Mrs Patterson 72 with colorectal cancer underwent an anterior resection and is now left with a permanent stoma. The care plan used was a colorectal core care plan (RLT model used but adapted for use on a surgical ward). The different stages of the nursing process need to be discussed according to the Roper, Logan and Tierney model, identifying strengths and limitations of the nurse core care plan. Did the approach in clinical practice take consideration of elements suggested by the RLT model. Focus must be given to only two elements within each stage of nursing process. What does RLT, say about coping strategies? What do other theorists say about them? What coping strategies did Mrs Patterson have, were these identified in assessment? Mrs Patterson verbalised her fear over her forth coming surgery (fear of inability to manage stoma care & amp; engage in social activities which included yoga, dancing, visiting family and friends and church) -internal coping strategies- stress/anxiety - BP 150/90, respirations 20, pulse 90-compared to base line observations obtained at pre-assessment BP130/80, pulse 80, respirations15 Mrs Patterson has read lots of information about her procedure although admits not all remembered/understood. ASSESSING 1. Coping strategies/ behaviours, maladaptive and adaptive 2. The assessment needs to allow for expression of fears, worries and so requires application of the principles of therapeutic communication (listening skills, body language). For planning i have included 1. goal and interventions as stated in the ‘colorectal core care plan’, that applied to Mrs Patterson. Goal For Mrs Patterson to be as relaxed as possible and be fully informed of operative procedure and pre and post operative care. For Mrs Patterson s psychological and social needs to be met. Interventions 1.Explain all procedures. 2.Provide written information. 3.Involve doctors and carers. 4.Encourage questions. 5.Give time and privacy to discuss worries. 6.Involve multi disciplinary team and specialist nurses as approppriate. PLANNING 1. RLT says by applying SMART principles, patient and nurse can negotiate some agreed goals of care. This promotes an active role for the patient, increasing patient autonomy and balances any perceived power problems (but this goal was preset as part of core care plan, although supposedly based on philosophy of RLT does not adopt all SMART principles, nurse did confer with patient about goal and it was a relevant goal to have for Mrs Patterson) . This sense of control can be highly effective as a coping strategy for the patient and also promotes the concept of informed consent. IMPLEMENTATION 1. Evidence should always be evidence based - actions may include; Preventative behaviours Comforting behaviours Seeking behaviours ‘ Is evidence based and involves a range of health care professionals. Specialist nurses have a major role e.g. stoma nurse and dietician (developing new schemas for eg managing stoma Implementing these and any other measures identified will aim to redress any imbalance of Mrs Pattersons Body Image triangle resulting from her recent change in body reality. These measures tackle body presentation issues in terms of use of involvement of discussion with stoma nurse about best site for stoma so as not to interfere with waste line on clothes she wears or sitting underneath her full breasts which would interfere with stoma care and body ideal issues in terms of promoting new norms and values for Mrs Patterson for her position as a woman, wife, friend, person. Interventions identified for anxiety of surgery and altered body image stated for Mrs Patterson on core careplan are relevant ones although again have not been individulised for her, it’s easier to modify an existing behaviour than substitute a new one, Mrs Patterson is into yoga so utilise behaviour already learnt like interventions encouraging relaxation and prayer, as she is practising CofE. EVALUATE 1. Progress in meeting goals should be measured / assessed directly through observation and indirectly through the patients accounts of their experiences (It was very difficult to evaluate whether the goal for anxiety due to surgery and altered body image had been met when there was no measure of anxiety eg on scale 1-10 how anxious was she also BP, resps and pulse indicated measurements of stress and coping these could have been used as measurement. There was no review date to allow for a scheduled evaluation to take place although the communication sheet sporadically had entries made with regards to Mrs Patterson s involvement in her stoma care.