Integrated Patient Care Planning

Proper management of patients’ conditions in health facilities requires inputs from different physicians offering different treatment, diagnostic and recovery services. These services require extensive coordination and monitoring to ensure the patient progress positively to recovery. Furthermore, management of severe or chronic conditions of patients requires elaborate contributions from a multidisciplinary team of medical experts in facilities. To ensure easier management and monitoring, patient care planning is undertaken and documented.

The patient care plan can be defined as a document which details the areas requiring care and the respective type of care accorded to patients (Young et al. 2016). Patient care plans are developed having gathered vital information about the patient and the conditions they are in with consideration of the diagnosis and treatment accorded to the patient. Care plans may include recommendations on patient's nutrition, mobility, sleeping, and positioning. Other aspects included in the patient care plans include prevention of falls, recording of clinical signs and patient's response to medication and treatments as well as documenting the psychological needs of the patients (Carpenito-Moyet 2010). It is therefore quite clear that patient plans are an integral part of efforts to better and effectively manage their patients and ensure their recovery.

Care planning is aimed at achieving a number of objectives, some of which shall be covered in detail. These objectives include providing evidence-based care to patients, providing holistic care, recording and measuring care given to the patients, and offering psychological support to patients. Furthermore, care plans also seek to support care pathways and care bundles. By definition, care pathways are the team efforts aimed at achieving consensus about the standards of care accorded to patients while care bundles signify the best practices on the care provided to patients (Burt et al. 2014).

Integrating care plans with the diagnosis, treatment, and medication of patients aids in enhancing the quality of healthcare provided to patients. The absence of care, studies have identified, resulting in poor patient's response to medications since other aspects of their wellbeing are not taken into considerations (Magno 2010). This hampers the goal of providing patients centred treatment, a model that has been identified as the most effective way of providing quality healthcare to patients.

Patient care planning needs to be effective. Effective care plans capture critical elements. Client assessment is covered in care plans which detail the crucial medical information about the patient and includes medical results and diagnostic reports. This information provides a sound description of the patient and their condition which also provides insight into the specific care accorded to the patient in light of their condition. Care plans also document the expected patient outcomes which are projections of the anticipated response of patients to care provided to them (Paans 2011). The other components of care plans include nursing interventions and the rationale for the respective interventions. Evaluation component documents information on the patient's response to care and recommendations for improving care.

Evidence-based care

Evidence- based practice (EBP) has been exhibited to improve the quality and security of patient consideration while lessening costs identified with blunders and antagonistic occasions. So as to completely understand the estimation of EBP on patient results, apparatuses must be built up that can be used by medical caretakers and united wellbeing experts. Proof based consideration plans can guarantee the joining of research-based prescribed procedures into consideration and take into account customization of the consideration intend to reflect singular patients' needs. Prove based consideration plans are a required structure for coordination and correspondence, adding to sheltered and viable patient consideration.

Different studies have evaluated the application of care plans in the medical institutions to patients with long term illnesses. A study by Young et al (2016) sought to review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflicts and synergies between conditions, and (iv) setting dates for reviewing the care plan and found that upon reviewing 16 templates, all of the care plans templates addressed patient preference, but this was not done comprehensively. Only three templates included setting priorities. None assisted in identifying conflicts and synergies between conditions. Fifteen templates included setting a date for reviewing the care plan.

In another study, Burt et al (2014) examine the components and structure of evidence-based care plans and propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network).

Managing Complex issue in patient care: a case study of palliative care

Our case study patient was diagnosed with Alzheimer’s, a mental condition that resulted in the need for palliative care. We shall refer to the patient as Kim, which is a pseudonym for confidentiality. Kim exhibited complexities when interacting with family and medical practitioners often exhibiting aggression towards doctors.

Considering the dynamic nature of the disease, just like other related mental illnesses, extensive care is required and should outline the respective care initiatives that can be used to manage the conditions. A study by proposes 8 key elements of a care plan for the condition as : psychiatric management, specific psychotherapies and psychosocial interventions, special concerns regarding somatic treatment, treatment of cognitive symptoms, treatment of psychosis and agitation, treatment of depression, treatment of sleep disturbances, and managing special issues in long term care (Young et al. 2016). Such a plan will significantly be derailed if hindrances such as lack of skilled workforce, overworking of staff and inadequate equipment to support care for patients are pronounced in the health institution.

Effectively planning care

The multidisciplinary nature of healthcare calls for elaborate plans to provide quality and standardized care to patients in health facilities. However, planning for care should aim at providing an elaborate roadmap for effective care provision. Thus, effectively planned care takes into consideration the physiological, pathological, psychological, socioeconomically and cultural aspects of care (Falan 2010).

Physiological care

This details the measures aimed at enhancing physic health and wellness of the patients in health facilities. Nurses, physicians, and other medical practitioners collectively contribute to enhancing physiological care plans for patients. This entails three core functions which are: providing basic comfort and care pharmacological and parenteral therapies, reduction of risk potential and physiological adaptation.

Basic comfort and care

The patient care planning should extensively cover measures aimed at enhancing the patient's comfort while undergoing treatment at the health facilities. This is achieved through a number of measures aimed at providing comfort to the patients. To begin with, basic care and comfort are achieved by providing assistive devices to patients, especially those with physical and sensory impairment (Paans 2011). Nurses should also detail the elimination aspects aimed at enhancing the elimination of substances from the body of the patients. This includes bowel or urinary elimination, skin care and toilet schedule for patients while at the health facilities.

The second aspect of physiological care is mobility/ immobility assessment. Nurses should assess the patient’s level and ability to move around and this provides tailored care for enhancing their wellness. Patients with immobility complications such as skin breakdown, and contractures should be considered and appropriate care accorded to them (Young et al. 2016). The plan may stipulate mobility testing tools to assess the level of patient's response to the medication

The psychological aspect of care

Patients not only require physiological care but also psychological care in order to improve their wellbeing and recovery. Having an understanding and supportive yet non-judgemental medical practitioners attending to patients increase their sense of belonging and motivation to battle their conditions. Patients have reported cared for when psychological needs are as well factored in the treatment or care plan (Alfarao-LeFevre 2009). Therefore, the care plan should extensively outline the psychological interventions which can be achieved by elaborating the cognitive, supportive and counseling functions of care. Cognitive or behavioural therapy is an approach aimed at enhancing the ability of patients to manage the various mental distresses they may be grappling with. This therapy focuses on building problem solving and decision-making abilities as well as bolstering thinking capacities of the patients. A cognitively empowered patient will feel less vulnerable and more independent and thus cared for. Supportive therapy, on the other hand, is an aspect of psychological care which seeks to foster the expression of emotions, feelings, fears, and experiences of clients. Psychologists attribute better emotional management to less mental distress and anxieties and thus, patient care plans should elaborate on the supportive therapy care accorded to the patients (Falan 2010). The final aspect of psychological care is counseling which is the engagement of patients to professional counseling services aimed at understanding the underlying problems and develop the patient's potential of managing their stress and mental conditions that could lead to psychological empowerment.

It is, however, prudent to express that the applicability of psychological care varies widely with the patient involved. Patients with mental health complications largely benefit from psychological care and thus tend to receive more focused and robust care. However, the level of care differs widely from one patient to the other depending on their mental health condition and the manifestation of psychological aspects such as anxiety, depression, and stress just to name a few (Paans 2011).

The pathological aspect of care

Patients in medical or health facilities primarily seek treatment for their respective medical conditions. However, during their interactions with doctors, clinicians, and physicians among other medical professions, they clearly manifest the need for care just as much as they need medication (Alfarao-LeFevre 2009). Thus, the pathological aspect of care us quite crucial in patient care planning. Usually, the pathological aspect of care entails the entire diagnostic process from reception to medication and did charge. Much as the studies recommend adoption of complex patients centered approach in the diagnosis of the patients, care ought to be integrated into every bit of pathological care and medication provided to patients (Falan 2010).

Pathological aspects of care manifest right from information gathering, interpretation to forming a working diagnosis and should be carefully documented in the patient care plans. Therefore, care should be accorded to patients as they progress from clinical history or interview, physical examinations, diagnostic testing, consulting all the way to medication and discharge and should be detailed as such (Magno 2010). Patients should be made to feel comfortable, relaxed and confident about the medication they would receive and thus, the doctors and other healthcare workers should be committed to upholding the dignity of patients when interacting with them in the course of discharging their duties.

Socioeconomic aspects of care

Socioeconomic status had been identified as the main criterion for determining the care accorded to the patients. Unlike the previous aspects of care, this aspect provides divided opinions on the care accorded to different classifications that exist in society. With the capitalist structure of the communities, patients have self-reported discrimination in the treatment and access to healthcare (Carpenito-Moyet 2010). Generally, low socioeconomic status leads to low health and care accorded to patients. Doctors and medical practitioners tend to offer healthcare in a biased manner with the patients from low economic status being disadvantaged. This results in low life expectancy among people in low socioeconomic status and at the same time they continue grappling with chronic medical conditions, access to only a few diagnostic tests and limited accepts as to quality healthcare due to high costs and coverage associated with chronic medical conditions (Falan 2010)

It is common for physicians to delay in performing diagnostic testing of patients of low socioeconomic status, prescribe more generic medications and avoid referral of such patients into specialized care. This significantly limits access to healthcare. Effective care plans should, therefore, seek to offer a level field with equitable access to health and care.

Cultural aspects of care

Cultures define the individual perception of self, the world and their interactions with other people. Cultural differences manifest in healthcare and result in disparities in the care provided to patients. The views and values of a culture determine the predisposition of an individual of accessing or offering healthcare for patients and medical practitioners respectively. Studies have identified that cultural differences ultimately create problems in communication, building rapport and compliance with health procedures such as physical examination and treatment (Falan 2010). An effective care plan recognizes these cultural differences and offers a robust framework for managing cultural differences and offering quality care. Aspects such as cultural tolerance, drawing consensus between culturally different individuals can be integrated into health care planning (Young et al. 2016).

References

Alfaro-LeFevre, R. (2009). Critical thinking and clinical judgment: A practical approach to outcome-focused thinking (4th ed.). Missouri: Saunders Elsevier.

Burt J, Rick J, Blakeman T, Prothroe J, Roland M & Bower P (2014): Care plans and care planning in long term conditions; a conceptual model, Prim. Healthcare Res Dev 15 (4)

Carpenito-Moyet, L.. (2010). Invited Paper: Teaching Nursing Diagnosis to Increase Utilization After Graduation. International Journal of Nursing Terminologies and Classifications, 21(3), 124-33. Retrieved March 12, 2011, from ProQuest Medical Library. (Document ID: 2118705271).

Falan, S. (2010). Identifying nursing concepts: Are we similar? International Journal of Nursing Terminologies and Classifications, 21(3), 108-15.

Magno, C. (2010). Integrating nursing quality with achievement and aptitude: Towards assessing nursing potential. The International Journal of Research and Review, 4, 37-49. Retrieved May 3, 2011, from

Paans, W. (2011). Accuracy of nursing diagnoses: knowledge, knowledge sources and reasoning skills. Center for Health Services and Nursing Research, Retrieved May 7, 2011, from

Young C, Boyle M, Mutch J (2016): Are care plans suitable for the management of multiple conditions, J. Commorb. 6(2)