Introduction
Definition of Complex Care
The administration and coordination of care for patients with multiple and chronic health illnesses, impairments, or other complicated health requirements is called complex care. This form of care often involves a team approach and requires a high level of knowledge and experience on the part of healthcare providers (Manning & Gagnon, 2017). Complex care aims to enhance health outcomes and quality of life for people with complex health needs.
Respecting Confidentiality in Case Studies
Respecting confidentiality is a fundamental aspect of nursing practice. According to the Nursing and Midwifery Council’s (NMC) (2018) Code, nurses must respect people’s dignity and independence and acquire agreement before sharing personal information. The use of pseudonyms, such as Gladys Cabrera in this case, protects patient confidentiality and adheres to the NMC’s principles on research privacy and anonymity.
Overview of the Scenario and Acute Situation
Health Condition and Hospital Admission Context
Gladys Cabrera, a 64-year-old Caribbean woman, is the subject of this research. She was taken to the hospital with an acute aggravation of chronic obstructive lung disease (COPD). She had been more breathless and fatigued due to coughing and had begun her rescue pack two days prior, as instructed by the respiratory team, but it had made little impact on her.
Upon arrival, Gladys got 24% O2 and nebulizer treatment, but her health did not improve. She has a three-year record of acute COPD exacerbations and has been hospitalized twice in the previous two years. She was diagnosed with sepsis, blood cultures were taken, and she is currently on broad-spectrum antibiotic medication.
Assessing Complex Needs and Vulnerabilities
Gladys’ story and situation have a profound impact on her complex needs and vulnerabilities in multiple ways. According to Karam et al. (2021), Gladys Cabrera’s complex health and social care demands are the consequence of many concurrent chronic diseases, functional and cognitive limitations, mental health issues, and social vulnerability, as well as her particular traits. First, Gladys’s familial features and cultural background as a Caribbean woman may impact her experience of illness and her readiness to seek and accept care. For example, Jones et al. (2015) discovered that Caribbean women residing in the UK were more likely than their white British counterparts to postpone seeking treatment, citing concerns such as a lack of faith in medical professionals and dependence on traditional remedies. Overall, including Gladys’ cultural background is critical while assessing her needs and devising a care plan.
Applying the Humanising Framework to the Patient’s Case
From the standpoint of care, it is crucial to understand Gladys’s specific qualities, values, and her physical and psychological needs. As such, Galvin and Todres (2013) suggest categories of humanization and dehumanization. These categories may be applied to Gladys’s personal qualities in light of her vulnerabilities and complex demands.
Gladys’s medical issues, for example, may lead to objectification by healthcare personnel (Vaes & Muratore, 2012). If her healthcare professionals solely concentrate on her diagnosis and treatments, they may overlook the psychological and emotional parts of her care that she values (White & Tait, 2018). Due to her complex medical circumstances and demands, Gladys may feel passive in her healthcare encounters (Purdy, 2004).
Gladys’s individual characteristics may contribute to homogeneity in her care. Instead of honoring her unique experiences and needs, healthcare practitioners may regard her as just another patient with similar medical issues (Galvin & Todres, 2013). Finally, Gladys may face isolation due to her complicated demands, which may restrict her capacity to participate in social activities and interact with others, resulting in a loss of personal journey and dislocation.
Gladys is also physically vulnerable as a result of her severe exacerbation. COPD is a chronic condition that causes symptoms such as shortness of breath, coughing, and exhaustion (Alter et al., 2019). As a result, she has a functional impairment and is unable to speak owing to the shortness of breath (Yoshimatsu et al., 2020). These symptoms can significantly impact an individual’s quality of life and hinder their ability to perform daily tasks (Vaes et al., 2019).
Gladys’ consolidation in both lungs suggests that she has a lung infection. This can aggravate her COPD symptoms and lead to future difficulties (D’Anna et al. 2021). These disorders can cause impaired lung function, fatigue, and a reduced capacity to engage in physical exercise (Mousing & Srensen, 2021). As a result, Gladys’s chronic condition therapy focuses on quality of life rather than rehabilitation. Furthermore, she has psychological vulnerabilities such as social isolation, a lack of family support, and living alone in a rented residence, which might have a poor influence on her health outcomes.
Environmental and Social Factors Affecting the Patient
According to Dahlgren and Whitehead’s (2021) Rainbow Model of Health Determinants, various environmental and social factors influence health. These influences encompass individual lifestyle characteristics, social and interpersonal relationships, living and working environments, as well as broader socioeconomic, cultural, and environmental conditions. According to research, poor self-esteem among chronic disease patients leads to depression, anxiety, and a higher chance of suicide (Korkmaz et al., 2019). Furthermore, studies have indicated that social support might lessen the risk of sadness and anxiety in chronic disease patients (Lin et al., 2019).
On the other hand, Gladys has no family support because her husband has died, and she lives alone in rented housing, making her even more vulnerable. Additionally, her poverty and cultural background as a Caribbean woman may potentially impact her disease and care. Poverty has been found in studies to raise the likelihood of adverse health outcomes such as hospitalization and death (Raharja et al., 2021).
Discharge Planning and Long-Term Care for Gladys
Impact of Critical Illness on Vulnerability
Using Naylor et al.’s (2016) methods and Li et al.’s (2019) study, it is crucial to recognize that COPD is associated with anxiety and frailty, which may worsen her other vulnerabilities. However, there is no information provided in the case that suggests Gladys has a cognitive impairment or psychiatric vulnerability.
Gladys’ vulnerabilities and requirements might be linked to the fact that assessing individuals with complex care needs can be difficult. Patients with complicated care requirements have several chronic health illnesses, impairments, or other complex health demands, making it challenging for healthcare providers to identify and prioritize their needs (Olde Rikkert et al., 2012). Healthcare personnel may also find it challenging to organize care for patients with complex care requirements, as they often require services from multiple providers (Kasteridis et al., 2021; Schot et al., 2020). Moreover, Thompson et al.’s (2008) Person-Centred Support (PCS) approach, which emphasizes the importance of individual needs, preferences, and circumstances, can be utilized to assess and manage Gladys’s complex needs and vulnerabilities. Namely, healthcare practitioners can develop a care plan that addresses Gladys’s physical, psychological, and social needs by considering her unique qualities and values.
Gladys’s diverse requirements have elevated her chance of acquiring a critical illness due to her existing and new vulnerabilities. Gladys has COPD, which affects her capacity to perform daily duties. Her ability to perform everyday responsibilities is hampered by her COPD symptoms, which will worsen and make her weaker and sicker (Young et al., 2020). She is also at risk of depression and has more significant anxiety levels (Pumar et al., 2014). Her circumstances, with no support network and staying alone, enhance her risk of poverty and influence discharge planning.
Integrating Etic and Emic Perspectives
Furthermore, the etic and emic views, as well as their influence on Gladys’s discharge plan, must be considered. These words refer to two distinct approaches to studying cultural issues. Etic refers to an outsider’s point of view, whereas emic refers to an insider’s (Spiers, 2000). In Gladys’ example, the emic viewpoint would be Gladys’ perspective on her health requirements and vulnerabilities, whereas the etic view would be the opinion of the healthcare experts. If Gladys does not see her difficulties as problems, she may not follow the plan, and her health may worsen, resulting in her readmission to the hospital.
Advance Care Planning and Chronic Stress Reduction
Gladys’s circumstances required advanced planning to implement methods that can help decrease hazards while still meeting her physical, psychological, and social needs. First, a proactive method, such as proactive identification advice, entails anticipating future difficulties or challenges and making efforts to avoid them (Simsekler et al., 2015). A proactive approach in Gladys’ discharge plan should include recognizing potential obstacles she may experience after leaving the hospital, such as difficulty obtaining healthcare services or managing her COPD symptoms (Ali et al., 2013). Healthcare professionals may work with Gladys and her support system to devise ways to overcome these obstacles, such as linking her with community resources or offering information and training on COPD treatment (Barton et al., 2015). Healthcare practitioners can help ensure Gladys receives the support and care she needs to maintain her health and well-being by taking a proactive approach.
Collaborative Working and Priorities of Care
In addition, by taking Gladys’s viewpoint into account, including her needs and vulnerabilities, healthcare personnel can create a personalized discharge plan that addresses her individual circumstances and concerns. As a result, healthcare practitioners may increase Gladys’s autonomy and perception of control over her well-being and overall health by including her in the formulation of her discharge plan. Involving patients in the creation of their discharge plans has been found to boost patient autonomy and satisfaction with treatment (Dooley et al., 2019). This can help mitigate the detrimental effects of the etic and emic viewpoints. This strategy can also help healthcare practitioners identify and address any impediments to effective long-term care, such as a lack of social support or financial means.
Integrated Health and Social Care for COPD Management
Gladys’s diverse needs and vulnerabilities influenced the handling of her care when she was seriously ill. Gladys had three major influences on her care management. These include her husband’s death, the growth of her COPD, and her increased anxiety. Focusing on Gladys’ impacting vulnerabilities is critical when developing her discharge plan.
Furthermore, management requires the application of crucial clinical decision-making factors in nursing, such as critical thinking, problem-solving, clinical judgment, and the utilization of nursing knowledge (Hamers et al., 1994; Hassani et al., 2016). Using these skills, it can be argued that the danger of increased vulnerability must be addressed by prioritizing integrated treatment for pulmonary illness, followed by suggestions to address socioeconomic concerns, and finally, the consequences of social isolation.
Gladys should get integrated care to alleviate the vulnerability presented by COPD. As a result, many interventions are suggested in the UK literature for this case. One such option is pulmonary rehabilitation, which can help her breathe more easily, reduce her symptoms, and improve her overall health and quality of life (Lindenauer et al., 2020). Pulmonary rehabilitation programs typically incorporate a combination of fitness training, education, and emotional support, tailored to the individual’s specific needs and abilities (British Lung Foundation, 2023).
Another technique that can be used to control her symptoms is oxygen therapy, which provides her with extra oxygen as needed (Nippers & Sutton, 2014). Furthermore, COPD self-management programs are recommended to help Gladys better understand her illness and manage her symptoms daily (Shaw et al., 2020). By applying these measures, Gladys can better manage her COPD symptoms and improve her overall health and well-being.
Addressing Social Isolation and Poverty
Next, one of Gladys’ vulnerabilities that must be addressed as part of her discharge plan is poverty. Gladys’ poverty may make it more difficult for her to obtain essential healthcare treatments and resources. The current environment of rising energy prices may exacerbate the problem.
Gladys might benefit from switching to a pre-payment meter for her energy supply. Customers can use this type of meter to pay for their energy in advance, allowing them to better control their energy use and reduce the risk of incurring debt (Ramsden, 2020). Gladys’ mobility limitations, on the other hand, may make it difficult for her to travel to the shop to replenish the meter. In this situation, healthcare practitioners may collaborate with Gladys to explore alternative options, such as arranging automated top-ups or assisting with meter refills (Tan et al., 2019). Healthcare practitioners can develop a plan that meets Gladys’s financial needs while promoting her overall health and well-being by collaborating with her and her support network.
Furthermore, it is worth noting that the issue of individuals being discharged in the evening and the package of care commencing later, resulting in a day without care, is a common concern. Gladys had this issue, which may be resolved by offering alternate care options. Research in the United Kingdom supports the need for prompt and suitable care arrangements for individuals with complex care needs (Foster et al., 2022). These include temporary housing and rearranging the care package to begin earlier in the day.
In addition, addressing Gladys’ poverty as a vulnerability necessitates a multifaceted strategy that takes into account her unique circumstances and needs. Gladys, being ill with COPD, may have additional challenges as a result of her poverty. Poverty, according to Lee et al. (2019), can result in insufficient housing, poor dietary habits, and a lack of access to healthcare, all of which can aggravate COPD symptoms.
One evidence-based strategy for combating poverty in patients with COPD is to provide financial support for housing and essential necessities (Naylor et al., 2016). Another suggestion is to make inexpensive and healthy food available, which can help control COPD symptoms and enhance overall health (Li et al., 2019). Healthcare practitioners can improve Gladys’ quality of life and reduce her risk of adverse events by addressing poverty and its associated issues.
The reduction of loneliness and associated anxiety is the second objective in the discharge plan. Healthcare practitioners should look at community services and support groups to help Gladys feel less isolated and more supported. The Carers Trust is a UK resource that assists people caring for loved ones at home, offering respite care, therapy, and advice on local resources (Carers Trust, 2023).
Age UK is another resource that offers a range of support services for older individuals, including befriending, social initiatives, and home visiting (Age UK, 2023). Healthcare practitioners should also consider local community centers and religious groups, which often offer social activities and support groups for those in need. Social support has been demonstrated in studies to lessen the likelihood and severity of sadness and anxiety in people with chronic diseases (Lin et al., 2019). Healthcare practitioners may give Gladys the social support she requires and reduce the impact of anxiety on her treatment plan by linking her with community services and support groups.
Palliative Care and End-of-Life Considerations
Gladys’ chronic respiratory condition may meet her requirements for palliative care, which is one possible outcome for her. As defined by the WHO (2020) and the Resuscitation Council UK (2023), palliative care is a specialist medical treatment for patients with acute diseases aimed at improving their quality of life. Gladys will receive care that focuses on treating her symptoms as well as providing emotional, interpersonal, and spiritual support.
A team of healthcare specialists, including physicians, nurses, and social workers, will supply Gladys with the care that addresses her bodily and mental needs. The Resuscitation Council UK (2023) aims to ensure that individuals nearing the end of their life receive high-quality, empathetic care tailored to their specific needs and desires. Gladys’ security, quality of life, and overall well-being are likely to improve, regardless of whether she continues to receive curative therapy.
Health and Social Care Needs Assessment
A health and social care needs assessment is one strategy used to analyze Gladys’ potential outcomes. Gladys’ emotional and social factors, needs and desires, physical skills and talents, cultural and religious aspects, physical challenges and hazards, and health or housing requirements would all be assessed in this sort of evaluation (NHS, 2018). Gladys’ cultural and social background, as well as her unique needs and vulnerabilities, should be included in the evaluation (Karam et al., 2021).
As a result, the evaluation may determine whether NHS Continuing Healthcare can provide Gladys with personal medical and psychosocial care in a residential or nursing facility, or at home. Based on the information provided by Age UK (n.d.), Gladys may be eligible for NHS continuing healthcare because she has ongoing major physical and mental health requirements that necessitate continuous care and assistance. However, a formal evaluation would be required to determine her eligibility. Overall, the assessment should be comprehensive and person-centered, taking Gladys’ unique situation and cultural background into account.
Long-Term Outcomes of Critical Illness
Finally, Gladys’s severe sickness has various long-term outcomes that must be considered. One of these consequences is a greater susceptibility to despair, anxiety, and suicide. Gladys may be going through a challenging moment, and she must receive the appropriate care and support to help her get through it. Gladys can be helped by providing her with integrated care, which means that all of her healthcare requirements are coordinated.
Another method to help Gladys is offering her social assistance, such as linking her with support groups or staying in touch with friends and family (Lin et al., 2019). Lastly, treatments to increase her quality of life can be highly beneficial. Examples of such services include physical therapy, vocational therapy, and counseling (Shrestha et al., 2019). In summary, there are several methods to support Gladys during this challenging time, and she must receive the care and assistance she requires to manage these long-term consequences.
Conclusion
The critical discussion analyzed Gladys Cabrera’s complex healthcare needs and vulnerabilities in the context of discharge planning and long-term care after her acute exacerbation of COPD. Gladys’ distinct characteristics, values, physical and mental needs, and social support were all considered in the analysis. The critical discussion drew on various theoretical and scientific evidence bases, such as the PCS approach, the rainbow model of health determinants, and empirical studies. The analysis highlighted the importance of integrating Gladys’ cultural background and unique experiences in assessing her needs and devising a care plan.
The analysis indicates that Gladys has several vulnerabilities and requirements that need to be addressed in her care management. The care approach should be advanced, proactive, and personalized to mitigate her risks and enhance her health outcomes and quality of life. A comprehensive and tailored care approach is essential for addressing Gladys’ vulnerabilities and requirements. By prioritizing integrated care, improving her lifestyle, and empowering her to take an active role in her care, healthcare practitioners can mitigate her risks and improve her overall health and well-being.
In conclusion, the critical discussion demonstrated that Gladys Cabrera’s complex healthcare needs and vulnerabilities require an advanced, proactive, and personalized care management approach that considers her specific qualities, values, and cultural background. The analysis emphasized the significance of considering Gladys’ cultural background and personal experiences when evaluating her needs and developing a care plan. The practice recommendations emphasize the need for integrated care for pulmonary illness, poverty reduction, and social isolation prevention, as well as a person-centered approach that involves Gladys in formulating her discharge plan and addressing her anxiety. The recommendations suggest that healthcare practitioners collaborate with Gladys and her support network to identify and overcome potential obstacles to effective long-term care.
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