|3.A standardized information system centered on the individual client's needs
system starts from the basic principle that at all levels, decisions must be
oriented according to the needs of each client and not according to available
operationalizes this basic premise by focusing on services
the client instead of the services which are given.
services are defined as the nursing care and assistance required by the
dependant client to answer his aid needs.
The client's aid needs are assessed by (a) professional(s) according to
professionals form from this starting point, their perceptions of the client's
aid need. On
this basis, they determine the specific services required by the client.
This determination takes into account their care philosophy which
translates into a certain number of rules, norms, professional standards that
specify in a more or less precise and objective fashion, the way to respond to
different aid needs.
given does not always correspond to care required as just defined.
This may be due to a lack of resources, a poor evaluation of the
client's needs or the regulations of an institution.
Hence, nursing staff may assist a client to walk once a day (care
given); yet, standards of care stipulate (care required) that the client
should receive help to walk three (3) times a day to activate blood flow and
prevent muscular atrophy in the lower limbs.
In the FRAN©, one would indicate for this nursing action;
with assistance" at
10:00 - 15:00 -20:00
instead of "walk
mentioned above, the philosophy of care as well as the norms and professional
standards which are derived from it, influence the determination of care
required. These philosophies,
norms and standards vary from one institution to the other.
Hence, if one did not frame the determination of what is required
within a set of rules, required care for the same client (in terms of services
and consequently in terms of resources) would vary from one institution to the
other. This poses an important
problem of equity if the results of PLAISIR©
evaluations are used, as is the
case in Quebec, to distribute a regional budget between the different programs
or institutions of a region, according to the resources required by their
clients or to determine individual clients allocations as is the case in
it is necessary to define standards of care which all institutions must adhere
to for the purpose of PLAISIR©
following standards of care and assistance correspond to current good practice
in the nursing homes and extended care hospitals of Quebec.
No studies have been done to establish their clinical validity.
They simply stem from observations made in the facilities and, in the
opinion of the nurses consulted, although they do not correspond to optimal
care, they still ensure that the client has an acceptable sense of well-being
and security. Considering
the presently available resources, nursing personnel are currently finding it
impossible to do better in general and unfortunately, in certain cases, cannot
even offer the care and assistance corresponding to these standards.
standards are not prescriptive but only indicative. The nurse evaluator can
move away from a standard, providing that she justifies this deviation
by the particular needs of the client she is evaluating.
Therefore, each time the nurse evaluator uses a frequency or an
intensity that is different from the standard frequency or intensity for a
particular nursing action, she must explain her reasons in writing in the FRAN©.
it must be noted that if it is necessary for everyone to adhere to the same
standards in order to ensure equity when allocating the resources, it is
nevertheless possible, once these resources have been made available to the
different institutions, for each facility to set its own standards. However,
the facility's proper standards will be constrained by the resources allocated
on the basis of common standards. This
is the price to pay in order to achieve equity in the allocation of resources.
must however note that in the application of PLAISIR©
in Switzerland, Germany,
France, Italy and Belgium, the committees of nurses of these countries have
defined the standards of care which correspond to their respective practices
and which are different amongst themselves and different from Quebec
standards. Finally, it is
important to note that the utilization of common standards of care by all the
institutions of a country or region is only necessary when there is a
system. An institution
which implements the system solely for its internal needs of information could
very well use its own standards. Yet even in such a case, a certain uniformity is necessary;
in fact, if one wishes to compare the units of the institution amongst
themselves, it is then necessary that all adhere to the same standards of
care. Thus, even in such a
situation, one cannot bypass the explicitation and the formalization of the
standards of care of the institution without losing the ability to compare
units amongst themselves.
One will find, below, the list of care standards currently being used in Quebec.