoroughly just skimmed over as it would take too much time. As I am inexperienced in doing this I realized when writing the care plan that there were many questions that I didn’t ask so there where many parts that could not be filled in. I also didn’t gather e nough objective data for certain parts so I didn’t have any evidence that the care had worked or how effective it had been. This is where Barrett et al (2009) state that there should be a systematic nursing diagnosis where nurses establish a nursing diagnosis rather than just a medical diagnosis. This is where the holistic needs of a patient are taken into consideration. Although nursing diagnosis differs from a medical diagnosis the two do interlink but a nursing diagnosis considers the physical, psychological and spiritual aspects of the medical diagnosis and problems that may arise from these. Another part of the systematic nursing diagnosis is to provide baselines to state where the patients are at at the present time so that a needs statement can be written in conjunction with the patient in terminology that they can understand(Barrett et al 2009). Planning The next stage of the nursing process is planning this is where all the information gained in the assessment part to plan the care of the patient. The planning stage of the process is where achievable goals need to be made through discussion with care givers and the patient or the patients representative. These goals need to contain both subjective goals and objective goals in order for them to be measurable and evaluated. The plan of care is to solve the actual problems the patient has and to prevent potential problems from becoming actual ones. It also aims to help the patient cope with their illness in a positive way and to make them as comfortable and pain free as possible (RLT 2008). Planning needs to be totally individualized and patient centered they need to feel they have a voice and part of the team. The more information gathered in assessment the easier the plan of care will be. The main objective of a nursing plan is to ‘provide the information on which systematic, i ndividualized nursing can be based and individualized nursing can be based and implemented by any nurse’ (RLT 2008). Through a detailed individualized plan of care any nurse caring for a particular patient should be able to see exactly what is required of them as all the information will be recorded in the care plan. The NMC (2008) says that nursing interventions need to be specific for that particular patient, based on best evidence, measurable and achievable. There are many different criteria for setting goals just one of these is PRODUCT which stands for, Patient centered, recordable, observable and measurable, directive, understandable and clear, credible and time related. This is just meant as a way of helping nurses to set goals (Barrett et al 2009). When planning care a great emphasis needs to be based on the dependence/independence continuum which will have been established in the assessment phase. The care to be given will encourage the patient to get back to as rea sonably possible or as close to where they were on the continuum as they were before they were admitted to hospital. Planning also needs to take into account the resources available to implement the care as they need to ensure that the care they are planning is achievable and will not be compromised by lack of resources or a shortage of nursing staff (Roper et al 2008). When I did a plan of care for mabel it quickly became evident how inexperienced I was. I didn’t gather enough information in the assessing period to be able to do an effective plan of care. I also didn’t know how achievable the goals where as I wasn’t aware of how long they would take to improve or if they where achievable or not, I also found it difficult determine which problems were interrelated and as a result tried to link anxiety in with another problem when in fact it was a problem on its own. I was able to write the needs statements effectively that were not long but on a couple of these the influencing factors were missed out which would be necessary when providing holistic care. Planning care for a patient requires a great deal of knowledge in the chosen specialty which is why it must be carried out by a qualified member of staff or a student under supervision. Implementation Implementation is the next part of the nursing process and where all the goals which were set in the planning stage are put into motion and the goals can start to be achieved through nursing and medical interventions. The main component of the implementation stage is the delivery of the care to the patient. This is done with nursing staff, the multidisciplinary team members involved in the patients care such as doctor, dieticians and physiotherapists and the patient themselves in order for the patient to be able to return to how they were previously before they were admitted to hospital. The plan of care will be specific to the particular patient and will focus on the biopsychosocial aspects of the patient (Marriner 1983).Implementation provides great emphasis on individualized care which is why it is important to establish in the previous phases where they are on the dependence/independence continuum and what they are able to do now and what they were able to do before. Individualis ed care is associated with how the patient did things before such as how the person carries out the ALs and how often they carry these out. An example of this would be when carrying out the AL of personal cleansing and dressing to individualise the care it would be necessary to have determined in the assessing stage how the patient usually did this and how often it wouldn’t be individualized if in the care plan it was stated that they got a shower every morning if at home they only did this once a week. Core care plans may be used in certain situations this can provide a greater level of care as potential problems can be foreseen if related to a certain problem on the other hand it is also important not to standardize care as patients react differently to different illnesses and treatment. (Faulkner A, 2000). The NMC (2008) state that nurses are required to ‘Make the care of people your first concern, treating them as individuals and respecting their dignity’. In order to deal with certain problems or situations people often develop coping strategies which can be either adaptive or maladaptive. Adaptive coping strategies are usually helpful to the patient whereas maladaptive ones could be detrimental to their health such as smoking or drinking, the patient may feel this helps them to deal with a present situation but it is actually causing them harm. Patients need to be discouraged from using maladaptive coping strategies this could be done by introducing them to adaptive coping strategies and encouraging them to change their maladaptive ones into adaptive ones. Diamond (2008) states that there are also legal and ethical issues when it comes to implementing care as consent needs to be gained before any care is implemented and if this is not given the care cannot be given this will obviously have an effect on how effective the care has been when evaluating the care. The Nursing and Midwifery Council (NMC) state in section 3 of the code of c onduct ‘you must obtain consent before you give any treatment or care’ (2002). During the implementation of Mabel I found that although I was able to implement the care effectively I hadn’t recognized all of the nursing interventions needed to provide holistic care and I wasn’t fully aware of timescales of the planned care. I feel I also needed to research further into Mabel’s problems in order to gain the appropriate knowledge to provide the best care available as this would ensure that are the interventions are evidence based and best practice (NMC 2008). Barrett et el (2008) state that this is where recheck should take place which would enable the health care provider to establish how effective the plan of care is before the treatment ends this would enable them to re-evaluate the plan of care while the treatment is still ongoing and adjust the goals accordingly. Evaluation Evaluation is where the care that has been given can be assessed to evaluate the care given and whether it has worked or not. Chalmers (1986) describe that it is an ongoing and continuous process and also occurs at timed points in a formal setting. Roper et al (2000) say that evaluating care also provides a basis for ongoing assessment, planning and evaluation. There are two different parts to evaluation summative evaluation and formative evaluation. Formative evaluation is done with the patient taking into account whether they feel the care given has worked when done with consideration of the dependence/independence continuum information regarding the patients previous place on the dependence/independence continuum can be obtained from the patient, their friends and relatives as well as other health care professionals in the multidisciplinary team involved in the care of the patient. Summative evaluation is when the holistic view of the patient is taken into consideration how they feel about the treatment, whether they felt that the goals were achievable. It so where all the measureable data stated in the baselines and data received after this time are analyzed to show how effective or not the treatment has been. When evaluating care consideration needs to be given to the influencing factors such as biological factors as the bodies physical ability varies according to age the physical ability of an older person is generally less efficient, therefore therefore the plan of care needs to take this into consideration so that when the evaluation takes place it its hoped to have been effective. A nurse needs to evaluate her patient’s status regularly for some patients this will be just once a day but for others it will be much more frequent depending on their illness and healthcare status. RLT (2008) says that evaluation must be individual to the specific patient and not just a standard goal that is related to a specific problem. If goals haven’t been achieved then it is up to the nursing staff to determine why. Maybe the goals set weren’t measureable or achievable. Parsley and Corrigan (1999) say that if goals haven’t been measureable or achievable then new goals need t o be set. It could also be that the nursing interventions were not successful in which case new interventions should be set. Through my evaluation of Mabel it was evident that I did not require all the information to do a comprehensive plan of care. Although I did set baselines which meant I could compare data I wasn’t experienced enough to set goals to the correct timeframe I also didn’t obtain enough measureable information in certain problems to be fully able to assess how effective or ineffective the care had been. Had I had more experience I feel that the evaluation wouldn’t be a problem. Evaluation requires checking and rechecking in order to see the effectiveness of the care delivered. It requires knowledge and expertise to be able to effectively evaluate and amend the goals and interventions set as necessary. The whole care planning process took me a long time and I still was not very good at certain aspects of it. When setting goals a lot of detailed information is required in order for the plan of care to be effective so I can now understand why it is necessary for a trained member of staff to carry out the task. Conclusion This assignment has shown that when used together the nursing process and the nursing model provide a good basis to providing care. It sets out a systematic approach to providing care. Care needs to be set out in a way that both the nurse and the patient know exactly what is happening as well as any other health care professional in the multidisciplinary team providing care for the patient. It has also shown that involving patients in their care enables them to feel they are part of the team and are more likely to help themselves with their care. Reference list Sutcliffe E 1990, Reviewing the process progress. A critical review of literature on the nursing process. Senior Nurse, 10(a), 9-13. Applying the Roper-Logan-Tierney model in practice 2008 Elsevier ltd. Roper N, Logan W, Tierney J (2008) The Roper Logan Tierney model of nursing, Churchill Livingstone:London. Dimond, B. (2008) Legal Aspects of Nursing, 4th ed. Harlow: Pearson Education. Barrett D, Wilson B, Woolands A (2009) Care planning a guide for nurses: Pearson, Essex. Faulkner A (2000) Nursing The reflective approach to adult nursing. Stanley Thornes: Cheltenham. Peate I (2010) Nursing care and the activities of living 2nd ed. Wiley-Blackwell: West Sussex. Yura H, Walsh M (1983) The nursing process: Assessment, Planning, Implementing, Evaluating. Appleton Century: Crofts Norfolk. Cook S (1995) The merits of individualized measures within routine clinical practice. . http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_093359(2009) (29/04/11 Alfaro R (2002), Applying the nursing process: Promoting collaborative care 5th ed. Lippincott: London. Moseby’s Medical Dictionary (2009), 8th ed, Elsevier. http://www.nmc-uk.org/Nurses-and-midwives/Advice-by-topic/A/Advice/Accountability/[Date Accessed 11/04/2011]. McCormack B, Manley K and Garbett R (2004) Practice Development in Nursing, Blackwell Publishing, Oxford. Atkinson L Murray E, (1995), Clinical guide to care planning, McGraw, Oxford. NMC (2002), The NMC code of professional conduct, Nursing and Midwifery Council Publications

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