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E-Pathways: What is the role for nursing?. Alex Westbrook Lecturer Practitioner School of Cancer Nursing & Rehabilitation Royal Marsden Hospital, London. Overview. Nursing Language, ICPs & EPR Nursing and e-pathways Some reflections from practice Recommendations for future development.

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e pathways what is the role for nursing

E-Pathways: What is the role for nursing?

Alex Westbrook

Lecturer Practitioner

School of Cancer Nursing & Rehabilitation

Royal Marsden Hospital, London

overview
Overview
  • Nursing Language, ICPs & EPR
  • Nursing and e-pathways
  • Some reflections from practice
  • Recommendations for future development
background
Background
  • The hospital
    • At the time a new hospital building and Trust
    • 500-bedded (approx) London teaching hospital
    • Mixed specialities
  • EPR ‘test-bed’
  • My role (then!)
the nursing language project 1997 2000
The nursing Language Project 1997-2000
  • The need for change
    • Nursing documentation
    • Nursing terminology
  • Feasibility study initiated:
    • Translation of NANDA
    • New care plan documentation
    • New nursing assessment tool
  • Project strategy & roll out throughout the hospital
philosophy of nursing language development
Philosophy of nursing language development
  • a more rounded picture of ‘sickness’
  • Medical diagnosis: representsickness as a disease process (e.g. Cerebral Vascular Accident)
  • Nursing diagnoses: representsickness as the patients illness experience (e.g. Self care deficit-hygiene/toileting; Impaired physical mobility; Carer role strain)
icp development
ICP development
  • Multidisciplinary document
  • Development & implementation led by Nursing & Quality
  • Examples of ICPs:
    • THR, TKR, TURP…
icp development8
The concerns:

Task/Process Focused

Medical Model of Care

Cookbook Medicine

The benefits:

Patients

Clinicians

Audit/Clinical Effectiveness

Evidence Based Practice

Collaborative Care

ICP development
nursing e pathways a compromise
Nursing + e-pathways =a compromise!
  • In considering the use of ICPs for nursing we:
    • Identified the nursing contribution to care
    • Used our common nursing language
    • Paper and electronically ‘dove-tailed’ ICPs and nursing care plans to create an individualised plan of care
translation to epr reflections from practice
Translation to EPR – reflections from practice
  • Multi or uni-disciplinary pathways?
    • Where does the ownership lie?
    • How do the pathways map to other clinical records?
    • Are e-pathways accessible for all professions?
recommendations for future practice
Recommendations for future practice
  • All-Involving at all stages
  • Each profession must identify their unique contribution to the care pathway
  • Professions should already be documenting electronically to avoid duplication of records
  • Use of a clear structure and agreed language is essential