Potential Barriers to Effective Planning for Transition of Care - Case Study Example

Name Course Tutor Date Previous studies have shown that effective planning for transition of care is one of the major factors that are related to recovery of health for a patient who have been through medication, Health professional such as nurse need to have this understanding for them to develop an effective discharge plan. The motive this study is to explore the perceived quality of transition of care and also identify the potential barriers that may be present for cardiac disorder patient. Mrs Elizabeth Rose green is our main focus in the study. Family history has shown that his family had been plagued by chronic diseases her sister died of breast cancer, her father had pneumatic fever while her mother die of cardiac arrest. She ought to have gone through many medical check-ups to reduce chances of her being diagnosed with any of these chronic diseases. She started feeling chest pains but the pain persisted for more than ten minutes thus she thought it was noble to call the ambulance. Proper intervention needed to have been carried out for earlier detection of the disease. Since she was discharged from the Hospital she need post medical care and we are going to analyse the potential barriers present in the setting. Integrated medical care transition especially for older people have remained to be a problem within the universal, health systems. Care transition problems are complex have different dimensions in nature with varying patterns and types .Precisely in our study Mrs Rose Green is lonely the only friend she have is Matlida her pet dog. Thus she need more company may be from her grandchildren. Loneliness can be the source of depression thus increasing chances for cardiac arrest. The nurse should schedule time for Mrs Rose Green to have time with her family to reduce levels of stress. High transitional care is very vital for adults who are older faced with multiple chronic infections and complex care medical management. The nurse should identify that the family of Mrs Rose Green has a past record of multi-faceted medical disorder .The carry a well organised intervention, Mrs Green ought to be introduced to physical exercise to reduce such disorders from occurring .She has type two diabetes which accelerate her condition ,the potential problem that may occur here inadequate diabetes management program .The nurse should institute a program that will ensure Mrs Rose Green take the necessary medication at the require time. The nurse and Mrs Green may have communication breakdown problem because of the age difference between them. Enhancement of the health professional skills of communication with the patient will be of great help. The patient psychological needs to be addressed since that is a potential problem on its own .Mrs Rose green has psychological needs which may worsen her condition. She opts not take a taxi instead of driving. May be she is afraid of driving maybe she has emotional stress of living with a diagnosis of cardiac disease and its treatment, fear for the disease recurring and also the stress associate with distress of living with the disease. Although the blockage had been removed she may feel it’s not yet complete over. She may have physical and psychological impairments in her body due to surgery procedure and these can lead to social problems that are substantial. Such social problems may include inability to perform work and also inability to fulfil other normal social roles. Chronic illness have been associated with anger, sadness fear and confusion. The patient need to be taken through therapy for her to acclimatize to the medical situation she is facing. Lack of standardized policy driven planning approach is lacking. Past medical history of Mrs Green need to be evaluated. Past she had a Hysterectomy surgery in which her womb was removed .She could not bear children anymore .Due to this, she may felt all is lost for her thus increasing the chances of him contracting cardiac disease. In addition to this she had been a smoker for not less than five years .This could have increased her chances of contracting cardiac disease. There is a high possibility that she go back to smoking to reduce pressure that had piled up on her. Proper interventions such as making her aware of the dangers associated with smoking may be of great help. Another potential barriers that may occur is the patient interpretation of predictive information. There have been findings that are consistent for a period of last 20 years that reveal patient with advanced coronary cardiac disease are over optimistic about the duration of their expectations of life (Zandani 2009). Mrs Rose may not understand whether this surgery will be curative. She shouts to Doctor Burgeon when she was prepared to the lab .She may not understand whether the surgery will be going to cure her disease. Other methods of treatment may be available such radiation and scanning. Mrs Rose green may not understand why such method can’t be used on her. Poor communication with the therapist may be another source of potential barrier .Patients tend to interpret information given with for reasons that are purely unrelated with the quality of communication given. After the cardiologist test one the Mrs Rose Green may have optimistic expectation which is associated with better life quality ,strong religion faith and optimism .She may experience poor numeracy in that she may not be able to understand a statistical outcome of treatment .Post medication therapists may not have consult with the patient .Mrs Rose Green is bound to lead a discussion about the goals ,options ,preferences ,prognoses and in decision making process .Evidence from empirical evidence suggest that patient and their therapist do not reach the same conclusion about the issues outlined above . However it’s unlikely that that disagreement and with goals that are supposed to be achieved can affect timely planning of transition process. When Elizabeth was transferred from the Angio suite recovery centre to cardiac Caree ward 1250,,the nursing staff were impressed by here recovery procedure .This was because she was optimistic .Patients who are optimistic than their therapists were more likely to receive a treatment that is pre extending There have been a problem relating with understanding of prognosis. Physician therapist estimates are calibrated with survival that is observed a fact that is contrary to what patients observed. Elizabeth asks John who just came for a shift at night to disconnect her GTN infusion since its restricting her arm .Mrs Elizabeth green suggest the Cannula is very sore, and asks John if he can disconnect although when flushed its very painful .We can see the physician depends on what is observed by facts while the patient understands by what he or she is feeling. John did not want to remove the cannula but he yielded the pressure from Mrs Elizabeth who was feeling discomfort. Patients and treatment therapist don’t understand the goals of treatment. Previous studies had reported that in 35 % of advanced coronary heart problem thought that the main purpose of care for the disease is for curative purposes .Mrs Green seem not to agree to the extent of treatment she is receiving. She thinks that Dr Burgeon should have to do more than he is doing. She cannot understand the stage she is taken from emergency department to the day of discharge were not curative. On the same note clinicians and post hospital therapists are not able to identify preferences for their patients when it comes to decision making. Doctor Burgon carries out surgery without informing the next of kin in Mrs Elizabeth family. Mrs Elizabeth may have wanted to. Since she is in Old age at 78 years they assume she should assume a passive role. Therapist identify the percentage preferences for patient to make decision was about 41 % of all time. Evaluation of patient performance status is another potential problem that face past medical transition care .Physician tend to evaluate how patients are performing by determining prognosis and also in making treatment decision . In our context Mrs Elizabeth did not realise how she had been breathless in the last time she had chest problem .She is pleased that she has no chest pain and very happy in the progress .She is thinking because she have recovered ,she don’t need any further medication . More optimism is shown by the physician with about performance status and it relates inversely with the patient performance. There is an association between disagreement and the increased risk of death. After being discharged many patients dislike any other subsequent treatment .Initial phase of analysis suggest that physicians knew that patients avoided cardiopulmonary treatment .45% of the physicians knew that their patient avoided post medical treatment. Whereas there is likely hood of survival the patient tend to take post treatment seriously. Pathophysiology has been identified as a potential problem that surround transmission of care. it’s where pathology combine with physiology .pathology is the situation in medical practise that describes conditions observed in a disease state . On the other hand physiology is the biological process that describes mechanisms and processes s that operst6e within living organism. Pathophysiology tries to explain the physiological process organism s develop and progresses in .Also it can be used to explain functional changes that are associated with disease and injury . Elizabeth Rose Green is affected by this phenomena. She has to change her schedule and attend rehabilitation seminars. She already has started making new friends. Functional changes started when she was to be discharged (Cahill 2009). By means of per ward Angioplasty plus stent insertion Protocol Elizabeth's observations had decreased 4 hourly observations.  Hourly neurovascular interpretations continue the same as cardiac monitoring Older people susceptible to poor quality and fragmented care during transmission. In the mean while transmission can be psychological, physical and a social process for the people who are older. Physical and psychological interventions are forgot by post medical nurses which is fatal to the patients. Discharge of olds people from the hospital is a complex process and also multifactorial .Overdue transfers of care is a continuing challenge to the health sector in general .in my opinion it’s was the right time to discharge Elizabeth Green. Delayed transfer occurs when she was occupying a bed in hospital and he was ready for transfer’s .During this period he could have developed complications thus highlighting her vulnerability to other diseases such as cancer. The level of involving patient in transitional process is very vital for transitional care. International studies have revealed that there exist poor communication with the patients and this has led to collapse of the whole system. In addition to that family inclusion and communication which is effective with the family is key in successful discharge of older people. The program ought to have coordinated Mrs Elizabeth daughter and son arrival in the day of discharge .The way older people are treated by staff have an impact of the overall experience on the outcome of the exercise . There must be new focus on the standards of older adults during any intervention. When older adults move from home to different institution they feel unwanted ,unheard, unsupported and treated with dignity that they don’t deserve .They tend to feel like they are bystanders in the process .To avert this there is need to build lasting relationship between PR actioners, older people and their relatives thus empowering them during transition . Some of the examples creating effective communication with patients include holding regular discussions with patients and families ,updating families on the state of medication and also identifying date for transition of the patient .Community health staff may lack understanding of the resource on their disposal thus they f=don’t transmit the benefits to the patients ..Other staff may not be confident with the intervention they are serving In our daily lives we encounter many different individuals who portray emotional, behavioural or social disorders. In our context we have that Mrs Elizabeth portrays such disabilities. We have to find an intervention plan to mitigate the disorders he is experiencing (Liben 1992) one of the methods is to use Cognitive behavioural method as a means of helping him out of this scandalous situation. Basically this intervention method is short term based, psychotherapy method directed towards solving the current behavioural and social disorders. Mostly to correct the behavioural disorder the therapist uses a combination of both cognitive and behavioural corrective mechanisms .In this situation, we have to acknowledge that some behaviours cannot be controlled using rational thinking but rather conditioning of the environment the affected person is and other extraneous variables that affect the individual behaviour. The model has proven to be a success to persons who have been affected by anxiety, eating, reading and comprehension and behavioural concepts. Focusing on Mrs Elizabeth he has a difficulty of controlling verbal and physical outburst during her time in hospital, therefore we have to come up with an intervention method to correct the situation. First of all conducting behavioural experiments will modify the violent behaviour of Mrs Elizabeth. To do this the therapist should perform a behavioural test for testing thoughts such as trying to criticize him for verbally attacking other people such as John who comes for the night shift .This would give the therapist a result oriented outcomes based on the feedback about whether criticism will coarse Mrs Elizabeth to abandon his behaviour. Which intervention methods that can be used to control Mrs Elizabeth anxiety disorders? She is scared of tornados .May be that is the reason why she is very scared of them that why she is very aggressive causing disturbance to other people in the facility. The basic intervention method for this behaviour is exposing Mrs Elizabeth to the objects she fears .She should be accompanied with the therapist to gain the necessary courage to face the situation he considers risky. For instance Elizabeth fears post medical experiences; maybe she should be exposed to the films about cardiac testing for her to overcome that. Through the introduction of Mrs Elizabeth to the stimulus the conditioning he considers as harmful can be modified and adapted thus the fear is eliminated .It goes without mention that indeed exposure model have been successful used as the method of intervention to treat individuals who face anxiety disorders. Elizabeth has bullying tendency. She is very aggressive at sometimes .She seem to be controlled by emotions derived from mood disorders. According to this intervention method, the affected party should be taken through a series of testing things on reality terms by change of delusions (Bigler 1992) this will in turn lead to decrease in hallucinations thus managing relapses. Hence the cognitive therapy on behaviour can be ultimately used to reduce bias and prejudice towards others .Elizabeth has a prejudice based on that she must be cured of his infection. Thus the cognitive behaviour recommended for this is to train Elizabeth to identify and response to thought and belief automatically. Furthermore the therapist should structure sessions of play for trey alone to restrain him from hurting others. However she exhibits some weaknesses in terms in the field of pumping of her heart. The scores for Retell fluency measures are below par. when we critically analyse her scores there was inadequate intervention and that’s why she was referred for a special education evaluation. After a team looked into her scores they realised she had a deficit in the area of heart pumping (Swanson 1998).The calibrations measurements showed that the standard deviation computed twice was below the mean score. Her performance in cardiac heart pumping also wanting .The administration of the hospital facility used Terra Nova screening measure to assess all third grade students. Her score was at risk according to the measurements .She did not possess the necessary results towards the content matter evaluated by the tests. Offering S.R.A reading mastery II would and Linda mood Phonemic sequencing with a special nurse would be of great help to her. The programme would be offered for one hour per day for a period of 5 days in a week. I wouldn’t mind adding any other extra hours for better cardiac heart pumping .Using the SRA cardiac Mastery II will help the patient to develop into an independent, highly skilled and fluent heartbeat of all time. The program merit is that is flexible and comprehensive thus can adapt to any student who have a reading problem. Balanced heart pumping by using stimulators can also be a wise intervention to administer to Elizabeth Rose Green to improve her heart pumping skills .When practising this skill the patient will challenge herself with grade level texts while using stimulating which is non-functional which will offer great tools for her to meet the needed standards. Basing on her poor performance posted by her in cardiac and psychological outcomes it’s my opinion that she needs special intervention. Although the decision is left on the hands of her family members, the patient has diabetes type 2; due to the results for her sugar levels are more than twice standard deviations which are below the mean. Elizabeth receives general insulin injection as programming model for tier one .For glucose uptake its takes 1.5 hours a day for a period of five days .She is in a therapy group of 6 patients which are with Scholastic therapy place. The general therapy takes the form of Oral therapy fluency and Retell therapy in which the assessment is in form of DIBELS. For insulin injection, the tier one general intervention takes place one hour per day for five days in a week with Houghton –Mifflin Central. (Jordan 2005)There are 17 patient for therapy in each class. The assessment for proteins tier one is administered by Terra Nova screening measure for all the patient in third stage. The measure depicts the risk status which is equivalent to the proficiency level. Evaluation is done quarterly during the period of assessment. The above represent some of the potential problems that are expected during transmission for care for Mrs Elizabeth Rose Green References Bigler, M. T., Smith, B. 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