Case Study For Nursing Intervention: Management Of Complexities

Complexities of care in health and social care delivery

Describe about the Case Study for Nursing intervention.

Healthcare professionals are dedicated to the well-being of the public, through provisions of excellent health care services according to their health needs. Healthcare providers need to have specified skills for handling different kinds of health issues when presented by the service users. A small mistake can be fatal for the service user but can also have a major negative impact upon the care provider. Thus, skills for handling complexities in care delivery is very important for the healthcare professionals (Swayne, Duncan & Ginter, 2012). In accordance with the Nursing and Midwifery Council (NMC) code of professional conduct, within this assignment confidentiality shall be maintained throughout and pseudonyms will be used to protect the individuals and their identities such as, all staff, patients and local health services (Nursing and Midwifery Council, 2015). In this assignment, the complexities management will be discussed in a specific case study of Mr. X who is a 75 years old male, experiencing a condition of Chronic Obstructive Pulmonary Disease (COPD) over the last ten years. Currently, he has mobility issues and struggles to support himself at home, so the use of a Zimmer frame is needed to mobilize. Recently Mr. X has been given a diagnosed recently with type 2 diabetes with his stay in the hospital. This means that the patient would require multiple healthcare professionals to manage his health issues at home. In this case study assignment, the patient would be assessed thoroughly, and the management interventions would be analyzed for his betterment. As the patient has diverse health requirements, his discharge planning would have to include interventions in place so that they can be significantly managed. In addition, management of complexities after his discharge would also be highlighted to show if they had an impact on Mr. X. Finally, a summary of the discussions made from the case study to conclude including actions plans for the future nursing practice.

Complexity in healthcare can be characterized as the multiple dimensions and multifaceted medical conditions including issues regarding socio-economic realities, behavior, age, culture, environment and system factors of a service user, which have co-occurred (Aller et al., 2012). Healthcare complexity is very important to be considered while implementing holistic care activities, but as there are many emerging conditions, which are understood in different ways, defining complexity in health care is becoming difficult (Kongstvedt et al., 2012). Multiple co-occurring medical conditions can be referred to the complexities or diagnostic dilemmas are referred to complexities in health care. Usually, there are three dimensions of healthcare complexities, medical complexities, situational complexities and system complexities. Thus, the personal and environmental factors have also important contributions in individual’s healthcare complexities that should be considered (Bardsley, 2012).

Theory of case management

According to the system theory, it can be based on an effective system constructed and including individual needs, expectations, rewards and abilities of people contributing in the system. According to this theory, all the contributors including the patients, nurses, doctors, physiotherapists as well as his family members would have a significant role in resolving the patients’ health-related complexities (Volggera et al., 2015). According to the rational choice theory, before planning the management of interventions for Mr. X, the healthcare professionals should rationalize all his health needs, risks and benefits for all the interventions and then only the most appropriate management interventions should be implemented (Barnett et al., 2012).

According to the crisis intervention model, the management team in health care practices should undergo seven stages of crisis intervention before implementing the complexity management plan for Mr. X. Mr. X has a previous history of COPD and currently diagnosed with diabetes which is the major focus of his complex health intervention along with his mobility issues and old age (Olsson et al., 2013). 

The first stage in this model is assessing safety and lethality. In the case of Mr. X, the medical issues include COPD, diabetes type 2 and mobility issues and stressors include his old age and social isolation. Therefore, the major focus of the intervention would be these issues. The next stage is rapport building; with respect, empathy, and genuineness the caregiver builds a trustworthy relationship with the care user (Tinetti, Fried & Boyd, 2012). It would help Mr. X to combat with his health-related crisis confidently. In the next step, with appropriate communication, the problems would be identified and prioritized according to the severity of the conditions. In the next stage, with reflective listening and other communication skills, his feelings would be addressed. After analyzing all of his health concerns, alternative health interventions would be generated and analyzed for improving his health complexities. After analyzing all the alternatives, based on the current situation and after gaining the consent of the patient and his family, the best possible alternative would be implemented. Here, a shift from crisis to a resolution would be done. After successful implementation, the results would be followed up (Carlin, 2012).

Mr. X had been diagnosed with COPD ten years ago and currently he is experiencing type 2 diabetes. There is an interrelationship within COPD and diabetes type 2, as COPD negatively affects the glucose metabolism and thereby enhancing the chance of developing diabetes type 2. Chronic obstructive pulmonary disease is an umbrella term related to diseases with progressive lung diseases such as chronic bronchitis, emphysema, asthma and bronchiectasis (Carlin, 2012).  There are a number of risk factors for developing COPD including smoking, genetic factor, environmental factors and age. On the other hand, diabetes type 2 has a direct effect on lung physiology and thereby promoting the prognosis of COPD (Tinetti et al., 2012). It has been revealed from the study of Lnzucchi et al., (2012) that COPD enhances the risk of type 2 diabetes because of the inflammatory process and side effect of high-dose corticosteroids. According to Lobach et al., (2012) the chronic inflammation has emerged as a new risk factor for the type 2 diabetes development.

Relation between health issues of Mr. X

It has been seen that the pro-inflammatory cytokines are the contributing significantly to the insulin resistance and type 2-diabetes pathogenesis that include C-reactive protein, IL-6 and TNF-alpha. In chronic obstructive pulmonary diseases, the disease prognosis up-regulates these pro-inflammatory cytokines, thereby increasing the risk of COPD (Dyson et al., 2014). Researchers found that to combat with lung inflammation, the corticosteroid is given to patients who have a major contribution in developing COPD (Brooke, 2014). In addition, Mr. X was 75 years old, so his age has a direct effect on the onset of type 2 diabetes. It has been seen in the study of Saini et al., (2012) that increased age has a direct effect on the proliferative and regenerative capacity of pancreatic beta cells from where insulin hormone is secreted for regulating glucose metabolism. It can be said that increased age is significantly related to the onset of diabetes type 2 disorders (Wilson et al., 2012). 

In addition, diabetes type 2 has a relation with the muscle strength. Mr. X is 75 years old and this factor also has a significant effect on his mobility impairment. It is because the combined effect of type 2 diabetes and age negatively affects the musculoskeletal system and the capacity of a person to perform daily activities including walking. Thus, a complex health care management plan should be developed within the healthcare environment for Mr. X after analyzing the interrelation within these health issues (Gale et al., 2013).  For managing these complexities and co-occurrence of severe diseases, the contemporary healthcare team has to work with excellent co-ordination for the benefit of the patient. From a holistic perspective, all of these factors have to consider while implementing person-centered care for the best possible result (Inzucchi et al., 2012).

Mr. X is experiencing severe disorders, which can influence fatal consequences due to lack of healthcare management. Thus, intensive care interventions are very important for Mr. X. Initially, he would be assessed based on his health priorities. Firstly, the registered nurse would assess his health needs and would be sent to a counselor where a good rapport would be established with him for enhancing his self-esteem. He is 75 years old patient experiencing different health issues that are affecting his mental health also. Social isolation is another issue that should be significantly considered during his health care planning (Cunningham et al., 2012). Building a positive rapport would be helpful for him to combat with the isolation related issues. After assessing his health needs thoroughly, the occupational therapist and the physiotherapist would make an exercise plan for Mr. X which would help to improve his mobility issues, in addition, it would also help Mr. X to reduce the severity of diabetes type 2 disorder. To deal with the complex care delivery to Mr. X, the pharmacist would prescribe medication for controlling his blood pressure as type 2 diabetes has an increased risk of hypertension leading to cardiovascular accident. With regular exercise, his quality of life can be improved (Knai et al., 2012).

Here, the involvement of the patient and his family has been prioritized as a component of holistic care. Mr. X and his wife were consulted about the exercise plan and required medication plan suggested for him. As he has an issue of isolation, the community care workers have also been included in the care planning. The community care workers would help him to be socialized by involving in different social activities. In addition, during discharge the health care team has to ensure that he can get oxygen facilities from the Community Respiratory Team also (Momsen et al., 2012).  The dietician would work with Mr. X and his family to provide advice and food chart which would help to control the sugar level within the blood. In addition, a health promotion session would be provided to Mr. X and his wife, where they would be aware of the risk and benefits of the care plan made by the health care team (Abdullah Al-Maqbali, 2014).

From the teams involved the co-ordinate management of care is needed for the improvement of Mr. X’s status. As complex health needs have been identified for Mr. X, he would need the assistance from different healthcare professionals, as discussed above, the care coordination can help the care professionals to share information about his health needs (Curry et al., 2012). Effective communication would help the healthcare professionals to share common healthcare goals for Mr. X. In co-ordination of care, professionals would also discuss the health needs with his family; as a result, Mr. X would gain appropriate and suitable assistance at home also (Holland, 2012).

The case study chosen explains that Mr. X is an elderly male of 75 years suffering from COPD and diabetes, he also uses Zimmer frame as he has difficulty in walking.  If the family background is taken into consideration, then there was no immediate family at home other than his wife.  The intervention plan for his treatment would include the multidisciplinary program for his COPD and diabetes (Dyson et al., 2014). The treatment of COPD of Mr. X involves a multidisciplinary approach because the disease in itself involves various body organs, this disease could only be managed, and it has a co-morbid effect on the patient (Cumin et al., 2013).

As Mr. X is aging and facing many sorts of disabilities and he would look forward to person-centered nursing (Olsson et al., 2013). This approach in nursing mainly focuses on the personal needs of the patients by seeing their respective goals and desires. The nurses do so because the patient becomes centralized to the nursing care process. This type of care creates a strong patient interest in experience his health illness.  Mr. X also wanted to have this type of approach so that he could get the best of the treatment plan with the nurses look after him well (Christie et al., 2015).

There are different frameworks adopted by the nurses to give this approach to their patients. These frameworks are as follows:

The nurses should know the patient as individual

The nurses should be more responsive

They should provide meaningful care to the patients

The nurses should have respect and value the patient

They should maintain trustful and caring relationship

They should give patient more freedom in their treatment

The nurse should also give them the emotional support to the patient

The most important of this framework is to involve the patient’s family and friends in planning the treatment of the patient (Gale et al., 2013).

The multidisciplinary team comprises of health professionals for Mr. X would include physician, case manager, registered nurse, respiratory therapist, registered dietician, occupational therapist and pharmacist. The primary aim of this team is showing co-operation for the patient’s management suffering from COPD.  Every member of the team has its role to play in the treatment (Lamb et al., 2013). The role and responsibilities of the different people involved are as follows:

The doctors are the part of the multidisciplinary team and are the people who make the primary diagnosis’s while also looking at the patient’s history and assessing their current situation. They also look at the making future goals in relation to the condition and look at the planning for the future. The use of continuous evaluation is needed to help see if all teams are working together to provide the best possible outcome for the patients (General Medical Council, 2012).

Case Manager/ Social Worker:

The case manager mainly coordinates between the patient and his family and also with the hospital (Taylor et al., 2013). For the resources, the patient may require and also the support which they may require (Momsen et al., 2012).

The role of the registered nurse is very inclusive in this approach as the RN could only provide the care needed by the patient and could make necessary alerts to the other members of the team when required. RN also identifies several remedies which could be needed by the patient instantly (Figueroa et al., 2013).

The respiratory team is also the part of the diagnosis of the patient as he could evaluate the patient through several tests. They mainly advise the patient to go for the pulmonary function tests so that he can identify the various severities with their ailments (Yoo et al., 2014).

The major role of the dietician is to provide the information for the best-balanced diet for the patient, but also educating them on simple changes so that they can cope with their disease (Fitzgerald et al., 2013). The dietician’s plans such food for him that he meets his energy requirements which he needs for his sustenance (Khan et al., 2015) (van Eijk-Hustings et al., 2012).

The role of the occupational therapist is to see that the patient lives his normal life with his daily practice, and he also ensures that such activities are not hampered by his disease (Freud, 2013). This occupational therapist serves as the bridge between the doctors and case managers, who are given the role of making an action plan for the patient (Higgins et al., 2014).

Pharmacists have a key role in the patient’s care because management of the correct drugs in combination is crucial while analyzing Mr. X’s case. They would also counsel patients so that they knew if needed which rescue medications could be used in emergencies. Lastly, they also see and implement future medical care according to their action plan (National Institute for Health and Care Excellence, 2015).

All of the above would be the multidisciplinary team that is involved in Mr. X’s case, but as Mr. X has also been suffering from diabetes, then he would also require certain other health professionals like Diabetes Specialist Nurse and even diabetes educators that may help. The role of the Diabetes Specialist Nurse is to focus mainly on the hormone related problems which mainly affects the diabetes level and role of the diabetes educators is to give the patient, the knowledge of diabetes. These educators are important because they make the patient recognize about the consequences of diabetes and how to help themselves improve their lives(Gale et al., 2015).

Thus, these both teams are important for Mr. X’s progression with the issues that he is facing but also they can effectively manage the case of Mr. X by taking the considerations of all the people involved in the team.

The multidisciplinary team emphasizes to improve the patient’s daily function and also the quality of life; it also reduces the admission charges of the hospital by limiting the costs and reduction in the exacerbation rate. With all these, there are many problems as well as challenges associated with the adoption of such programs. The reason for this is that all such programs include heterogeneity. There is no standardization in the objectives and nor the databases are centralized which could access the outcomes of such programs. There might also be the chances that some of the members of the program may have inadequate training or lack proper skills so the patient may not receive adequate training (Bunn, 2014).

There were certain complexities with Mr. X case also.  In the COPD management, there were some problems with some of the services such as; nutrition, respiratory team and also the diabetes specialist. The dietician associated with this program for Mr. X was not able to give him the appropriate nutrition chart due to his wife struggled to participate in the changes of her husband’s condition, so this made it difficult for the dietician to adapt changes to her routine, as she was the sole cook. Mr. X was suffering from COPD, so sometimes he would have respiratory and breathing problems, but the person who was attending from the team was found to be not very attentive to his needs and therefore the question was made from the family for them to be changed. There were problems with his diabetes management also. The diabetes nurses would try to deliver advice on how to improve the management but due to his age and also his home life, there was a communication barrier appearing at home. As the communication was not passed on to Mr. X and his wife about the management of the disease they faced a lot of problems. He could not understand the instructions left by the team, with this rebelling saying “he will deal with him in his own way.” Mr. X lived at home with his wife alone, so there was not family nearby so that he could gain much information from others.

If all the problems of Mr. X are taken into account, then it is seen that though the multidisciplinary team has given many advantages to the patient and his family, at the same time it comes with many complexities as there are so many people involved in this team who may have different views and perspectives that may make it becomes difficult to manage the patient, and ultimately the patient suffers (Figueroa et al., 2013).

This same thing happened with the case of Mr. X. To improve such complexities, there are many strategies adopted by the management to have an effective multidisciplinary team so that both the professionals involved and the patient may get the benefit of it.If the communication problem of Mr. X is taken, then the following strategies should be taken care of: The diabetes nurse should have been more attentive towards Mr. X expectations which he had from his, by listening to his whole story of the disease. When the nurse listens to the patient, then the patient have a sense of satisfaction towards the team. In this way, there is a control between the patient and the counselor. If the nurse of Mr. X would have given much of the time to him, then he would not have faced such problem. Then the most important thing to improve the communication is dignity. If the patient is treated with due care and respect, then they are much able to communicate effectively with their professionals in the healthcare system (Kovshoff et al., 2012).

A multidisciplinary team is of patients and staffs involved in improving the patient’s health. So in this, team satisfaction is very much important. Working as a healthcare team mostly influences the working relation of all and this has the impact on the patient’s safety. In the teamwork when the tasks by each member are done successfully, then the patients are greatly satisfied and contented. Two scientists named Larson and Yao had found a relationship between the clinician’s satisfaction level and their capability to support the patient and how they build up the rapport with the patient and his family (Tomura et al., 2011)

The concept of team dynamics in the healthcare system could be defined by the Tuckman model. This model has four stages: forming, norming, storming and performing. The performing stage is the productive one in the team because it enables the healthcare professionals to stay at appointing where they have reached in the treatment. The other stages are also important in maintaining the team dynamics because it helps in the better understanding of the team and also sets the boundaries within the team. It also helps in reducing the difference between the multidisciplinary team and the patient (Zeiss, 2016).

Thus, with the case of Mr. X, a multidisciplinary team was formed comprising all the staffs from the different departments which could assist in his treatment and provide him with the better life. When a team works then, there are some complexities associated with it and in his case also they were some communication problems as well as the problems from the team. These problems were resolved by taking into consideration the different strategies discussed above (Van Eiji-Husting et al., 2013). Along with this, as we know that Mr. X is 75 years old, who lives only with his wife and no family nearby, the doctor decided to include the community care services for him so that he when he gets the discharge from the hospital then he could socialize with people and does not feel isolated but also to give his wife some free time also.

The community services intended for Mr. X would help him to have support and care from the society as well as new friends who would help him to live in the society with full independence and dignity (Squires, 2013).  These services are mainly focused to help the elderly people like who have a physical disability, mental disabilities or any learning disability to cope up with the changing society. In the case of Mr. X, he was suffering from diabetes, respiratory illness and also used struggles with his walking, so he greatly needs a little support from the community service care. The community care services included the wide range of services like cultural activities, educational or occupational activities, and also home care services if needed or sometimes meals even. In this case, the home care services for Mr. X would be managing his personal tasks like washing, bathing, shopping (Proia et al., 2014)

As Mr. X is living alone with his wife, then he could also have the option of having domestic help who could do all his domestic works. The recreational activities would include outings, games, going out people, socializing with them and inviting them to their places.  The meal option would also be beneficial for Mr. X since he lives alone with his wife, he can have his meal delivered every day or on a weekly basis. At times, Mr. X may also require the need of physiotherapist so that he could help him with his walking disability and also help him with daily exercises. The physiotherapy can also be part of the care program (van der Marck et al., 2013)

Co-ordinate care is effective for managing the health issues of a patient having diverse health needs. Kovshoff et al., (2012) have been stated that co-ordination and teamwork enhance the quality of care delivery and reduces the time of patient’s recovery. It has been evaluated that the multidisciplinary team has a diverse and specific role in the recovery of Mr. X. The information shared by the registered nurse and respiratory therapist helped the registered dietician to recommend the best diet chart for Mr. X’s needs with his wife involved. In addition, the physiotherapist arranged the physical exercise program for Mr. X for improving his mobility and sugar metabolism. From the perspective of holistic care, the patient and his wife would be educated in health promotion where they have been discussed with the treatment plan and the risk and benefits of the care plan. (Ellis, 2012). From the holistic perspective, Mr. X got an entire package of treatment including the physical treatment and his socialization through the community services. It helped to improve his health status quickly. Thus, it is significantly effective for Mr. X.

Conclusion

In conclusion, it can be said that considering complexities in healthcare while dealing with a patient with diverse health care needs is very important. A number of complexities can rise within the healthcare environment while handling patients with diverse healthcare needs. In this context, it can be said that the holistic perspective would be beneficial for evaluating the health needs of the patient. The major concern found within the case study was the management of complexities faced by Mr. X and his wife. The complexities raised in the healthcare delivery have been discussed along with the management but to always involve the patient and their family, so they are aware at all times what then next step are. It has been revealed from the case study management that the co-ordinate care can enhance the affectivity of the healthcare delivery significantly. Here, the complex healthcare delivery for Mr. X has been discussed who was suffering from COPD and diabetes along with his mobility disorder. The study would suggest that from a holistic perspective working in a multidisciplinary team is beneficial for working with a patient with diverse health needs. The art of communication is key to delivering the best available care possible, but to make the patient the center of everything. Let them control their own outcome with the assistance of trained professional to point in the right direction.

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