Evidence of the understanding of the context of practice setting from a person centered perspective
Over the years, different types of changes have taken place in healthcare sectors. These changes mainly consist of the changes of the model of care provided to patients. With the help of different researches and over the growing debates of human rights, recent treatments have included person centered care over the medical model of care in the treatment procedure. Evidences also suggest that team collaboration result in more effective output a nurse caring for a patient with complex case (Milles and Mezich, 2011). Moreover, including a biopsychosocial care over biomedical care had added to the benefit of the patients’ treatments. The report will mainly portray how these practices have been incorporated in modern treatments and the various barriers it still face, recommendation are also provided to overcome the barriers and provide the best treatment to patients.
Working in a nursing care is a challenging job as well as a extremely diverse and hence the nurse needs to extremely skilled in order to provide best treatments to the patients. A wide variety of skills are required by such nurses because old patients behave and respond quite differently than their younger counterparts. This is because their cognitive skills, memory as well as their physical strength decrease (Eckman et al. 2011). A large number of physiological changes occur in old patients and hence wound treatment also gets compromised for such patients. A brief discussion about the difficulties faced by nurse in wound healing in aged care needs to be described so that one might develop a clear idea that why it had being challenging for a nurse to handle wound care in aged people. With the growing of age, the inflammatory response of the body to any wound gets much slower. The first phase of wound healing mainly involves the dilation of the blood vessels so that the different white blood cells as well as different nutrients may easily reach the wound site. This phase is extraordinarily slowed in such patients. The following phase of proliferation becomes sluggish over time. The final stage which consists of maturation can take a time of around more than a year. The remodeling of collagen that takes place in order to reduce the different wound size helping to return the skin to its natural state takes a large number of time making the process more painful as it lingers for a long time (Koren 2010). Hence it becomes the duty to support the patients both mentally and physically to overcome the painful period that destroys quality time. As the wound healing method of older patients take place much slowly and also has several complications, it becomes difficult for a nurse to expend so much time to a particular old patient with a rising uncertainty that whether the wound would get well or not. Such a strenuous treatment has always urged for multiple individual participation who would be dividing the task among themselves so that best care can be provided. Therefore over the years, the culture of work has changed gradually form the soloists culture to that an orchestral culture of team members working collaboratively over a patient with each performing their own assigned task responsibly. The transition over the years had taken a national momentum with the help of different types of healthcare reforms as well as with the help of substantial inter-professional policy with practice development in these years recently (Pelzang 2010). The main reason for the adoption of such practices in the healthcare settings is the growing importance of the person centered approaches which are claimed by researchers to be the most beneficial way of providing care and compassion to patients. Researchers over the years have helped in the development of many tolls which if followed properly will help in guiding the team about how to establish a proper team work culture in the wards. Team work assessment culture mainly helps in putting forwards ten most important questions which helps a team to realize its positive and negative aspects. These in turn help them to develop skills that in turn can assure the overcoming of the negative aspects and strengthening the positive aspects. The team assessment tool consists of ten most important questions. This includes the diagnosis of the current state of the present team culture. The second important question is the discussion of the results as well as the brainstorming the different possible improvements that can be helpful for betterment of the care provide to patients. The third domain would be creating a staff which will be compact as a group (Hudon et al. 2011). The fourth domain would be the creating opportunities that will enhance team communication throughout the day. The next domain would be to meet regularly with the next being strengthening the team by focusing in individual development. The seventh would be the proper knowing of the team members and then teaching the leaders to be mentors instead of being managers. The ninth one would be to create an environment which will support continual learning with the tenth one being engaging patients in services. Once the nursing team is able to achieve a team which will effectively follow the above guidelines and portray best collaborative practice will be successful in giving the best results in patient care.
Evidence of the understanding of the context of practice setting from a person centered perspective:
Over the period of time, changes have not only taken form a soloist practice to a team culture practice but also from the medicine centered model of treatment to a person centered approach. The culture of work as well as providing care to patients has changed over the decade. Researchers conducted by eminent scientists have shown that a concept called person centered care is of immense help when treating patients. This is very much different from the medical care centered approached which was followed for a long time in different settings in healthcare organizations. The traditional care which was mainly the medical care or medical model of healthcare was followed previously and it consisted mainly of evaluation of symptoms and complaints of the patients and prescribing treatments followed by correctly assessing the outcomes (Peyrot et al., 2013). The main center of the care was the doctor as well as other highly trained professionals who used to be the main person taking all the important decisions. It was the main function of the professionals to decide and the function of the patient was to comply with the decisions that the professional had taken on the behalf of the patients and his family members. However over the decade this type of working culture had changed a lot resulting in the incorporation of a new type of approach called the person centered approach. The healthcare services comprising of both long term and short term care and services have moved away from the paternalistic and the doctor-knows-best approaches and had inculcated the consumers as the main central individuals having the most powerful as well as the most active roles. An incident can be depicted in this scenario to provide light over the changes (Rosser et al. 2011). A few years back, a diabetic patients who have developed several wounds over the body by falling down in her rocky garden, came for suggestions and interventions. The healthcare setting after admitting her called for the doctor who diagnosed her wound and instructed her with medications, injections and several wound dressing ointments that the nurse had to use during dressing her wounds. While her treatment was conducted the nurse noticed that the patient was not comfortable with the intervention and complained of immense pain and burning sensation of the patient. However, the nurse in the traditional medication model had to follow the doctor’s decision and the treatment that the doctor provided was not at all person centered care as the patient was not at all comfortable with the treatment (Barry and Engman-Levitan 2012). However, very little importance was given to patient’s dignity and autonomy by the doctor and therefore it in turn resulted in negative effect. The patient started suffering from emotional pain as well as mental instability and her physical pain that she experienced during her wound dressing created fear in her in such a way that she used to lose her senses and behave abnormally mainly by shouting and yelling at nurses. In spite of this, the nurses were not being able to change any intervention without any command of the doctor. When the family complained this to the doctor, the doctor advised them not to worry as he was providing the correct treatment for the patient. The family was not even properly addressed and was not given importance as well. Hence, it became extremely difficult for healthcare professionals to provide the correct care for the best recovery of the patients. However, situations have changed over the years where more importance was given to the patients’ wishes and interventions were planned in way that would help to address each and every issue separately and plan interventions accordingly. The multidisciplinary teams working together are now given enough freedom to sit together and decide interventions in a collaborative manner (Brownie and Nancarrow 2013). If the same patient would have been admitted in the present day, her treatment would have been much different. In the present days, medical model is not followed and more importance is given on person centered care. The main differences that would have been noted are that centrality of the physician would have been moderate in person centered care in comparison to that of the medical model where it used to be quite high. On the other hand the role of the patient who is receiving care from the healthcare professionals would be moderate in person-centered care in comparison to the other where the importance given to them is quite low. In present day a good amount of importance is not only provided to the medicine and interventions that the nurse provides to the student but also to that of the nonmedical issues in decision making (McCormack, Dewing and McCane 2011). This attitude was low in medical model of treatment and moderate in person centered care. As a result the patient feel that they are provided respect and their choices are given importance. Often living arrangement are made in accordance to the patient or even if the treatment is painful, the interdisciplinary team of the nurses and healthcare staffs provide emotional strength providing her confidence to overcome the difficult phase of the old patients’ life. Moreover, person centered care also influences the inculcation of the culture of education as well as that of the empowerment of care for not only the patient but also the family (Reeves et al. 2011). This is very low in case of medical model of care but is quite moderate in the case of the person centered care. Therefore, family members are included in the treatment and are discussed about the interventions that the healthcare professional has decided for the patients. This save them from anxiety about their patients and also gives them a mental peace as they understand that the best care has been allocated for the patient. Educating the patient and the family members make them understand that although the medical intervention might sometime be painful but they will help in long term benefit and such discussion provided them with strength and empowers them to tackle the painful intervention unlike the case where the patient was mistreated. Moreover, also coordination between the different acute, post acute and long term care is much low in medical care of treatment but higher in case of person centered care. Hence this had resulted he eminent researchers to advise healthcare sectors to incorporate such practices for treating different aged patients suffering from different types of wounds and address the multidisciplinary as well as the interdisciplinary team to take proper measures required effective practice (Rigby 2010).
In order to describe the recent culture of the person centered care as well as the rising importance of multidisciplinary team, the first feature that can be described is the overall biopsychosocial model of healthcare that is incorporated which is more evidence based and yields a more successful result than biomedical model alone. The biomedical model which considers the human body as a vessel which when affected by disorders or diseases must be treated with medical interventions and surgery. However the recent culture of treatment is composed biopsychosocial model where person centered approach is incorporated and acts a s very good combination with the help of multidisciplinary team (Nugus et al. 2010). This approach emphasizes the importance of not only diagnoses, medical and physical needs but also the social, emotional, mental as well as the spiritual needs. This culture of treatment mainly respects the concept of personhood and mainly is based on the foundation where the world is seen from the eyes of the patient and the family members who are moving through tough days. This culture helps in recognizing the needs of the people in terms of opportunities for different activities and also helps in conducting social interaction that provides them room to grow with the involvement of family members (Etherton et al. 2013). It involves shared decision making as well as application of detailed knowledge of biological, behavioral, social as well as biographical aspects in order to provide the correct interventions with the maximization of choice and autonomy of the clients.
Some of the threats to the present culture are the fight over the power and hierarchy that stays among the different healthcare professionals. Often power conflict among the healthcare members among the multidisciplinary team often may act as a barrier that may affect the person centered interventions planned for the patients. Often such conflicts result in poor quality treatment (Badger et al. 2012). Moreover as person centered care involves a large number of aspects like biological, social, emotional and many others and therefore to address them in may require longer period which may affect the profitability of the healthcare centers. Moreover to concentrate over a number of aspects, a larger number of resources are required and hence it becomes difficult to provide a complete person centered care. With the growing population of aged cohorts due to advancement in scientific treatments as well as in the field of medicines, resources have become restricted as a large population needs to be treated with limited resources. This is the only missing aspect and once it is overcome, a full person-centered approach can be ensured.
Evidences of findings from different types of observations and stories from people:
Evidences have been collected from the different surveys where patients have participated and shared their views of the care that have been provided to them. Team effectiveness survey was conducted and results from the team effectiveness survey helped the teams to understand what the negative aspects that they need to overcome were (Jeon et al., 2010). The survey was based on a number of questions which helped in providing numbers for each attribute which at the end would give an idea about the status of a team. From the survey, it was seen that at an individual level, the team members were seen to portray transformational leadership as well as developed skilled facilitation however a problem was seen in role clarification as the individuals were not clear about the part of the role that they had to perform which often lead to confusion and hence had a very negative impact on the patient treatment. However except this part, the enabling factors for the organizational level were successfully maintained that involved transparent management, proper leadership and decisions making, organizational readiness and also ensured proper human resource support as well as management. However, it was seen from the team effectiveness survey as well as from the information provided by the patients’ experiences and their stories that open communication was absent among the different members as well as positive attitude to change. These acted as barrier in attending a successful team collaborative work proving that power and hierarchy are still present within the system (Greenfield et al. 2010). However all of them worked towards a same goal of following person centeredness and believed in lifelong learning with the following of proper leadership development.
Analysis of current caring practice with help of tool:
They also followed the practice of evidence based researches to incorporate up to dare practices in their treatment. “Patient-Centred Dimensions of Care provided by NRC+PICKER, a Division of National Research Corporation” have provided a framework which helps the patient to describe their positive and negative aspects (Cartwright et al. 2015). They need to cover eight important aspects of care which help in developing an all over idea about their experiences. They patients have responded positively in the domains like access to care and also stated that the healthcare nurses provided them with enough respect and paid significance to their values, preferences and their expressed needs. They also responded positively stating that their family had been involved and their friends were allowed to discuss the interventions with the healthcare staffs. However they complained that their coordination among the team members were not effective and they were seen to apply same intervention by two people consecutively making them understand that they have not discussed the work decision clearly. It was told by the patients to the nurses that the previous staff had already done a particular job and the next person should not perform that. This had been annoying for the patients as they thought that their life was in danger. Moreover transition and continuity were also obstructed a number of times due to the ineffective communication and coordination among the different members of the teams (Chenoweth et al. 2010). However the team was effective in providing correct information as well as provides education to the patients and family members. Moreover the stories and the surveys which were participated by the patients showed that team members had correctly handled their fear and anxiety and tried to alleviate the symptoms. They were also provided proper emotional support as well as their physical comfort was confirmed. Hence the main negative aspects that was found out was ineffective communication among the team members that resulted in improper coordination among the team members resulted in improper treatment and threat to patients (Nosbusch. Weiss and Bobay 2011). Moreover role clarity was also not done properly which resulted in improper interventions or repetition of the interventions. A conflict among the powers was seen from the evidences.
In order to overcome the conflicts among the different members of teams, it is very important to maintain a professional code of conduct not only in the healthcare sector but also as a part of the group practice policies. This would act as ground rule helping in the maintenance of the discipline and would help to exclude personality out of equation. Different types of miscommunication, lack of communication and communication barriers must be addressed by proper training classes which will help staffs to overcome their communication barriers and help in active participation in discussions where the communication issues are revealed (Pullon et al. 2011). Moreover the power struggles could be minimized by proper counseling of the mentality and making them share their views for other. Often several workshops encourage healthcare staffs to disclose the negative aspects and positive aspects of their colleges in front of them only. It is believed that greater the transparency, lesser is the ego struggle and better development of bonding in workplace (Pearce et al. 2011). Moreover, proper development of bonds among the team members is also important. Role clarification should be done by holding proper meetings by the leaders before interventions are planned.
Conclusion:
With the advancement of years, changes in culture in the working environment in healthcare sectors have been noticed. Medical model of care has gradually been replaced by person centered approach and at the same time soloist mode of working had been converted to team collaborative activity. Often the biomedical care is also replaced with biopsychosocial model of care and hence all the important aspects of a patient’s life are considered before providing interventions. However, different barriers like lack of proper communication, power struggles, ego clashes and lack of role clarification may be present which need to be properly addressed in order to provide the bed care to aged patients.
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