Summative: Case Study
Chronic Obstructive Airway Disease and Parkinson’s disease
Introduction
The individual healthcare professional’s ability to do what is proposed with proper competence and skill is, of course, crucial in ensuring that the best is given to patients, specifically for those who have underwent surgical operations. However, professional competence is only part of the bigger and wider picture. The vital role of the healthcare provider through collaborative professional practice must always give priority by providing holistic care, its patient and giving all the possible assistance so as to alleviate their sufferings from pain brought by their specific disease.
The prime responsibility of being the healthcare provider is to assist individuals in the attainment of an optimal level of wellness. The focus of healthcare provider practice is on individuals’ specific needs based on their healthcare choices related to physiological, psychological, socio-cultural, developmental and spiritual dimensions of individual lifestyles. Primarily, the main goal of this paper is to provide health care intervention about acute and chronic illness and pathotherapeutics.
Clinical Intervention
The healthcare provider process is utilized as a systematic procedure to considering healthcare provider practice. In spite of all the disparagement of the healthcare provider process (Varcoe, 1996) it seems that the critiques focus on idealistic underpinning, issues of power relationships, inadequate development and poor change management more than on the process itself. I see the phases of the healthcare provider process as a useful framework for practice—which could be used in any discipline—around which a conceptual procedure strengthening the relationship to healthcare provider can be developed.
Purists would argue that the version of the healthcare provider process used here, omitting the healthcare provider diagnosis phase, substituting a summary for the planning phase and using the term intervention in place of implementation, is a considerable digression from the healthcare provider process as generally understood. Healthcare provider or clinical intervention for patients was generated to be able to develop, maintain and strengthen the patient’s quality living in spite of his illness.
In chronic illness such as Chronic Obstructive Airway disease and Parkinson’s disease, the patient can be given different healthcare provider or clinical interventions. For this case, the top most healthcare provider intervention includes physical, intervention, biological, psychological, social and spiritual interventions.
Physical: This physical health needs include the patients’ inability to do activities like what normal or healthy people do. Since he is an elderly individual, he is having difficulties in physical activities. Accordingly, physical activity for individuals with chronic obstructive airway disease and Parkinson’s disease is important to let them maintain a healthy lifestyle. This is because participation in regular physical activity may help reduce the rate of occurrence of heart disease and cancer as a complication of the disease (Stalker and Harris 1998). The same relationship also exists between disease and physical activity, such as exercise because with increased levels of physical activity, there is a decreased prevalence for an individual to develop certain diseases (Draheim et al 2002)
The management of the hospital or the healthcare provider themselves must know how to relieve these problems from the patients in order to pave their way towards their bodies’ improvement. In the case that this will not happen (for example, the patient may be extremely ill and they need immediate treatment for their disease) then it would be the healthcare provider’s job to remove these hindrances for the patients’ albeit a little satisfaction when it comes to removing some pain up to the extent of their knowledge.
At the same time, it is also the healthcare providers’ job to make sure that the clients are as comfortable as possible, especially when it comes to their basic health needs as these will affect their disposition and future health needs.
Biological: Biological help that healthcare providers may be able to offer their patient includes the recommendation of different tests to know if there are complications, to determine the cause of the breathing problem of the patient. In addition, other biological may be offered if the patient is suffering from pains and other symptoms.
Psychological: Besides the physical help that healthcare providers may be able to offer to their patients, they may also serve as emotional pillars and supports for their patients. The jobs of healthcare providers include the insurance of their patients’ emotional needs, especially if in the possibility that they may become unstable. It must be remembered, however, that the emotions and feelings of the patients must not be the only ones addressed but also those of the friends and families. Problems may arise in the case that these people find that their loved ones are not being treated into what they believe should be beneficial for the patients’ health. The healthcare provider must then prepare the patient and the families and friends into a period of adjustment that will help in their slow improvement.
Social: The healthcare provider may help the patient achieve a good relationship with its peers, families, and friends and as well as other healthcare providers. The social need of the patient is another aspect to consider being able to identify whether the patient has a problem when it comes to having a good relationship with others.
Spiritual: At times, the healthcare provider must also play as the spiritual guide for the patient. This may clash with any religious beliefs that the two may have; however, since it is the duty of the healthcare provider to keep the patients fit and healthy as possible, as well as remove stress from their minds in an effort to hasten the improvement of their patients. In this case, the healthcare provider must also make a moral and ethical decision, especially since it will touch their beliefs. At the same time, the healthcare providers must also be careful when it comes to giving spiritual guidance for their patients as these may be grounds for legal problems concerning religion and convincing patients to turn away from their beliefs. However, healthcare providers must then make their own decisions when it comes to the spiritual needs of the patients but keep in mind that they must also consider the feelings and needs of their patients (Johnstone, 1999).
Psychosocial Diagnosis
Diagnosis is structured to allow for the classification of psychiatric conditions that are clinically significant but do not meet major criteria for major syndromes. In this particular case, the psychosocial diagnosis as an integral part of the healthcare for Chronic Obstructive Airway disease and Parkinson’s disease patient includes eating disorder for the patient. The patient was diagnosed to have eating disorder which was an implication for the clinical management of the Chronic Obstructive Airway disease and Parkinson’s disease infection. Herein, the investigation for having a weight loss, compliance and dietary intervention may all be influenced by the presence of such eating disorder. In addition, the development of Chronic Obstructive Airway disease and Parkinson’s disease may exacerbate the symptoms of disorder. Another psychosocial diagnosis that can be attached to the patient is mood disorders. When the episode of depression comes, the patient must be promptly treated, if possible, in an integrated manner which involved psychotherapeutic.
Family healthcare providers are a precious resource who bears many
physical, emotional, and often financial burdens; it is in the best interest of the patient that they be supported in every way possible. Healthcare provider stress can lead not only to illness and frustration for the healthcare provider but can progress to abuse and neglect of a vulnerable elderly person. It is important to remember that an elderly patient’s support system may not be a “Conventional” one, yet it is no less important or valuable. An elderly person living in his or her home may rely on neighbors, church members, or a building maintenance provider for assistance, support, and friendly conversation.
SOAP MODEL
For this report, SOAP model will be considered. SOAP stands for Subjective Objective Assessment Plan which was originally noted by Weed in the 60s and considered as an integral part of the patient-oriented medical record (Epstein, 1997). SOAP model has been utilized in the medical arena since the model’s inception.
. In this particular case, it can be argued that the subject/patient was diagnosed to have Chronic Obstructive Airway disease and Parkinson’s disease. Based on the Soap Model the observation shows that the patient is having difficulty in to have a comprehensive and superior treatment and care to achieve recovery. The patient is given medicines which can be taken once a day to improve the situation of the patient. Aside from this, the patient is also receiving Chronic Obstructive Airway disease and Parkinson’s disease medication regime. This collaborative care was given to help the patient recover from other health problems which has been due to the infection of Chronic Obstructive Airway disease and Parkinson’s disease. Elderly patients, like the one mentioned in this case with Chronic Obstructive Airway disease and Parkinson’s disease may present with reduced level of energy, unhappiness as well as difficulties in performing daily activities and also in participating in social activities. Attributing such symptoms purely to the effects of Chronic Obstructive Airway disease and Parkinson’s disease may mean that the diagnosis of depression is overlooked. Furthermore, depression in elderly Chronic Obstructive Airway disease and Parkinson’s disease patients may reduce independence, resulting in a growing dependence on medical care as well as being a source of concern for healthcare providers and healthcare providers.
In this case the pathophysiological clinical manifestations and observation that can be considered may include cardiovascular manifestations. Herein, the patient is suffering from inability to catch breath at rest having a heartbeat of 126 per minute. Chronic Obstructive Airway disease and Parkinson’s disease infection is characterized by an acquired, irreversible,profound immunosuppression that predisposes patients to multipleopportunistic infections, malignancies, and progressive dysfunctionof multiple organ systems (Lewis, 2000) but may also affect other cell types.
Other pathophysiological clinical observation that can be seen is the occurrence of bacterial pneumonia which happened to the patient. Bacterial pneumonia is considered as one of the common dilemma for many Chronic Obstructive Airway disease and Parkinson’s disease patients, the case of bacterial pneumonia and less severe airway (respiratory tract) infections can be due to one of several bacteria. In this case, the patient has encountered bacterial pneumonia which must be treated immediately.
Of all the cosmopolitan medical professionals, healthcare provider and caregivers for elderly people who have chronic obstructive airway disease and Parkinson’s disease are the most enthusiastic about the concepts of holistic health. They are a majority at many large symposia, and afterward they include holistic approaches and concepts in their daily work. Conventional healthcare provider roles, with emphasis on teaching, counseling, as well as caring, are akin to the ideal patient-practitioner role in the holistic model for caring patients with Chronic Obstructive Airway Disease and Parkinson’s disease. Hence it is comparatively easy for healthcare provider to make the transition from their more orthodox training to holistic health (Mattson, 1982:114).
There are certain holistic health models that have been formulated for healthcare provider and in this case study, the most appropriate model to use SOAP model. The SOAP MODEL is a consultation guideline which can be used in holistic health care assessment for the patient in this case who has been diagnosed with COPD and Parkinson’s disease.
On the first part of the Soap Model, it is the duty of the personnel to establish an initial rapport with the patient. Herein, the healthcare provider may greet the patient to start the conversation. In addition, the nursing personnel should introduce her and the role that he or she plays in the interview or consultation process. The healthcare provider should always sees to it that she demonstrates respect towards the patient and show that she is interested to know the situation of the patient to make sure that the patient feels comfortable both physically and emotionally as the consultation process continues.
The next thing to do is to identify the reasons for the consultation. It is important that the patient is asked about the reasons or the issues that the patient wishes to deal with the consultation. During this part, the healthcare provider should always pay attention to what the patient is saying by listening attentively to the patients without interrupting or directing to the response of the patient. After the patient have said the main reason for his consultation, the healthcare provider may asked additional question for confirmations and to know other issues related to the issue being consulted and note the patients answer. After which, the healthcare provider must be ready to negotiate the agenda by taking into account both the patient and the attending physician’s needs.
In the SOAP model, the next part is to gather pertinent information and this section is divided into three sections. The first section is the exploration of patient’s problems. Herein, the role of the healthcare provider is to encourage the patient to tell his problem by using open and close questions. The healthcare provider must show interests by listening attentively to what the patient is saying without any interruptions. The healthcare provider should also facilitate the patient’s responses and to make clarification on certain statements to ensure that all the information needed for the holistic care will be gathered. After the exploration of the problem, the next thing to consider when gathering information is to understand the patient’s perspective by identifying actively and accurately the patient’s ideas regarding the issues, the concern of the patient about the problem that he is facing and knowing the patient’s expectations about the issue. In addition, the healthcare provider should also identify the effects of the problem to the patient.
Herein, the healthcare provider should also encourage the patient to express his feelings regarding the problem. Lastly, the next part is to provide structure to the consultation. The role of the nursing personnel in this part is to make the organisation overt by summarising a specific line of inquiry to confirm understanding before going to the next part. The progressions from one part to another may be done through the use of signposting and transitional statement. After which, the healthcare provider should always be ready and prepared for the next section by having a structured interview and logical sequence of such process.
The next section of the SOAP model is to establish a good relationship and rapport with the patients. This can be done by ensuring that all the patients’ needs from emotional and clinical support should be given by the nursing personnel. Herein, the healthcare provider must always ensure that he or she treats the patient in a way that he will not be intimidated or irritated. The healthcare provider must remember that patients are sensitive and this sensitivity must consider as a line which limits all actions of the healthcare provider. The healthcare provider must assist the patients both emotionally and physically and show the willingness to help in any way he can. Aside from this, the healthcare provider should also allow the patient to be involved in the process by letting him know what you think and what can be done to solve his problems. During the process, the healthcare provider should explain everything to the patient specifically during the physical examination so that the patient may not feel that his presence is being taken for granted.
The next part of the model is the explanation and planning. Explanation and planning can be done by providing the correct amount and type of information. This can be achieved by checking all the information for understanding and using patient’s response as a guide to continue the session. In addition, assessment of patients prior knowledge and asks patients of other helpful information. Aside from this aiding accurate recall and understanding is also an important part of this model as well as the achievement of shared understanding by incorporating the patient’s thoughts, ideas and perspective. The next is the planning section which includes all the options that can be used in solving the problem or issue raised by the patient. The last part is the closing session. Herein, the healthcare provider should summarise the entire plan for the patient care and check if the patient agrees or have something to add in the plan of care.
Planning, Implementation and Evaluation
Planning
The main focus of this holistic care case, is regarding my ability to do prescriptions of the medicine needed by the patient. As a healthcare provider it is also my duty to provide the patient a medicine which will alleviate his suffering and not to provide other problem. During the consultation period, the patient has opened his thoughts about the possible effect the drugs that she will be taken.
In this case, I had been able to create a healthcare provider-client interaction which helps the client become more comfortable to say all the things he wants to say. The outcome of the healthcare provider -client interaction depends on the healthcare provider’s ability to engage the client in decision making and share the control and power in the relationship (Roberts et al 1996: Spiers 1998). Healthcare providers build their communication skills by studying and practicing techniques, trial-and-error, observing role-models, experience, and gaining comfort with the use of their own intuition. Face work and politeness theory point to the need to consider the client and healthcare provider’s “sense of self-esteem, autonomy, and solidarity in conversation” (Spiers, 1998). The main issue is about giving prescriptions.
Healthcare provider prescribing means that the healthcare provider takes accountability for the clinical assessment of the patient, establishing a diagnosis and the clinical management required, as well as responsibility for prescribing where essential and the correctness of any prescription.
There are also mechanisms through which healthcare providers can supply medicines without actually prescribing them or waiting for a doctor’s prescription. Independent prescribers are responsible for preliminary diagnosis and evaluation of patients, after which they prescribe the appropriate treatment. In addition to doctors, independent prescribers can be appropriately qualified healthcare providers who can prescribe from the original or the extended formulary.
And supplementary prescribing, previously known as dependent prescribing, is a partnership between an independent prescriber and a supplementary prescriber to implement an agreed, patient-specific Soap Model with the patient’s agreement. There are no authorized restrictions on the conditions that may be treated or on the drugs, providing they can be prescribed and are referred to in the SOAP MODEL. It is said that since there are number of people, especially elder people who have been diagnosed with COPD with or without Parkinson’s disease, the UK government has been able to provide bills and regulations One of the government policies is the development of the COPH passport for individuals living with COPD, which was established to be able to help people from a debilitating fear of further exacerbation. This policy was developed to give advice to patients and able them to live quality life in spite of their disease. Medical insurances, especially for older patients are also given by the government.
While some poor prescribing may be done in ignorance of or in defiance of the best evidence available, it is, perhaps, more often the case that the best evidence is not adequate to the clinical decision which must be taken. There may not be a good quality trial and one may have to be guided by poor quality trials. The patient may not fit the categories used in the trial(s), but may still be sufficiently similar in terms of the condition being suffered to mean the treatment should be actively considered at least. Or it may be that there are no trials of the treatment for the condition, in which case an effort must be made to weigh risks and benefits using the best information available. Formal techniques to reduce this type of uncertainty, such as probability theory and decision analysis can also be used. These, though, are impractical in short GP consultations and some medical ethicists reject decision analysis as too mechanistic and insensitive to the patient’s perspective (Pellegrino & Thomasma, 1988). However, the philosophy underlying decision analysis and principle elements of the approach do have something to offer when trying to make difficult decisions in the absence of complete information or when seeking to individualize treatment on the basis of information derived from populations.
Thus, in prescribing decisions, one should ensure that all viable options are considered and that one’s perceptions of the probabilities of harm and benefit accord with whatever up-to-date clinical trial evidence is available. While formal measurement of patient’s utilities, i.e. the value they place on the various possible outcomes, will not usually be feasible, an effort should be made to ascertain the patient’s view of the risks and benefits. Great care is required in how information on the probabilities of risks and benefits and the margins of error of our knowledge of these is presented to patients (Tversky and Kahneman, 1981). On the one hand, patients must be given full and unbiased information sufficient to make their choice within the limitations of their willingness and ability to receive and comprehend such information. On the other hand, doctors must not abrogate their responsibilities to either assist patients make choices or make choices for patients when it is appropriate to do so.
Reference
Mattson, PH 1982, Holistic Health in Perspective, Palo Alto, CA: Mayfield Publishing Co.
Pellegrino, ED and Thomasma DC 1988, For the patient’s good: The restoration of beneficence in health care. New York: Oxford University Press
Roberts, BL, Madigan, EA, Anthony, MK, & Pabst, SL 1996,. The congruence of nursing diagnoses and supporting evidence. Nursing Diagnosis, 7, 108-115.
Spiers, M 1995, ‘Client Centred Standards: Risk Implications for Boards and Management’, Leadership in Health Services, vol. 4, no. 2, 10 – 3-.
Trickey, S, Hurst, K and Dean, A 1991, “The Recognition and Non-Recognition of Problem-Solving Stages in Nursing Practice”, Journal of Advance Nursing, vol16, no. 12, pp. 1444-1455.
Tversky, A & Kahneman, D 1981, ‘The Framing of Decisions and the Psychology of Choice,’ Science, Vol., 211, No. 30, 453-458.
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