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Hosted by WeLDnurses using #WeLDNsThis chat is guest hosted by @GwenMoulster @HabitualJoshing @SarahAmes20
As part of the centenary celebrations for learning disability nursing, Gwen Moulster, Sarah Ames, Jane Iorizzo, and Joshua Kernohan updated and published the ‘Moulster and Griffiths Nursing Model’. They did this with a view to sharing good practice with colleagues, and to show case a nursing model that was already embedded into clinical practice in various parts of the UK.
In preparation for this chat the introduction below will give some oversight into both the nursing process and nursing models and some background into the development of the Moulster and Griffiths model.
The Nursing Process
The Nursing and Midwifery Council (NMC 2015) code of practice requires that nurses assess, plan, implement and evaluate the care they provide in accordance with the nursing process as described by Virginia Henderson (1966) and introduced to health care in the UK in the 1970s.
The nursing process provides a framework for decision making but it requires nurses to have the clinical skills and knowledge to know what to assess and how to reach the right decision:nursing models provide the means to achieve this (Schober, 2008).
A nursing model, at its simplest, is a philosophy or view of nursing that informs the way people practice (Aggleton and Chalmers 2000). It is recognised within healthcare that there is a relationship between the use of models of care and the achievement of outcomes for those receiving support (Kaplow and Reed 2008).
Any nursing model should only be viewed as an aide to decision-making, and not a replacement for clinical judgement. At its core, a nursing model does this by exploring the relationship between 4 concepts: personhood, the role of the nurse or nursing,health and the environment (Hamilton and Price, 2017).
The use of conceptual models in learning disability nursing has been a challenge, in part due to models being borrowed from other disciplines, or branches of nursing (Horan, 2004).
It has been suggested that in the past learning disability nurses had difficulty articulating the contribution they make, leading to scrutiny and challenge of their purpose (Mitchell, 2002). Where there may be a lack of role clarity, use of a conceptual model acts as a means of highlighting what is important to and for the professional group (Curley 2004).
Pearson, Vaughan and FitzGerald (2005) suggest that when using a nursing model to structure work not only is care more consistent, but there is less conflict in the team, other professionals increasingly understand the role of the nurse, and it acts as a guide in decision-making, goal setting and even recruitment. When using a nursing model, a team can ensure continuity of care and provide a high standard of support (Aggleton and Chalmers, 2000),and by using the Moulster and Griffiths model, learning disability nurses will ensure that all people, regardless of locality, receive the same standard of person-centred and evidence-based nursing care (Ames 2013).
The value-base of the Moulster and Griffiths model
The values base for learning disability nurses is best described within Strengthening the Commitment (Scottish Government 2012), which includes
The Moulster and Griffiths model places the person with learning disabilities at the centre of the process, using the principles from Valuing People: promoting rights, inclusion, choice and control (DH 2001; DH 2009).The model is person-centred and encourages all nurses to ensure the person who has learning disabilities and the important people in their life are fully included and engaged in the process.
Schober (2008) suggests that nurses who have developed models of practice attempt to explore the interplay between the person, their health, the nurse and the wider social environment. This can be clearly seen in the Moulster and Griffiths model, which sees the nurse as a facilitator of social inclusion and the promoter of the rights of the individual to enable better health and wellbeing. The model recognises the individual is ‘disabled’ by the social environments around them and the services and support they can access;if learning disability nurses can help get this right for the person by supporting reasonable adjustments, they can help that person live a meaningful and fulfilled life.
Learning disability nursing may differ from other fields of nursing practice in that we work with people who may not be ‘ill’ or ‘sick’. Our role, however, fits well with modern definitions of nursing that focus on the role of the nurse in improving quality of life, advocating for the person and incorporating health promotion and prevention of illness (International Council of Nurses 2002; RCN 2003).
Our role then, in working in a person-centred and holistic way, is to increase the person’s resources in order to help the person realise their goals or increase their ability to cope and adapt to the changes around them. Health is a dynamic concept, and the importance of the social determinants of health, and the impact of health inequalities cannot be overlooked (Brooker and Waugh 2017).
Developing the model
The Moulster and Griffiths model was developed in the Haringey Learning Disability Partnership in 2009 in response to a need for a more consistent approach to nursing in a multi-disciplinary and multi-agency learning disability team. Nurses in the Partnership didn’t use a specific nursing model, and the quality of care planning and implementation depended upon the knowledge and skills of the individual practitioner (Moulster, Ames and Griffiths 2012).
However, the nursing team relied on the initial multi-disciplinary assessment and based their care planning on the information gathered. At the time nurses did not undertake further,profession specific assessments, not all interventions were evidence-based and there was a limited use of routine outcome measures.
It was felt the introduction of a standard nursing model could help improve nursing care. In identifying a model appropriate for their service, they agreed it should be evidence-based, outcome focused,person-centred and reflective. Following a review, it was felt no one model fitted the needs of learning disability nurses within the service and the Moulster and Griffiths model was created.
The Moulster and Griffiths model has many unique attributes, but also draws on and combines elements from the self-care nursing model (Orem 2001), the ecology of health model (Aldridge 2004), the cycle of reflective practice (Gibbs 1988), person centred care approaches (McCormack& McCance 2006), and the Health Equalities Framework (Atkinson et al 2015).It also includes a person-centred screening tool which is based on work by Amey et al (2006). Other aspects of the new nursing model were drawn from the experience, knowledge and skills of the nurses. In developing the nursing assessment, the inclusion of reasonable adjustments was influenced by work in Gloucestershire and the easy read care plans were developed from resources created in Barnet.
The model has been trialled in a range of different settings, including inpatient services, respite services and community learning disability teams. The model is dynamic and can be adapted to reflect changing practice and feedback from those individuals using the model. As the model changes it remains based on the four key principles of being evidence-based, supporting reflection, demonstrating outcomes, and being person-centred.
We recommend the following:
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