The Setting Affects Treatment And Management Strategies That Might be Employed In Clinical Practice of Podiatry - Essay Example

The setting affects treatment and management strategies that might be employed in clinical practice of podiatry. of Institute Course Name Date Table of Contents I. Introduction II. Characteristics of Client Group III. Policy and Practices-Impact on Patient Care IV. Practice Podiatry V. Discussion VI. Conclusion VII. References I. Introduction This paper is an effort to study the elder group of the society, there problems are particularly related to the podiatry and the study of various settings in which they get clinical support. The paper starts with the characteristics of the client group. The various sub phases of old age is discussed here. The next section deals with the various policies regarding this specific client group. It is followed by the discussion on podiatry. At the end of the paper various parts of the discussion are put together in the discussion section. II. Characteristics of Client Group It is due to better heath services and awareness of people for health care that average age of people around the world is increasing. The client group considered in the paper are elderly people of the society. They form a considerable section of the society. “England is an ageing society. Since the early 1930s the number of people aged over 65 has more than doubled and today a fifth of the population is over 60. Between 1995 and 2025 the number of people over the age of 80 is set to increase by almost a half and the number of people over 90 will double.” (National Service Framework for Older People: 2001) Elderly people have spent their time, energy and entire active life within the society contributing to it in minor or major ways. This group of clients are gamut of experience of life. There are various factors associated with aging. The concept of aging is different for different societies. There is no fixed age from where a person is considered old. The timetable of aging differs from society to society and individual to individuals. Aging is one of the factors of discrimination. Old people are usually discriminated for services available or offered on unofficial grounds. This group of people expects care and respect from the society. They need empathy and proper care. There are various symptoms of aging i.e. wrinkles, balding, aches, and inability in doing certain activities. There are various other factors like personal history of a person, genetic pool, lifestyle, psychological conditions, gender etc have impact on determining the older phase of a person. According to National Service Framework the old age people can be divided into 3 subgroups. 1. Entering old age 2. Transitional phase 3. Frail Older People In the entering old age people usually have an active life. There are different definitions for the old age group. Some include people of age group of 50 into the old age segment. Official retirement age is 60 years for women and 65 years for men. This includes people who have completed two important cycles of their life i.e. career and child rearing. These people enjoy healthy life style and independence in their life and decisions. The health concerns at this level are high. If taken care properly the healthy and active life can be extended. The policies are focused towards healthcare promotion and compress morbidity. The active life of the people entering to old stage transform into the frailty and inactive stage. This duration is known as transitional phase. It can occur at any stage of life. But in England the usual pattern is that this occurs at the seventy or eighty years of age. This phase the individual goes through difficult mental and physical changes. There can be various other problems related to physical and mental health of an individual. The next stage is the frail old stage people are inactive and in vulnerable health and mental condition. This group of people of people faces various health related and psychological challenges. Malfunctioning of body organs, low vision, dementia and other are some common problems at this stage of life. The dependency factor is high. This often creates a condition where individual compromise on quality. The NHS spent around 40% of its budget - £10 billion – on people over the age of 65 in 1998/99. In the same year social services spent nearly50% of their budget on the over 65s, some £5.2 billion. Older people tend to have a much greater need for health and social services than the young, so the bulk of health and social care resources are directed at their needs. (National Service Framework for Older People: 2001) III. Policy and Practices-Impact on Patient Care In April 2001, the National Service Framework for Older People’s Services was introduced. This had certain goals and focused areas. The policies and practices adopted for each stage has varying goals. In the entering phase the focus is towards the maintaining the healthy condition and compress the morbidity stage. In the transition phase it is to identify crisis and reduce the long term dependency by effective response to crisis. The goals for the frail stage as mentioned in National Service Framework are as follows: The goals of health and social care policy are to anticipate and respond to problems, recognising the complex interaction of physical, mental and social care factors, which can compromise independence and quality of life. The National Service Report considered other issues for the well being of older people. These issues are related to day to day life of old age people. These address issues of transport, learning, poverty and social care and health. In order to provide better care and meet the needs of the elder group government have implemented the strategy of intermediate care service. These services are defined as "… those services which help to divert admission to an acute care setting through timely therapeutic interventions which aim to divert a physiological crisis or offer recuperative services at or near a persons own home." These services come between the primary and specialist services. The aim of these services was to avoid unnecessary hospitalisation and effective rehabilitations. These services included the services of range of specialist, generalist, social workers and carers. For the services of older people it is the core service in present scenario. This has been effective to improve services to the elders of the community today. Older people will have access to a new range of intermediate care services at home or in designated care settings, to promote their independence by providing enhanced services from the NHS and councils to prevent unnecessary hospital admission and effective rehabilitation services to enable early discharge from hospital and to prevent premature or unnecessary admission to long-term residential care. There have been various works to improve the services towards the older people. Policies like National Service Framework for Older People (DoH, 2001), Intermediate Care: Moving Forward (DoH, 2002), Supporting People with Long Term Conditions (DoH, 2005) has been some of various effort towards this direction. The appropriate and effective use of resources, human empowerments and creating effective environment with overall goals of supporting older people is one of the key areas in this direction. Older people are encouraged and educated to adopt healthy habits. The emotional, mental, physical and psychological all kind of support is needed for the older people. The intermediary care services work in the collaboration with the health care professionals and social workers. The proper communication and training is required to the people working together. The planning for various resources like human resource, funding, inventories, utilisation of place and space are the area of concerns. Intermediate care services are delivered in the community settings. These settings include schools, community centres, rehabilitation centres, institutes and other premises. As define by Gibson (1998) community is: The ‘community’ can be defined as anywhere ‘outside the hospital’ where people live e.g. the patient’s own home. IV. Practice Podiatry The setting affects treatment and management strategies that might be employed in clinical practice of podiatry. Podiatry or chiropody is an area of healthcare studies for the treatment of disorders of the foot and ankle. There are many different foot problems and conditions. These can be result of infection, growing age, inherited, any accident etc. there are more than 300 different foot conditions recognised so far for treatments. People tend to be careless towards the proper care and treatment for foot. Many foot conditions were treated successfully in the retirement age of people. The pain of foot can result from wrong shoe size as one of the assumption is foot size remains constant the other painful conditions can arise due to dry and brittle nails. The foot problems range from calluses, ingrown toe nails, claw toes, hammer toes, heel pain/ heel spurs ,Achilles tendonitis ,flat feet , arch pain ,aching feet and legs , abnormal walking patterns e.g. In toeing , shin pain / shin splints, ankle pain ,knee pain, lower back pain and hip pain. This pain can be result of improper sitting or walking, weight gain and other reasons. The social workers and podiatrist try to understand the problem or crisis situation. The second step for them is to evaluate the long term impact of the crisis and taking preventive measures like educating people to take proper care of foot and body and if required providing medical assistance for prevention. The setting affects treatment and management strategies that might be employed in clinical practice of podiatry. The treatment and management strategies in the clinical practice of podiatry are based on certain things. It includes the physical setup of the setting to the human component of it. The Physical setup of the setting includes management of all the available resources and operational efficiency of the centre. The limitation of the centre being intermediary should be kept in the minds of the planners. The areas should be well defined like which kind of problems should be directed to the critical or speciality treatment and which should be referred to the intermediary cares. The criteria should be set and the social workers and other professionals working with the old group should be trained for that. The emotional need for the old age group of people can be higher; these people should be treated with respect. In the initial contacts the criteria should be clear for the interviewing professional. Figure 1: Chiropody first and initial contacts, England, 1988-89 to 2004-05 As per the Health and Social Care Information Centre the number of initial contacts is 4% less than in 2003-04 and continuing the downward trend seen since 1996-97. The approach of the professionals should be problems solving. According to National Service Framework for Older People the Intermediary care should have the followings: All ward staff should be competent in the care of older people. But specialist attention from a range of disciplines, for example, audiology, ophthalmology, podiatry and orthotics services, or from the specialist old age multidisciplinary team may be necessary. Older people who have complex co-morbidities associated with older age are best treated by a dedicated specialised team. Care provided by specialist old age medicine teams can result in shorter lengths of stay and a reduction in the need for long-term care. Various factors of settings influencing the treatment and management strategies are as follows: The size of setting. demography, complexity and maturity of the local health Available social care systems and associated intermediate care system in the particular area and nearby locations The skills, experience, capability and capacity of individuals Communication and Coordination among professionals Management style Funds and resources available. Empowerment of people V. Discussion Government came up with its ambitious agenda with National Service Framework Older People in 2001. The strategies was not just focused on the health or social care, rather it was based on the total well being of the older people. It promoted the independence of the older people by providing them support to compress the morbidity. It promoted the overall well being of older people living in community or home. After three years, it is clear that the NSF has galvanised the NHS and social care into more person-centred services and reduced ageist attitudes and practices. Each setting like domiciliary, care home, school and community hospital has different features. The domiciliary setting where in the old people will be at their home requires certain specific skills from the professional i.e. follow of ethical standard of work, respecting the privacy of the patient and family. There are various handling, consent and confidentiality, personal setting and protection and goal setting and outcome measurements are some of the area of concerns for professional dealing with client in domiciliary setting. In the care homes there are various types of care home i.e. normal care homes to speciality care homes. The care homes response to any problem will be higher as compared to the domiciliary setting. This is due to the professionals available at care homes and their knowledge and expertise to recognise and diagnose problems at the early stage. Podiatry within care home settings must be integrated with the other health professional inputs as part of recognition of the importance of multidisciplinary care. The hospital setting would be providing the most professional treatment to the problem. The treatment and management strategies in clinical practice will be very different due to the availability of professionals, equipments and medicines to deal with the adverse health situation. VI. Conclusion Various settings have certain limitations which have impact on the clinical practice of podiatry. These limitations can be based on skill and expertise of professionals to the facilities and resources available within that setting. The podiatry related problems are more prone in the old age group due to their aging body. There are several problems which can be taken care of with initial efforts of individuals. The treatment strategies at the domiciliary level will be simpler than the treatment strategies at the hospital based on the problems. The setting affects treatment and management strategies that might be employed in clinical practice of podiatry. VII. 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