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KEYWORDS
Elderly health
Rehabilitation nursing
Models and theories
These key words are based on subject headings from the British Nursing Index. This article has been subject to double-blind review.
This article describes a new model which aims to ensure that older people who are discharged from hospital are sufficiently confident, independent and self-caring.
THE ESHUN-SMITH model explains the care given to older patients when they are admitted to Holcot ward, Northampton General Hospital NHS Trust. Holcot ward is a rehabilitation ward within the hospital's new elderly care centre. The model was developed five years ago on Cavell ward by the author and the ward's co-manager Sue Smithon. It was used as the basis of nursing practice for more than four years before patients on that ward transferred to the new purpose-built centre. Although initially designed for a pre-discharge ward, the principles and values that underpin it can be applied to almost any nursing environment.
The Eshun-Smith model spans all aspects of patient care, including the assessment of the individual's needs on admission, the setting of care goals and the planning, implementation and evaluation of care. The emphasis of the model is to encourage patients to perform for themselves those activities of living that are considered critical or essential. These are the activities that everyone has to be able to perform if they are going to be able to live successfully on their own, or at least cope safely, when they are finally discharged home from hospital.
The origins of the model
After a period of illness many older patients may lose their ability to perform basic self-caring activities. The reason for transferring them to a rehabilitation ward is, primarily, to assist them to regain confidence in performing those activities. A review of nursing practice on Cavell ward revealed that this objective was not being fully met. It showed that up to the time of discharge, many of the patients remained anxious at the prospect of going back home, fearing that they would not be able to cope. It also showed that soon after discharge, often within two months, many of the patients were re-admitted into hospital for social or non-acute medical reasons, indicating that they had, in fact, not been able...