Supportive process maintenance model

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The model of the supportive process maintenance or system of the supportive process maintenance is a care model developed by the German nursing scientist Monika Krohwinkel . It is based on the Krohwinkel nursing theory presented and further developed in 1993 . The model initially was based on the A ctivities and existential E XPERIENCE d it L and provide the per ( AEDL ) since 1999, was B ELATIONSHIP presented by Krohwinkel as an additional factor, the abbreviated title is ABEDL . The care model, which is widespread in German-speaking countries, is used in professional health and nursing care as well as in care for the elderly . Different terms are used for the care model, including "care according to Krohwinkel", "AEDL structure model" or "care according to AEDLs". The model is counted among the holistic needs models with a medium range and is the only model so far that has emerged from German nursing science.

The starting point of the model is the needs of the person in need of care. Krohwinkel assumes that a limited satisfaction of needs in one of the ABEDLs leads to the need for care and requires the care staff to act. The care model itself is based on five components, each of which covers an area of ​​care, for example the care process or the framework conditions for care.

Origin and basics

From 1988 to 1991, Krohwinkel led a research project on the holistic care process for apoplexy patients . From the research and her work within this project, she developed her care model. Krohwinkel's theoretical work was particularly influenced by the model of care for life activities presented in 1976 by Roper , Logan and Tierney . The foundations, which also use the previously published model of the 14 basic needs by Virginia Henderson , are above all the theories of Carl Rogers humanistic psychology, Abraham Maslow and the needs of people as defined in Maslow's hierarchy of needs . In Krohwinkel's care model, the care theories of Dorothea Orems ( self-care deficit model ) and Martha Elisabeth Rogers ( energy field theory ) are also continued. The model is similar to the care model of activities in daily life formulated by the Swiss Liliane Juchli .

Meta paradigm

According to the nursing science aspect, nursing theories and models can be divided into four paradigms or key concepts. In their entirety, they are referred to as the metaparadigm of care and encompass the areas of man / person, environment, health / disease and care. Using these criteria, the objective, the self-image and the systematic of each theory can be described and recorded. The metaparadigm as a descriptive element is controversial in nursing science and metatheoretically, but is used within nursing education to provide a comprehensive overview of a nursing theory.

human

In her concept, Krohwinkel speaks of "human" or "person", referring to both the person in need of care and the carer. The human being is understood as a complex and integral being that has its own identity and integrity . Through his integrity, a person is able to develop, grow and change and is capable of judgment, can make decisions, take action and take responsibility.

Surroundings

In Krohwinkel's holistic view, the environment is viewed as an important factor for life , health and well-being, which influences the life and experience of the individual. People and their environment are open, mutually influencing systems. The environment includes all social, physical, economic and material factors that affect the "human" system and allow him to gain experience.

health and sickness

Krohwinkel defines illness and health as an ongoing process from which nursing staff can derive the resources and deficits of what is being cared for. The person in need of care identifies well-being and independence as subjectively perceived parts of their health.

maintenance

Care should maintain the skills of the person in need of care or their relatives or encourage them to regain them in order to achieve the independence and well-being of the person being cared for. The elements of care are described in the ABEDL.

Components of the model

ABEDL structural model

The ABEDL structure model depicts the needs, abilities and resources of people and serves as a recording and data allocation instrument with which the individual need for care can be identified. Krohwinkel defines 13 ABEDLs that are related to each other but do not have a hierarchical structure. With this division, the documentation of the nursing process is made possible, for example, the structured creation of a nursing history or nursing planning is facilitated. In Krohwinkel's model, eleven areas are identical to Roper's model. The twelfth area, in which the well-groomed tries to secure his social areas, results from the rehabilitative approach of Krohwinkel. The thirteenth area, which is circumscribed "dealing with existential experiences in life", Krohwinkel divides into existence endangering experiences, existence promoting experiences and experiences which promote or endanger existence. It refers to experiences such as pain, fear, security, trust, but also culture and biography.

  1. To be able to communicate
  2. Can move
  3. Maintain vital functions of the body
  4. Can take care of yourself
  5. Being able to eat and drink
  6. Can leave
  7. Know how to dress
  8. Rest and sleep
  9. Being able to keep busy
  10. To feel like a man / woman
  11. Being able to ensure safety in the area
  12. Be able to secure social areas of life
  13. To be able to deal with existential experiences in life

Care frame model

With the care framework model, Krohwinkel defines the primary interests, objectives and methodology of process care. These central elements are action-oriented towards the person in need of care and their caregivers. These superordinate nursing activities and tasks are divided into three areas:

The primary nursing interest

The person in need of care is at the center of care. For the nursing staff, the nursing needs, the individual deficits of the person being cared for, their skills and resources as well as their handling of existential experiences of life are essential and are defined and described using the ABEDL. Care is influenced by primary influencing factors, which include, for example, the environment, the living conditions of the person in need of care, health / disease processes and diagnostics and therapy.

The primary nursing objective

The aim of care activities is to maintain, promote or regain the well-being and independence of what is cared for within life activities and in dealing with the existential experiences of life. To achieve this goal, the skills of the person in need of care and their caregivers must be systematically recorded. Building on this, the caregiver can support and encourage the person in need of care. The primary care goals are independent of the individual condition of the person in need of care, regardless of whether they are sick, disabled, healthy or dying.

The primary nursing assistance

Five basic methods of assistance are provided within the care methodology. These are applied needs and goal-oriented, the actions of the caregiver primarily serve to support and promote the individual and should maintain their independence or have as their goal.

  • Action for the person in need of care
  • Leading and leading what is well-groomed
  • Create an environment that is conducive to positive development
  • Support for the person in need of care
  • Guidance, advice, instruction and support for the person to be cared for and their personal reference persons.

Nursing process model

Krohwinkel defines the nursing process as a four-phase and individual problem-solving and relationship process. First of all, data is collected as part of the care history, based on this, in the second step, the goals and measures are determined within the care planning. As a third step, care is carried out and the planned measures are creatively implemented before the final step of the care process is followed by the evaluation known as evaluation. This is achieved by a target-analysis and a feedback ( Feedback ) allows.

The maintenance process documentation is an essential part of this process. For Krohwinkel, this documentation is a means of interdisciplinary cooperation, serves as a basis for evaluation, can be used to develop new knowledge and to review care performance, and increases the effectiveness and consistency of care.

Management model

With the management model, the necessary framework conditions for care are defined in Krohwinkel's view. This includes time, personnel and structural resources that are required to fulfill the main nursing tasks and areas of responsibility. It describes five areas of activity:

  • Direct care: Concrete implementation of the care measures
  • Nursing documentation: Implementation of nursing documentation within the nursing process
  • Work organization: needs analysis, determination of decision-making, delegation and evaluation responsibility for nursing tasks, methods and resources
  • Diagnostics and therapy: assumption of responsibility for implementation within medical decision-making, delegation and evaluation responsibility
  • Cooperation and coordination services: Tasks that are carried out by the nursing staff in coordination with the other professional groups and work areas

Method of reflective experiential learning

The method of reflective experience learning is identical in its structure to that of the nursing process. By applying the control loop, the nursing action becomes a process that leads to experience-based learning. According to Krohwinkel, this form of learning is necessary and sensible, because analytically gained knowledge leads to reflection on actions and a renewed awareness of the problem. This stimulates new actions and measures, positive and successful actions are included in the individual action repertoire and reinforced. Krohwinkel assumes that the synthesis of experience and theory will permanently lead to a changed understanding of care and to new care concepts.

literature

  • Friedhelm Henke, Christian Horstmann: Care planning precisely formulated and corrected. Practical working aid for teachers and students . 2nd Edition. Kohlhammer, Stuttgart 2010, ISBN 978-3-17-021668-6 .
  • Friedhelm Henke: Formulation aids for care planning. Central care documentation with information from the MDK guidelines . 5th edition. Kohlhammer, Stuttgart 2010, ISBN 978-3-17-021560-3 .
  • Ulrike Brög-Kurzemann: Basic care, treatment care: structured according to AEDL . Vincentz, 2000, ISBN 3-87870-620-0 .
  • Stefanie Hellmann: Formulation aids for care planning according to the AEDL and the care diagnoses . 5th edition. Schlütersche, 2006, ISBN 3-89993-443-1 .
  • Angela Paula Löser: Nursing concepts in inpatient care for the elderly . 3. Edition. Schlütersche, 2008, ISBN 978-3-89993-188-4 .
  • Andrea Zielke-Nadkarni: Organizing care activities in a person-related manner . In: Workshop books on care today . 4th edition. Analysis and suggestions for teaching. Elsevier, Urban & FischerVerlag, 2006, ISBN 3-437-27640-9 , pp. 61-68 .

Individual evidence

  1. ↑ The year of publication is often stated on websites as 1984, but basic nursing literature indicates 1993, for example in Beate Rennen-Allhoff: Handbuch Pflegewwissenschaft . Juventa, 2003, ISBN 3-7799-0785-2 , p. 574 .
  2. ^ Herbert Müller: Work organization in geriatric care: A contribution to quality development and quality assurance . 3. Edition. Schlütersche, 2008, ISBN 3-89993-193-9 , theory-guided work, p. 52-54 .
  3. ↑ Andrea Zielke-Nadkarni: Organize care trade in a person-related manner . In: Angelika Warmbrunn (Ed.): Workshop books on care today . 4th edition. Analysis and suggestions for teaching. Elsevier, Urban & FischerVerlag, 2006, ISBN 3-437-27640-9 , pp. 61 .
  4. ↑ Christine R. Auer: History of the nursing professions as a subject. The curriculum development in nursing education and training , dissertation Institute for the History and Ethics of Medicine, Chair Wolfgang U. Eckart , Ruprecht-Karls-Universität Heidelberg 2008, pp. 97-107.
  5. ↑ Jasenka Korečić: standards of care elderly care . 4th edition. Springer, 2005, ISBN 3-540-23508-6 , 1.4 The structural model of the AEDL, p. 8 .
  6. ↑ The paradigms developed by Kuhn in 1970 and differentiated by Kim are questioned in particular because of the use of the nursing paradigm as a self-description of nursing, see also Beate Rennen-Allhoff: Handbuch Pflegewwissenschaft . Juventa, 2000, ISBN 3-7799-0808-5 , Nursing Theories, p. 53-55 .
  7. ↑ Petra Fickus: Fundamentals of professional care. Georg Thieme Verlag, 2007, ISBN 3-13-127242-2 , pp. 125–127.
  8. ↑ Andrea Zielke-Nadkarni: Organize care trade in a person-related manner . In: Workshop books on care today . 4th edition. Analysis and suggestions for teaching. Elsevier, Urban & FischerVerlag, 2006, ISBN 3-437-27640-9 , pp. 63-64 .
  9. ↑ Andrea Zielke-Nadkarni: Organize care trade in a person-related manner . In: Workshop books on care today . 4th edition. Analysis and suggestions for teaching. Elsevier, Urban & FischerVerlag, 2006, ISBN 3-437-27640-9 , pp. 64-65 .
  10. ↑ Andrea Zielke-Nadkarni: Organize care trade in a person-related manner . In: Workshop books on care today . 4th edition. Analysis and suggestions for teaching. Elsevier, Urban & FischerVerlag, 2006, ISBN 3-437-27640-9 , pp. 65-66 .
  11. ↑ Andrea Zielke-Nadkarni: Organize care trade in a person-related manner . In: Workshop books on care today . 4th edition. Analysis and suggestions for teaching. Elsevier, Urban & FischerVerlag, 2006, ISBN 3-437-27640-9 , pp. 66-67 .
  12. ↑ Andrea Zielke-Nadkarni: Organize care trade in a person-related manner . In: Workshop books on care today . 4th edition. Analysis and suggestions for teaching. Elsevier, Urban & FischerVerlag, 2006, ISBN 3-437-27640-9 , pp. 68 .