Primary and Community Care Services - Essay Example

Primary and Community Care Services Need to Provide Comprehensive, Integrated and Coordinated Care for Individuals and their Families According to Nay and Garratt (2009) "Primary and community care services need to be strongly focused on providing comprehensive, integrated and coordinated care for individuals and their families. They are essential to ensuring that older people can continue to live at home and participate in the community when they become frail, ill or disabled" (p18). Introduction Structural decision making in the healthcare field is an important part of all science-based professions where specialist professionals apply their knowledge in a given area to make informed decisions. This is thus a process involving psychological construct that imputes a cognitive process leading to selection of a course of action among alternatives to ultimately reach a final strategy that begins with a problem that demands action. In collaborative healthcare practice in the clinical setting, it can be an action dependent on opinions based on a process of reasoning that builds on academic learning. A multidisciplinary team comprises professionals from different specialities who work as a group towards care to the patient. The main reason for such a care strategy is diversity and complexity of healthcare, rapid advancement of medical specialities in terms of knowledge, technical dexterity of members of the team, enhanced client concerns about health and care, and many other intricate issues in present-day healthcare where no profession has superiority over another across the contexts of healthcare delivery plan to a patient. This is a case study of a patient, whose identity will remain undisclosed in this work for ethical and confidentiality reasons. A nickname, Mrs. Chang will be used throughout the work. This writer had an opportunity to assist in her care while she was admitted to the hospital following a trip and fall in the shower few days back, and she was admitted to the hospital due to her age of 82, frailty, baseline neurological disorder Parkinsonism with gradually declining cognition and deteriorating mobility, and lack of support at home and community, for further assessment and evaluation. In this work, based on nursing assessment of the case, a nursing discharge plan was enacted and presented with an attempt to critically analyzing the discharge plan based on her needs and at the same time finding evidence from contemporary literature about the justification of the discharge plan in association with other professionals involved in care, coordinated so that the family can participate in the care when the patient is discharged to the community. This condition is characterized by gradual slowing of voluntary movement, muscular rigidity, stooped posture, and distinctive rigid gait. Over and above that, she has evidence of rheumatoid arthritis of both hands. She tripped and fell in the bathroom; this impairment of mobility may get accentuated with her rheumatic disease. A thorough examination of all her joints indicated osteoarthritis and associated osteoporosis, which are age related, and these would further aggravate her problem of mobility. During this admission, she was admitted since she sustained a fall at home in the bathroom, and she had been admitted to the hospital for observation and further evaluation. She had been on ibuprofen. This indicates her baseline chronic pain, which may further compromise her mobility. The impaired mobility was further accentuated by the fact that at home, she stayed with her husband who was older than her by 4 years, who himself might be frail enough to be insufficient to help her out in these activities at home. The discharge plan must include provision for the patient to maintain joint mobility and range of motion while exhibiting adaptive coping behaviour. Improvement in muscle strength and endurance would be the goal. With age, there is baseline muscle wasting from the 50-80 years of age, and this is the result of aging process in the neuromuscular system combined with a decreased level of physical activity over and above her rheumatic disease and Parkinsonism. The nursing intervention would include provision of support and reassurance to help to cope with limited mobility. She would be given opportunity to voice her feelings about immobility and nodular joints. While doing the care management plan for her, she and her husband would be included in all phases of care with all their questions answered honestly. Encouraging her to pursue physical activity and reassuring her is important since there is a chance of developing depression given her social situation and late stage of the disease (Jamison, 2007). Gradual return to normal physical activity is expected with the physical exercise regimen. With regards to pain medications, they would be instructed to take medications exactly as prescribed, and adverse reactions such as bleeding and gastrointestinal irritation must be reported as soon as possible given her polypharmacy (Basger et al., 2008). Overexertion must be prevented along with minimisation of weight bearing activities. She should stand and work correctly. Given her fall and increased propensity of fall due to her disease conditions, safety devices such as grab bars in the bathroom and elevated toilet seat would help her a lot. She would be taught range of motion exercises with training on gait and posture. Pointing out to improving or at least stabilizing physical functioning, the patient's efforts to adapt must be positively reinforced. Depending on her progress, the patient would be referred to a physical therapist, and help at home care may be necessary to help her cope with her care needs. Patients may also demonstrate problems with social isolation, ineffective coping, potential for injury, and sleep pattern disturbance. Falls are the major sources of injury for patient of Mrs. Chang's age group, and they need to be prevented. The accumulation of deficits in her, such as, muscular weakness, decreased balance, or neuromuscular abnormalities would result in mobility impairment and consequent fall and difficulties in performing activities of daily living. Physical training has positive effects on balance, and many older adults lose stability and require assistance to regain balance. Physical training affects muscle strength and endurance and is important in delaying the crossing of the threshold to physical dependence. In her case all, including mobility, gait, balance, and depression and cognition need to be improved. These changes will be included in the discharge planning, which would be done in collaboration with Mrs. Chang, her husband, and physical therapy, and her physician (Davis, 2008). The nursing diagnostic and assessment procedure for the discharge planning must consider the possible presence of bathing or hygiene self-care deficit, dressing or grooming self-care deficit, feeding self-care deficit and resultant imbalanced nutrition, which could be less than body requirement, and impaired physical mobility, leading to risk of injury. Since the levels of disability and functioning differ with the number of chronic diseases and management of chronic diseases depend largely on self-care, self-care is an important parameter to be attended to in care. Her hypertension, Parkinsonism, chronic congestive heart failure, age, and rheumatic disease all contribute to restricted mobility, loss of strength, easy fatigue, restriction of range of motion in the joints, decreased flexibility of the limbs, fear of fall, all contribute to self-care deficits. It becomes really hard for her to get around and do what she used to. Moreover, low self efficacy and sense of loss of control would also worsen the picture further. Self-care is a major component of management of her problems. Moreover, some major determinants for not attaining a high level of self care are age, severe motor impairment due to parkinsonism, perceptual deficit, weak or poor family involvement along with no social involvement in her care, and all of these might have made her psychological adjustment difficult (Brown et al., 2005). The patient will perform bathing and hygiene activities to the fullest extent possible, and the patient will verbalize feelings regarding self-esteem. The bowel elimination pattern of Mrs. Chang showed she was constipated. Motor function has been acknowledged to be the most important determinant of self-care ability. In addition complex perceptual qualities also predict the level of self-care abilities. Nutritional deficits would reduce strength and would aggravate her frailty and would lead to easy fatigue when attempting some self-care activities. Failure to do so would reduce confidence and positive feelings about her abilities to herself. Added to this, her cognitive decline would lead to failure of assessing the environment and may lead to trauma, injury, or fall while doing such activities. It is important to provide emotional support to the patient and to listen to her concerns. To promote independence, the patient should be encouraged to participate in care decisions and to perform as much of her own care as possible. The independence should be encouraged by helping the patient recognize the ADLs that she can perform alone. Assistive devices should be provided as appropriate. Occupational therapy may assess her and prescribe assistive devices. To help her with severe tremors and achieve partial control of her body, she can be made to sit on a chair and use its arms to steady herself. It is to be remembered that fatigue may cause the patient to depend on others, so adequate rest must be provided (Eliopolous, 2005). The patient is to be helped to overcome problems related to eating and elimination. An occupational therapist must be involved to develop a program of daily exercises to increase muscle strength, decrease muscle rigidity, prevent contractures, and improve coordination. The program should include stretching exercises, swimming, use of a stationary bicycle, and postural exercises. Frequent warm baths and massage should be given to help relax muscles and relieve muscle cramps. The patient will be protected from injury by using the bed's side rails and assisting the patient as necessary when she walks and eats. Provision of clothing without buttons and with fasteners can be made and advised. Her diseases, their progressive stages, and treatments need to be discussed, and proper positioning must be demonstrated. Household safety measures will be explained and demonstrated such as installing or using side rails in halls, toilets, showers, and stairs and removing throw rugs from frequently traveled floors to prevent patient injury. An older adult's ability to independently complete activities of daily living (ADLs) is a benchmark for health (Marshall & Mackenzie, 2008). Assessment of functional limitations in older adults is very important for detecting disease and dysfunction, selecting appropriate interventions, and evaluating the results of these interventions. With the older adult, the ultimate goal is to maintain optimal function and be as independent as possible (Potter and Perry, 2005). The geriatric interdisciplinary team works towards promotion and maintenance of functional independence with the goal of assisting the older adult to live independently as long as possible and preventing hospitalization and institutionalizations. Moreover, regain of physical strength and self-esteem is time-consuming affair. With the improvement in nutrition, practice and encouragement in the ward, hopefully these time landmarks will be met. Even though this timeline is a prolonged one, given her other co-morbid conditions, all affecting mobility and strength, she would need to be given more rest and time. If the goals are unmet in the stated timeline goals will be revised following discussion with the patient, and new goals would be decided. Household safety measures will be explained such as installing or using side rails in halls and stairs and removing throw rugs from frequently traveled floors to prevent patient injury (Giummarra et al., 2007). Family members will seek support resources and develop adequate coping behaviors. The patient will maintain family and peer relationships. The family must be educated in the management of her condition. Teaching needs will depend on the severity of her condition. The patient's and family's needs for information is ongoing as adaptations become necessary. The education plan should include a clear explanation of the disease, assisting the patient to remain functionally independent as long as possible (Redfern & Ross, 2006). The patient and family must be taught about the effects and side effects of medications and about the importance of reporting side effects to the physician. Support can be given by encouraging the patient and pointing out that activities are being maintained through active participation. A combination of physiotherapy, psychotherapy, medication therapy, and support group participation may help reduce the depression that often occurs. Patients must be active participants in their therapeutic program, including social and recreational events. There should be a planned program of activity throughout the day to prevent too much daytime sleeping as well as disinterest and apathy. Family and social support groups can play a major role in this. On discharge family will be actively participating in patient's care and family's knowledge about the drugs and disease and safety measures will be demonstrable. Family support in coping, communication, mobility, assistance, safety measures, and pharmacotherapy would be very important in this case, and consideration of a social support group would be necessary given the age of her husband (Amarshi et al., 2006). Conclusion Taking the example of this present incident, given her situation and age, a fall in the toilet is very natural, and her husband, being aged further, would be barely able to respond to this accident, and a psychological panic is expected. All these conditions are prone to cause deterioration of her health-related quality of life that needs attention. Along with that other issues may creep up, such as, multiple medications. This discharge planning demonstrates that she needs to be managed appropriately with efficient and cost-effective care delivery, and to this end, the practice model must accommodate a nursing-oriented case management skill base and the elements of Mrs. Chang's and her family's support system. The main aims in her case management would include improvement in her mobility, reducing her fall risks, improvement in her symptoms and self-care deficits, reducing her polypharmacy and ascertaining appropriate medication regimen, helping her to cope and communicate, and helping her family to help her improve. A social support group is preferable along with establishment of safety measures at home, with key being the patient's and her family's education and active participation. To this end, this case management approach is perfectly suitable which can be accomplished through interdisciplinary involvement in the discharge planning. Reference Amarshi, F., Artero, L., & Reid, D. (2006). Exploring social and leisure participation among stroke survivors: Part two. International Journal of Therapy and Rehabilitation, 13(5), 199-208. Basger, B., Chen, T., & Moles, R. (2008). 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