Experiencing Long-Term Care, Rehabilitation, and Recovery - Essay Example

Experiencing Long –-Term Care, Rehabilitation and Recovery. By Experiencing Long –Term Care, Rehabilitation and Recovery. INTRODUCTION This chapter aims to discuss long term care needed and provided to people living with long term conditions by carers, nurses and other professionals. Long term care involves various services designed to meet peoples’ health and personal needs for either a short period of time or a long period of time. It is an approach to improve a person’s quality of life, career and family when living with an advanced or a progressive illness. In long term care the symptoms are not cured but minimized through effective symptom management with its main aim being promotion of comfort for both the patient, their family and caregivers. The study focuses on two themes that are important to understand long term conditions and long term care. These themes are; self care/self support and supported care management. Self care/ self support involves persons with long term conditions managing their own care plans without much help from others for instance nurses and other professionals. This concept is known as “expert patient” and it is based on the premise that the person with the condition or disease understands it better than health care professionals. These patients have more knowledge about their conditions and have therefore learned ways of managing them. The patients undertake programs which provide information, resources and ways of developing relationships with healthcare bodies. This approach has demonstrated benefits for patients because they possess more knowledge of their conditions, ensures participation in decision making and get involved in the symptoms management processes. Although the concept of “expert patient” has its advantages, we must always be mindful of leaving some patients feeling abandoned and neglected when they are not able to manage skills and information they have been provided with. It is therefore advisable for patients to enroll in the supported care where nurses and other professionals are able to take care of both their personal and health needs. This is the reason that there must be a partnership with the patients, nurses and other professionals. The second half of the twentieth century brought a realization that due to the increase in numbers of people living with long term conditions (LTC), health care needed to be improved with an emphasis on patients being empowered to become decision makers in their care (Margerson, 2010). In the case scenario of Angela, the study concludes that she should focus more on supported care management where professionals with vast knowledge will assist here and address her anxiety about the future. She should also engage in self care management and get the facts about her condition so as to ensure she understands proceedings and participate in all of them. The combination of these two themes is effective in all patients of Long Term Conditions because in both they are provided with the necessary knowledge of their conditions, making it easier for them to participate in their care and decision making during treatments and medication. LITERATURE REVIEW Long term conditions are different from acute illnesses in that they are not usually curable and have a completely different trajectory (Margerson 2010). Multiple sclerosis is a neurological condition affecting one’s central nervous system. It is an autoimmune condition where a person’s body mistakes part of the own body as a foreign part and attacks it (Nicol, 2011). The symptoms of multiple sclerosis depend on the part of the central nerve system affected, but can include fatigue, visual disturbances, muscle pains and depression (Drennan & Goodman, 2007). Historically, there wasn’t much knowledge of multiple sclerosis like many neurological disorders. In 1920 it was believed that multiple sclerosis was caused by “female hysteria” this lead to a notion that men were likely to be more affected than women, therefore, women were wrongly diagnosed. Over the past decade, researchers have discovered a great about the disease with many constituents of the immune system that are involved in the autoimmune theory identified and doctors have been able to come up with new therapies that specifically target the cause of the problem. While existing treatments lack possible cure, disease-modifying therapies (DMTs) have proved to be effective in limiting the number of relapses. Studies have shown that most people living with long term conditions do not take their medication as prescribed. It is therefore important to make individualized treatments and recommendations for each patient and provide education on the benefits of treatment adherence. As a former USA surgeon C. Everett Koop noted, drugs do not work in patients who do not take them (Osterberg L, Blaschke T, 2005). Nurses should take up the task of ensuring that patients comply with their medications and are aware of the benefits which include: lower rates of emergency room visits, hospital stays and absence of work leading to savings of time and money. Compliance refers to taking medication as prescribed- the right dose at the right time with the right frequency (Devonshire 2007). There are factors that influence adherence include: patient self efficacy and patient-clinician relationships and communication. Recently, researchers and doctors are coming up with new ways to reduce cases of non adherence in patients with multiple sclerosis. These methods include: oral drugs such as BG 12 for patients with injection phobia, however, this will need safety monitoring to prevent risks of long term oral medication. Another method that is being used by doctors is reduction of frequency, dosage where the doctor administers medication at least twice a week or once a month. In the case scenario, the nurses involved in the supportive care management should make sure that Angela has knowledge of the benefits of compliance this will help her address her anxieties of the future about her family and career. The nurse should also ensure a good relationship with Angela and communicate with her any developments on the disease so as to keep her informed, ensure her participation and involve her in decision making. Doctors should come up with a medication plan for Angela that is convenient for her that will enable her to attend to her family and to her job. Long term catheterization is needed by those whose bladders will not empty fully or empty at inappropriate times. Each day the caregiver needs to clean the area around the urethra mostly in females, this area must be cleaned after every bowel movement the catheter should be also changed periodically according to a schedule developed by the doctor or the nurse. When the catheter becomes obstructed by debris such as mucus, protein deposits and or mineral crystals, when this happens the flow of urine may stop temporarily. To deal with this the care giver should flash the catheter with a special solution or the doctor should prescribe medication to make the urine more acidic. Insertion of catheters poses the following problems: The urethra or the bladder can be damaged, but very rarely the bladder wall is punctured. When catheters are inserted for a long time its balloon can be inflated in the urethra instead of the bladder thereby injuring it. Growth of bacteria in the urethra causing urinary tract infections. In people using catheters, the following symptoms can be signs of an infection and other complications and they should immediately contact a doctor and or a home-care nurse. These symptoms are: Leaking of urine through the catheters. Thick urine, cloudy or that is tinged with blood. Urine with unusually strong or foul smell. Occurrences of fever with or without chills. Pains in the abdomen or lower back Lack urine flow in the urine collection bag. In the case of Angela,345 the doctors and the home care nurse should first inform her of the uses of the catheters, benefits in the management of her bladder movement and the risks of long term use of the catheters. This is a move to ensure that in the absence of a nurse or a caregiver, she can take care of herself or make her own decision for or against the use of catheters. It is the role of the nurse is to ensure that the catheters are properly inserted at all times and are clean including the areas around the urethra to prevent urinary tract infections. This will ensure that they are not wrongly inserted risking damages in the urethra or the bladder. To sustain these needs, therefore, Angela and other people dealing with similar conditions require proper housing to maintain privacy and room for care givers and finances to manage the use of catheters. These patients also require living in very clean environments to ensure cleanliness and safety of the catheters and proper disposal of the urine collection bags. (Nolan et al 2006) Noted that to achieve enriched environments of care, staff, patients and their families have to have six senses that have to be met by staff, people receiving care and support and families. They discuss these scenes as follows: Security-To feel safe mentally, physically and socially. Belonging-Feeling wanted by others, to create new relationships and maintain them. Continuity-To be able to make links between the past, present and future Purpose- To be happy at being important to others and having reason to achieve things. Achievement-To attain the set goals as expected by self and others. Significance-To feel valued and your contribution important to others. In this paper, we will discuss the sense of belonging in relation to Angela. BELONGING The nurse who is to take care of Angela should use her preferred name. This shows respect and makes her comfortable. Secondly, in a situation where there are patients suffering like Angela the home care provider should recognize their importance as Angela can relate with them. Another thing is that the family members should be able to participate in helping the patient. In our case, Angela’s family members should, for example, assist her in moving or even giving her beverages and food. The fourth thing is that Angela should continue being treated as family. She should be taken care of as before and be made to feel a member of the family by all people including the home care provider. Patients should be provided for a qualified individual to take proper care of them. In Angela’s case, she should be provided for a nurse who is conversant with Multiple sclerosis. Another factor is flexible visiting hours by the nurse. The nurse to Angela should visit frequently so as to check on her since her urinary tract is affected. There are legal and ethical issues involved issues involved in home care. Dailey and Newfield (2005) discuss the following. Fraud- This can come in many forms. The most common one is over billing the patient. The nurse should be able to give the right billing of the medicine and even services without taking advantage of the patient’s health condition. For example, in our scenario Angela is not in a position to walk long distances to go buy medicine. The nurse is likely to buy the medicine for her. The nurse should buy the correct medicine for the right price. Abuse- It comes in different forms. It can be physical, psychological or even verbal abuse. Nurses should not be involved in any form of abuse to the patient as it affects their recovery. In addition, the patient should be respectful to the nurses so as to avoid situations that may lead to abuse. Frequency of visiting- Nurses should avoid inappropriate use or overuse of services. However, some situations call for frequent visits or even full time care. Our scenario, for example, calls for frequent visits so as to check on Angela and assist her in visiting the washrooms. Malpractice claims- Nurses should adhere to the standards of practice always. This helps protect both the nurse and patient. Phillip J (2009) says that a person living with long term care should be responsible for adapting their lifestyle, taking prescribed medicine and reporting changes as it helps maximize their wealth and well being. He further discusses the importance of having a nurse and family members to assist in the following situations; Eating healthy- a professional helps in dieting depending on the condition of the patient. It is important to have a fully qualified nurse who knows the foods and fluids that are important to maintain a healthy lifestyle among the patient. Coping with depression, fear and frustration- Most patients in long term care suffer from one or all of these situations. Having a nurse help ease the fear as they help patients handle the health situations both physically and psychologically. Relaxation techniques and exercises - Nurses have a wealth of experience in relaxation techniques and exercises that are important to long term care patients. For example, Angela would benefit from exercises that make her feet stronger to enable her move short distances. Communicating with family, friends and professionals- The patients at times are not in a position to express themselves and their condition to others and the nurse helps in this role. Planning for the future- Nurses are in a position to assist the patient in the future. They are able to advise the patient on the seriousness of their condition and are able to plan ahead. HOMECARE In situations where the patient is in home based care and a nurse is involved, the needs of a patient are put first and the patient is the focus of the relationship (Nicol, 2011). He further states that this happens mostly in therapy relationships and the needs of the patient are assessed at the outset to identify mutually acceptable goals and who is responsible in achieving those goals. In order for family members to understand their loved ones they need to understand Different people have different reactions and coping mechanisms hence the need for therapy. Nicol (2011) highlights these reactions as; Fighting spirit- Some patients take up the disease as a challenge and are able to cope with it. However, there is the need for therapy so as to guide them to how to fight the condition. Stoical acceptance- This is where the patient takes the situation as it is and they decide to live with it. Denial- Some patients do not accept the situation. It takes a lot of therapy to help assist patients deal with the situation. Resigned helplessness- this is where a patient is resigned to doing nothing for their condition as the damage is already done. Therapy at times helps change the perspective of these patients. In most cases, family members are called upon to take care of their loved ones who are in long term care. Family is defined by the individual and it includes any caregiver or significant person who assists a client in need of care at home, and includes assisting clients meet their basic needs providing direct care such as personal hygiene (Stanhope and Lancaster, 2010). In our scenario, for example, Angela has two children and they are likely to be called upon to assist her in different chores or ways be it psychological or physical. In such a case, this is called palliative care and Nicol (2011) defines it as “an approach to a personal care that improves the quality of their life and that of their family, when they are living with advanced and progressive illness.” Palliative care has the following advantages as highlighted by the World Health Organization (2012) and also by Meier and McCormick (2009). It eases pain and other symptoms It involves the psychological and spiritual aspect of the patient. Helps patient understand the advantages and disadvantages of available treatment. It helps gain a better understanding of the illness. Uses a team approach to address the needs of patients and their families. It improves quality of life. It offers a support system to help patients live as actively as possible until death. It is applicable early in the course of illness in conjunction with other therapies intended to prolong life. Walsh (2004) notes that taking care of a sick person, especially where they have a chronic condition is tasking and can affect marriages and even relationships among family members. He furthers says that this happens mostly where the individual suffers from lack of mobility and where the patient suffers from pain. In dealing with pain, Baille (2009) divides the type of pain suffered by these patients into two: cognitive dimension and the socio cultural dimension of pain. In the cognitive dimension he explains that, it explores the way in which pain is influenced by, and influences peoples thoughts, beliefs and preferred cognitive strategies for coping. In our case, Angela is likely to get influenced by the pain to change her thoughts. She is likely to think of the pain she will suffer whenever she thinks of walking long distances. In the socio cultural dimension, Baille (2009) states that family, culture, society and environment influence pain. He further notes that children learn about pain, pain behaviors and coping strategies from their families and peer groups. This is applicable in our case whereby Angela’s children are likely to feel the pain their mother is experiencing and they have to find ways of coping with it. There are some guidelines that can guide people who are taking care of long –term care and rehabilitation patients as discussed by Crawford, Brown and Bonham (2006). These include; Being approachable- this is of great importance to the patient and the family members as well. A nurse should be easily approachable by all members of the family and the patient. A friendly attitude of the nurse will help maintain high approachability. Professionalism should be mentioned, however towards the patient and family members. Maintaining a smile- A smile helps the patient and those around her/him to relax. A nurse should be able to maintain a smile often as it will ease things up. Maintaining a conversation- A conversation will often start with greetings. It shows respect to the patient and starts a bigger conversation. Conversations help to communicate the thoughts of the patient or nurse. Politeness- This is a key factor in taking care of the patient. The nurse should be polite to the patient and the family and vice versa. It creates respect and professionalism and thus better service provision. Praising the patient- people like being praised for their achievements. Praising the patient makes them feel good and keeps them motivated to recover. For example, in our scenario, the nurse can praise Angela if she is able to take herself to the washroom without much assistance from other people. Humor – this acts as a good ice breaker, especially in tense situations. However, one should be careful about their choice of humor as the patient might take the joke personally. Maintaining eye contact- Eye contact is vital as it shows respect and assures the patient that communication is being achieved. Physical appearance- it goes a long way towards creating an impression to the patient. One should strive to have a professional appearance as it creates a good impression. This can involve dressing among others. Being relaxed. This helps calm down the patient, even in serious situations. The nurse should be relaxed when handling patients. It assures the patient that they are in safe hands. The three authors also insist that the dignity of a professional should be maintained regardless of the clinical setting you work in and the gender/age of your patients. QUALITY OF LIFE Fallowfield (2009) defines quality of life as “an ambiguous concept that has different philosophical, political and health- related definitions.” He goes ahead to state that health –related quality of life includes “the physical, functional, social and emotional well-being of an individual.”According to Fallowfield (2009), there are several reasons as to how health related quality of life can improve patient care. These are discussed below using Angela as our case study. Widening the parameters of benefit - The patient is able to offer more information on health related quality of life. For example, Angela is in a position to explain the pain she experiences thus making the nurse and doctors better understand her situation. Indicating a need for supportive interventions – Patients are likely to suffer from side effects from therapies of the different conditions. Quality of life helps these patients deal with these side effects as they get professional help. Angela for example, is likely to suffer from stress due to the sudden changes in lifestyle and it might take therapy sessions with experts to help her deal with this situation. Decision making - It helps the patients and doctors make decisions on the best way to treat diseases. Angela can discuss with her doctor about the potential harms and benefits of treatment. CONCLUSION Since long term conditions are not curable, prevention and management should involve a team of people or healthcare bodies. Patients and their families should not be left alone to deal with these conditions and in cases of relapses nurses should take it upon themselves to empower both the patients and their caregiver. The government and the community should also assist these people by offering social support for instance assisting them with finances. By dealing with these conditions as a team and providing care for them as a team empowers these patients, giving them a sense of security and belonging, thereby offering them comfort, improving the quality of their lives and reducing costs required during treatment, therapies and long term care. References Baille, L., 2009. Developing Practical Adult Nursing Skills.3rd Ed. London: Hodder Arnold Crawford, P., Brown, B., and Bonham, P., 2006.Communication in Clinical Settigs.UK: Nelson Thornes Ltd. Dailey, M., and Newfield, J.2005. Current Legal issues in providing wound care in home care. Home Care Management and Practice, 17(2), pp.93-100. Devonshire, V., 2007.Adherence to Disease- Modifying Therapy:Recognizing the Barriers and Offering Solutions.USA: Delaware Media Group. Drennan, V. and Goodman, C., 2007.Handbook of primary care and community nursing. Oxford: Oxford University Press. Fallowfield, L., 2009.What is quality of life? 2nd Ed. pp. 1-8 Magerson, C.,2010.Trajectory and Impact of Long Term Condition. London: Routledge. Meir, D., and McCormick, E., 2009. Benefits, Services, and Models of subspecialty palliative care, pp. 11-13. Nicol, J., 2011.Nursing Adults with Long Term Conditions.UK: Learning Matters Ltd. Nolan et al. 2006. The Senses Framework: improving care for older people through a relationship – centered approach. Getting Research into Practice. Report. 2 Osterbeg, L., and Blaschke T. 2005. Adherence to Medication. Vol.353. pp 487-497. Phillips, J., 2009.Improving access to self-management services. British Journal of Neuroscience Nursing, 5(11), pp 524-525 Stanhope, M., and Lancaster, J., 2010. Foundation of Nursing in the Community.3rd Ed. USA: Mosby Elsevier. Walsh, M., 2004. Foundations in Nursing and Healthcare.UK: Nelson Thomes Ltd. World Health Organization, 2012. Definition of Palliative care. WHO Read More