The Delivery of Health Care - Essay Example

Case Study Introduction The delivery of health care is a complicated process which is rich in standard procedures and processes. Health professionals provide these services in the best possible way in order to ensure that the patient would receive quality health services and timely care. This paper shall discuss the case of Edgar (not his real name), an 80 year old man who experienced a fall. This case narrates how I was called in to a small terraced house where a man (Edgar) in his 80s has fallen. Edgar was unsure about what happened, however, his carer expresses that the patient has had a long and complex medical history. Rationale Older adults are vulnerable to various health issues. Due to their advanced age, they are also likely to suffer from chronic diseases which require full-time care (Poon, et.al., 2003, p. 53). They are also vulnerable to senile dementia which compromises their memory and their normal mental functions. Communicating with these patients can be a major challenge. Moreover, health care interventions cannot be implemented in their behalf without an adequate and accurate assessment carried out on their person (Poon, et.al., 2003, p. 54). However, with limitations in the communication process, the assessment, planning, and treatment of the patient may be compromised. It is possible however to make an accurate review and assessment of the patient based on his current conditions, and based on a review of his history and current health care needs (Poon, et.al., 2003, p. 54). A discussion of these issues can also provide adequate strategies to address the health care needs of the patient. Moreover, through the application of adequate communication strategies, it is possible to secure a thorough and appropriate plan for the patient’s care. Informed Consent Informed consent and its various applications are part of the core values of health care delivery. There are however specific problems which can be seen when working with vulnerable groups (Milligan, 2011). For those with disabilities or with health issues which limit the application of informed consent, informed consent is still possible and the health care giver still has the obligation to ensure that such consent is gained from the patient. In instances when a patient is unable to make a fully informed decision or does not have the mental capacity to make a decision, the Mental Capacity Act of 2005 must apply. In these instances, the care giver must consult with specific persons, and gain their advice in relation to the patient’s care, as well as what the patient’s wishes would have been if he had the capacity to say (Milligan, 2011). It is therefore important to consult with the patient’s family or friends who are involved in the patient’s care. Informed consent mainly involves competence and voluntariness in order to establish what is actually involved in the decision. For those with memory problems, as well as mentally compromised patients, making an informed decision may be difficult. For health care givers administering to these patients, it is crucial for them to judge the patient’s competence (Milligan, 2011). Elements which the researchers have to bear in mind while making an assessment includes the patient’s abilities in: expressing and communicating their preference; understanding the purpose of the intervention; understanding the potential risks to themselves and to others; understanding the rights to refuse or withdraw their consent; understanding confidentiality and its limits; and retaining the above understanding within the duration of care (Milligan, 2011). According to the Royal College of Nursing (2011, p. 2), the principles in obtaining informed consent are more or less similar to the principles for potential research participants, except in instances where special circumstances are involved. In some instance where it is not possible to gain the patient’s informed consent, extra care must be applied by the care givers in order to protect the interests of the patients and to consult with the appropriate individuals regarding the patient’s care (RCN, 2011, p. 3). There may also be an implied informed consent in instances when express written and/or verbal consent is not given. This may be seen in instances when a patient implies their consent to the care by cooperating with the care giver during the administration of care (RCN, 2011, p. 2). Consent by proxy can also be used in these instances, for as long as the patient has family who understands his condition and who have had prior authorization from the patient on the administration of interventions in his behalf. For the benefit of the patient in this case who has fallen and who does not remember what happened, it is important for the caregiver to assess and review the patient’s ability to communicate and to understand his condition and the interventions which have to be administered in his behalf (Zolnierek and DiMatteo, 2009, p. 826). For as long as the patient understands his condition and expresses a clear comprehension of the interventions which have to be administered, the care giver can expressly gain the patient’s consent about the care to be implemented. The health professional must also try to clarify with the patient about the implications of his consent, and the interventions which would now be forthcoming. Physical issues In communicating with the patient, there may be physical issues which would likely be encountered. One of the obvious issues is that of the patient’s being “unsure of what happened.” This statement may speak of underlying health issues like senile dementia, stroke causing the fall, or head injuries resulting from the fall. With advancing age, the different senses usually decline and changes in hearing and vision would likely affects communication (Smith, 1993, p. 13). Due to these issues, the reaction time of elderly patients may be slowed and this sometimes puts them at a greater risk for injury. Some diseases may also impact on the ability of patients to communicate. Dysarthria is seen in patients who have slurred speech or who are not able to form words properly (Smith, 1993, p. 13). This is common among stroke patients. Their loss of teeth may also compromise their speech and their ability to speaker and say words clearly. Brain injuries may even lead to the inability to speak. Speech-related brain injuries may include receptive aphasia and expressive aphasia. Head trauma can also lead to cell death. Dementia can also destroy brain cells and lead to the loss of language over time. These losses may be permanent if no remedies are implemented (Smith, 1993, p. 14). In the case of this patient, he has had a previous history of stroke, which has since compromised his speech. He has been undergoing speech therapy and so was able to improve his ability to communicate with other people. He is however suffering from dementia which makes him very forgetful and which has compromised his mental processes. Whether or not his fall was caused by another stroke is a matter which has yet to be determined. Other possible causes of his fall have also yet to be determined. The determination would include a comprehensive assessment of the patient’s current condition and previous history. It is important to note however that the carer also expresses that the patient is hard of hearing sometimes, and has a compromised vision. He also has a slight limp due to his previous stroke. These elements are all factors which affect the effective communication processes with the patient. He may not understand clearly what is to be communicated to him because he is hard of hearing. He may also not be able to express clearly what has caused his fall because he may not have seen that something may have blocked his path. His ability to express himself may also be compromised by his dementia. He simply may not recall what he was doing or what caused his fall. This would cause problems in the accurate assessment of the patient, and not knowing these details about the patient may also eventually impact negatively on the appropriate care to be administered in his behalf. Social issues in communication In relation to the social environment of the patient, barriers in communication mostly involve role expectations, including the task orientation of the staff, especially when some of them believe that talking with the patient is not part of the therapeutic process. Some health care givers also believe that being seen talking with patients signifies laziness (Smith, 1993, p. 14). This belief may be considered an issue in communicating with the patient. In this instance, I feel that in some way, I do not want to be viewed by other people as lazy. Although I do believe that talking and communicating with the patient is an important part of the health care delivery process, I am self-conscious about other people’s perceptions of my actions. Many people, even patients believe that talking to the patient is not a pro-active way of dealing with the patient’s needs. This belief makes me very much conscious about talking with the patient because I do not want to give out the perception that I am just talking with the patient, and not doing anything to relieve him of his symptoms. I was conscious of this barrier when I was managing the patient because he was sometimes uncommunicative with me and at one point asked me why I was asking so many questions. He also viewed my talking and communicating as an inessential part of the delivery of health services. Cultural issues in communication Cultural issues may also sometimes impact on communication processes with patients. Cultural issues may involve values, beliefs, and traditions which interfere with the communication process (Capezuti, 2008, p. 153). These values may prevent the expression of certain preferences to the patient. In some cultures, a male or a female patient cannot be cared for by a health care giver of the opposite sex (Lauwers and Swisher, 2010, p. 488). Even age is a barrier for some cultures with the age prejudice against young or first time nurses being dominant. The practice of certain traditions for some patients may also be a barrier to communication. Some traditions for some ethnic groups may require the application of rituals before medical care can be administered to the patient (Capezuti, 2008, p. 153). Some beliefs also revolve around superstitious beliefs and practices which prevent the timely administration of care. Language barriers for non-English speaking patients can also cause significant issues even with language translators present. In some cases, family translators tend to interpret what the health care giver wants to communicate, instead of just translating the words (Capezuti, 2008, p. 153). There is an element of miscommunication which can result in these instances because the family member may try to shield the patient from any worries by editing or delivering the wrong message to the patient. This causes misinterpretation of data on the part of the patient and subsequent difficulties in the administration of care by the health professionals (Capezuti, 2008, p. 153). In the case of this patient, there were some cultural barriers in terms of the patient’s old school and traditional beliefs. He had conservative beliefs about my abilities as a health professional, especially due to the fact that I was a woman. He was therefore shy and a bit embarrassed about expressing to me the areas of his body which hurt and were injured during the fall. He could not even refer to his posterior side in front of me, even if I noticed that he was hurting in that area. I believe that he had traditional beliefs about the roles of men and women, and he had a bit of trouble getting past such beliefs. Psychological issues in communicating Psychological issues in communicating are mostly based on the personal issues which all people have, in relation to their past, histories of personal loss, painful relationships, and events (Capezuti, 2008, p. 154). In addition to these psychological issues, depression and anxiety also impact on the communication process between patients and health professionals. Personal issues in relation to personal loss and past events may cause patients to refuse to communicate of cooperate with their caregivers (Epstein, et.al., 2005, p. 1516). A traumatic event with a care provider may also cause them to refuse cooperation with their care givers and other health professionals. Depression and anxiety is also common among elderly patients (Nelson, 2001, p. 18). Such depression is often attributed to the looming end of their life and their limited socialization activities. In the case of this patient, he feels wary of health professionals administering care in his behalf. The care giver already expressed that he can be uncooperative towards new health professionals. He also mostly prefers the same people to administer to his care. He has had a traumatic experience with multiple health professionals caring for him, and he considers their overwhelming number to further cause panic attacks. During his confinement in the hospital for stroke, he was constantly surrounded by doctors and nurses. They poked, prodded, and ministered to his care for more than two weeks and during that time, he felt helpless as a patient. He now fears that he would again be subjected to such impersonal treatment. It took a while to reassure the patient that he would not be subjected to such treatment again. I also needed the help of the caregiver and family members to assist me in putting the patient at ease. Issues on communication with other health staff involved in the patient’s care In relation to other health staff caring for the patient, there may also be some communication issues. Issues in communication can involve human elements, which can refer to attitudes, behaviours, morale, memory failures, and stress among the different staff members (Department of Health, 2010, p. 5). These human factors can be seen among health professionals who do not wish to acknowledge the important and the differentiated roles that each health professional has in the adequate care of the patient. Failure to acknowledge these roles causes the health professionals to refuse to cooperate and coordinate with each other or to display arrogant attitudes towards each other. Ultimately such attitudes interfere with effective communication among the health professionals. Human elements, such as stress and fatigue can also cause a breakdown in communication among the health professionals involved in the patient’s care (Department of Health, 2010, p. 5). Stress and fatigue can compromise the delivery of health services and they sometimes lead to medical errors and a reduced quality of health care services. Distractions and interruptions in the functions of health professionals can also impact on their communication and coordination (Department of Health, 2010, p. 5). These distractions and interruptions can cause a health professional to forget about his additional responsibilities – that of coordinating with other health professionals. Shift changes can also impact on the coordination between the health professionals (Fortinash and Holoday-Worret, 2004, p. 339). Shift changes, especially those without proper endorsement and referral practices can cause gaps and issues in the delivery of health care. It can interrupt the communication between health professionals and eventually cause errors in the administration of care. Gender, social, and cultural differences among health professionals are also barriers to effective communication among health care givers (Fortinash and Holoday-Worret, 2004, p. 339). These differences can lead to reduced cooperation, misinterpretation, and prejudices between and among the health professionals. The power play between the different health professionals is also a significant issue in the multiprofessional working scenario. The hierarchy which also dominates the relationship between the health professionals impacts significantly on their relationship with each other (McPherson, et.al., 2001, p. ii46). The higher ranking health professionals may insist on pulling rank on the lower ranking professionals without adequately considering the unique functions that each professional (regardless of rank) plans in the delivery of patient care. The junior staff may also feel reluctant about expressing their opinions and their contribution to the patient’s care. In instances where particular qualities about the patient have to be revealed to the other health professionals, the junior staff may just choose to keep the information to themselves (McPherson, et.al., 2001, p. ii47). They may even choose not to question other staff members in relation to pertinent details about patient care, and in instances when inconsistencies and contrasts in patient care may be seen. Effective communication between the different professionals is the cornerstone of a successful collaborative practice. In the traditional sense, the NHS has used the written format, including the use of feedback forms, case notes, care plans, and message books in order to communicate with other professionals. However, although adequate records are crucial to the delivery of health services, they can also cause inactive collaboration where the group of professionals have rigid and single inputs in patient care. Purtilo and Haddad (2007, p. 230) emphasize that verbal communication is important to the establishment of a healthy professional and patient relationship. Carrying out meetings can help achieve this end. Regular conferences with the interprofessional team which is also linked by common care goals can help secure verbal communication; it can also activate team collaboration (Purtilo and Haddad, 2007, p. 230). The effective integration is based on a single referral system in the multiprofessional team which has a consensus in its objectives, priorities, and procedures (Leathard, 2000, p. 170). Strategies to overcome issues in interprofessional working In order to overcome the barriers to communication, it is important for the health care giver to speak slowly and clearly. The focus of the health provider must be on clearly enunciating and slowing down one’s speech (Berardo, 2007). The health provider must enunciate and not rush through the communication process. Rushing usually takes a person more time in communicating with the patient and even leads to miscommunication and misunderstandings in the administration of care. A care giver often ends up spending more time repeating oneself in order to be understood clearly (Berardo, 2007). Clarifications must also be sought by the care giver in appropriate instances, especially when the care giver is not sure what the patient is trying to say. Assumptions must be avoided as much as possible. The care giver must also frequently check with the patient for understanding, if what is being expressed by the patient is correct, and whether or not what is being expressed by the care giver is understood properly by the patient (Berardo, 2007). Idioms should also be avoided and relatable terms must be used by the care giver in communicating with the patient. Using terms like dyspnoea, tachycardia, hyperthermia, and similar technical terms are not relatable to the client. It would be better to use terms like difficulty of breathing, fever, or fast heart beat in order to communicate clearly with the patient (Berardo, 2007). In a similar vein, jargons must also be avoided, including the use of abbreviations which the patient would not really understand. For example, he would not understand abbreviations like PR (pulse rate), V/S (vital signs), and similar abbreviations. This makes the communication process more awkward and even more threatening to the patient (Berardo, 2007). It is also important to be specific during the communication process in order to make it easier for the patient to comply with interventions and implemented treatments. Instructions must be specific, not vague. Telling the patient to take his medication three times a day is not specific enough. A specific instruction must be expressed as: “take 1 tablet of Aspirin, 80 mg, once a day for one month.” This simple instruction negates the possibility of any misunderstandings on the part of the patient (Berardo, 2007). Patience is also an important virtue in communicating with the patient. It may be frustrating to allow oneself to be understood by this patient who does not exactly know what happened to him and who is suffering memory gaps. Repetitions may be necessary and this should not drive the caregiver to impatience. Another strategy in addressing the different issues and barriers to communication is on the skilled use of nonverbal communication. What is actually being said must therefore match what is being communicated through facial features, gestures, and other nonverbal cues (Abou-Auda, 2011, p. 8). Differences in culture must also be taken into account during the communication process. Eye contact for some cultures may be seen as rude or immoral, or it may be viewed also as a violation of personal space. However, other cultures give more credence to communication with eye contact as they interpret is as a sign of sincerity and of honesty (Samovar, 2009, p. 262). The interpretation of nonverbal cues must be done after duly considering the cultural qualities of the patient, qualities which may affect the meaning of these cues. Active listening is also an important means of establishing adequate communication. A good and effective care giver must learn to listen well. By listening to the customer, it is possible to put across the message that we genuinely care about them and what they have to say (Lang, et.al., 2000, p. 225). This improves their trust and confidence on the caregiver and thereby leads to a more collaborative and cooperative relationship. It is also important for a health professional to avoid doing two or more things at the same time because the lack of attention may project the message that one does not care about what the other has to say (Crawford and Kessel, 1999, p. 2). Distractions must therefore be eliminated during the communication process. Jumping to conclusions must also be avoided, and before a conclusion is drawn, due consideration must be made to decipher the actual meaning of words or gestures. In these instances, it is sometimes best for the caregiver to stop talking, instead, to listen to the person talking (Abou-Auda, 2011, p. 10). Moreover, the stereotypes in communication must also be eliminated and the reaction must be to the information given, not to the person. Faking interest in any scenario is also not advisable; therefore, good eye contact must be established in order to help the caregiver concentrate (Samovar, 2009, p. 262). It is also important for the care giver to judge an individual not according to his or her condition or physical appearance. The content, nonverbal cues and the manner in which something is said must be highlighted instead. Other skills can be utilized in order to ensure effective communication; there skills include: paraphrasing, clarifying, summarizing, and feedback (Abou-Auda, 2011, p. 10). Reflective responses must also be made by the receiver of the message and to the response of the messenger. Reflective responses allow empathy to develop, without having to agree with the patient. They allow the caregiver to assess the patient’s level of understanding. This type of communication also helps establish rapport with the patient, setting across the message that the health professional cares about the patient’s feelings, enough to listen and reflect on them with much thought. It is also important for the health professionals to listen and to empathize with other health professionals by informing them that their issues will be sufficiently resolved and for them to take appropriate steps regarding the issues to be resolved. It is also important for the health professionals to be assertive and to resolve their issues by giving facts clearly and concisely, to avoid criticizing other people, to be flexible, and to use feedback to ensure understanding of concepts and communication content (Abou-Auda, 2011, p. 12). Conclusion The above discussion establishes the issues which are encountered in the case presented. These issues include physical, psychological, social, cultural, and environmental barriers to communication which interfere with the effective transmission of data and knowledge to the patient. Communication issues may also be seen from the interprofessional working of various health professionals when these issues prevent the efficient relations of these professionals. In order to resolve these issues, different strategies are based on the elimination of barriers and the application of clear and concise links in communication. These solutions, in effect, seek to link the health professionals with each other and with the patient in order to seek better and more professional care for the patient. Works Cited Abou-Auda, H. (2011). 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