This essay the author has selected a patient who was admitted to a care of the elderly ward with continuing health care needs. A brief biography will be outlined and the patient’s needs or problems will be further explored. Within this profile the author will consider the major cultural, socio-economic factors that influence the health and health choices made by individuals. The author will identify and discuss the differences between Health education and Health Promotion and describe the relationship between the concepts of Health, Public health and Social care.
The author will also explore the challenges inherent in meeting the needs of people of varying abilities and needs and consider the relevant legislation related to provision of care and identify why inequalities of provision may arise. In the whole essay the chosen patient confidentiality and place they live will be maintained in accordance to one of the NMC Code of Professional Conduct (2004) which nurse must adhere to meaning that their real names will not be used will be given the pseudonym of Maggie.
Maggie was an 89 year old Asian lady who for the previous five years has been known to be suffering from Alzheimer’s type of dementia. She was admitted to hospital following a fall in her home which caused lacerations and multiple bruising to her face. When she was admitted Maggie was disoriented in time and place and unable to understand why she was in hospital. Maggie was able to give little information about her home and family; it was her nephew who gave a comprehensive history and account of her present circumstances because Maggie English was not her first language.
Once admitted it became evident from the results of Urinalysis test the Maggie was also suffering from a Urinary Tract infection. During a previous admission Maggie’s dementia had been thoroughly investigated with a CT scan of the brain. The conclusion of this was that Maggie was suffering from cerebral atrophy. Clear evidence of mass lesions could also be seen, that Maggie’s dementia was classified as severe with formal mental test score of 0/10. Maggie’s mobility was restricted to the extent that a walking stick was required at all times, although Maggie mobilised sufficiently around her flat she only ever went out if escorted.
Up until shortly before her admission Maggie had been self caring in her hygiene needs but due to the increased phases of confusion, at times had becomes too much for Maggie to cope with. Maggie’s two main carers are her daughter and her nephew, her daughter lived in Thailand, but travelled to visit her mother once every year. Maggie’s nephew lived locally and is responsible for the bulk of her care. Maggie lived in a first floor, council rented flat that have been her home for the previous thirty years.
The stairs had posed a major problem for Maggie and had been the cause of many previous falls. Maggie loves her home and is adamant that despite her problems that she wish to return home upon her discharge. Both Maggie’s daughter and nephew were concerned about Maggie’s safety should she return home, both parties felt that she would benefit from residential care. Maggie’s nephew who have a full time job was often unable to attend to her during the day and is increasingly finding that caring for the Auntie although loving her dearly is causing a strain on this own marital relationship.
The decision of where to discharge Maggie to once well enough was a subject that both staff and relative agonised over in order to reach the most appropriate answer for. Denham (2004) defined the term continuing care as long term need for care and support due to either physical disability or illness. This care is provided in a multiplicity of settings hospitals, nursing homes, and residential care homes and in the community. Services to older people have changed dramatically in recent years.
Legislation has had a profound effect by dictating how are care to older people should be delivered both in the hospital and the community. Community care has no single definition which causes some controversy, however the 1998 White paper, “Caring for people defined it as providing the services and support which people need to live as independently as possible in their own homes or in a homely settings in the community enabling people to achieve their full potential (DoH 1998). Community are draws on a range of services including, domiciliary care, in the form of home support services and day, respite and residential care. Although the majority of care is satisfactory, deficiencies in both public and private sectors does occur the assumption that for most people, community care is the best care available. One of the main objectives of this act was a recommendation that services should be tailored to allow people to live as normal life as possible in their own homes.
This was to be implemented by assessing social care needs in collaboration with other appropriate agencies, developing an individual package of care to meet assessed needs within resources available and by securing the delivery of appropriate services by the development of a mixed economy of welfare provision using private voluntary and public sectors.
Three main general policy objectives can be seen to run through community care legislation, that the appropriate services are available to those on need of them, that the users view point is taken into consideration when choices are being made and the provision of care in the patient’s home whenever possible or in a normal setting as possible having taken into account the patient’s needs (Denham 2004).
Changes to community care made by legislation have been controversial, criticisms include that the services coordination, the competition between providers that the policy of community care has been subject to close scrutiny by a series of government reports in recent years. The challenges inherent in meeting the needs of people of varying abilities and social backgrounds, when accessing health and social care, the National Health Services Frameworks (DoH 2001) as set as White paper “Valuing people”, The principles inherent at the heart of the review were community care recipients hould be enabled to either live in their own homes or in a homely environment in the community leading as much of a normal live as possible and have equal rights, choices, inclusion, to be independent and inclusion. Individuals most in need should be provided with services and users should decide on how they live their lives services they need. According to the NMC code of professional (2004) as a registered nurse you must promote the interests of patients, this include helping individuals to gain access to health and social care information and support relevant to their needs.
The factors that trigger the accessing of multi-professional health and social services is that each assessed Maggie at different times, so communication between the team was vital. The initial medical assessment where medical diagnosis and treatment were decided on was followed by the nurse’s identification of immediate problems and the formulation of care plan. The philosophy care of the ward on which Maggie received her care is quite conclusive and in my opinion covers the major points of importance. The nursing care given is based on a multi-disciplinary approach to care.
According to Squires (1996) multidisciplinary teams brings together different perspectives and skills in a co-ordinated manner to provide for the needs of the individuals patient. This team work together and through the successful input of individualised interventions and constant monitoring and review are able to plan rehabilitation programmes. It acknowledges that in the elderly population the discharging of a patient often requires thought, consideration and lengthy planning as to what will be the best in the future for all involved.
The chartered Society of Physiotherapy (2002) defined assessment as a “continuous process by which the acquisition of relevant, quantified and other data will result in the formulation of treatment plans which have been actively set to the patient. ” A collaborative team approach was used in the assessment of Maggie. Each individual member of the team had a varying degree of involvement, but all contributed to the final comprehensive assessment. This assessment resulted in the clear identification of goals which were consistent.
Maggie’s nephew had informed the nursing staff of a sudden increase in her confused state. Early detection of the Urinary Tract Infection from which Maggie was suffering allowed prompt action. It was acknowledged by the nursing staff that an infection of this kind could increase confusion and early resolution was vital, antibiotics were given orally. I believe that IV drugs would have been inappropriate in that Maggie would not have coped being attached to a drip stand and having a cannula in her arm.
Once Maggie’s medical problems and needs had been identified she was assessed by physiotherapy, Denham (2004) suggests that the aim of the physiotherapy is the alleviation of movement disorders that decrease the functional level. Although Maggie’s mobility was clearly restricted it was decided that after her assessment that no further input was needed, apparently no movement problems were picked up on. Perhaps it was decided that Maggie’s level of mobility was sufficient to meet her basic safety needs.
Maggie had been admitted to the ward following a fall, surely the cause should have been investigated and some kind of fall training given observation and monitoring of the situation was required; this was not included in the plan of care. From my observation I came to the conclusions that Maggie had a poor awareness of feeling of hunger and thirst, was inclined to wander once a meal was placed in front of her. Maggie was easily distracted and tended not to concentrate on the task when eating a meal preferring to play with her food or hide it.
Hof and Mobbs (2001) argued that although it is difficult to maintain adequate calorie intake in a patient with dementia reports show that it can be done with good nursing care and ongoing nutrition and planning. I my opinion Maggie should be given encouragement when eating and drinking and observed during meal times, her intake could have been monitored and charted, build up drinks could be prescribed and she could be weighed weekly. The ward although 30 bedded had access to only one hostess, it is impossible for assistance and observation to be provided for all of the patient’s in need with the limit resources.
Meals, from my observations are often left in front of patient’s who it are known incapable of feeding themselves due to lack of time and staff. These I feel is immoral and should not under any circumstances have happened. Ideally I believe that Maggie should be referred to dietician who has the knowledge and skill to investigate and assess Maggie’s nutritional needs thoroughly. During the assessment Maggie was washed and dressed by the Physiotherapist due to inability to follow instructions because she could not understand English properly and inability to functionally perform the activity.
Language use has been considered an important influence on some health related activities among Asian groups, however the tendency to refer to this as a factor tends to mask more deep seated difficulties of communication. From interpreting the assessment results the Physiotherapist suggested that Maggie would be unable to maintain herself or her environment if she were to return home and that the dependency demonstrated suggested that Maggie required residential care to assist with her daily living activities.
Although the Physiotherapist considered Maggie is more suitable to residential care Maggie neither agreed nor wanted this. However Maggie considered that the provision of care three times daily would benefit her helping maintain her independence and safety. Denham (2004) suggests that Physiotherapist assessment can be used as a baseline of function against which to measure the impact of any interventions. Maggie would have benefited from the active engagement of the Physiotherapist suggestions of appropriate activities to maintain functioning levels.
This could include health education and health promotion to adopt alternative strategies for achieving tasks or the provision of aids to enable tasks to be carried out. Health education comprises consciously constructed opportunities for learning involving some form of communication designed to improve health literacy and developing life skills which are conductive to individual and community health (Bernard 2000).