Clinical Assessment in Minor Illness - Essay Example

Clinical Assessment in Minor Illness Concepts of Health and Illness Health is defined by the World Health Organization (WHO) as "a of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Some health workers and authorities extend this definition to having the ability to adapt or respond to changing environments, to growing up, healing when injured, and facing death peacefully. While many still believe the importance of harmony between the body, the mind, environment and community (Engel, 1980). Disease and illness constitute aberrations in the health of a person and are used to categorize a state of being unwell. Disease arises from a physician's diagnosis of a pathophysiological abnormality and is the main focus of the practice of medicine. Disease diagnosis is followed by appropriate therapeutic interventions (Dingwall, 1976). Concepts of disease and illness are changing. Disease is said to be a social contract which is established only after all parties concerned agree to the presence of such condition while illness is often described as a subjective experience which means that it is an account of a person regarding the state of his/her health (Robinson, 1971). Disease and illness concepts are constructed based on different personal, familial, ethnic and cultural backgrounds but it is the universal experience of feeling ill which drives an individual seek medical and other kinds of assistance (Engel, 1980). Across cultures, ethnicities and or religion, there is a consistent view of illness as a detachment from the dynamic interaction between the self and the external world. There is also a perceived breakdown of balance in the person's system (Robinson, 1971). In certain cultures, for examples, diseases and illnesses are a form of punishment and may include perceptions of dissociation of the body and the soul or consciousness (Engel, 1980). In the context of modern medicine, disease or illness is defined as a state of imbalance or disorder of a person's health caused by pathological microorganisms, genetics, pollution, malnutrition, stress and other psychological problems. This state is manifested through symptoms which are actually changes in the structure and function of the body. Symptoms come in the form of pain, abscess, swelling, dizziness, and collapse of organ or body parts (West Bar Surgery, 2005). Minor Illnesses In general practice, the range of illnesses includes major and minor illnesses. Major illnesses or diseases are considered chronic and highly disruptive conditions of a patient. Some of the most common diseases are cancer, hypertension, and heart and lung impairment to name a few (Johnson, et al., 2000). Minor illnesses, on the other hand, are temporary and relatively less intrusive conditions. These include colds, sore throat, earache, coughs, diarrhea, vomiting, urinary tract infection, warts, head lice, low back pain, sprains, strains and sun burn, depression and anxiety (West Bar Surgery, 2005). Colds, coughs and sore throats are generally caused by viruses and cannot be treated by ordinary antibiotics. The only treatment recommended is mitigating pain and fever that are associated with the said conditions. This can be achieved by taking pain relievers and anti-pyretic over-the-counter medications such as aspirin, paracetamol and ibuprofen which are available as mixture for infants and tablet for children and adults. Patients are also advised to drink plenty of fluids and rest (Johnson, et al., 2000). Diarrhea and vomiting may be caused by ingesting certain foods or some other factors such as dizziness brought about by problems with eyesight or sleep. These may be critical to infants and elderly persons thus requiring attention from primary care practitioners but for most people these illnesses may be treated through simple means such as drinking of plenty of fluids. Specific fluids and certain foods are recommended to prevent the worsening of symptoms. Some medications may be taken to end these conditions. Also, supplements are also advised to prevent dehydration (West Bar Surgery, 2005). Urinary tract infection is characterized by difficulty or pain in passing urine and usually associated with low back pain. Immediate treatment includes drinking plenty of fluids and taking pain medications. Urine test and medical attention is warranted in most cases (Johnson, et al., 2000). Warts and head lice are minor problems that can be remedied at home. While warts which are caused by virus can be physically removed, there are also wart-removing preparations available. Head lice result from poor hygiene and can therefore be avoided or prevented by placing importance in proper grooming and hygiene (West Bar Surgery, 2005). Minor burns, scratches, cuts and splinters are superficial injuries that require first-aid by putting creams, bandages and by removing small foreign objects that impregnated the skin. Proper cleaning and handling of the wounds is recommended which may be performed at home, school or work (Johnson, et al., 2000). Low back pain is a common complaint among adults and elderly people. There are many causes of low back pain such as lifting of heavy objects, wrong posture, sports related-activities, sudden twists while lifting and bumps or falls. Medications such as pain relievers and muscle relaxants may be taken to alleviate the pain and hasten the recuperation of the affected area. Also, hot or cold compress are also deemed very effective in bringing relief and healing the strained muscle. Two-day bed rest is sometimes recommended for severe cases after which specific stretching and exercise are advised to prevent recurrence by strengthening the lower back (West Bar Surgery, 2005). Sprains and strains are common problems for athletes and persons involved in outdoor activities. These result from twisting and stretching specific parts such as ankles and wrists. Swelling and redness usually develops accompanied by excruciating pain. The immediate treatment should include resting and applying ice packs to the affected area. Medication may also be taken to help with the pain (Johnson, et al., 2000). Sunburn and rashes result from staying outdoors under the sun too long. Applying lotion can help with the irritating sensation while use of sunscreen can prevent the occurrence of such conditions. Patients are advised to stay indoors during the hottest periods of the day and to drink plenty of fluids (West Bar Surgery, 2005). Depression and anxiety can be a sign of stress or psychological imbalance that may be transient but may also be a sign of a deeply troubled person. Being down is part of the fluctuations of human emotions and may be solved through communication or changing stressful situations or factors in the patient's lifestyle. Invigorating activities may help eliminate simple cases of depression while chronic depression requires the attention of psychologists (Johnson, et al., 2000). Clinical Practice Guidelines and Minor Illness Management Clinical practice guidelines are developed to help practitioner and patient decision-making on the appropriate health care for given clinical conditions (Field & Lohr, 1990). These procedures are based on extensive evaluation of available evidence and intended to be extracted from up to date evidence and opinion on best practice. Clinical practice guidelines are often times referred to as clinical pathways, practice protocols or policies. The difference from these terms is that clinical practice guidelines are more evidence-based and less prescriptive. It is a component of ideal medical decision-making which takes into consideration the preferences and values of the patient, experience and values of the practitioner and the available current evidence. The objectives of these guidelines are to achieve better health results by advancing the practice of health professionals and offering patients more information on treatment options. Through these initiatives, risk factors are identified, education of the community is promoted and quality of health care is assured (Wensing et a.. 1998). The evidence on which recommendations are founded can be classified according to degree, quality, significance and strength. Recommendations should be made according to the highest level of evidence which pertains to the study designed to minimize bias, highest quality of evidence which refers to the methods used to negate bias, high relevance pertains to the applicability of the study conducted and the strength refers to the magnitude of treatment outcome in the clinical studies (Field & Lohr, 1990). While these guidelines are implemented in a wide range of medical situations, there is one specific area warranting further evaluation and development which concerns the management of minor illnesses in general practice. A study on the effectiveness of management, implementation and evaluation of general practice was conducted in the United Kingdom, United States and Canada (Wensing et al. 1998). The best evidence of effectiveness on intervention included the following: duration of the intervention, number and type of physicians, intervention group, outcome, follow-up interventions, etc. The effect of intervention was determined on different outcomes considered. These were percentage of patients consulted, compliance with existing protocols, medical costs, and other activities. On the other outcomes, physician knowledge or skills and patient outcomes were measured. Each of these elements was found to contribute in the determination of effectiveness on intervention (Field & Lohr, 1990). Apart from determining these elements in patient care or intervention, they have also analyzed the effectiveness of single intervention versus none and multi-faceted intervention versus no intervention. They concluded that multi-faceted interventions are more effective than single or no intervention. According to Wensing et al. (1998) the methodology of these studies was problematic. Less than half were considered acceptable since most of the studies focused on the patients who, they said, tend to cluster within practices. The focus, according to the authors, should have been on the clinician or the clinic. Whereas this may be considered unacceptable to the scientific evaluation of effectiveness of intervention, the impact of patients in the success should not be emphasized. The main focus of modern medicine is the solution of the patient's problems which are illness and diseases and taking away the focus on them would only benefit the evaluation of the physicians and the clinics performance. The consideration should be on the experiences of the patients relative to the intervention and not on the skills or the management of general practice (Field & Lohr, 1990). As a practice nurse who aims to alleviate and protect the welfare of patients, I suggest that evaluation should be brought back to the consumers or may place higher value on feedbacks and overall satisfaction of patients as opposed to other elements in general practice. This remains true even in the case of minor illnesses. Although self-help and community education may be the proposed approaches for these types of conditions, there is still a need to consider the individual effect of nurse - patient interaction towards the resolution of their concerns. Assessment of Minor Illness in General Practice Minor illnesses take a huge chunk of the workload of general practitioners each day. Around 70 to 80 per cent of emergency care presentations can be dealt with elsewhere which includes 30 to 40 per cent of accident and emergency attendances. This means that there is an inefficient distribution of workload for practitioners who should be attending to more urgent or critical conditions of patients (Whittington, 2000). Understaffing and overloading of general practitioners is the result and overall performance of healthcare systems is jeopardized. Therefore there is need to improve the management of minor illnesses which implies focus on the following aspects of healthcare. First is that there is a need to empower patients and make them aware of their capability for self-care. Second is to put in better use the skills of nurses and pharmacists appropriate for treating minor illnesses. Third is to improve the public access of the services of primary care centers (Morris et al, 2001). These changes should enable general practitioners to allot more time for consultations to non-minor illnesses or emergencies and reduce the attendance of minor illnesses in accident and emergency services (Calnan, 1983). Generally, classification of concerns as minor ailments were facilitated through the following (Blenkinsopp & Noyce, 2002): pharmacy schemes that possess well-defined set of minor illnesses agreed upon by GPs and pharmacists which focus mainly on respiratory, gastrointestinal tract and skin problems. This list is sometimes extended after experience with other minor illnesses. Other ways to categorize ailments as minor include high attendance rate of the illness to local GPs, willingness of the GP to transfer the management to nurse or pharmacist or the availability of over-the-counter medicine for treatment. Other tools such as triage which is used to sort emergencies or minor ailments can be considered. Triage is initially used to determine whether a patient's condition may threaten life, limb or the senses. Whereas it is mainly used for emergency and disasters, it can also be considered as alternative tool for determining the different symptoms a patient may present. From this method and the above schemes, a nurse may proceed with a level of confidence if there is a need to refer to other practitioners or to apply minor illness treatment or other steps (Hughes et al., 2002). In addition, the basic tools of a nurse which are the conduct of physical assessment and history are very important in determining the nature of an ailment or illness. By establishing relevant symptoms and physical conditions, emergency or urgent attention may be ruled out. Common minor ailments may present differing symptoms but experience in these different conditions may instill the skillful eye for separating trivial from important signs. Communication with Patients The importance of communication of nurses with patients revolves in the recording of history, pinpointing hidden concerns, assessment of concordance, preparation of plans and giving advises regarding minor illnesses (Hughes et al., 2002). Communication is an integral part of patient-practitioner relationship. Without communication no need can be established upon which the solution and suggestions can be constructed. The responsibility of opening and maintaining a smooth flow of communication between the two parties lies in the practitioner, and in the case of primary care setting, the nurses and staff (Cross & Rimmer, 2002). An open and smooth communication entails the elimination of possible barriers which come in the form of language, cultural and ethnic differences. Every aspect of consultation should be prepared to cater to different affinity or origin of patients. In order to extract relevant information, proper guidelines must be followed to be able to tackle the essential aspects of health and well-being (Hughes et al., 2002). Confidentiality of information passed between the concerned parties is a well-known and expected practice. Practitioners including nurses are privileged to listen and record personal and historical facts that has relevance to the present condition of the patient or the environment from where a patient came from. This agreement works two ways: both the practitioner and the patient feel at ease and unburdened whatever information may be passed on. This gives the impression of unbiased and objective approach to the personal matters and helps facilitate the overall function of patient-nurse interaction, for that matter. There are legal frameworks that support these agreements which add credence and security to the health care service (Cross & Rimmer, 2002). Recording of history is a pre-requisite of all medical proceedings. All pertinent historical backgrounds should be reflected to clear the stage for further plans of intervention. Hereditary traits and illnesses, allergies, past diseases and related information should be established during the taking of history (Hughes et al., 2002). Relevant information will all be considered in drawing plans for action and patient advice. An integrated design tailored for each patient is the main objective and the satisfaction of current science requires such proceeding (Cross & Rimmer, 2002). Furthermore, this is also warranted in all dealing with insurance and health programs for social security or private firms, and the computerization and centralization of patient information further standardizes this protocol (Hughes et al., 2002). As the first level of contact with patients, nurses have the initial opportunity to extract relevant information regarding the experience of the patient. Since nurses are generally perceived as accommodating and gives more time and empathy, patients are more relaxed with them and tend to share more information. At first, superficial or common description may be given by patients but as time goes by, the patients gain confidence in talking and may divulge hidden concerns or information they unknowingly kept from the start (Cross & Rimmer, 2002). Patients come up to practitioners not only to relieve the pain or suffering but to obtain answers and to pare down apprehension for unexplained conditions. Patients tend to present problems as they see them and form perceptions regarding these problems while accepting there own opinion before more informed explanations are available. This leads to the narrowing down of reports of perceived illness and exclusion of other experiences that may play more consequential roles (Hughes et al., 2002). Before deciding to seek professional attention, patients undergo various stages wherein he/she forms his own opinion regarding his/her state shaped by relative(s), co-worker(s), authority(ies) and other community figures. These interactions may instill prejudiced views regarding the illness or disease which may affect the reporting or answering of questions by the nurse or attending personnel (Cross & Rimmer, 2002). Reasons behind downplaying some symptoms or deliberately omitting some information are varied. Factors to be considered are personal, familial, cultural and religious beliefs and practices. Patients hide concerns hoping that the resolution of declared illness will also bring about total relief (Hughes et al., 2002). Knowing these complications, the nurse and attending personnel are confronted with the responsibility of getting the most out of the initial encounter. Nurses should set an atmosphere of security and confidentiality from the get-go. This will enable the patient to relax and tell all his/her concerns (Cross & Rimmer, 2002). Another issue regarding the gathering of information is the attitude of patients related to concordance. Advice and prescription medications are given in the hope that they will be followed to bring about the resolution of reported problems or illnesses. Some patients may follow instructions at the start of the prescribed regimen but may fail to follow up or deliberately stop intervention attempts. Some patients may even directly disobey instructions from the start due to apprehensions or unmet expectations (Hughes et al., 2002). Other limitations in following instructions include social conditions, financial problems and behavioral or psychological complications. During and after intervention, proper accounting of steps and observations are taken to evaluate effectiveness. Regular monitoring and follow-up consultation is an ideal practice to tract the progress and effect of intervention strategies. Cooperation of the patient is crucial in the success of such objective and nurses and other practitioners must make sure that there is indeed cooperation as agreed upon (Cross & Rimmer, 2002). Planning of intervention strategies comes after proper diagnosis of illness or disorder. This implies satisfaction of the general practice guidelines. The first step is to lay down the facts about the patient's condition, the current evidences for requiring treatment, and the options that the patient can choose from and the risks involved for each option (Hughes et al., 2002). Consultation with the patient's concern related to the preferred treatment options must be thoroughly explored. This step is crucial since this is where the intervention fails if the patient becomes unable to follow the agreed instructions (Cross & Rimmer, 2002). Upon consideration of the multifarious aspects of the patient's state and views, a suitable treatment is chosen. Planning involves setting goals for each step before completion of the intervention. This way, a progress chart can be developed and effectiveness can readily be explained for each case (Cross & Rimmer, 2002). It would be helpful to involve family members or other close persons in the planning. This is to create awareness in the immediate environment of the patient where he/she can expect reminder or assistance. Stumbling blocks should be identified and consequences must be highlighted in order to emphasize the importance of each step (Hughes et al., 2002). Expectations should also be clear in the part of the practitioner or the nurse in particular and the patient. Doing so will define the limits and the gains that the patient must be aware of. With the expectations established, a timeline is also determined apart from the regular schedule of medications and activities aimed at the timely resolution of illnesses (Cross & Rimmer, 2002). Regarding minor illness, clear advice should be given to ensure full compliance by the patient. The importance of each step should be explained for relevance in the whole intervention process. Since minor illnesses can be self-medicated, the patient is left to look after his/her own. Therefore, education of patients is an important responsibility of primary care practitioners including nurses (Hughes et al., 2002). The education of patients is not only limited to the practitioners. There are many avenues of patient education for minor illnesses. These include information transfer through reading materials, group discussion, and peer-to-peer education (Blenkinsopp & Noyce, 2002). Reading materials are one of the more effective instruction methods. Leaflets, pamphlets, and short articles are mainly used for this purpose. Simple but comprehensive discussions of minor illnesses are presented in reader-friendly manner. First, the categorization of minor illnesses is explained and the effectiveness of self-medication. Included is the emphasis of not going directly to the general practitioner to inquire about minor illnesses. Aside from the futility of such action, there are also other complications such as long lines and abbreviated consultation periods (Blenkinsopp & Noyce, 2002). The capability of nurses and other primary care personnel can be highlighted to downplay any misconception of inadequate service. Caricatures and catchy phrases are usually used to depict these situations and are very helpful in conveying such messages (Little et al., 2001). These pamphlets or leaflets can be dispensed on the information desk where the patients can easily spot them. Information materials can even be provided to companions to widen the coverage of dispersal (Blenkinsopp & Noyce, 2002). Aside from the free information, patients can also access nurses for more questions and free consultation and free treatment which can all be reflected on the leaflet or pamphlet (Blenkinsopp & Noyce, 2002). Another way to disseminate information is through discussion groups. Organizing a discussion group in a community is one sure way of transferring information with input and opinion from the major stakeholders, the consumers and patients. Through this activity concerns, popular beliefs and misconceptions can be identified and brought into light (Cross & Rimmer, 2002). Personal views can be aired in this venue to allay certain fears or apprehension. It is constructive activity where resource persons can also introduce helpful information and tips and also answer questions from the group. The advantage of this activity is the interactive way of dealing with minor illness issues (Hughes et al., 2002). The group can also plan and find ways to go about problems in the primary care service as they see them. They can give suggestions that can cater to their specific needs and inclinations. Through the guidance of nurse practitioners, topics can be thoroughly discussed and agreement can be reached (Cross & Rimmer, 2002). A dimension of discussion group is peer-to-peer education. This is a more personal approach and may result to more open sharing of information that cannot be aired in a large group. Personal issues may be discussed relevant to the minor illnesses or intervention strategies. A nurse practitioner may take the lead in this activity or other community members capable of such role may be involved. This type of interaction is very flexible due to the small number of persons such that longer or more sessions can be facilitated for better information transfer. Volunteers can be very helpful in filling the shoes of the nurse practitioner to reach more people (Hughes et al., 2002; Blenkinsopp & Noyce, 2002). The practice of nursing in primary care setting should be flexible and accommodating to all the needs of patients. Since there is a great variety of persons in a community, nurses and other personnel should be sensitive to the affiliations and beliefs of patients. There are many familial, ethnic, cultural and religious beliefs that affect a person's view on health and illness (Baekert, 2000). Apart from these are the practices that may influence the conduct of interventions. There are situations or objects that may be prohibited in a certain culture or religion of which a nurse must look out for. This includes gender-related issues and diet (Cross & Rimmer, 2002). From record keeping, communication to complaints, nurses should be sensitive to their needs. Language barriers are the most important problems during record keeping where the ethnic or cultural needs should be formally addressed (Baekert, 2000). Barriers can be overcome by having translators or relatives that are able to communicate the experience of the patient effectively (Hughes et al., 2002). It would also be helpful if nurses undergo training on how to handle different cultural and ethnic differences in general practice. Doing so would give more awareness for issues not usually brought up in ordinary situations but may present complications in the long run. Patients have the right to complain about whatever irregularities they deem accorded them (Baekert, 2000). Again, nurses and attending practitioners must be sensitive and must expect the importance of such complaints to the patients (Cross & Rimmer, 2002). Health care centers and hospitals should have programs that would cater to the needs of minorities. Some institutions have already installed related changes that would make them more receptive and accommodating to all types of patients such as the The Horton General Hospital which provided ethnic menus (Baekert, 2000). Literature Cited Bekaert S (2000) Minority integration in rural healthcare provision: an example of good biopsychosocial model. American Journal of Psychiatry.; 137: 535-44, Blenkinsopp, A and Noyce, PR . (2002). Minor illness management in primary care: a review of community pharmacy NHS schemes. Department of Medicines Management, Keele University. Calnan, M. (1983) Managing 'minor' disorders: pathways to a hospital accident and emergency department. Sociology of Health and Illness vol5 no2 149. co.uk/minor_illnesses.htm> [Accessed 10 June 2007] Cross, S and M Rimmer (2002) Nurse Practitioner manual of clinical Skills. Edinburgh: Bailliere Tindall. Dingwall, R. (1976 ) Aspects of illness. London:Martin Robertson p100. Engel G. (1980) The clinical application of the Field, M.J. & Lohr, K.N. (eds) (1990) Clinical Practice Guidelines: directions for a Hughes A et al. (2002) A minor illness course for practice nurses. Primary Health Care; 12: (4) Johnson G et al eds(2000) The minor illness manual. Abingdon: Radcliffe. Morris CJ, Cantrill JA, Weiss MC (2001) Minor ailment consultations: a mismatch of perceptions. Int J Pharm Pract 9(suppl):R83 new program, Institute of Medicine, National Academy Press, Washington, DC. practice. Nursing Standard. 14, 45, 43-45. Roobinson, D. (1971) The process of becoming ill. London: Routledge & Kegan Paul p.27. Wensing, M., Van der Weijden, T and R Grol. (1998) Implementing guidelines and innovations in general practice: which interventions are effective British Journal of General Practice West Bar Surgery (2005) Minor illnesses. Available from Read More