Strategies to Support and Empower the Patient Living with a Long Term Condition - Essay Example

DISCHARGE STRATEGIES Introduction Long-term conditions remain common sources of hospitalisation amongmany patients affected by such conditions. The conditions commonly lack medical treatment and management is enhanced through therapies and medication. The process of discharging a patient suffering from these conditions is complex and comprises numerous challenges (Margereson & Trenoweth, 2010). This article seeks to analyse the conditions necessary when discharging a patient with several LTC, form hospital to home based care. The patients and family members are provided with information and skills to administer self-care outside the hospital (Nicol, 2011). This follows a comprehensive analysis of the medical conditions facing the patient, by a team of different professionals. Key words Long-term conditions – they refer to medical situations which do not have immediate treatments but are managed through medication and therapies, such as diabetes, asthma etc(Suhonen, Alikleemola, Katajisto, & Leino-Kilpi, 2012). Type 2 diabetes – it refers to chronic condition which is marked by the human body being unable to use insulin properly. It is the most common type of diabetes, commonly called hyperglycaemia(Kirk, Barnett, & Mutrie, 2007). Glycaemia control – it refers to the capability to maintain blood sugar levels among individuals suffering from diabetic conditions at 70–130 mg/dl, which is the normal blood sugar level(Kirk et al., 2007). Leg ulcer – it can be defined as a chronic wound either on the leg or foot, which takes more than six (6) weeks to heal(Presho, 2008). Hypertension – it is a medical condition in which a person’s blood pressure remains above 140/90 mm/Hg for most of the time. It can simply be defined as abnormal high blood pressure(Williams et al., 2004) Case Presentation A 77-year-old woman has been admitted with leg ulcer infection and has had her right leg amputated below the knee. The woman also suffers from type 2 diabetes with poor glycaemia control, which has resulted in 3 previous admissions, within the last 18 months, for poor management of the diabetes. She has also been diagnosed with hypertension and is currently under hypertension and diabetes medication. The woman is about to be discharged and requires a care package to be organised. She speaks fluent Punjabi, with limited understanding of English, though she can express herself in English. The woman is a widow and lives with her daughter, daughter’s husband, and her two grandchildren. These conditions have resulted in her living a very sedentary lifestyle. Despite requiring support from the family members, the woman remains resistant to self-care. Self-Care Long-term conditions have commonly been managed through self-care, which is the type of care Meeha has been utilising. Self-care has been defined as the undertaking of actions and attitudes aimed at ensuring the well-being and health of oneself. This involves the assistance provided by family members and other individuals within the social environment to improve the health condition of an individual (Presho, 2008). Self-care in long-term conditions enables the patients to manage their conditions from their residences, consequently minimising visits to hospitals (Small, Bower, Chew-Graham, Whalley, & Protheroe, 2013). Patients suffering from a combination of long-term conditions must be accorded such care to ensure they do not become repeatedly admitted to hospitals. Supported Self-Care Supported self-care involves periodic visits by medical professional to the patient and subsequent provision of information to empower the individuals and immediate members to administer the self-care effectively (Carrier, 2009). The patient referred to in the mentioned case will be placed under supported self-care after being discharged from the hospital. This will include planned visits by members of the multidisciplinary team to check on the progress of the treatment while at home. Supported self-care has been necessitated by the presence of several LTCs, which have been worsened by the amputation of the right limb of the patient. The patient has been living a very sedentary life, and amputation of the leg might make it increasingly difficult to move. Discharge Planning This could be defined as an assessment of an inpatient’s requirements and needs upon leaving the healthcare facility. These requirements are evaluated based on the medical conditions observed by the medical practitioners providing healthcare. Planning involves estimating the period during which a patient might remain admitted, expected outcomes of the admission, and the requirements upon discharge. The requirements upon discharge form a fundamental element in ensuring continuity of care upon leaving the healthcare facility. The process involves the anticipation of problems which the patient might face outside the hospital environment. Discharge planning must involve the active participation of patient, family and the multidisciplinary team (MDT). The patient requires complex discharge planning because of the combined long-term conditions which have affected her. The patient has previously been resistant to administering self-care, and this has resulted in hospitalisation regarding poor glycaemia control over the last 18 months (Shepperd et al., 2013). If the patient becomes readmitted after being discharged, she will be facing a serious risk because of the amputation of the limb. Continued resistance to self-care poses a significant health risk to the patient. The patient must undergo a comprehensive analysis of her medical condition to ascertain her health before being discharged. She must also be undertaken through discussions to explain to her the significance of self-care. This will make the patient understand the concept and possibly accept self-care after discharge. The Patient The patient remains the person who is at the centre of the discharge planning because the process directly affects him/her. Involvement of the patient is essential in establishing the perceptions held regarding the treatment being administered. The patient also has a right to present his/her views regarding the method which will be employed in ensuring continuity of care following discharge (Katikireddi & Cloud, 2008). Within the context of this case, factors related to the patient’s resistance to self-care can be properly established and effectively solved by involving the patient. Family Members The family members form an essential part of the people providing support in the self-care package proposed for the patient. Their involvement becomes essential as they must understand their responsibilities and role in the continuity of care following discharge (Lillis, LeMone, LeBon, & Lynn, 2010). Since the family members reside together with the patient, they understand the patient better, and can provide basic information which the patient might lack because of the current situation. MDT The multidisciplinary team will consist of various professionals who will be providing professional information to enhance care. The different professionals will provide specialised information to the patient and family as well as render assistance as might be required after hospital discharge. Within the context of this case, the MDT will include the following professionals Cardiologist – the role of the cardiologist will be undertaking examination of the hypertension levels of the patient before discharge. This professional will provide information on how to best manage the raising blood pressure when under supported self-care. The cardiologist will also provide prescription of drugs for treatment of the condition(Lteif, Mather, & Clark, 2003). Hypertension remains one of the fundamental conditions which could result in the patient being admitted again into the hospital. Diabetic team – the patient has been diagnosed with suffering from type 2 diabetes. The diabetic team will seek to analyse the diabetic condition of the patient and provide essential guidelines. The provided guidelines will include the current condition of the disease, medical interventions which can be applied, and drugs prescribed for management of the condition. Ophthalmologist – the patient has been had a cataract surgery hence assessment of her eyesight must be undertaken by a professional. This will establish the condition of the patient’s eyesight before discharging the patient(Townsend, 2013). Dietician – it is a professional who will provide advice regarding the type of foods which should be administered to the patient. The long-term conditions facing the patient require strict observation of diets to minimise worsening of the conditions, and subsequent hospitalisation. Diabetic conditions require consumption of foods which are low in sugar, to prevent hyperglycaemia occurring. Occupational therapist – this specialist will provide assistance to the patience regarding physical activities which the patient can engage in. The individuals will be responsible for assigning exercises which the patient can undertake to reduce the sedentary lifestyle and become active (Lawton, 2012). Light physical activities assist in management of hypertension and keeping the patient physically healthy. Physiotherapist – following the amputation, the services of a physiotherapist will become essential. The physiotherapist will assign activities to the patient, which will be aimed at enhancing mobility of the patient. Allocation of exercises within the discharge planning will be undertaken by the physiotherapist. Pharmacist – the role of the pharmacist will be providing information and administering effective medicine to the patient. Under the current condition of the patient, medicine should be administered carefully as some common prescriptions could produce adverse effects upon the patient (Willens, Cripps, Wilson, Wolff, & Rothman, 2011). The pharmacist shall provide analysis of the best medicine to be administered to the patient. Psychological support – this will be provided by the individuals giving care to the patient, and will be aimed at healing the psychological wounds from the illness. This becomes essential in reducing the possibility of the patient suffering from psychological disorders such as distress, which would significantly affect the health of the patient. The patient will also be able to understand and appreciate the need for administering the treatment provided by other professionals. Prosthetic specialist – the amputation performed on the patient means the patient will have to utilise a prosthetic limb for movement. The prosthetic specialist will provide assistance to the patient regarding the utilisation of the limb. This remains essential in ensuring the patient achieves the most from the limb and becomes empowered to perform activities identified by other members of the MDT, such as the physiotherapist (Blume, Jain, & Sumpio, 2012). Interpreter – this person will play a significant role in enhancing communication between the patient and various members of the MDT. The patient has limited understanding of English and might require interpretation in comprehending the instructions provided. Communication Good communication becomes essential in ensuring the clinical knowledge and skills are utilised to the best possible outcome. This is important while undertaking assessment of the patient as the medical staff require to understand the patient’s requirements and expectations (Randall & Ford, 2011). Within the context of this case, a possible communication barrier remains imminent because of the limited understanding of English by the patient. It would be necessary for the multidisciplinary team to utilise an interpreter in enhancing communication between the patient and the MDT. The interpreter would also enhance passing of information from the staff to the patient. The daughter of the patient can be utilised as the interpreter for cultural purposes and ensuring cultural sensitivity on the part of the medical team. Communication can ensure that the MDT understands the psychological state of the patient and reasons for her resistance to self-care, which remains the only method for managing the long-term conditions facing the patient. Conclusion Prevention of rehospitalisation of patients suffering from long-term conditions involves establishment of a proper self-care process. The self-care process involves the patient undertaking activities which seek to enhance the health from home (Meerabeau & Wright, 2011). Despite the effectiveness of self-care in preventing rehospitalisation, complex situations require enhancement of the caregiver’s skills. This is done through supported self-care programmes where professionals offer their support in improving the health of the patient. Discharging a patient involves ensuring the patient and the family members become empowered to administer self-care to the patient (Tomura, Yamamoto‐Mitani, Nagata, Murashima, & Suzuki, 2011). A multidisciplinary team consisting of different professionals is established to provide the required information to ensure the patient becomes fully equipped to understand activities that will enhance the wellbeing. The role of the team includes performing analysis of the patient’s health before providing recommendations during the discharge. Communication between the MDT, patient and the family members remains an essential factor in ensuring proper implementation of the supported self-care programme developed. References Blume, P. A., Jain, A. K., & Sumpio, B. (2012). Diabetic Foot Ulceration and Management. In Diabetes and Peripheral Vascular Disease (pp. 63–91). London: Springer Publishers. Carrier, J. (2009). Managing Long-Term Condition and chronic illness in Primary Care A guide to good Practice. London: Routledge. Katikireddi, S. V., & Cloud, G. C. (2008). Planning a patient’s discharge from hospital. British Medical Journal, 337, 2694. Kirk, A. F., Barnett, J., & Mutrie, N. (2007). Physical activity consultation for people with Type 2 diabetes. Evidence and guidelines. Diabetic Medicine, 24(8), 809–816. Lawton, L. (2012). Discharge Planning. In M. Aldridge & S. Wanless (Eds.), Developing Healthcare Skills Through Simulation (pp. 265–276). London: Sage. Lillis, C., LeMone, P., LeBon, M., & Lynn, P. (2010). Study Guide for Fundamentals of Nursing: The Art and Science of Nursing Care. Lippincott Williams & Wilkins. Lteif, A. A., Mather, K. J., & Clark, C. M. (2003). Diabetes and Heart Disease: An Evidence-Driven Guide to Risk Factors Management in Diabetes. Cardiology in Review, 11(5), 262–274. Margereson, C., & Trenoweth, S. (2010). Developing Holistic Care For Care For Long-term condition. London: Routledge. Meerabeau, L., & Wright, K. (2011). Long-Term Condition.Nursing Care and Management. New Jersey: Wiley - Blackwell. Nicol, J. (2011). Nursing Adults with Long Term Conditions. London: Learning Matters Ltd. Presho, M. (2008). Managing Long Term Conditions. A social Model for Community Practice. New Jersey: Wiley - Blackwell. Randall, S., & Ford, H. (2011). Long term Condition.A guide for nurses and healthcare professionals. New Jersey: Wiley - Blackwell. Shepperd, S., Lannin, N. A., Clemson, L. M., McCluskey, A., Cameron, I. D., & Barras, S. L. (2013). Discharge planning from hospital to home. Cochrane Database System Review, 1. Small, N., Bower, P., Chew-Graham, C. A., Whalley, D., & Protheroe, J. (2013). Patient empowerment in long-term conditions: development and preliminary testing of a new measure. BCM Health Services Research, 13(1), 263. Suhonen, R., Alikleemola, P., Katajisto, J., & Leino-Kilpi, H. (2012). Nurses’ assessments of individualised care in long-term care institutions. Journal Of Clinical Nursing, 21(7-8), 1178–188. Tomura, H., Yamamoto‐Mitani, N., Nagata, S., Murashima, S., & Suzuki, S. (2011). Creating an agreed discharge: discharge planning for clients with high care needs. Journal of Clinical Nursing, 20(314), 444–453. Townsend, S. (2013). Auditing a local cataract referral pathway. Optometry Today, 36–38. Willens, D., Cripps, R., Wilson, A., Wolff, K., & Rothman, R. (2011). Interdisciplinary team care for diabetic patients by primary care physicians, advanced practice nurses, and clinical pharmacists. Clinical Diabetes, 29(2), 60–68. Williams, B., Poulter, N. R., Brown, M. J., Davis, M., McInnes, G. T., Potter, J. F., … Thom, S. M. (2004). British Hypertension Society guidelines for hypertension management 2004 (BHS-IV): summary. British Medical Journal, 328(7440), 634.  Appendices Appendix 1 discharge planning At the time of discharging the patient, the following tasks will be accomplished if possible: • D: Drugs for various ailments diagnosed will be administered by the physicians and approved by the pharmacists • A: Appointments will have been attended and others planned by the anticoagulation team, diabetic team, dietician and others • M: Moderations of work will have been developed by the physiotherapists. • A: Alcohol will be restrained from the patient by the dietician • G: G.P. / G.P. Letter will be provided detailing the social circumstances surrounding the discharge • E: Exercises (sports) will be assigned to the patient by the physiotherapists, and the prosthetic specialist will train the patient on how to utilise the prosthetic leg. • D: Driving will be prohibited to the patient Read More