Integrated Care for Comprehensive Health

Part 1:

Introduction

Integrated care is seen to combine mental health care as well as primary healthcare within a single setting. The provision of integrated care is important as it helps to improve the health condition of the patient by blending mental healthcare expertise along with primary care clinicians. In this report, integrated care resources and provisions for Mr Jhonson who is a 65-year-old individual is to be identified in the local area of Guilford in the UK to meet his multi-disciplinary care needs.

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P1 Outlining the local resources and provisions which supports integrated care

In my local area, which is Guildford there are different nature of support resources and services available for elderly individuals with the physical disorder and mental illness like dementia. The Alma Care is a dementia service organisation that delivers home care services of different nature such as assisting with personal care, ensuring proper diet for the service user, offering respect and maintaining the privacy of the service users and others for the dementia patients (housingcare.org, 2019). This local organisation would be effective for Mr Jhonson to live independently with his dementia at home as they are going to offer home care services of all nature to the service user. The Sunflower Cafe located in Guildford acts as a support group for individuals who are living with dementia by offering them place and opportunity to socialise with others in the society (rightathomeuk.co.uk, 2019). This local provision would be effective for Mr Jhonson to be able to socialise since it is reported in the case study that after the closing of the local pub in the area as he faces issues with socialising that has led him to get depressed and socially isolated.

Dementia UK provides Admiral Nurses for each and every area in the UK including Guildford. The Admiral Nurses are referred as specialist nurses who have knowledge regarding the way practical as well as emotional care is to be provided to the service users with dementia to support their effective living (housingcare.org, 2019a). The admiral nurses are required as resource for Mr Jhonson to help him get care assistance at home for accessing protection from sudden falls and access aid for daily care. This is because the case study informs that the service users are suffering from vascular dementia and is weak on the left side as well as has issues with physical health and has become forgetful in nature that has rendered him unable to take proper self-care. The Age UK under Guildford Shopmobility provides different walking aids for elderly individuals who face difficulty to walk freely without assistance in the locality (ageuk.org.uk, 2019). This is effective resource and provision for Mr Jhonson to be used as he is reported to be elderly with difficulty in walking and the services from the provision would help him to walk safely without experiencing falls.

M1 Explaining different healthcare and care providers and types of interagency care provision for meeting needs of the individual requiring care

The Alma Care provides care services for dementia patients by offering them support for shopping, managing personal hygiene, assistance with buying medication based on prescription, washing, cleaning home, escorting them outside and others. There services cover local areas such as Guildford, Barnet, Greenwich and others (housingcare.org 2019). In the case of Mr Jhonson, it is seen that his neighbour who usually helped him for shopping, meals and other purposes is out of town. This indicates that he is need of help to assist him to execute the activities because dementia, heart disease and age has made him unable to take his own care personally and execute daily activities in a proper manner. Thus, accessing help from Alma Care would be effective for Mr Jhonson to be able to access assistance regarding his meal, shopping and maintaining personal hygiene. The Sunflower Cafe allows dementia patients to share their experiences with similar people as well as socialising with other on each fortnight from 10:30 am to 12:30 pm on Wednesday (rightathomeuk.co.uk, 2019). In the case of Mr Jhonson, it is seen that closing of the local pub has made him lack the opportunity to socialise. Thus, the provision of Sunflower Cafe is going to act in an effective way for Mr Jhonson to have the opportunity to talk and share emotions with others, in turn, helping him to remain socially included in the society. The care providers in the form of Admiral Nurse provided by the Dementia UK in the Guilford locality are special nurses who act to provide advice to the service users for accessing services from other health and social care professionals for diagnosis and improvement of their health condition regarding dementia. These nurses also offer practical care services to dementia patients to help them cope with psychological and emotional adversities due to dementia as well as assist the service users to develop proper coping strategies to be empowered to take their own care (Harrison Dening et al. 2018). In case of Mr Jhonson, it is seen that no family members are present with him to care for his needs of taking medicine for his heart disease on daily basis which he often forgets to take due to dementia. Moreover, there is lack of any service provider who can take regular care for Mr Jhonson and offer him information as well as arrange meetings with other health professionals to care for his dementia condition. Thus, in this condition, the admiral nurses provided by Dementia UK would be effective for Mr Jhonson to avail so that he can get care provider at home to make him remember of his daily medication and assist him in executing his daily activities in a fruitful manner.

The Age UK by working with Guildford Borough Council manages Guildford Shopmobility where they offer manual and electric-powered wheelchairs as well as scooters for people of any group who are facing disability to move freely (ageuk.org.uk, 2019). In the case of Mr Jhonson, he is seen to be weak on the left side and is walking with a stick but still fears of falls and avoids going out. Thus, accessing services from the Guildford Shopmobility through Age UK is going to help him access wheelchairs to make free movement without fear that would help to resolve his issues with mobility.

D1 Evaluating the local resources in relation to meeting needs of individuals in need of multidisciplinary care

The case study informs that Mr Jhonson’s neighbours are reporting unpleasant, strong and foul smell coming from his flat. This indicates that proper hygiene is not maintained in the flat which is evident as Mr Jhonson due to his dementia is forgetful and previous stroke has rendered him disability to walk freely to execute his daily chores and manager personal hygiene in a proper manner. The Alma Care offers different range of services from arranging meals, assisting to maintain personal hygiene, clean household and others (housingcare.org 2019). Thus, it can be evaluated that the resource is important for meeting needs of Mr Jhonson as services from them would help him to get services for maintaining personal hygiene as well as cleaning household that is currently could not be done by him due to present health condition of dementia and heart disease. The case study informs that the neighbour would help with his meals is not present. Thus, in this aspect, Alma Care is an important resource for Mr Jhonson to help him prepare meals and feed to get proper nutrition in the condition. The Alma Care offers services to dementia patients for taking them out (housingcare.org 2019). In this respect, the resource is effective to meet needs of Mr Jhonson to assist him to walk without making accident or falls as he reported of fear going alone outside home due to his weakness on the left side that has disabled him to walk properly and fall. The dementia patients are often seen to forget as the disease attacks their brain cells, in turn, reducing their ability to think and execute daily activities properly (Morgan et al. 2016). In case of Mr Jhonson, similar condition is seen as he is suffering from vascular dementia. The Admiral Nurses in Dementia UK ensure proper care is provided to the dementia patients by assisting them to execute their daily chores, take medication, maintain hygiene and others (housingcare.org 2019). Since Mr Jhonson is reported to be facing disability and require taking medication for managing his heart disease, the admiral nurses can be evaluated as valuable resource. This is because the nurses would help him to take proper medication, assist him with walking at home without falling by providing assistance, refer him to proper health professional at times and others to ensure his good health (Kehoe, 2017). As mentioned by Evans et al. (2018), dementia patients are often socially isolated for their improper medical condition. This result the individuals to experience depression out of isolation as they feel they are not valued in society. In the case of Mr Jhonson, the closing of the local pub where he frequently used to socialise has led him to get depressed. Thus, in this condition, the Sunflower Cafe is going to act as an effective resource to meet his needs of socialising because in the place he can be engaged in fun activities and communicate with other individuals with dementia to share his feeling, in turn, making him feel valued. The Guildford Shopmobility can be evaluated to be effective for meeting needs of Mr Jhonson as their services would help him to get wheelchair that would assist him to move freely without experiencing falls.

P2 Describing present local unmet needs in relation to health, care and support services in the locality

In Guildford, there are certain unmet needs regarding healthcare and support services for different service users in the locality. One of the unmet needs in the locality is that there is lack of resources for creating effectiveness awareness regarding dementia in the area. It is evident as Guildford which is located in Surrey where around 2,400 individuals are suffering from dementia it is seen that there are still 40% of the population in the area as well as in locality are not diagnosed with dementia and living with the disease (surreydownsccg, 2018). The lack of proper awareness regarding diseases delays or avoids diagnosis because the individuals are unable to understand and relate the symptoms with any disease and regards it as a coming of age condition (Parveen et al. 2018). Thus, proper awareness is important in Guildford to ensure effective diagnosis and care for dementia patients. In Guilford, there are no regular cafes or places present where the dementia people can socialise on daily basis. This is evident as the dementia cafes present are opened for fortnight which does not provide daily opportunity to the service users to interact (rightathomeuk.co.uk, 2019). The daily socialisation of the dementia patient is required so that they are able to make them emotionally active and avoid depression due to isolation (housingcare.org 2019).

Conclusion

The above discussion informs that Alma Care, Age UK, Dementia UK, Guildford Shopmobility and others are potential resources and provision for Mr Jhonson to help him meet his needs of care. The unmet needs in the locality include lack of awareness regarding dementia and proper availability of regular places for dementia service users to socialise.

Part 2:

Introduction

Person-centred care is referred to the way of executing care activities in which people involved in using health and social care services are regarded as equal partners to plan, develop and monitor the care for ensuring the care plan meets their needs. In this report, an anonymised care assessment is to be done and care plan is to be present based on the case of study of an individual.

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P3 Providing support to an individual in healthcare settings to identify their needs of care

The patient named Mr Williams who was 76 years old was admitted to the hospital as he suffered sudden stroke while doing his daily activities. It was revealed on assessment that as a result of stroke Mr Williams is unable to move his right hand and legs. Moreover, the health assessment of the patient revealed that he has high blood pressure levels. Mr Williams personally reported that he lives alone at home and for the past 2 years is suffering from type-1 diabetes for which he has been taking insulin therapy. In this condition, Mr Williams along with the health professional are involved to develop care plan by assessing the care needs of the individual. Mrs Williams by maintaining a notification dairy for his health condition has the capacity to identify his own care needs because the dairy would help him to mention the fluctuation in his health condition. Thus, while plan cares for him by the nurses he would be able to mention the factors to be considered to ensure all his health needs are fulfilled. The triggers of changes in blood sugar level are required to be identified by the patient so that they can remain alert to identify when the health professional and nurses are to be approached for care (Sohn et al. 2016). In case of Mr Williams, the individual by identifying the triggers of blood sugar fluctuations would have the capacity to identify his when he is needed to approach the health professional and nurses to ensure proper management of health condition. The identification of proper dietary supplements is necessary for the individual suffering from diabetes to control their blood sugar level at normal level as dietary intake plays a major part in controlling the nutrient elements that control the blood sugar level of the body (Ferrannini and DeFronzo, 2015). Mr Williams by identifying proper dietary intake would be able to identify the specific dietary needs to be fulfilled for him to lead a healthy life. Moreover, Mr Williams by indicating the activities to be performed by him for controlling blood pressure would have the capability to support his own care needs. This is because he would be able to mention the activities to be included in the care plan by the nurses so that he can maintain proper blood pressure level and regain better movement. The patients by identifying the triggers of high blood pressure are able to aware of their health condition making them alert to seek care assistance at the right time (). Thus, Mr Williams by identifying the triggers of high blood pressure would have the capacity for supporting identification own care needs as he would be able understand when to access healthcare at the avoid health deterioration.

P4 Describing the role of health and support practitioner to support person-centred care

As a nurse in person-centred approach, I have the role to offer different care services to Mr Williams focused on his particular health condition so that he is able to control his blood sugar and well as blood pressure level to normal for leading a healthy life. In person-centred approach, initial role to be played as nurse for Mr Williams is to execute timely review of his health conditions. This is because timely health review helps the nurses to monitor and understand the health progress of the patients based on which the changes to be made in care plan is ensure to improve health of the individual (Dubois et al. 2016). I also had the role to instruct Mr Williams to identify triggers of high blood sugar level so that he remains aware when to approach for immediate and emergency care services. As nurse for Mr Williams, to offer person-centred care I have the role to mention dietary intake to be taken by him to control his blood sugar. In this process, the dietician has the role to inform me about the food to be suggested for Mr Williams. This is because dieticians have information about the detailed nutrient content of all foods and have knowledge which patients are to be provided which nature of foods based on their health condition (D’Andreamatteo et al. 2015). Mr Williams is seen to be weak on the right side of the body after the stroke due to which he is often unable to execute his daily chores and activities one of which is taking proper insulin injections to control his blood sugar level. In this relation, according to the person-centred approach I have the role to inject insulin in proper amount on regular basis for Mr Williams to make him able to keep his blood sugar levels normal. As a nurse for Mr Williams, I have role to provide him proper medication as suggested by the health professional for keeping his blood pressure level at normal. The high blood pressure level damages as well as weakness the blood vessels causing them to be rupture or become narrower and cause blood clot formation in the arteries blocking the proper flow of blood leading to stroke (Ettehad et al. 2016). Thus, the medication is to be provided at the right time to Mr Williams so that he is protected from any further stroke as it may be fatal in nature. The physiotherapist is individuals who are qualified to treat injury, deformity and diseases through physical methods such as exercise, heat treatment, massage and others (Sadler et al. 2017). In case of Mr Williams, the physiotherapist has the role to offer massage and other intervention for him so that the blood flow and nerve functioning in the right side of the body can be improved to make him efficient to make free movement.

Care Plan:

M1 Explain the process of different person-centred assessments in defining the individual’s own care pathway

The feedback questionnaire is one the person-centred assessment used to identify the individual’s own care pathway. The feedback questionnaire involved different questions that are to be asked to Mr Williams to identify his ability and health condition after the stroke. This is because the use of the feedback received from Mr Williams through the questionnaire is effective to understand the needs of the patient and the care responsibilities that can be availed by the individual in his care pathway. The physical efficiency assessment of Mr William to make movement of right side of the body is done as one of the assessment for person-centred approach for identifying the individual's own care pathway. The physical efficiency assessment informs about the physical efficiency of all parts of the body to be made by the individual (Hugues et al. 2017). Thus, this test was essential for determining the care pathway for Mr Williams to understand to what extent the individual is able to take own care and in which aspects the assistance of nurses are required to ensure holistic care provision. The blood pressure monitor is used for person-centred assessment of Mr Williams so that his own care pathway can be identified. The blood pressure monitor informs about the blood pressure level of the individual (Lou et al. 2016). Thus, by using the device Mr Williams would be able to identify fluctuations in his blood pressure level and can remain aware in the care pathway when to access health assistance from health professional on an immediate basis. The blood sugar monitoring device is also to be used for person-centred assessment of Mr Williams so that any changes in blood sugar level can be identified in the care process to attain immediate care from health professional.

D1 Critically evaluate a capacity assessment of an individual’s care needs to identify areas for improvement

In the case of Mr Williams, it is seen that after the stroke he is unable to properly move the right –side of the body. This indicates that he does not have the capacity to hold things in the right hand and make the movement of the right leg properly to walk. In the care plan, it is mentioned that Mr Williams is to maintain a dairy where he would keep a check on daily health information. In the study Quandt et al. (2015), the right side of the body is usually active in human and many people are seen to be writing with the right hand. Since Mr Williams is unable to move his right hand, thus it would be impossible for him to maintain written record in the notification diary as mentioned in the care plan. Therefore, improvement in this aspect is required in the care plan for the patient where the nurses require taking initiative for helping Mr Williams to keep a health diary for his everyday health condition. The inability of an individual move any side of the body interferes with their personal ability to make improvement making them prone to experience falls (Armour et al. 2016). In case of Mr Williams, it is seen that the person is unable to move his right side and in the care plan no information about providing support for the patient is mentioned to protect him from falls or assist him in making movement. Thus, the improvement in care required in this aspect is that the nurses are to arrange beds with protection on both sides to avoid Mr Williams from falling while sleeping. Moreover, walking aids and wheelchairs are to be arranged for Mr Williams to make him able to move small distances personally. An alarm bell is to installed near the bed of Mr Williams to ensure he does not have to make increased movement and can alarm the nurse in need preventing unnecessary falls.

Reflection

Introduction

Reflection in nursing is important as it helps the nurses to understand the way their care services are impacting on the service users. It also helps them to understand their strength and weaknesses helping them to identify the changes are to be made in their practices to ensure quality care.

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P5 Explaining appropriate leadership within the remit of own role in healthcare for promoting effective inter-professional and multi-disciplinary team working

The multi-disciplinary teams in healthcare are referred to the group of healthcare workers who are members of different disciplines such as psychiatrist, dieticians and others. They collaboratively and through partnership provide specific healthcare services to the patient (Brogan et al. 2018). In order to deliver care to Mr Williams, I as a nurse used the help of the multidisciplinary team to offer care in partnership so that the patient is provided quality support to improve his health condition. The relationship and partnership working within multi-disciplinary team are that each of the members of different disciplines is provided information about the patient to be cared making them able to help the health professionals working on the team to develop an effective care plan for offering best quality care to the patient (Rullo et al. 2018). In relation to information sharing, the responsibility of the multidisciplinary team is that true information of the patient is to be equally shared among all the team members. This is required to allow all the team members to understand the part they have to play for delivering quality care support to the individual (Smith et al. 2018). In case of Mr Williams, while working with the multi-disciplinary team all the members were informed in details about the health condition and health reports of the patient to ensure development of a quality care plan. The other responsibility of multidisciplinary team to share information is that they are to abide by the communication protocols mentioned in the organisation (Donnelly et al. 2018). This is to violation of any communication policies in the organisation while arranging care for the patients that may lead the patient to experience harm or abuse in the society. The team in sharing information have the responsibility to respect all team members and develop trust between one another (Thorogood et al. 2018). This is to avoid conflict during sharing of information of the patient within the team.

P6 Describing the responsibilities for information sharing between multi-disciplinary teams

The advantage of sharing information within multidisciplinary team is that it helps the health professional to create improved care for the patient by mixing the skills of all the team members in framing the care plan (Ng et al. 2017). This is evident in case of Mr Williams where I as a nurse after sharing information about the patient while working in multidisciplinary team accessed assistance from the dietician along with the physiotherapist who lend their skills to work with me in offering care to the individual. Another advantage is that it leads to creating a streamlined pathway of treatment of the patient and reduces duplication of services along with providing opportunity for the health professionals to deliver improved holistic care to the patient (Jenkins et al. 2016). This is evident as the assistance from the dietician and physiotherapist in case of Mr Willaims helps me to provide complete care. The sharing information within multidisciplinary team impacts the patients to receive treatment within short time span and improves their satisfaction towards care as their needs are fulfilled (Bamford et al. 2018). The disadvantage of sharing information within multidisciplinary team is that team members belong from unique backgrounds who do not have information about the way other members work. This may lead them to interfere with other members in deciding final care for the patient (Brogan et al. 2018). It is going to negatively impact the patient as it would lead them to face delay in care services.

In providing care to Mr Williams, I was involved in partnership working with the multidisciplinary team and the individual. In this process, my role was to share details of the patient with all the team members of the multidisciplinary team so that specific support to arrange effective care for the patient can be accomplished. Thus, I initially shared the information regarding the patient’s health with the dietician. This is because dieticians provide proper information about the nature of food to be eaten for ensuring good health condition of the patient (Chaddock, 2016). Since Mr Williams was experiencing high blood sugar and blood pressure, proper diet is required to be informed to ensure keeping the level of pressure and sugar to normal. Moreover, the patient was seen to be experiencing issues with making movement on the right side of the body. Thus, the physiotherapist is involved in the care from the team as they are qualified to treat deformity or issues with mobility through different techniques (Clough et al. 2016). Therefore, to ensure better mobility of right side of the body I consulted with the physiotherapist for the patient. During the care, Mr Williams was informed in details by me regarding the way and need of sharing his personal health information with others in the multidisciplinary team to achieve ensure data is shared in an ethical way and care is provided through informed consent. This is because NMC code informs that informed consent of the patient is required and no information is to be shared regarding the patient without their prior permission (NMC, 2015).

LO4

P7 Describing different methods of communication for offering proper care

The responsibilities abided by me to perform care duty by balancing individual rights and choices are as follows:

To inform Mr Williams and other patients in details about the nature of care required for their condition in turn providing them free will to chose their own care

To provide Mr Williams and other patients make informed choices and deliver informed consent without any influence

To allow Mr Williams free will to maintain confidentiality of information

To respect concerns and opinions of Mr Williams and other patients

The different communication methods used for supporting Mr Williams in meeting and reviewing their care needs are as follows:

Oral:

The oral communication method is referred to verbal communication where words and phrases are used to provide information (Hansen et al. 2016). This communication method is used to inform Mr Williams about the specific nature of care to be focussed on according to his health condition to help him identify his care needs.

Written:

The written communication is process of informing facts through written format (Alsawy et al. 2017). In this method, Mr Williams is informed about his amount of high blood pressure and blood sugar level to help him understand the care needs he required to ensure good health condition.

P8 Applying appropriate communication strategies to identify and responds to the needs of different service users in healthcare environment

Positive-risk taking is the approach in which an individual recognises the risk as an inevitable but perceives it to be necessary to ensure benefit for the person (Mapes, 2017). In healthcare, positive-risk taking includes empowering the patients by the nurses to take their own care even though the patients have risk of failing to deliver them personal care. The balanced approach taken for positive-risk taking in case of Mr Williams to meet his ongoing care needs is that he is empowered to monitor his own health irrespective of his lack of movement of the right side of the body. Moreover, the patient was empowered to walk with a stick to make him empowered to walk alone even though there is risk of fall to be experienced by him. My role in facilitating and empowering Mr Williams and other patients in communicating their changing needs is by helping them to make informed decision regarding changes in care plan. This is because informed decision includes the patient to analyse their condition and treatment process as well as identify and decide nature of changes to be made in treatment to ensure their good health condition (Stevenson and Taylor, 2017).

Conclusion

The above discussion informs that while caring for Mr Williams and other patients in the workplace I as a nurse used partnership working to work with multidisciplinary team. This is because in the team different professional from various specific health domain are present who mix their skills to help health professional and nurses arrange best care plan for the patients. In the process information is shared, that helped the patient to receive improved and early care.

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