Introduction
The Carper model of care (figure 1) requires nurses to use their knowing, empirical knowledge, reflection and intuition in order to create a foundation of expecting patient’s outcomes (figure 3). This paper addresses how Carper model of nursing care could be adopted in order to enhance mouth care. It analyses the outcomes of utilizing Carper’s nursing care model and its impact on delivering mouth care. The paper looks into a placement case study and descriptively analyses how use of Carpers model of nursing care impacted on the quality of care that was advanced to the patient. Finally, the essay addresses mechanism in which mouth care was communicated and documented (figure 2).
Types of nursing models of cares
Mckenna (1994) in his report, indicates there exists at least five models of care namely Roper, Logan and Tierney (ADL), Peplau that involves inter-personal communication, Orem which involves self-care, Roy that employs adaptation model, Fawcett’s explanation on nursing model and Carper models that is build on personal communication. This essay looks into Roper, Logan and Tierney (RTL) and carper models of care, Fawcett’s model and their application in provision of spirituality care.
The carpers model of nursing care
The carper model of nursing care (figure 1) has four dimensions of care namely empirical, ethical, personal and aesthetic dimensions (McKenna, 2000). Empirical dimension of nursing care requires dental hygienist to draw on the fields of science like psychology, microbiology and pharmacology in order to diagnose the problem based on observable, measurable and testable parameters. By using empirical dimension, a dental hygienist is able to describe the health condition of the patient. Ethical dimension is dependent on making judgments on what should be done against what should not be conducted (Alfaro-Leferer, 1999). Ethical dimension draws knowledge from identifying values of the patient, nurses, and professional practitioners, relatives of the patient or other employees (Lazerbalt, 2002). Following value determination, the dental hygienist should clarify and examine reasons behind specific identified values and how the values identified inter-relate with the patient medical condition. Use of ethical knowledge positions a dental hygienist nurse to act as the patient’s advocate (Potter and Perry, 2001).
Personal dimension is a measure towards dental hygienist nurse growth and development. According to carper model, a dental hygienist nurse is accepted to have components of human being and therefore, as a nurse, the mouth health care provider is subject to have qualities that may affect therapeutic interaction with the patient (Pereira, 2003). Personal dimension requires the dental hygienist nurse to be open and non-judgmental about the patient’s situation. The nurse should be aware of his strengths and weaknesses in addressing the patient’s situation (Potter and Perry, 2001). The nurse is supposed to reflect on the patient’s ill-health and draw from his past experiences. In so doing, the dental hygienist nurse should integrate patient’s actions and opinions into past experiences and make informed decision based on intuition in order to be a resource to the patient. Aesthetic dimension requires dental hygienist nurse to be involved in patient’s situation of ill-health and be able to interpret what could help the situation (Lazerbalt, 2002).
Carper’s nursing model as a component of holistic care in mouth care
Carper model of nursing care would help to ensure mouth-care nurses adhere to standards for clinical dental hygiene practices and help in cultivating a sustainable nurse-patient relationship (Carper, 1978). By utilizing Carper’s model of nursing care, mouth-care nurses would be able to use standards that are required in order to implement collaborative-patient-centered care in a multi disciplinary team of mouth-care practitioners and dental hygienists. Mouth care nurses should not use experience as a form of academic exercise when dealing with the mouth care patients. Carper’s model of care (Carper, 1978) advocates use of relational dimension of care which is build around personal knowing on the patient. This helps to cultivate an environment where the mouth-care nurse understands who the patient is, what defines the life of the patient and what is of value in the life of the patient. By implementing this stance, it becomes possible to create and realize possibilities that could pin patient’s possible sickness and create an opportunity for perceiving and anticipating the likely change on health of the patient.
If I want to know what you’re thinking of right now, all I have to do is care more about what you are thinking than what I am thinking….As soon as I care more about what you are thinking, I will give up my thoughts and I will absorb yours and I will understand you (Soloman, 1991, p. 28)
A clinical placement case study
Benjamin Holt* visited our hospital. He appeared stressed and drained emotionally, psychologically and mentally. He was referred to psychiatric unit for assessment. Benjamin expressed concerns that his life had been a failure. He was a smoker though he did not engage in hard drugs like morphine or cocaine. I arrived at the psychiatric desk when the nurse in charge was making short notes to the effect that smoking and drinking was the primary cause of the Benjamin’s ill-health secondary to a lifestyle that predisposed mental imbalance due to lack of positive personal development and growth. After my initial examination of Benjamin, I determined that Benjamin was not in a position to know what medical condition he suffered from neither was he able to provide any guiding information on how medical interventions could be scaled to help alleviate his pain. It was observable that Benjamin had neglected his mouth care(Darby & Walsh, 2003). He had been to different dental hygienists and his condition seemed not to have responded positively to medication. I made arrangement for the cancer specialist in the hospice to come to our aid. Meanwhile my teammate and I carried out a comprehensive dental and periodontal charting, assessed the gingiva and periodontion and performed a dental hygiene diagnosis as primary cause to Benjamin disease. We interpreted dental radiographs, got rid of biofilm plaques that was primarily composed of hard and soft deposits. We made assessment of coronal and apical gingival margins using dental instruments (Mueller-Joseph & Peterson, 1995).
We then applied pain control agent nitrous oxide analgesia, provided education on biofilm plaque control and home care standards for the mouth care. We utilized techniques that were to guide Benjamin’s self care oral hygiene program. We finally educated Benjamin on importance of good nutrition as a component for sustainable oral health. When Radiographs test results were finally presented, they confirmed right my fears for the possible disease that Benjamin was suffering from. Benjamin had oral mouth cancer and his medical case got a new lifeline of management (Carper, 1978; Atkins & Murphy, 1993).
Carper’s model of nursing and Mouth care communication
In implementing Carper’s model of nursing, I had to create reflection on the Benjamin case to my colleague and team mates. This ensured the team mate was carried away with reflections and presumptions. This made it possible for the team mate to follow on my analysis and reflection. As confidence on my reflection build in my colleagues mind, involvement was developed (Mueller-Joseph & Peterson, 1995). The questions that my team mate asked helped to deepen his level of thought on the Benjamin’s case. In utilizing personal reflection and knowing, I helped to improve my team mate unknowing of the Benjamin case when they first met. This provided an opportunity for the nurse to maintain alertness to Benjamin’s perspectives on his mouth care case. Active listening was a required without loss of conscious or triggering unknowing conflict that could distort nurse-patient relationship (Carper, 1978; Cook, 1991).
In communicating use of knowing, I stressed on the need for the nurse to be aware of his probable lack of empirical knowledge and how the nurse should use intuition, knowing, drawing from past experiences and expertise to determine nursing theory and research that should be applied or rejected without competent thought into it. This helped to create a benchmark that was envisioned to produce the desired outcome that could add value to patient management of care plan. I stressed applying intuition, knowing and past experiences should be guided by ethical knowing and help influence on patient’s judgment and provide a framework that could help to pin down the reasoning process that was used to diagnose the problem (Carper, 1978).
This helped us to assess Benjamin’s Health history, perform teamwork clinical evaluation on bleeding points and suppurations. We were able to assess mucogingival defects, present loss of attachments and then performed evaluation of hard tissue and charted oral habits. This was immediately followed by a mouth care diagnosis to interpret assessment data and clinical findings. This facilitated mouth care diagnosis. We also evaluated patient needs, by getting informed consent from Benjamin, on modalities of improving mouth care plans. We then incorporated the mouth care diagnosis into mouth care treatment plans. We prioritized mouth care intervention measures like treatment, education and referral for the oral cancer management. We further presented and documented the mouth care to Benjamin. We later reviewed the mouth care plan and obtained consent from Benjamin to modify his mouth care plan (Smith, 1992; Carper, 1978).
At the end we evaluated the possible outcomes of Benjamin’s mouth care plan, the criteria used and its validity in order to determine probing measures, plague control and retention mechanisms of the sealants. We communicated the mouth care plan to the other mouth care providers in the hospital with aim to seek collaboration towards determining if there was any additional diagnostics, treatment plans, education or self care behavior that ought to be communicated to the patient (Munhall, 1993).
Efficacy of my spirituality care communication
The quality of my mouth care patient record keeping was a reflection of the standards of my practice. The ethics of good record keeping is a portrait of my skilled and safe mouth-care practitioner principles. My record keeping was an evidence of my high standards of my clinical practice as well as documentation of my mouth care patient continuity of care. The documents on care of the patient played a great role in communicating and disseminating information between members of my dental hygiene team and the hospital administration. The documents provided accurate account of the mouth care patient treatment, the care plans during and after discharge and procedures followed when delivering the mouth care. The up-to-date record management practices of the spirituality care of mouth care patients under my care demonstrated that I took all reasonable steps to care for the mouth-care patient and any action or omission that resulted on my part as a dental hygienist could not have compromised the safety and health of the patient (Johns, 1995; Mueller-Joseph & Peterson, 1995).
In mouth-care patient documentation of care, the information provided was factual, legible and accurate and on each side of the numbered pages were patients name, patient’s date of birth and patient’s identification number. The entries on the patient data sheet were all dated, and timed as well as signed or if signature was invisible, a name was printed. Any alteration on the care plans of the patient were signed dated and timed. The original text data that was altered was also readable.
The patient data sheet showed all patient assessment, care given to the patient and any planned care after discharge or during hospital length of stay. The data provided relevant information on patient’s condition of health at any given time and any measures that were taken to respond to their needs (Jarvis, 1992; Wilkins, 2005).
Conclusion
A mouth care nurse should use Carpers Model of nursing in order to develop the right judgment on the patient’s needs for mouth care. Carper model of nursing helps practitioners to make decisions on mouth care based on their experience of dental hygiene, expertise in dental hygiene and intuition. By making use of Carper’s model of nursing, a mouth care nurse will be able to help to avoid crisis or possibility of wrong diagnosis of the mouth care related ill-health. It will help the mouth care nurse to make timely intervention measures that can prevent possibility of patient’s condition either getting worse or becoming a predisposing factor to a more dangerous ill-health like cancer of the mouth, gingival or periodontion. The mouth care nurse should make use of a reflective period by being open to the patient in order to be positioned to receive further information on the patient that could help to validate his feelings against any available objective data. The mouth care nurse should utilize habitualization attitude and be able to focus on new learning opportunities that could help to guide the patient’s possible next condition of the ill-health. By knowing the mouth care patient as a human being, who has dignity and personality, a mouth care nurse would institute the right actions and reflections.
Mouth care nurses should use personal knowing and intuition in order to be able to fill information gaps that are linked with the patient’s medical case presentation. Mouth care nurses should not try to enter into a relationship with the patient in a holistic and caring sense in order to avoid major omissions in the mouth care nursing practice.
Bibliography
Alfaro,L.R. (1999) Critical thinking in nursing (2nd Ed.) London, Saunders.
Darby, M.L. and Walsh, M.M. (2003). Dental Hygiene Theory and practice 2nd Edition, St. Louis, Mo: Saunders.
Lazerbalt, A. (2002). The evaluation handbook for health professionals, London.
McKenna (2000), nursing theories and models, Routledge.
Mueller-Joseph L. and Peterson, M. (1995) Dental Hygiene Process: Diagnosis and Care planning. Albany, NY: Delmer Publishers.
Potter, P. and Perry, A. (2001) Fundamentals of nursing (5th ed.) London, Mosby.
Wilkins, E.M. (2005) Clinical practice of the dental hygienist. (th ed. Philadelphia, Pa: Lippincott Williams and Wilkins
Atkins, S. and Murphy, K. (1993) Reflection: A review of literature; Journal of advanced nursing 18(8), 1188-1192.
Bishop, A and Scudder, J. (1990), The practical, Moral and Personal sense of nursing. State university of New York Press, Albany, New York.
Carper, B. (1978) Fundamental patterns of knowing in nursing: Advances in nursing science 1 (1), 13-23.
Cook, S. (1991). Mind the Theory practice gap in nursing. Journal of advanced nursing 16 (2), 1462-1469.
Johns, C. (1995). Framing learning through reflection within Carper’s fundamental ways of knowing in nursing: Journal of advanced nursing 22(2), 226-234.
Munhall, P. (1993) ‘Unknowing’: Towards another pattern of knowing in nursing. Nursing outlook 41(3), 125-128.
Pereira, A. (2003). Patient attitude towards continuity of care: Archives of internal medicine, 163 (8), 909-12.
Smith, M. (1992) Is all knowing personal knowing? Nursing Science quarterly 5 (1), 2-3.
Jarvis, P. (1992) Reflective Practice and Nursing: Nurse education Today, 12(3), 174-181.
List of appendices
Appendix 1: the four dimensions of Carpers model of care
