Nursing Care for Femural Fracture

Introduction

As Donahue (1996) writes, the origin of the words “nurse” and “nursing” are varied, and shift in meaning as reflected in the perception of nursing’s role in health care and in society. From nursing’s earliest Latin derivative from nutrire, “to nourish,” and nurse, nutrix, meaning “nursing mother,” Donahue (1996) continues, “…the meaning of the word [nurse] has progressed from a term indicating a woman who performed the basic unlearned human activity of suckling an infant to one describing a person who is part of a highly learned, sophisticated profession.”

Integral to the progression of nursing from perceived “mother-care” to professional was the contribution of Florence Nightingale (Kenworthy, Snowley & Gilling, 2002). As far back as 1860, Florence Nightingale recognized the importance of theory and process in health care, and her message has gotten stronger as the years have progressed (Kenworthy, Sonwley & Gilling, 2002). Nurses in the United Kingdom today are trained in clinical practice and, as established by Nightingale, demonstrates the importance of following defined methods, theories and practices (Aggleton & Chalmers, 2000).

Nursing theories arouse out of the need to define the role of nursing as a profession and to begin thinking theoretically about nursing (Tierney, 1998) whilst moving away from medical orientation (Wimpenny, 2002). Utilising nursing theory allows for the empowerment and autonomy of the nurse (Holland, 2003), providing the nurse with a clear sense of purpose and their role within the multidisciplinary team (Colley, 2003). It is vital however not to be too caught up in the idea of theory for theory’s sake, but to remember that theory has arisen out of a need to improve the care that nurses provide (Fraser, 1996). Regardless of the specific practice model or theory nurses follow, first and foremost nurses must adhere to the Nursing and Midwifery Council (NMC, 2004) code of professional conduct. The code sets the standards on matters such as patient respect, consent, teamwork, confidentiality, professional competence, trustworthiness, and risk mitigation. However, the NMC does not specify how a nurse is to embody these standards (Alexander, Fawcett & Runciman, 1999).

This paper will discuss the role of nursing theory and how it has affected the nursing care of a patient who sustained a fractured neck of femur following a fall. It will critically analyse how the Roper Logan & Tierney (1996) model of nursing has assisted in the assessment, planning and delivery of her care, whilst examining the role of the nurse and the multi disciplinary team in providing this care. Due to the word constraints within this assignment it has not been possible to cover all the actual and potential problems sufficiently, therefore I have concentrated on analysing two problems pain and dyspnoea also paying particular attention to the care of the dying patient, these problems were identified as a priority by both Gina and the staff nurse. In order to protect the patient’s confidentiality as required by the NMC code of conduct (2004), she will be referred to by the pseudonym Gina and her profile is included in Appendix 1.

Nursing Models

So why is it necessary to use a nursing model? Walsh (1998) describes nursing models as being a framework offering suggestions to guide practice. The value of nursing models has been much debated. Nursing models are conceptual frameworks used to make sense of the varying approaches to care, providing a direction for practice (Goodridge & Hack, 1996). They can be used effectively to increase knowledge as all are based on the foundation concepts of nursing, these are the environment, the individual, nursing and health (Hancock, 2000). When viewed in isolation, these concepts fail to elicit the information required to fulfil quality care planning and delivery. Nursing models seek to combine these concepts, demonstrating their interrelationship. However, nursing models are only as effective as those who use them (McGee, 1998). One of the limitations is that in the hands of novice practitioners, lack of experience may lead to over-focus on one dimension of the chosen model, neglecting other areas (Aggleton & chalmers, 2000). Through regular use and with increasing professional and clinical knowledge, models can be used creatively and adapted to various practice settings (Alfaro-LeFevre, 2002).

A plethora of nursing models have been designed and are widely available from the nursing literature. They vary with regards to patient perception (Aggleton & Chalmers 2000) and the degree to which patients are expected to accommodate