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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. 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?

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  1. E-Pathways: What is the role for nursing? Alex Westbrook Lecturer Practitioner School of Cancer Nursing & Rehabilitation Royal Marsden Hospital, London

  2. Overview • Nursing Language, ICPs & EPR • Nursing and e-pathways • Some reflections from practice • Recommendations for future development

  3. 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!)

  4. 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

  5. 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)

  6. How does this ‘fit’ with the concept of ICPs?

  7. ICP development • Multidisciplinary document • Development & implementation led by Nursing & Quality • Examples of ICPs: • THR, TKR, TURP…

  8. 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

  9. 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

  10. 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?

  11. 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

  12. So, what is the role for nursing in e-pathways…?

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