Delivering Family Centred Care - Essay Example

Family Centered Care is a modern method used in preparation, delivering as well as assessment of health care based onmutual benefits among providers, health care patients and families (APA). This method is applicable to patients of every age, and can be practiced in any health care setting. In this particular case study that concerns the case of an old widow, more will be focused on family centered care and how it will affect the family she is living with ones she is admitted in a health facility. We seek to implore on what are some of the decision that will be put into consideration before leaving her son’s home for hospital and from the hospital back to her son’s home among others. The reason Iris was in a nursing home is not clear although her family say it was increasingly difficult to take care of her. Maybe they did not have the ability to do it. Nursing homes do not have the best reputation but they give care families may not. However, Iris was not very debilitated that is why she would take care of Sam. Additionally, her situation got worse while she had to be hospitalized and later joining the Roberts. Her health deterioration while at the home shows a bad reputation and maybe this calls for Care Quality Commission. The Care Quality Commission is a health inspecting body that works to make sure each person gets care that is safe, effective, high quality and compassionate (McLeroy et al 1988.p.360). For this to be, it inspects hospitals, GPs, care homes, dental and other general practices. Although this is a worthy cause, the commission additionally takes enforcement action, register services and collaborate with other organizations. For the case of Iris, who is now returning home, a decision has to be made. However, although this is important, both her family and the health experts should listen carefully to her ideas, if any and paraphrase them to be easily understandable to her (Iris). Let each of the other two parties (health care experts and Iris’ family) express their concern and engage constructively to get a common ground. Basically, this process is called optimal decision and might be reached for a patient at a fateful health crossroad (Burns et al 2004). Mostly, it involves the patient as well as a clinician, although family is invited. This is applicable in Iris’ case. Since it is the will of Iris to return home, both parties should share information: clinicians will offer options as well as describe their dangers and advantages, while Iris and her family express their values and preferences (Jones, 1996). Because decision sharing is not only between clinicians and patients but also the patient’s family, Iris and her family were in a better position to understand her preferences and values. From experience, when patients are aware of the best treatment options, screening tests and diagnostic procedures, participating with their families and clinicians to settle on a decision becomes a lot easier (Katzman, 1983.p.735). Iris’ family decided she is going back home because her health was deteriorating and maybe she was not happy being under nursing care. This may be true because of her weight loss and unkempt appearance. To the highest percentage, Iris is happy to be going home considering she kept busy with her grandchild, whose milestone developments are depended on. Families come in all configurations including Iris who is an already aging and sick widow. The good thing is that her family has stood by her side to offer the support she needs as well as keep other relationships happy and healthy. However, there are also weaknesses/ challenges in the entire setup, Iris has started to be a bit forgetful and that means she needs someone to look after her, secondly, her son Robert has just lost his well paying job and this has forced her wife to be away from home most of the times. However, family centered care institutes advise focusing on the family strength is most important as compared to their weakness and that is what the Robert’s have done (Cummings, 2003.p.49). They have recognized that emotional, developmental and social supports are integral elements of Iris’ wellbeing. In relation to this case, (Iris’), it is advisable to look at the ‘ecological model of health and life span development theory and how this may aid the nurse in understanding the patient and family. Mental health interventions are a result of adult clinical models, which is demonstrative of individual changes. Still to achieve a long-term change services have to put into consideration developmental customs and status and the fact that issues arising from this populace are inherent in family and relationships. Ecological model of health is essential in examining psychopathology in a family, but most in children and adolescent in the background of their ecology since it presents their empirically acquired, assessment –driven approach, demonstrating how to shape developmentally and culturally appropriate intervention. It also illustrates how ecological approach functions in a health maintenance framework (Jones et al 2012). According to personal difference in susceptibility to environmental strains, episodic evaluations and interventions are applicable in the treatment of mental health conditions. Life-span developmental theory presents a framework for coming to terms with human aging. Basically, this theory provides a background for defining and explaining the normal changes that take place with time to organisms existing under representative conditions. Age/ aging is a universal process characterized by changes in human behavior and takes place almost at the same age for everyone. In case of Iris, she has already suffered Alzheimer’s for the last three months (at 68 years). The first step into understanding her condition is that family should know Alzheimer’s is a progressive failure of the brain cells although the cause is not clear (Alzheimer’s disease.p.65). It is linked to age and genetic as contributing factors, but several questions are still calling for answers. Janet has realized Iris has started to forget things, (memory) which is one of the main signs of Alzheimer’s. Additionally, some of the age-related changes are managed by a “biological clock”, while primary aging means biologically based mechanism responsible for breakdowns in specific organ systems. Unlike the outcomes of several diseases that are comparatively abrupt and have effects on a single cell or organ, primary aging affects every system in the body, while aging takes place slowly as well as in collective fashion. For instance, all the sensory systems become less sensitive and the speed of information processing becomes slow. Additionally, some expected changes in physiological system and physical appearance start to emerge.  Now that Iris’ family has decided home is the best place for her, discharging is the only option. However, discharging patients from the hospital is such a complicated process that is loaded with problems (Keady & Gilliard, 1999). Avoid probable cases of re-hospitalization has the “power” to greatly enhance the quality -of-life for patients as well as the financial growth of the healthcare systems. Clinicians in charge of Iris’ admission should therefore be prepared for her discharge in the following appropriate ways:- Necessary ongoing hospitalization Medical necessity for admission is mainly determined by the signs of acute health conditions of adequate severity that continuing diagnostic or therapeutic interventions and close monitoring are called for. Conversely, patients remain in hospital in case such criteria are not met because of incapable alternative setting to offer the required care or other social factors (Purtilo & Have, 2004.p.48). Back to Iris’ case, her discharge is not premature and she is not released to an environment that is not capable meeting her medical needs. Thus, her readmission is not expected. Deciding her Post-Discharge Site of Care Since it has been determined Iris is medically okay for a discharge, the clinicians/ health team have to settle on the most suitable setting for ongoing care. Such involves medical, social and medical aspects of her illness. Further, things like if she has acute and chronic medical conditions, decision making ability and possibility of rehabilitation have to be looked at too (Lawlor, 1995.p.106). Contributions from many sources to establish the most appropriate discharge plan are further needed. Involved parties include family, patient (Iris), nurse, occupational therapist, insurer and social worker. Factor of the Discharge Procedure The discharging plan is obligatory part of hospital certification. The effects of discharge planning on results seem to be restricted. According to 2011systematic review, patients showed a great satisfaction and a small decrease in length of stay and readmission rates with discharge planning. A study intended to examine a discharge plan for heart failure patients measured documentation of discharge instruction and the reports patients had received concerning the discharge plan (Dewing, 2003.p.46). There was no relation between readmissions rates and the chart-based measure, and only a small relation was found for lower readmission rates with utmost against the least quintile on the patient-reported measures (22.4 vs. 24.7%). Medication reconciliation This involves proving patient’s medication list at the point of care transition. In this case, Iris and her care givers should know which medications have been added or stopped and so on. Carrying out correct medication reconciliation is an imperative discharging step. It also ensures patients and their care givers understand what medicine they are taking, why and when to. According to the 2012 systematic review, there was a fall in actual and potential adverse drug events. Whether reconciliation important role or not it is compulsory and a caregiver involved (Garber, Gross & Slonim, 2010). Tele-monitoring This implies the use of tele-monitoring devices in concurrence with follow-up nursing calls in patients. This has proved to reduce cases of admission and general costs. Others are devices for remotely monitoring different physiologic changes such as heart rate, blood pressure and oxygen saturation. Home visits Home visits by different health care providers have proved positive which is advisable for Iris’ case since improvement/ any deterioration will be known and the right measure taken. One trial demonstrated that a single home visit by a nurse and counselor to patients discharged with mental loss, with an aim of optimizing medical management led to 50% reduced danger of unplanned readmission. Coping with Iris’ Situation It is stressful to learn a loved one is suffering from Alzheimer’s disease. After learning of the diagnosis, the family should seek help whenever necessary from professionals and people who have gone through a similar experience. Many local, state and federal organizations can offer advice and assistance for a family suffering from Alzheimer’s disease. Robert and his wife should encourage and help Iris join an Alzheimer’s organization (Lundy & Janes, 2009). This will help her find friends with the same condition and in one way or the other; it’s much helpful compared to living alone. When taking care of a loved one with Alzheimer’s disease family members experience different reactions. Difficult decisions are reached at that profoundly have effects on the patient and her family. The Robert’s in this case might be aware of strong feelings and changes in their behaviors as well as activities during this stressful situation. This is normal as it is a natural response to difficulties. They should share their experiences with mental health professional or talk to qualified social worker, psychologist or psychiatrist or family service agency (Resnick, Gwyther & Roberto, 2011). Alzheimer’s is called a family disease because it affects everyone in the family. Getting the initial diagnosis is hurtful for everyone. Therefore, the first effects of the disease on the family immensely take processing the diagnosis, learning/understanding it and getting ready for the future. Patients might start by saying things or act in an unpleasing ways. A calm person might become violent or reckless (Delieu & Keady, 1996.p.220). In such situations family members should start differentiating between Iris and the disease to stop from internalizing such actions as intentional. Correct cognitive assessment of older people suffering from Alzheimer’s disease is an indispensable element of the problem-solving and examination process to guarantee successful planning of care and treatment and forecast of patients’ care requirements in future. Therefore, the assessment differs since different practitioners apply different assessment measures, tools and rating scales. However, those are used have several fundamental errors that obstruct their accuracy and strength as diagnostic tools (Sanderson & Lewis, 2012). Practitioners are needed to have something to guide them during prescription and evaluation of care, treatment and assessment procedures. In several Western jurisdictions, the law believes that adults and children that meet specific criterion are in a position to make personal health care decisions. However, what if a subject lacks the required ability to decide? This is a central theory in health care law and ethics and a progressively autonomous topic in philosophical inquiry. This doctrine is meant to foster and safeguard the independence of health care subjects. For Iris’ case, she is suffering mild-moderate Alzheimer’s disease thus; she can make some but not all decisions although her impaired memory recall may stop her capability from showing she is aware of the treatment options. Both mentally and legally it is ethical to attempt to ascertain the patient’s wishes, values, goals and preferences instead of surrogating a decision maker. Conclusion The best the family, nursing homes and the community can do for the Alzheimer’s disease is trying to help those suffering by ensuring they feel loved and they belong. In this case, this is best communicated by Saunders 1976, Alzheimer Society. “You matter because you are you and you matter to the last moment of your life. We will do all we can to help you, not only to die peacefully but to live until you die.” This should be the message that all those involved with people with the condition should pass. Bibliography McLeroy, K. R., Steckler, A. and Bibeau, D. (Eds.) (1988). The social ecology of health promotion interventions. Health Education Quarterly, 15(4):351-377. National Association of Student Personnel Administrators. (2004). Leadership of a healthy campus: an ecological approach to student success. U.S. Department of Health and Human Services, Secretary’s Advisory Committee. (2008, December 11). Phase I report: recommendations for the framework and format of healthy people 2020. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th edn). Washington, DC: APA. Burns, A. et al (2004). Assessment Scales in Old Age Psychiatry (2nd edn). London: Martin Dunitz. Cummings, J.L. (2003). The Neuropsychiatry of Alzheimer’s Disease and Related Dementias. London: Martin Dunitz. Cummings, J.L., Back, C. (1998). The cholinergic hypothesis of neuropsychiatric symptoms in Alzheimer’s disease. American Journal of Geriatric Psychiatry; 6: 564-578. Delieu, J., Keady, J. (1996). The biology of Alzheimer’s disease: 2. British Journal of Nursing; 5: 4, 216-220 Dewing, J. (2003). Rehabilitation for older people with dementia. Nursing Standard; 18: 6, 42-48. Dewing, J. (1999). Dementia part 1: person-centred care. Professional Nurse; 14: 8, 585-588. Garber, J. S., Gross, M., & Slonim, A. D. (2010). Avoiding common nursing errors. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins. Jones, H. (1996). The impact of aging. In: Wade, L., Waters, K. (eds) A Textbook of Gerontological Nursing: Perspectives in Practice. London: Bailliere Tindall. Katzman, R. et al (1983). Validation of a short orientation-memory-concentration test of cognitive impairment. American Journal of Psychiatry; 140: 6, 734-739. Keady, J. & Gilliard, J. (1999). The early experiences of Alzheimer’s disease: implications for partnership and practice. In: Adams, T., Clarke, C.L. (eds) Dementia Care: Developing Partnerships in Practice. London: Balliere Tindall. Lundy, K. S., & Janes, S. (2009). Community health nursing: caring for the publics health. Sudbury, Mass, Jones and Bartlett Publishers. Resnick, B., Gwyther, L. P., & Roberto, K. A. (2011). Resilience in aging: concepts, research, and outcomes. New York, Springer. Lawlor, B. A. (1995). Behavioral complications in Alzheimers disease. Washington, D.C., American Psychiatric Press. Soukup, J. E. (1996). Alzheimers disease: a guide to diagnosis, treatment, and management. Westport, Conn, Praeger. Heston, L. L. (1997). Progress in Alzheimers disease and similar conditions. Washington, DC [u.a.], American Psychiatric Press. Purtilo, R. B., & Have, H. T. (2004). Ethical foundations of palliative care for Alzheimer disease. Baltimore, Johns Hopkins University Press. Sanderson, H., & Lewis, J. (2012). A practical guide to delivering personalisation: person-centred practice in health and social care. London, Jessica Kingsley Publishers Jones, J. S., Fitzpatrick, J. J., & Rogers, V. L. (2012). Psychiatric-mental health nursing: an interpersonal approach. New York, Springer Pub. Read More