Planning Care Delivery on Occupational Settings

Planning Care Delivery on Occupational Settings

Introduction

Patient involvement in health decision making is now a central element in the local and national policy in the National Health Service (NHS). It is based on the idea that individual empowerment and involvement are crucial in improving health outcomes. The weight of chronic long-term conditions is on the rise, and this has displayed vulnerabilities in the traditional models of delivery of care, which are usually curative, reactive, and aimed at acute, episodic illnesses. The involvement of patients improves their experience and satisfaction with services from NHS, including the outcomes and appropriateness of care (Brotherton, G. and Parker, S. 2013, 5). Studies reveal that patients feel involved in the process of their care if they are provided with sufficient information, listened to, and are treated as equal partners. Care planning involves the process of discussion, negotiation, decision making, which takes place between the individual and the professional. The care planning joins the principles and concepts of patient-centred care, self-care support, shared decision-making process, and patient involvement. This paper will examine the planning care delivery process and illustrate healthcare professional and patient experience to determine factors that influence effective care plan development.

A sixty-seven-year-old woman was brought in to the hospital from an assisted care facility. She complained of chronic pain in her joints and had impaired physical mobility. This report illustrates the steps taken into caring for the patient.

Stages of Care Delivery Process

There are five systematic steps in the care delivery process include assessment, diagnosis, planning, implementation, and evaluation. The utilization of a systematic care delivery process increases the possibilities of safe care leading to the improvement of care quality, satisfaction from customers, and financial performance (Aggleton, P. and Chalmers, H. 2000, 123).

1. Assessment

Assessment in the fists steps when the patient is referred to the health facility and requires data collection and critical thinking skills from nurses – objective and subjective. Objective data includes measurable and tangible data such as height and weight, intake and output, including crucial signs. Data may directly come from patients or from their primary caregivers who may be or may not have a direct family connection with the patient. Subjective data comprises of verbal statements from the patient or caregiver.

The application of Peplau’s Model in the assessment stage will be effective as the model involves concepts such as client engagement, informed decision making, motivational intervening and client self-management. This model initiates the client-nurse relationship where the client informs the nurse of their concerns. This stage also involves client education to achieve the needs of the client.

1. Diagnosis

The establishment of a nursing diagnosis assists in the planning and implementation of patient care. A nursing diagnosis is a clinical judgement regarding responses to actual or potential health problems on the part of the patient, community or family. With the aid of Maslow’s Hierarchy of Needs, nursing diagnosis can focus on patient-centred outcomes. Abraham Maslow developed a hierarchy founded upon the most basic needs of all individuals in 1943. Thus, in realization, the patient’s psychological needs must be addressed before the meeting of higher needs, such as self-esteem or self-actualization. Physiological and safety needs provide the foundation for nursing care interventions and implementation.

1. Planning

This is where outcomes and goals are established, which directly affects the patient’s care based on evidence-based practice guidelines. Thus, through such goals particular to each patient and their achievement leads to a positive outcome. Nursing care plans are crucial in this stage of setting goals. Care plans can provide a structured guideline for personalized care customized to the special need of every individual. Care plans strengthen documentation, care continuity, communication and reimbursement within the health sector (Ahn, H. et al. 2019, 52).

1. Implementation

Implementation refers to performing the actual acts of nursing intervention, as outlined in the plan of care. This stage involves nursing interventions such as standard protocols of treatment, direct or indirect care, cardiac or oxygen monitor application, and administration of medication. The Roy Model can be effectively applied with strategies that assist in implementation. These strategies include the establishment of an implementation committee; inclusion of the just-in-time training framework and the utilization of principles of adult learning; and developing special documentation and assessment tools that focus on the areas most applicable to the patient being served.

1. Evaluation

Evaluation is the last step of the nursing process and is key for positive outcomes from the patient. Each time healthcare providers implements or intervenes in care; they must evaluate and reassess to determine if they attained the desired outcome. Depending on the overall condition of the patient, reassessment may be required from time to time. A care plan may be adapted as a result of new data assessment. Nurses may apply the Roper Logan Model as it is convenient for holistic assessment of patients which is the basis for the development of care plans. Outcomes are evaluated based on the method of nursing care. Thus, the patient was observed throughout the treatment. The patient responded to treatment and care according to the planned out procedure.

The Orem Model focuses on the ability of individual’s to carry out self-care. These are the activities performed by the individual to maintain their healthy life and wellbeing. It involves the encouragement of clients to bring out the best in themselves to be independent after being cared for by nurses and doctors. Thus, clients are released from care in a process referred to as termination by Peplau’s Model.

Policy and Legislation Relevant to Care Planning

Policy

1. Access to health records (2010)

This policy is intended to guide NHS organizations through a procedure of dealing with access requests concerning relevant legislation and subsequent considerations. Persons have a right to access information about their health and other people in other cases. Organizations of the NHS have to ensure they sufficient procedures in place that enable patients to exercise this right.

1. A National Framework for NHS continuing healthcare and NHS-funded nursing care (2010)

This is aimed at supporting practitioners with the responsibility for NHS continuing healthcare. In the implementation of the revised National Framework (July 2009) and the use of associated tools. As an NQSW, One will need to demonstrate their collaborative efforts with other professionals in meeting the needs of persons with various complications.

1. Carers at the heart of 21st-century families and communities: a caring system on your side, a life of your own (2008)

This policy illustrates how carers’ needs must be elevated to the centre of the family policy and receive the status and recognition they deserve. It projected that by 2018, there would be a universal recognition and valuing of carers as being crucial to stable communities and strong families. Carers need to be recognized and given the deserved support by NQSW.

Legislation

1. Building the national care service – White Paper (2010) Shaping the future of care together – Green Paper (2009)

The Green Paper deliberated on how personalized special care could be delivered. It focused on building an equalized system founded on six elements; far funding, personalized care, and support, information and advice, joined-up services, national assessment, prevention services. The White Paper supported the transformational idea and the need for early intervention and prevention. People would be protected against the cost of care through the National Care Service.

1. Equality Act 2010, Parts 2, 3 and 11

This act prohibits discrimination based on disability, race, or gender. Similar protection is stretched to characteristics of sexual orientation, religion, and age. It illegalized the discrimination of individuals in the provision of services and goods, including social care services and health. It mandates public bodies to provide equity through the elimination of discrimination and the advancement of equal opportunity.

Importance of the Integration of Person-centered Care and Anti-discriminatory Practice

Elements such as autonomy, equality, respect, fairness, and dignity are important in the practice of non-discriminatory patient-centred care. Human rights are only meaningful if they are relevantly enforced among marginalized minority and vulnerable groups. Health workers’ behaviours could be seen as discriminatory or in violation of individual dignity if they do not respect diversity or do not offer care in ways that advance equality (Holland, K. et al. 2008, 37). Thus, it is necessary that each healthcare worker practices non-discriminatory behavior, respect the differences of every individual, and uphold dignity equality.

The culture of the organization influences the implementation of person-centred care approach.  Unless the culture of care is changed in the workplace, patients will not experience compassionate person-centred care. For instance, the Royal College of Psychiatrists (2011) recommended that a whole team and an organizational approach will enable all healthcare workers to interact more positively with people with dementia because individual staff cannot provide person-centred care.

Healthcare organizations are tasked with the responsibility of promoting cultural values that advance dignity, diversity, and equality and in the provision of resources to meet the requirement of diverse populous. The Operating Framework for the NHS in England requires that NHS organizations should keep progress when it comes to equality by meeting statutory duties under the Equality Act for the provision of high-quality care for all patients (Department of Health, 2011). Organizations must put in place practices and policies that allow the diverse needs of patients to be met within the framework of dignity, flexibility, and respect. There should be a consideration by organizations whether there are sufficient resources that meet all the requirements of all diverse groups ensuring that healthcare access is equitable. For instance, through the provision of interpretation services for non-English speakers, environments that care for people with dementia. As much as every person who accesses health care has their own unique need, organizations should have a wide appreciation for these needs within its local populous. The designs to healthcare systems should ensure that patients are sufficiently informed, maintain control and take part in care delivery, and receive care that respects their preferences and values.

The development of anti-discriminatory practices requires knowledge of legislation on diversity, professional and personal advancement of the individual through the examinations of misunderstandings, challenging assumptions, promotion of critical thinking, increasing self-awareness about values (Parker, J. and Bradley, G. 2010, 58). It is the responsibility of the organization to ensure that members of the workforce at all levels are made aware of dignity through a systemized program that includes issues dealing with diversity, providing members of the workforce is equipped with relevant attitude and knowledge.

Recommendation of Improvement of Care for Clients

The policies, program, and practices highlighted below have been chosen because they have been found to represent patient preference and need. This section stresses the need to provide care according to the preference of patients. The recommendation focus on both staff and patients to achieve maximum effectiveness (Reeves, S. et al. 2007, 129). Consideration has also been placed on improving the experience of staff.

1. Effective Communication with Patients and Families

The effective communication between patient and their families is the foundation of the provision of quality healthcare. The manner of communication of information by a healthcare provider to a patient can be as equally important as the data being passed on. Patients that get their health providers have a higher possibility of accepting their health problems, understanding their options for treatments, conform to follow-up instructions, and modify their behaviours. When communication is lacking, patients experience powerlessness, vulnerability, and increased anxiety. Therefore, to have an environment of communication with the patient, caregivers should ready themselves for optimal exchange, organizations should establish an environment that encourages connections and true exchange.

1. Personalization of Care

This involves the establishment of mechanisms and processes that personalize and customize patient experience is an essential strategy for dealing with fear, stress, and anxiety with being at the hospital. The encouragement of patient empowerment and involvement, including their families in an attempt to establish a more homelike experience, are some of the ways healthcare providers begin to reframe past procedures (Holland, K., 2017, 98). The unique program should be implemented by hospitals geared towards the validation of the preferences of the patients, maintaining the personal identity of the patient throughout their treatment, and the preservation of the usual routine of patients. The particulate nature of this process may include allowing patients to wear back covering attire to preserve their dignity, establishing flexible times for hospital procedures such as vital signs and blood draws.

1. Care Continuity

While the healthcare system might be normal for healthcare practitioners, it is crucial to note that for many patients, healthcare can be an intimidating and complex maze where patients are forced to steer without the help of a guide to assist them in finding their way. Thus, tools and systems should be improved to assist patients in their expectations in the set time they will be seeking medical assistance from the hospital. Care should be delivered in a system coordinated among several caregivers involving the family and the patient in exchange of information between providers. For instance, patient navigators closely work with patients to mitigate and identify any barriers that may prevent the ability of the patient to access optimal care. Patient advocates aim at improving the satisfaction of patients; they meet with patients daily, assessing whether their needs are being met.

1. Patient Education and Access to Information

Information exchange is a crucial element of healthcare experience in a patient-centred care setting. Patients are encouraged to become active participants in their care through community health libraries, bedside exchanges of information, and customized information packets. Hospitals should recognize the value the patients can provide their providers. Through the realization that patients are the best experts when it comes to their health care needs and bodies. Thus, the sharing medical record is a crucial strategy as, for many patients, their medical records are still a mystery. The fear, stress, and anxiety of patients are dealt with through such information. Patient progress note also stresses the exchange of information where patients can formerly note any concerns in their medical records.

1. Family Involvement

Hospitals should understand the invaluable role of the family. However, hospitals should note that the patients determine family. The family is persons who best know the patients and may take part in reassuring the patient in times of vulnerability, uncertainty. Or anxiety. Critically ill and elderly patients may go through difficult medical treatment, which requires long-term hospital stays or outpatient visits (Srinivasulu, S. et al. 2019, 63).  Family caregivers provide relevant needed assistance, including information on the patient’s symptoms, routines, and history. The role of the family as primary caregivers, therefore, extends before and after hospitalization. Thus, unrestricted patient visitation has a positive impact on the family of the patient.

Conclusion

When patients are treated as equal partners, they feel involved in their care properly informed and listened to. It is important to reassure patients that the opportunity for dialogue will always be open. Comprehensive goal discussion is taken as necessary for the promotion of effective communication ensuring adequate care planning. It is also crucial to consider the preferences and needs of the patients before physicians make any decisions. Patients should be allowed adequate time to reach a decision. The provision of information and effective communication is essential in the patient-carer relationship.

References

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Holland, K., Jenkins, J., Solomon, J., and Whittam, S. (2008) Applying the Roper Logan and Tierney Model., Edinburgh: Churchill Livingstone

Parker, J. and Bradley, G. (2010), Social Work Practice. Exeter: Learning Matters

Reeves, S., Goldman, J., and Oandasan, I., 2007. Key factors in planning and implementing interprofessional education in health care settings. Journal of allied health, 36(4), pp.231-235.

Srinivasulu, S., Shah, S.D., Schechter, C.B., Prine, L., and Rubin, S.E., 2019. Effectiveness of clinical decision support to enhance the delivery of family planning services in primary care settings. Contraception.

The National Archives, 2010. Equality Act of 2010. Legislation.gov.uk. Available at: http://www.legislation.gov.uk/ukpga/2010/15/section/13 [Accessed January 19, 2020].

Flowchart of Care Planning Process in the Treatment of Osteoarthritis