Optimal Care in Chronic Conditions | Assessment 2

Local Health District in NSW: Western NSW

Introduction:

According to McPhail, S. M. (2016), multimorbidity is an emerging concept mostly confined to older adults, and is currently lesser understood. The occurrence of multiple diseases either branches from a parent illness or has its own roots, and either way presents difficulties in devising a holistic treatment plan. Physicians are challenged by the heterogeneity of this age group, the complexity of multi-pharmacotherapies and fragmented health care systems. To overcome these challenges, we adopt a patient centered approach which as per Salisbury, C., Man, M. S., Bower, P., Guthrie, B., Chaplin, K., Gaunt, D. M., … & Lee, V. (2018), is widely recognized as a foundation to safe, high-quality healthcare. It is care that is respectful of, and responsive to the preferences, needs and values of the individual patient. Keeping this in mind, we shall discuss how health practitioners can adopt a targeted care plan.

In this case, we observe a 55-year-old patient with congestive heart failure and accompanied discomforts. Jean is a happily married mother and grandmother, who lived a fairly normal life until she was diagnosed with CHF and recently found her symptoms exacerbating. This chronic illness demands a complete lifestyle change and requires reassessing the daily choices to accommodate the illness.

As per, Conroy, T. (2018), “the key factors influencing optimal care for chronic illnesses include organizational factors, individual nurse or patient factors, and Interpersonal factors. Organizational factors include nursing leadership, the context of care delivery and the availability of time. Individual nurse and patient factors include the specific care needs of the patient and the individual nurse and patient characteristics. Interpersonal factors include the nurse-patient relationship; involving the patient in their care, ensuring understanding and respecting choices; communication; and setting care priorities.” In light of this, it can be seen that optimal care for chronic illnesses require a holistic person-centered plan, which would include careful assessment of not just the physical aspects of the illness but also the comorbidities that come with it, as well as the individual unique case scenarios.

Cardiac rehabilitation would require Jean to participate in therapeutic treatment regimens in order to ensure a considerably normal life even under strenuous circumstances. An effective treatment plan would involve multifactorial intervention from various health professionals with nurses at the epicenter. Typical priorities include physical and cognitive functions, symptom control, self-management, reduced burden of therapy, health-related quality of life, maintenance of independence, and overall well-being.

As per Dryer, D. E. (2007), patients who are enduring powerlessness may seem like they have no control over their situation and may act out with indifference, anger, violent behavior, or passivity. Also, patients who are suffering from chronic, debilitating, or terminal illnesses may have continuing perception of powerlessness because they are incapable of changing their inevitable outcomes.

According to Bos, L., Marsh, A., Carroll, D., Gupta, S., & Rees, M. (2008, July), patient empowerment on the other hand, in the health care context means to promote autonomous self-regulation so that the individual’s potential for health and wellness is maximized.

Patient empowerment entails supporting self-management, which as per McCorkle, R., Ercolano, E., Lazenby, M., Schulman‐Green, D., Schilling, L. S., Lorig, K., & Wagner, E. H. (2011) is defined as the tasks that patients must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management and emotional management of their conditions.

According to McCormack, B., & McCance, T. (Eds.). (2016), person-centered care consists of five core components: consideration of the patient’s beliefs and values, engagement, shared decision making, a sympathetic presence, and provision of holistic care which forms the basis for self-management and empowerment. Based on this, the role of nurses in supporting patient’s self-management can go a long way in effective outcomes. This includes:

Davidson, P., Driscoll, A., Huang, N., Aho, Z., Atherton, J., Krum, H., … & Stewart, S. (2010), Assessment of the current self-management status:

 

 

According to Keene, L. (n.d), one of the pivotal points in patient centered care is inquiring about the patient habits, especially those that counter act with the treatment plan and makes their condition worse. In this case, Jean is an avid smoker, averaging on 10 cigarettes a day. What makes her habit worse is the codependency she potentially has with her husband who is also a chain smoker and hence makes abandoning the habit much harder. She also consumes soft drinks, about 6 cans a day and has a diet consisting mostly of takeaway with few vegetables and fruits.

Nicotine dependence should be viewed as a chronic disease, with multiple possible comorbidities. For someone with CHF, this habit can be the last nail in the coffin, as it aggravates heart diseases. Lancaster, T., & Stead, L. F. (2017), stated in their systematic review that “there is high-quality evidence that individually-delivered smoking cessation counselling can assist smokers to quit”. Rice, V. H., & Stead, L. F. (2008), suggests that as a nurse, it is important to not only advice the patient to cease smoking but actually carve a practical path for them to do so. In order to provide a setting that would encourage Jean to quit, the nurse should also engage her husband in the smoking cessation program.

Furthermore, as per Paterna, S., Gaspare, P., Fasullo, S., Sarullo, F. M., & Di Pasquale, P. (2008), Jean and her family should be advised to make sure she cuts down on soft drinks as it can aggravate her condition. She should have a diet low in sodium and carbohydrates to avoid hypertension. Fruits and vegetable intake should be increased. A total of 30 minutes of physical activity every day should be encouraged.

Davidson, P., Driscoll, A., Huang, N., Aho, Z., Atherton, J., Krum, H., … & Stewart, S. (2010), Education and Counselling: Provide information and support for self-care, appropriate to patient’s circumstances:

Educating Jean regarding CHF is important in order to enable her to practice self-care at home. Regarding self-monitoring, she should be informed how CHF causes poor circulation, low oxygen levels and decreased cardiac output. As per Poppas, A., & Rounds, S. (2002), she is likely to experience symptoms of dizziness, light headedness, palpitations, shortness of breath and cold.

However, this education should not be limited to Jean. Molloy, G. J., Johnston, D. W., & Witham, M. D. (2005), it is just as important to keep the family up-to-date on the condition she is suffering from. For example, Jean has been known to have trouble keeping up with her medications. While in the hospital, the nurse has a direct responsibility to administer medications, at home it’s not that easy. Her husband should be coached to set timely reminders and a checklist for proper treatment regimens as she is not able to do so herself.

Davidson, P., Driscoll, A., Huang, N., Aho, Z., Atherton, J., Krum, H., … & Stewart, S. (2010), Assessment of psychosocial factors: Determine individual needs and develop a personalized care plan:

Jean feels weary of hospital visits and doesn’t feel heard by the healthcare staff. It is extremely important for a nurse to forge a meaningful relationship with her, which would make her feel heard. The nurse should keep a regular check on her mental health and encourage the patient to verbalize her concerns and make sure they are settled.

Moreover, Jean is concerned about the privacy of her condition when it is discussed freely among the clinical staff. The Nurse should make sure that the clinical details of her case are discussed behind closed doors which would make her feel less exposed, reducing anxiety and feelings of powerlessness.

Western NSW LHD has formulated programs aimed at improving provision of health services for the residents. This includes integrated care and building relationships and partnerships with other health providers. Some of the locally available sources include:

Hospital Facilities & Nursing Care:

Bathurst Base Hospital, Dubbo Base Hospital, Nepean Hospital and Orange Base Hospital provide cardiology care. Chronic Heart Failure Nurses are also available within the LHD who provide clinical services in the patient’s own homes, detect and treat exacerbation early, provide patient education, supportive counselling, facilitate self-management, and discharge planning including referral to outpatient rehabilitation. Blue, L., & McMurray, J. (2005).

Chronic Heart Failure Management Program:

The Chronic Disease Management Program (Connecting Care) is a high priority program that is being implemented in response to the Government’s Caring Together Strategy. Connecting Care is a free service intended to improve the health, wellbeing and independence of patients with complex chronic disease. The program focuses on the patient’s individual needs and links together the health services that look after the patient.