Integrating various disciplines within the health care system
The quality of health care is not only limited to its accessibility and affordability but also to care for an individual’s physical, social, emotional, and psychological well-being. This cannot be achieved without integrating various disciplines within the health care system like nurses, medical doctors, physiotherapists, relatives who take care of the patients and pharmacists. There is need to establish the continuity of patient care, locate the workforce that will help in patient care, find out the patient’s model of integration, get to know the approach to patient’s care and how the integration was made available to the patient. For instance, for a patient like Mr. D to have an integrated care that leans towards the health and social well-being, he needs to have the above tennets to provide a framework to understand the reason for need of multidisciplinary action towards care (Cohen et al. 2015)
This essay is based on Mr. D, and elderly man with a mental problem. He lives in a nursing home where the author works as a care manager. As a course of action in his interest, a multidisciplinary approach towards his care plan has been developed. Those involved includes the one giving the medication, physiotherapist and a personal caregiver. His care plan needs him to consent but because of being mentally ill, he cannot do so. The caregivers and the nurses who administer medication to him have to rely on the care plan.
Mr. D could not consent to his care plan. What if he could have been involved in his own care plan by any method available? This would have had a positive impact in improving his quality of life and treatment plans. It is important to acknowledge that patients and care providers have different goals and that patients like Mr. D need information and support guidance (Rajabiyazdi et al. 2016).
For better care, consent is needed. This helps the patient understand the process, risk, benefits, and alternatives of a procedure, in an autonomous way. Consent is only possible if one is competent to do so. Mr. D is an exception in this case due to his mental illness. The capacity to comprehend the consenting process reduces with age (Sherlock and Brownie, 2014). This could have further explained the need for a multidisciplinary approach to manage Mr. D since he is elderly, adding to his mental issues.
Because Mr. D did not consent to his medical care plan, there is a possibility of not achieving an improved patient satisfaction, management and clinical outcomes, thus shared decision making with other health care providers and relatives is necessary in this case.
Patient involvement in their care plan
Shared decision-making has been shown to help the patient choose their preferred method of care relating to the available options, its risks and benefits, available options, and need to change to another one if need be. One treatment option for patients with mental problems like Mr. D is through psychosocial involvement like behavioral therapy, besides medication (Gühne et al. 2015) In this case, another approach called motivational interviewing can be used as it focuses on changing behaviors using four steps: engaging the client, focusing on the preferred method, evoking and planning for the process to continue. Therefore integrating shared decision making and motivational interviewing is a prerequisite for a multidisciplinary approach to patient care (Elwyn et al. 2014)
Gühne et al. (2015) acknowledges the high burden of mental illness and a need for psychosocial therapy, with best evidence leaning towards multidisciplinary team. This involves a team of specialists within the health institution and the family and close friends of the patient. They can work towards community care and ensuring that the client is rehabilitated in a vocational institution. The type of rehabilitation option suitable for Mr. D can only be elicited through efficient communication with him as this would improve his health care plan (Gausvik et al. 2015) Another method would be to offer single intervention like the ones Mr. D has on his care plan like art therapy, in addition to occupational therapy and psych education.
Gausvik et al. (2015) states that timely and accurate communication leads to job satisfaction and improves the patient health care. Mr. D’s caregivers cannot engage in an accurate communication with him because of the concept of disorientation in time, person, and place in some mentally ill patients. Not working in tandem might lead to untimely administration of drugs especially at home where the family has to receive instructions on drug administration from the health facility. The overall effect is inability to achieve job satisfaction, but this can be improved by collaborative interdisciplinary relationships.
Financial constrain is a major hindrance to offer quality care, where good care is available. However, health care cost can be reduced by reducing the number of hospital stay that will in turn reduce the daily costs incurred in the facility, use of right choice of medication, health promotion, and personal care. If Mr. D could have been consulted on the type of care he needed, an idea of the exact problem would have been found. This in turn would have reduced the burden of managing an unknown condition. However, in his best interest, personal care was included in the care plan. According to Chiauzzi, Rodarte and DasMahapatra (2015), patient monitoring helps them advocate for their personalized care. Health promotion programs for Mr. D like the use of physiotherapist and art therapy reduces the number of sick days and hospitalization.
Shared decision making
Mr. D’s mental condition poses a challenge for him to access health care in an appropriate way since he cannot consent to his desired form of medication. This needs a social worker expert to handle him. Social change in behavior is a determinant for health. Health inequalities pose a challenge, as there is close link between social condition and health. It is also prudent to know that health and health care differ. For better health care, you need both health stakeholders like the nurses, physiotherapists like Mr. D has and also non-health stake holders like the community, social worker, family and relatives (Marmot and Allen, 2014) Involving both groups will see the gap in the health sector closed. For instance, in Mr. D’s condition, involving both the health and non-health stakeholders would mean that Mr. D would be taken care of holistically, for better outcome.
A good care plan is a prerequisite for good health practice, which will ensure both staff and patient satisfaction. Mr. D has a comprehensive care plan that was made without involving him, but in his best interest. The nurses and support workers need to adhere to the care plan to offer Mr. D’s medication. This means that there is need for effective supervision. The family and relatives also need to be supervised in the social care they give. According to Carpenter et al. (2017), effective supervision ensures work effectiveness due to increased critical think, professional development and positive feedback among others.
When medical and social services are integrated, health care provision becomes more efficient and satisfactory. Integration occurs in three levels being linkage, coordination, and full integration. Mr. D’s medical services needs to be integrated with social services like social therapy. Although the initial cost of integration is high, long terms benefits are always there. The hospital staff like nurses involved in Mr. D’s management plan together with other support systems can be involved in clinical and management levels for long-term benefits. This can be achieved through working together between health care providers and the social workers. Glasby and Dickinson, (2014) supports the need for integration for good outcome in care and as a tool for better resource utilization. Mr. D and the nursing home will both benefit from the united services by his caregivers, family, and the community.
Mental health problems like Mr. D’s pose a global burden and has an impact both economic and social costs, (Funk, 2016). Mental health patients are often stigmatized, thus health authorities need to work in collaboration with other stakeholders like the family and social workers. This opens an avenue by the health facility to use appropriate surveillance networks that includes social determinants of health to evaluate the trends in mental disorders. This might improve care in the future.
Multidisciplinary care for better outcomes
Since Mr. D is at the mercy of his health care providers, he could be exposed to numerous risks. Nevertheless, as part of social support, the team could link him up with a social media platform. Social media has had a variety of usage in the past with both positive and negative impacts on individuals. The caregivers handling Mr. D could post his story about his mental illness on twitter or a Facebook group for him to find peers. Peer to peer support on social media is the future for mental health care ( Naslund et al. 2016) In these platforms, the peers can interact online, enjoy the feeling of group belonging, share stories and strategies for coping up. Mr. D would enjoy these benefits and also be empowered and change the stigma around him. In overall, it will help promote treatment engagement.
Because of the potential risks in Mr. D’s treatment, health audit and monitoring should be done during and at the end of the treatment course to ascertain potential gaps. According to Bowling (2014), audit in the health system improves patient outcome in addition to developing cost effective use of resources and encouraging continuous education of professionals. In case a serious audit is done in the hospital taking care of Mr. D, the cost of care would be reduced as potential areas of high financial input may include the long hospital stay and use of wrong drugs.
Bickman, Lyon and walpert (2016) backs up the need for monitoring, feedback and evaluation as a necessity for precision medicine in mental health. The needs, preferences and prognostic capabilities of Mr. D should be well understood before undertaking any management procedure on him. For good treatment plan to be initiated, it must go beyond signs and symptoms. We need personal data of Mr. D that not only focuses on his age, gender and family but also genetics, social and environmental experiences as these can predispose, precipitate or relieve his mental problems. The service preference for this patient should also be known, that is possible through a good and collaborative communication approach, the progress in treatment and the risks and side effects of the care being given.
A research done by Norman et al. (2016) on Routine Outcome monitoring (ROM) had more advantages than disadvantages in both private and public hospitals. The physicians acknowledged that ROM was important in helping monitor their works, set goals, useful in keeping them focused and validating the treatment methods. This would have been even more advantageous in Mr. D’s case as the caregivers would get more focused in helping him get better, set other goals like engaging the social workers more and beating a deadline of getting other treatment methods like cognitive therapy. It also helps in finding out the drug side effects, monitoring the liver function and kidney tests since they function sub optimally in such an old age.
Integration of medical and social services for quality care
In the United Kingdom, health care benefits for the elderly is universal national entitlement but the long-term effect is out of pocket responsibility that leads to bankruptcy. In this situation, the community, family, and relatives can come to the patient’s rescue. A multidisciplinary approach to Mr. D would be beneficial as the access to health is determined by physicians and access to long-term care benefit is determined by nurses and social workers. The importance of economic evaluation in health and social care cannot be underestimated. In his old age, it would be in order to argue that Mr. D is being taken care of not to be fit again but to improve his quality of life. Well-being measure is suitable for economic evaluation of older people (Makai et al. 2014) thus every intervention must be well thought through and make sure its cost is commensurate to the quality of life desired.
Although Mr. D is receiving care, he must be communicated back to about the milestones his providers have achieved. This needs communication. Fuertes et al. (2017) brings out the idea of physician-patient working alliance as a guarantee to patient adherence, satisfaction and improved outcomes. Some of the physician behaviors like ability to show empathy and indulging with patient in an emotional talk are linked to the above advantage.
Therefore, all of Mr. D’s caregivers including his family should undergo training in health and social care. This will equip them with skills that would support Mr. D’s behavior, by doing the client-centered counseling approach for supporting behavior change. The support workers in Mr. D’s care have a duty of communicating with him each time they do a procedure. This type of communication, albeit good, should not be limited to advice giving only as the traditional methods of care giving were. Each person in question especially the physicians and the social workers should have an exploratory conversation with the patient by understanding his world. This would give an idea of the mood, affect, orientation, appearance and behavior thus a recipe for supporting the client to plan for solutions (Lawrence et al. 2010)
The concept of good patient physician relationship is a core principal in provision of care. Mr. D’s caregivers have to establish a good relationship with him despite of his condition. Good patient physician relationship has both emotional and informational component. It has been shown to improve patient outcome. (Kelley et al. 2014). For Mr. D, the nurse in charge, physiotherapists and the family at large have to have a good relationship with him, in terms of communicating verbally and non-verbally, not under estimating him and equally treating him like other patients. Failure to do this may lead to patient and staff demotivation in practice and behavior.
It is not easy to achieve a successful collaboration between health care providers. Things like government funding for the necessary infrastructure, (Leathard, 2004). Collaboration between health care providers taking care of Mr. D will help look at his problems in a new perspective.
By allowing him to be taken care of in the health institution despite not participating in consent and decision-making, Mr. D shows a high level of trust in his health care providers that have to follow the care plan. He also shows a level of self-trust by following the care plan. His trust is embedded in the risks the caregivers will pose him to, since it’s a psychological state. The patient physician relationship is strengthened by patient trust in the physician (Zhao, Rao and Zhang, 2016). This patient trust in physicians has been declining. Increasing level of mistrust between his caregivers may result in Mr. D involving in physical fight with his colleges and caregivers given his mental problems.
Various reasons have been shown to lead to patient-physician mistrust. They include conflict of interests and perception by patients that medical practitioners are there to monger money from them (Tucker, 2015) Incase such an incidence happens, this will ruin the reputation of those involved and the institution. Physicians need to be trained in conflict resolution to prevent such incidences. Nonviolent processes like hospital mediated conflict resolution.
Ethical issues in the medical field should be adhered to, though sometimes it poses a challenge when dilemma exists. Mr. is an elderly patient, who should be handled in a special way. He also has a mental illness and his care plan was made without his consent also poses a challenge to ethics, especially if he chooses to refuse health care. Patient autonomy and consent is a center stage in clinical practice. Occupational code also suggests that help should be given voluntarily and with a consent, which Mr. D did not give owing to his mental problem. This poses a risk of abuse, paternalism and coercion to him (Brodtkorb et al. 2015) Being an elderly person, Mr. D may qualify for physical restraint, in addition to his mental illness. This is usually necessary where the patient poses a risk to themselves and to others, helps in controlling behavior and makes treatment easier. However, it is increased with a risk of negative behavioral change, impaired mobility and cognition and even psychological retardation.
Decision-making and competency are also part of legal issues when it comes to patient care. A competent individual is able to make decisions and perform tasks. The overall rule is that they should be able to understand the information, understand the situation at hand and its consequences, considering the information rationally and making informed decision (Rincon and Lee, 2015) Mr. D has no capacity to give consent. The health care providers have a responsibility of finding out if he has drafted will or a durable power of attorney. The setbacks of these methods are that the physicians cannot get clear instructions to guide his treatment thus deemed suboptimal.
Mr. D qualifies for legal exception of consent because of his incompetency to do so. Therefore, it was reasonable to invoke the principle of best interest standard in formulating his care plan. It’s important in determining a wide range of issues. It is possible that the family of Mr. D did not know his explicit wishes to treatment thus this s principle can guide in treatment. This method has its own shortcomings like physicians being seen as authoritarian.
Health should be provided to all and sundry disregarding age, gender, race, political affiliation or economic status. It should be well distributed with an aim of doing well to people and with proper goals, proper prioritization, and being sufficient. (Judith, 2015). Inganski and Mason, (2018) also support this by taking about racism, equal opportunity, social change and health care agenda and lining policy, politics and health care. Mr. D must be given equal care as others regardless of his old age, social issues that he might have being mentally challenged and physical disability.
Education for both medical personnel and the society should be encouraged to help eliminate stigma related to health conditions like mental illness. Shen et al. (2014) did a research that showed that training in psychiatric condition greatly reduce the stigma toward the mentally ill. The nursing home in which Mr. D is should embark on a program to educate their workforce and the community around regarding mental health issues. This will benefit other people like Mr., making them appreciate whom they are and not feel guilty of their situation.
In conclusion, this essay is highlighting the need for multidisciplinary approach in health and social care. This includes shared decision making with health care providers and social workers, social support and good communication strategies. This case study highlights Mr. who is mentally challenged but lacks the capability to consent to his own treatment, thus leaving the medical personnel apply the principle of best interest. The nurse, physiotherapists, family, and the social workers must work in tandem to help Mr. D realize better health care and improved quality of life. Patient physician trust must also be ensured since Mr. D is a special case, and would need someone who has empathy towards him. Ethical issues prove to be a challenge in such situations, but with good medical practice, informed decisions that will not harm the patient and caregivers should be made.
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