NURSES' CARE PLANNING EFFORTS: A NATURALISTIC INQUIRY (HEALTH PLANNING).

Description

Care planning is a central concept of nursing education and practice. This was a descriptive study of care planning completed by clinical nurses on a selected unit and with a specific patient population. Naturalistic inquiry provided the philosophical foundation of this study. Clinical nurses were the informants of the study. Patients discharged after a total abdominal hysterectomy and/or bilateral salpingo-oophorectomy surgery served as the stimuli to observe and describe nurses' care planning efforts over time. Discharge planning was chosen as the study focus because it is a common expectation of professional practice and a prototypical care planning activity. Furthermore, the strategy of following patient situations in order to study nurses over time was consistent with the concept of planning. The study design emerged based on the nurses' participation and ongoing data analysis. Data collection activities included interviews, participant observations and review of written documents. A constant comparison method of data analysis was used to derive and refine the nurses' description of discharge planning. Purposive sampling led to eight nurse informants participating with seven patient situations. The nurses received an interpretation of the data for their feedback and verification. Member checks with the nurse informants and peer debriefing were means to strengthen the trustworthiness of the study. In this study, nurses' care planning efforts were found to consist of six components: nurses' expectations of patient progress, monitoring patient progress, patient teaching, nurses' evaluations of patient progress, communication with other health care providers and patient readiness for discharge. Nurses' expectations provided direction to their subsequent efforts and evaluations of patient progress. In a reciprocal manner, nurses' evaluations of patient progress reflected their judgements which included patient needs and necessary actions to get the patient ready for discharge. Study implications included strategies to encourage and document care planning in educational, practice and health policy arenas. Suggestions for further care planning research are offered.

Subjects