The Influences of Hospital Environmental Issues - Gina Crumble - Case Study Example

Gina Crumble Case Study Name Course Institution Date Gina Crumble Case Study Introduction Human beings have always modified the environments they live or work in into particular shapes, designs and arrangements in order to improve suitability for achieving particular goals and functions. The decisions that are made with regard to the mode of design to adopt in the working or living spaces are crucial in the realization of the anticipated quality of life. In the same breath, research studies have proved that the hospital environment have a great impact on the recovery of the patient and the time it takes to recover.Hospital environment could relate to the built environment, the competency levels of the medical staff, the quality of care as pertains to patient handling, interpersonal skills, communication skills and the general relationships among the medical professionals. As Linda, Sean, Douglas, Eileen and Timothy (2009) explain a patient sleep patterns can be negatively affected by high noise levels in the hospital environment which the nurses might not easily notice given that they are accustomed to the noise.Hospitals also demand a relationship amongst the various medicalprofessionals as no any single person would have a monopoly of medical knowledge to provide solution to a wide diversity of patient problems. This entails the interdisciplinary aspect of hospital environment where the various professionals work together on a complementary perspective in addressing a common patient pollination health needs as Monique (2011)postulates. Team work, competency levels and interrelationships amongst the various medical professionals are crucial to patient recovery. The essay discusses, with reference to Gina case study, the influences of hospital environmental issues, interdisciplinary care and ethical considerations to the quality of care received in hospital and the effect on patient recovery. Critical analysis of Gina Crumble case and the hospital environment effect The hospital environment include the both the built environment encompassing the hospital structures and the layout of the hospital with regard to the air quality, sound, the pictures, the smell and the service quality offered by the medical professionals in the hospital. The environment is new to Gina and this could cause confusion to her and a sense of loneliness. The emergency department is meant to handle and treat patients with serious injuries. A hospital ward represents a department in the hospital from where care is given to the patient. Gina Crumble, as the case statement indicates, is an elderly patient at the age of 77. Her skin tear is a serious injury that warrants admission into the emergency department. Being hospitalized in an Emergency department at such an old age calls for careful attention and tender care given that the patient is likely to be frail. However, upon arrival, she just receives antibiotics and an IV connection without any further treatment risking decline in her functionality. Studies have shown that hospital environment leads to functional decline amongst the elderly patients. According to Cebola (2010) studies, aged people who get admitted in hospitals are at the risk of iatrogenic complications and functional decline. The fact that Gina has a history of type 2 Diabetes, renal failure and hypertension demands for close monitoring mode of care upon admission to the hospital. Studies reveal that type 2 diabetes need person centered therapy to care for the psychological needs of the patient. Kyaw, Alan, Jocelyn and Gül (2011) explain that careful measures should be undertaken to minimize risk of hypoglycemia in the management of diabetes in the elderly. Person centered therapy requires demonstration of unconditional positive regard to the patient, show empathy and acceptance for the patient to attain congruenceas Seishi, Etsuko, Osamu, Chikako, Shigeto, Naoya, Ken andUchitomi(2013)corroborate. Having fallen from a scooter and sustaining a large full thickness skin tear means the hospital environment need to be very clean to avoid bacterial infections. As is evident in the admission in the hospital environment, there is no good care since Gina spends 2 days in the Emergency Department before being transferred to the hospital wards due to lack of enough beds. Fanny, Torkel, Gunnar and Maria (2013) argue that admission into the emergency departments in hospitals is usually associated with pain, stress and anxiety and therefore the patients should receive a healing touch from the emergency environment for consolation and to complement recovery. This is not reflected in Gina care since she spends two days in the Emergency Department due to inadequate beds which depicts a hospital environment that is not conducive to emotional support and pain relief for the patient. Gina issues relate to having a sore sacrum, dehydration, she is in pain, confused and upset with no history of dementia, poor urine output, feeding herself despite IV connection, has movement challenges, her wound deteriorates after surgical debridement, she is not eating and drinking, has a delirium as evidenced by confusion and right heel pressure ulcer. The hospital environment with regard to support from the medical professionals is largely to blame for Gina’s conditions and deterioration. Being in the acute hospital environments suggests that a close attention kind of care should be forthcoming from the care professionals. However, what we are seeing is an environment of laxity and don’t care attitude as is illustrated in instances of leaving Gina to feed herself despite having an IV connection. It is arguable that Gina’s confusion could have been caused by an IV disconnection for a sedative that lead to delirium. This is show of neglect and unprofessional conduct that should not be exhibited particularly to elderly patients. Covering the wounds with a skin graft that had been taken from the same leg without using a pain measurement tool such as Visual Analogue Scale (VAS) to determine the extent of pain was inappropriate.Besides, this would cause more damage asMargaret, Gerald, David, Barbara, Angela and Adam (2008) reveal. It is also evident that the hospital environment has no appropriate skills to take care of Gina condition given her old age and disability. Nonetheless, the staff do not show empathy to Gina as is evidenced through not caring about her level of pain during physiotherapy treatment and not giving her pain relievers. Besides, no efforts is made to seek assistance from a dietician given that she no longer eats or drinks anything and therefore is at the risk of malnutrition. The hospital environment is largely uncaring and the few caring staffs do not have the requisite skills to take care of Gina’s complications. Recommendations on care improvement The hospital environment is unfamiliar to Gina. Introducing things she were used to seeing at home like a photograph of close family members would go a long in providing a favorable hospital environment. A bedside help such as aiding her to eat and taking her to the toilet will also improve her sense of being cared for. A more person centered therapy in the emergency and wards departments based on the patients’ views about their situation as this has not been forthcoming in Gina’s care. According toKalpana, Bhavnit, Jeremiah and Schuur (2013) studies, understanding patients’ views about their care in the emergency departments is crucial in establishing an appropriate patient-centered approach to emergency care. The care could also have been improved by having adequately stocked hospital environment as there were no enough beds and Gina had to wait for two hours to be transferred to the ward. According to Labella, Merel, & Phelan (2011) research, caring for the elderly patients in the hospitals can be improved through controlling pain adequately, assisting the elderly in issues pertaining to mobility, regular interventions to prevent delirium, regularly checking the functionality of various body systems of the patient and giving proper doses of treatment medicine. Applying this to Gina’s case would require treatment of delirium, assisting her with movement, controlling her pain through pain relievers, feeding her, showing empathy through listening and talking to her beside her bed and giving her appropriate fluids taking into consideration her medical history. Critical analysis of Interdisciplinaryapproach to Gina care Interdisciplinary approach to patient care as explained by Reichel&Arenson (2009)entails the employment of a diversity of skills in providing solutions to a common patient population that exhibits different health problems. Application of the interdisciplinary approach to health care is premised on the fact that it has the potential to provide solutions to complex health problems particularly in the geriatrics fraternity as substantiated by Heather, Elena, Wayne, Terry, Linda and David (2011) studies.This supports the fact that elderly patients who are at the risk of chronic illnesses should be subjected to care from a diverse skills set from the various medical professionals in hospitals. For Gina’s case, she already has a history of a variety of health problems that include diabetes, renal failure and hypertension. This is an indication that despite being admitted in the emergency department for issues to do with skin tear, she qualifies to be attended to on a complementary basis by different medical professionals. Interdisciplinary approach calls for a set of interpersonal skills for the care to be efficient. There has to be proper communication skills amongst the professionals involved to avoid instances of medical error that may have serious negative consequences to the patient. Interdisciplinary approach cuts across all the aspects of patient health. For example, a patient admitted in the hospital is at the risk of malnutrition as research studies has shown. This implies that a dietician would be required to provide advice as to the appropriate diet that an elderly patient should take to mitigate risks of malnutrition. According to Christopher, James and Larry (2012) research studies, patients admitted in hospitals have a high risk of malnutrition and risk lengthening their stay in the hospital if they don’t follow the nutritional intake guidelines provided in the hospital settings. For Gina’s case, it is clear that there lacks interdisciplinary approach to her care right from the date she was admitted in the Emergency department and later transferred to the hospital ward. Despite showing the medical history pertaining to suffering for diabetes, renal failure and hypertension, no special measures were taken with regard to the appropriate mode of care in light of these conditions. She is being given water when the medical professionals are very aware that she is diabetic and is not even subjected to insulin injection. Upon refusal to take water, no measures are taken to provide an alternative and the person supposed to take care of her feeding activities does not seem to care and leaves her to feed herself. Interdisciplinary care requires proper record keeping of the activities of the various professionals and there seems to be no communication amongst the staffs as to the systemic approach to taking care of Gina through kept records. Staffs who are supposed to help Gina with mobility activities are nowhere to be seen and no one seems to care. To the extent that Gina develops a lot of pain and there lacks any forthcoming help to reduce her pain depicts lack of knowledge as to what roles various professionals are supposed to play in management of Gina conditions. It is to be noted that upon admission, Gina recorded mild renal failure but her condition progressed to an acute stage by the time of her death. This is a proof that there was no appropriate management of her renal conditions based on lack of team work, poor medical skills, miscommunication and mere laxity amongst the medical professionals involved in taking care of her health conditions. With regard to interdisciplinary approach to taking care of Gina’s conditions, there lacks proper team work that leads to lack of consultation amongst the staff members. The staff ought to have established a patient-centered therapy whereby they could have identified Gina’s issues and what her views were about her emergency care, recorded the same and passed communications to other staff members as to what steps were to be taken at each stage and appropriate interventions made as her conditions changed. Lack of initiative leads to Gina spending two days in the Emergency department as the staff was not pro active to consult what alternatives to be taken or to seek opinion from other team members. Arif, Kathleen, Monica, Babar, Jose and Malaz (2013) studies of effect interdisciplinary interventions on patient care revealed that team communication and proper coordination resulted into positive interventions without medical errors that culminated into improved patient health and quick recovery. In light of this information, I recommend that professionals involved in Gina’s case would have employed good communication and intervention methods such as record keeping, consultation, pro action, physiotherapy with regard to pain levels and referrals to improve Gina’s health. Appropriate care in relation to ethical considerations Ethical considerations relate to what is morally right or wrong. As Cohen (2013)explains, the basic principles for ethical conduct in the context of health care relate to justice, equity, autonomy, having respect for human life and body, respecting human disabilities and allowing access to health care on social worth basis. According to Belinda and Mike (2013) compassionate care was identified to be crucial to ethical practice in health care settings involving elderly patients. Manifestation of ethical considerations in Gina’s care is limited and her arrival to the hospital premises is not met with compassionate care as would be expected by looking for a somewhere to rest and being beside her for consolation. There lacks beneficence in Gina’s care as no staff is bothered for the two days to look for a bed for Gina considering that she is in pain due to the seriousness of her skin tear. Having waited for a bed for two days and considering her old age it would have been ethical to pay closer attention to her conditions and to show compassion on progressing to the ward. However, despite Gina developing sore sacrum, pain, dehydration, confusion and anger, it appears the staff had no respect for her life and body as can be demonstrated by neglect in giving her alternative fluid as she could not take water due to diabetes. Moreover, the staff brings her food and leaves it for her to feed herself in the knowledge that she was on IV and therefore experienced difficulties in moving. This is unethical as it could be interpreted as lack of regard for the patient and her life on the basis of her age. Taking a skin graft from the same leg and using it to cover the wound without caring about the pain level is a show of abuse and lack of care attitude to the patient’s feelings. It would have been respectful to issue pain relievers so as to ensure that the patient does not feel too much pain which would have been a show of compassion and respect for the patient’s life and feelings. There is increased laxity amongst the staffs in addressing the patient’s complications which is a show of ageist attitude by the staff towards the patient. To the extent that the patient was not eating or drinking for a period of 6 weeks, and being in pain for all this time without any of the staffs being concerned is unjust in spite of leaving the patient to make her own decisions. It would have been morally right to make pro active interventions to advice the patient on the appropriate diet to take in light of her decreasing appetite. Conclusion As has been evidenced in the case study, environmental conditions in hospitals affect the quality of care delivered to the patients and ultimately influence patients’ recovery. Lack of beds delayed Gina’s progression to ward and quality of care. Hospital environment could as well relate to the staffs’ attitudes, care skills, and interpersonal relationships. This as well affects quality of care as has been evidenced in the analysis. Effective interdisciplinary demands an atmosphere of good communication, team work and excellent interrelationships amongst the various professionals involved as the case has proved. It is also important that ethical considerations be incorporated in caring the patient as they also have an effect on the quality of care rendered to patients and the ultimate recovery. References Arif, N., Kathleen, U., Monica, T., Babar, K., Jose, A., &Malaz, B. (2013).Systematic Review of Interdisciplinary Interventions in Nursing Homes Review Article. Journal of the American Medical Directors Association, 14(7), Pages 471-478 Belinda,D&, Mike. (2013). Caring about caring: Developing a model to implement compassionate relationship centred care in an older people care setting Original Research Article. International Journal of Nursing Studies, 50(9), Pages 1247-1258 Christopher, L., James R., & Larry, B. 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