Holistic Approach to Long-Term Conditions - Essay Example

Holistic Approach to Long-term Conditions (Stroke) Contents Running head: HOLISTIC APPROACH TO LONG-TERM CONDITIONS (STROKE 1 Contents 2 Introduction 4 Discussion 4 Long-term Patient’s Journey 4 1.Diagnosis 5 2.Living for Today 5 3.Transition/Progression 5 4.End of Life 5 Overview of Stroke (Pathophysiology and Incidence) 6 Holistic Care of Stroke Patients during the Living for Today Stage 7 Just like the name suggests, a holistic approach to the care of stroke patients should be comprehensive in nature. A healthcare professional should strive to explore all care options available, in order to effectively meet the stroke patient’s physical, social and emotional needs. The subsequent sections address the constituents of the holistic approach that a healthcare professional should adopt. Each care measure targets physical, social or emotional requirements of the patient, as illustrated. 7 Pain Management 7 Physical Rehabilitation 8 Mental Exercises 9 Psychotherapy and Remaining Engaged 9 Speech Therapy 10 Occupational therapy 10 Dietary Measures 11 Alternative Therapies for Stroke Treatment 11 Self-Management Strategies 12 Holistic Approach during Other Stages 13 Diagnosis 13 Transition/Progression 14 End of Life 15 Conclusion 15 Recommendations 16 Bibliography 17 Introduction All health related problems require a systematic approach to treatment as one way of ensuring that patients get the best help. The systematic approach in treatment involves addressing the root of the problems and consequent effects. While some health problems are short-term, others are long-term and require continuous medical care to alleviate the effects. In many cases, long-term conditions like stroke require continuous rehabilitation through medication and different forms of therapy. Prior to developing a comprehensive treatment and care plan for patients with terminal ailments, it is imperative to understand the different progression stages of a given disease (Alexander and Runciman, 2006, p. 65). This paper seeks to provide insight into the treatment and care approach that a healthcare professional or caregiver can use for stroke patients. For an all inclusive examination, the manuscript evaluates specific stages of a stroke patient’s journey, including diagnosis, living for today, transition and end of life. These phases are examined not only within the context of their distinctive features, but also on the basis of care measures taken by healthcare professionals and caregivers at each stage. The principal focus, however, is on the living for today phase of stroke management. A holistic approach to caring for stroke patients during this phase, allows healthcare professionals to accord patients, as well as, their families an opportunity to uphold their life quality. Discussion Long-term Patient’s Journey Long-term patients usually go through four principal stages of life, that is, diagnosis, sustained living, transition or progression phase and finally the end of life (Donnan and Davis, 2008, p. 78). Even though these stages are not entirely distinct, they all present a vital opportunity for professionals in the medical field and caregivers, to ease the pain and suffering of patients, while making their life as comfortable as possible. These phases and their constituent features are outlined and described briefly in the subsequent sections. 1. Diagnosis The diagnostic stage involves establishing the pathophysiology of a disease, making an informed diagnosis, and suggesting treatment options to patients. It is also during this stage that physicians communicate with patients about the diagnosed disease and provide them with adequate information, as well as, support (Kelson and Rigge, 1998, p. 21). 2. Living for Today This is perhaps the most important phase in the care of a long-term patient. This is because it encompasses most treatment and therapeutic measures aimed at enhancing patient comfort and overall welfare. The stage comprises of pain and symptom management measures, strategies intended to reduce patients’ depression and increase their coping capacity. Sustained living and care also, covers self-management actions, cultural and social implications of a terminal disease (Donnan and Davis, 2008, p. 1614). 3. Transition/Progression The transition stage of long-term illness is where a patient deteriorates and develops intricate problems and the debilitating aspects of the disease worsen. In this case, care strategies in the preceding phase continue. It also at this stage that social and voluntary care giving aspects come into play, coupled with the multidisciplinary role of different health organizations like the National Health Service (NHS) (Welch et al., 1997, p.30). 4. End of Life This is the final stage in a patient’s journey since it culminates in death. This stage constitutes end of life and palliative care, usually delivered by healthcare or social professionals. Palliative care does not solely focus on the condition of a patient dying from an incurable disease. Rather, this form of care also seeks to ensure that both the patient and his or her family have a relatively high quality of life despite their plight (Goldszmidt and Caplan, 2010, pp. 51-54). Overview of Stroke (Pathophysiology and Incidence) With adequate information on the different phases of a long-term disease, one can adequately assess a specific case, in this case, stroke. Stroke refers to a combination of swiftly spreading clinical symptoms of focal or global loss of brain functionality. Symptoms of a stroke may last for more than a day and lead to death, without an apparent cause. Hemorrhage and ischemia are the two principal causes of stroke-related brain damage. Approximately 80% of stroke cases are ascribable to Ischemia, which occurs when reduced blood circulation deprives the brain of crucial substrates, especially glucose (WHO, 1988, p.12). The remaining 10 to 15% of stroke cases are caused by intracerebral hemorrhage, which is not trauma related (Brainin and Leiss, 2009, p. 75). This hemorrhage starts from blood vessels that penetrate deeply into the brain. Bleeding disrupts interconnecting pathways, causing localized pressure and brain tissue damage. In both cases, the biochemical substrates released from different sources contribute toward destruction of brain tissue and consequent impairment of bodily functions (Feigin, et.al, 2005, pp. 2774-2776). A stroke is sudden and severe in nature, which makes it a highly serious medical emergency warranting immediate medical care. Strokes are capable of causing severe and possible permanent brain injuries or even death in extreme cases. Once a person suffers a stroke, the brain stops working in injured areas. This leads to memory loss, paralysis, loss of vision and loss of the ability to talk (Welch, et.al, 1997, p.97). Causative behaviors of stroke include smoking and high cholesterol intake. Other risk factors include old age and atrial fibrillation. Stroke symptoms normally appear abruptly. Initially, a person might feel sick and seem pale. This is followed by an abrupt headache and numbness in the limbs or face, on one side of the body. Confusion sets in, with the affected appearing confused and incoherent in speech. There could also be problems with vision and inability to walk or maintain balance. In some instances, stroke patients may develop a seizure and lose consciousness (Chang and Elliott, 2006, pp. 41-47). Holistic Care of Stroke Patients during the Living for Today Stage Just like the name suggests, a holistic approach to the care of stroke patients should be comprehensive in nature. A healthcare professional should strive to explore all care options available, in order to effectively meet the stroke patient’s physical, social and emotional needs. The subsequent sections address the constituents of the holistic approach that a healthcare professional should adopt. Each care measure targets physical, social or emotional requirements of the patient, as illustrated. Pain Management According to Mehrholz (2012, p.15), Stroke patients usually suffer some form of pain. This pain could be mild Pain after stroke can be: mild, temperate or severe. Irrespective of the position or form of pain suffered by a stroke patient, a healthcare professional should take measures to alleviate it (Medifocus, 2012, p.11). For example, one can advise the affected to adopt simple solutions like avoiding actions likely to cause pain, including uncomfortable clothing, and unnecessary pressure on areas impacted by the stroke. A caregiver can also reduce the patient’s pain by positioning the weakened body parts in the most comfortable position (Gillen, 2011, p. 35). Physical exercise recommended by a qualified therapist may also help lower a patient’s pain. Alternatively, healthcare professionals can use standard treatments to lower chronic pain. Even though pain-killing medication like acetaminophen, ibuprofen, and aspirin are not very effective in alleviating pain in stroke patients, they can be used in accordance with doctors’ prescription. Other treatments that can palliate pain include anti-seizure, anti-depressant and anti-spasm medications. Cortisone or steroid injections could also be used (Hubbard, 2006, p.45). Pain management caters for the patient’s physical need for comfort. Physical Rehabilitation As indicated, stroke is capable of causing significant body disability. Mehrholz (2012, p.49) argues that repetitive physical exercises can aid in activating the spinal and supraspinal locomotion centers. Therefore a healthcare professional, for instance a qualified physical therapist, should recommend and supervise such physical exercise, in order to avoid exacerbating limb or body weaknesses and enhance patient’s physical strength (Mehrholz, 2012, pp. 52-54). Physical exercise is crucial, as it enables patients to sustain dynamism. It also enables individuals to keep cholesterol levels and blood pressure under control thus preventing incidence of another stroke or additional complications. Further, physical therapy ensures that a patient’s muscles do not grow weak from inactivity and it fosters unrestricted blood circulation in the brain and entire body (Margerson and Trenoweth, 2010, pp. 45-47). Regular exercise strengthens a patient’s cardiovascular system and body muscles. The ultimate goal in physical rehabilitation is to enhance an affected person’s bodily function, in order to make sure that he or she becomes as autonomous as possible. It is imperative for caregivers to accomplish physical rehabilitation in a manner that safeguards the stroke survivors’ dignity and inspires them to regain basic skills like walking, eating and dressing; all subdued by the stroke (Tortora and Derrickson, 2009, pp. 48-51). Mental Exercises Research into mental practices has shown that repetition of certain mental practices activates the muscles and neurological areas affected by the stroke. The basis for physical rehabilitation applies in this case, in the sense that, mental practice reactivates affected brain parts. The anatomy of the brain shows that the brain possesses unique memory, and when certain nerve cells are used repeatedly, the brain learns to trigger their functioning once a certain stimulus is presented to them (Alexander, 2013, pp. 21-23). Therefore, a healthcare professional should ensure that stroke patients engage in repeated mental exercises. This may help in arousing brain functionality, which is crucial to reviving the patient’s social capacity. Mental exercises may also enable a stroke patient to manage emotions with ease, and to motivate him or her to recover physically. Psychotherapy and Remaining Engaged Stroke survivors are susceptible to stress and depression due to the feeling of heightened dependency and being forced to live with the debilitating effects of the disease. For this reason, it is necessary for healthcare professionals to afford such patients psychological services through qualified psychological therapists. This would enable the patients to learn how to cope with their feelings of bitterness or self-pity (Raj, 2006, p.23). Motivation from such healthcare professionals also ensures that stroke survivors come to terms with their condition and its effects. Acceptance is one of the crucial steps toward commencement of body and brain function restoration. Early psychological intervention would also help patients to set practical recovery goals, hence avoiding some of the emotional pain linked to living after suffering from a stroke (Mathers and Ma Fat, 2009, p. 58). Psychotherapy by a healthcare professional would also play a significant role in enabling a survivor of stroke to renew and sustain their relationships with family members and friends. Therefore, it is a crucial tool in repairing severed ties and laying the foundation for a stable social life. It is for these reasons that a health professional is required to encourage a stroke patient to consult psychological therapists or join support groups comprising of other stroke patients likely to identify with their condition and emotions (Kelly and Enderby, 2010, p.51). Speech Therapy Language disability occurs when the Broca’s area of the brain is damaged. When the right-hemisphere of the brain is damaged, cognitive-communication impairment occurs. Symptoms of the impairment include; irrelevant thinking, loss of concentration, attention, memory, sequencing and vague language among other symptoms. Speech and language therapists train patients on compensatory strategies and intact abilities (Medifocus, 2012, p.32). A healthcare professional should avail early language and speech rehabilitation therapies to the stroke patient. This would improve the patient’s chances of regaining speech and language ability. Further, greater speech therapy intensity produces more positive results and will go a long way towards rebuilding the patient’s confidence hence emotional stability, and social skills (Sloan and Price, 1991, p. 42). Occupational therapy After a stroke, a survivor requires assistance in order to fully regain their abilities. Learning new skills, as well as, coping with any mode of lingering disabilities is imperative for an individual that has previously suffered from stroke. Therefore, a healthcare professional should avail occupational therapy, which will undoubtedly assist an individual to develop skills and confidence in managing important activities to one’s wellbeing. Occupational therapy should be conducted by a healthcare professional with the capability to assess an individual’s difficulties and give an explanation to the patient and also to the family. This would enable the patient to improve their independence and capacity to take care of themselves. Occupational therapy would also help an individual to adapt to new activities introduced in the course of rehabilitation (Combremont and Fisher, 2000, P. 137). Dietary Measures A healthcare professional should recommend improved and healthy dietary habits to the stroke survivor, since, as indicated earlier, poor feeding habits are significant stroke risk factors. By providing the patient with a healthy feeding regimen, the caregiver will assist in controlling the patient’s blood pressure, weight and cholesterol levels. The proposed feeding program must explicitly stipulate that the stroke patient should eat a healthful diet with low sugars, salt and fat. One should eat vegetables, whole grain reach in fiber-rich as well as chicken and fish, because they are good in controlling cardiovascular system and weight (Stein et.al. 2009, p. 16). Dietary measures would serve to improve the physical well-being of the patient and may also have positive social implications, due to heightened self-esteem on the patient’s part. Alternative Therapies for Stroke Treatment In extreme cases, healthcare professionals can explore alternative stroke management methods. These management methods could play a significant role in a patient’s physical, social, and emotional well-being, especially if other channels like medication and physical rehabilitation have been applied without success (Edmans, 2011, p. 35). Some of these alternative approaches are discussed herein. Acupuncture: this is a primordial practice, whereby tiny needles that are painless get inserted in the patient’s skin at selected points, in order to stimulate the body nerves and muscles. This is an option that can help a professional relieve pain in a stroke patient, and improve blood flow (Law and MacDermid, 2008, p. 17). Relief from pain enables a patient to relax; meaning that acupuncture fulfills both physical and emotional needs. Massage: A healthcare professional or caregiver can give the stroke patient regular massages. This is likely to lower the patient’s blood pressure, as well as, the heart rate. It is also good for easing anxiety and combating depressive feelings, given the fact that, stroke patients are usually stressed. Therefore, just like acupuncture, massage fulfills both physical and emotional needs of the stroke patient. Self-Management Strategies A healthcare professional may not necessarily carry out all the treatment options proposed for stroke patients. Therefore, he or she can recommend self-management strategies to the stroke patient and family members. The professional can also supervise the stroke patient, in order to ensure that he or she does not over exert himself or herself. To increase the chances of success of self-management strategies, a healthcare professional should ensure that the patient is fully aware of the different risks aspects associated with stroke, as well as, potential measures that can be used to modify them (Goldstein et al. 2006, p. 901). For instance, the caregiver should oversee a stroke patient’s withdrawal from smoking, by encouraging him or her to participate in replacement or behavioral therapy. This will help the patient to stay strong and avoid risk factors like clogging of the arteries (Margerson and Trenoweth, 2010, pp.56-60). The healthcare professional must also help the patient to formulate a proper diet program, based on the foods and supplements that he or she can afford (Treib and Morgenthaler, 2000, pp. 1599–1605). According to Fawcus (2008, p. 41), a person who has suffered from stoke in many cases experiences depression and occasional stress. Healthcare professionals should recommend and supervise individualized interventions, which are essential for lifestyle modification. These interventions can be delivered by utilizing behavioral methods like motivational counseling. By overseeing such measures, a healthcare professional can enable the stroke survivor to regain self-confidence and esteem, thus instigating the desire to live longer. All these aspects, coupled with adherence to medication and therapy form essential management strategies for stroke patients (Nfithompson and Morgan, 1990, p. 24). A healthcare professional must also make sure that the stroke patient goes for regular check-ups. This would show whether vital signs like blood pressure, physical ability and mental capacity are stable, and if the patient depicts overall improvement. With such knowledge, the professional can determine the best way to revise the care and management approach for higher efficacy. A professional can also ensure that the stroke patient under his or her care attends training workshops on social and health care for people recovering from stroke. These workshops would equip stroke patients with knowledge on self-management doctrines, as well as, how to stay healthy (Harwood and Good, 2011p. 45). Holistic Approach during Other Stages Diagnosis During this stage, health professionals are required to take a physical exam to assess the stoke patient for various issues. For instance, a professional must check for vision problems, reflexes, speaking and movement anomalies. Healthcare practitioners should repeat these tests regularly, in order to determine if the stroke patient is improving or getting worse. The doctors must also check for high blood pressure and also listen for abnormal sounds referred to as “bruits”, so as to make sure that blood is flowing properly. Other tests done can assist in helping the physician to find the cause and type of stroke from which a patient is suffering, as well as, ruling out any other disorders (William, J., Perry, L. and Watkins, 2013, p. 25). Transition/Progression Transition is yet another crucial stage for stroke patients. This is the stage where the public and health professionals are made aware of stroke risk factors and symptoms. This assists people in gaining knowledge on which actions to take incase a stroke happens (Brott and Bogousslavsky, 2000, pp. 715-720). It is, therefore, imperative for healthcare professionals to ensure that such people are involved in their treatment. Professionals should maintain all the care strategies utilized in the preceding living for today phase. Healthcare professionals should also provide specialized rehabilitation for stroke patients during the transition stage. This serves to ensure that the kind of care offered to the patient will provide long term support and access to sponsorship, care navigation and peer support. The principal role of this stage is to raise both professional and public awareness about stroke. This makes sure that individuals in the community that are suffering from stroke receive the right kind of care. In order to have an excellent stroke service it means that stroke awareness should be made part of patients’ and staff training (Brooker and Waugh, 2007, pp. 51-57). Nurses should also account for co-morbidity while caring for stroke patients. This refers to the worsening of patients’ symptoms, increasing complexity of clinical management and rising healthcare costs. Such considerations will enable them to support stroke patients in anticipatory care planning (ACP) and preparation for end of life. This will not only include palliative care, but also encouraging patients to acquire lasting power of attorney and complete an early directive on their needs for end of life care. For example, a healthcare professional can provide information on ACP or recommend a qualified lawyer, to help the patient organize his or her financial, health and legal issues. Alternatively, a nurse can requisition the services of an independent mental capacity advocate, to represent the patients that lack the ability to make rational decisions about their life and plans for their dependants after their demise. End of Life A healthcare professional should appropriately utilize an analgesic care approach alongside management of active disease from early stages. During this phase, a nurse should seek to provide calming care to the individual. This means that a professional must adopt a comprehensive approach, to make sure that the patient’s, practical, functional, spiritual and emotional needs are met adequately. For example, one can provide the patient access to emotional and spiritual care, while treating progressive debilitation and illness. Further a nurse is responsible for encouraging patients to deal with their pain and accept that death is a common and inevitable eventuality. It is also imperative to make the patients understand that hastening or postponing death will not change their predicament (Alexander, 2012, pp. 31-33). A healthcare professional should also focus on offering a support system to assist patients’ live as energetically as possible. This care should go on until both the patient and his or her family come to terms with the fact that death is the sole source of ultimate comfort and cessation of suffering (Albers and Teal, 2001, pp. 3008-3012). Conclusion As can be discerned from the discussion, a holistic approach to the care of stroke patients encompasses a wide array of treatment, management and long term care options. These approaches range from pain management to alternative treatment, and are all aimed at enhancing the physical, social and emotional well-being of patients. This comprehensive plan clearly shows that healthcare professionals have a significant role to play in enhancing the quality of life of long-term patients and their families. Recommendations Organizations that deal with issues relating to stroke should make it their priority to provide required equipment that will assist in diagnosis and other approaches imperative to the care of stroke patients (Alberts et al., 2001, p. 3103). Hospitals that admit stroke patients should make sure that they have well structured policies for dealing with complicated issues. 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