This essay will explore a needs orientated approach to the care that is delivered to a patient and examine the significance of the use of models and frameworks in the nursing process. It is intended to identify a patient with biopsychosocial needs that requires nursing intervention. Their holistic plan of care will then be critiqued in relation to the nursing model and framework utilised by the nursing staff.

Knowledge will be demonstrated of the importance of utilizing evidence-based practice when creating an individualized plan of care.

“The nursing process is an analytic problem solving method whereby the attainment of pre-determined nursing goals by means of chosen nursing care strategies is attempted through a systematic application of assessment, problem identification, planning, implementation and evaluation” (Arets and Morle, 1995, p311)


For the intention of this essay the conceptual framework used will be Assessment, Planning, Implementation and Evaluation (A.P.I.E) (Yura and Walsh, 1978). Conceptual framework indicates a logical, systematic process that is followed in order to plan and deliver care as part of the nursing process when used in conjunction with a model (Hogston and Simpson, 2002).


 The model used will be the Roper, Logan and Tierney (R.L.T) Activities of Daily Living Model. This model consists of five core components: 12 activities of daily living (A.D.L’s), Lifespan, Dependence/independence continuum, factors influencing the A.D.L’s and individuality in living. The factors that influence the A.D.L’s are biological, psychological, sociocultural, environmental and politicoeconomic (Holland, Jenkins, Soloman and Whittam, 2004).

The theory underpinning the Roper, Logan and Tierney Model is that the 12 A.D.L’s are basic human requirements and are unique to every single person. This allows if used correctly to create individualized plans of care for each patient (Roper, Logan and Tierney, 2000).

Permission was consented from the patient to use their condition for this essay; the information was accumulated from their admission, assessment and plan of care. The patient authorized usage of information relating to their period of hospitalisation in agreement that any personal information would not be used. This essay will address this matter in accordance with the Nursing and Midwifery Council (NMC) confidentiality guidelines set out in the Code of Professional Conduct (NMC, 2004). The pseudonym “David” will be used for this reason throughout this essay.


David is 32 years of age and has no medical conditions. He resides with his wife in a three-bedroom house, which they have recently purchased in a high-income area. David stated he was anxious about his sizeable mortgage payments and been unable to work.  David works as a self-employed electrician; he was admitted on to an orthopedic rehabilitation ward following a sports injury. David fractured his right femur whilst playing rugby and needed to have a plate nailing to correct the fracture;

This surgery was performed three days following the accident, due to swelling of the affected limb.

Assessment is described as”The first stage of the nursing process, in which data about the patient’s health status is collected” (Oxford dictionary of nursing, 2003, p23), following this phase a care plan can be devised.

David arrived on the ward having been transferred from an orthopedic trauma ward; he was one day post operative and part weight bearing with assistance. The nurse did not have a complete admission form owing to the transfer, and had received David’s pre operative plan of care from the orthopedic trauma ward. The nurse introduced herself to David and asked his permission for myself to be present while the assessment for his plan


of care was been conducted, he gave his consent to this and the nurse told him she would return soon to begin the task.

The nurse then obtained all the necessary paperwork to devise his individualized plan of care, the paperwork consisted of; a A.D.L’s assessment sheet, a medical nursing record sheet, core care plans related to the fracture, an assessment sheet, several blank evaluation/reassessment sheets and an additional information sheet.

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The nurse gathered a lot of David’s biographical details from her previous plan of care and his medical records, many of the core care plans were also completed in the office prior to returning to David to complete the A.D.L’s assessment sheet. The core care plans contain current problems and potential problems, each with the appropriate evidence based practice to support them, this enables the patient to make further informed decisions regarding their care (Pearson, Vaughan, and Fitzgerald, 2005).

Roper et al specify that the plan of care should be client centered and the gathering of information should be gathered ...

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