Assesement 2: Person Centered Approach

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Introduction:

According to McPhail, S. M. (2016), multimorbidity is an emerging concept mostly confined to older adults, and is currently lesser understood. The occurrence of multiple diseases either branches from a parent illness or has its own roots, and either way presents difficulties in devising a holistic treatment plan. Physicians are challenged by the heterogeneity of this age group, the complexity of multi-pharmacotherapies and fragmented health care systems. To overcome these challenges, we adopt a patient centered approach which as per Salisbury, C., Man, M. S., Bower, P., Guthrie, B., Chaplin, K., Gaunt, D. M., ... & Lee, V. (2018), is widely recognized as a foundation to safe, high-quality healthcare. It is care that is respectful of, and responsive to the preferences, needs and values of the individual patient. Keeping this in mind, we shall discuss how health practitioners can adopt a targeted care plan.

In this case, we observe a 55-year-old patient with congestive heart failure and accompanied discomforts. Jean is a happily married mother and grandmother, who lived a fairly normal life until she was diagnosed with CHF and recently found her symptoms exacerbating. This chronic illness demands a complete lifestyle change and requires reassessing the daily choices to accommodate the illness.

As per, Conroy, T. (2018),the key factors influencing optimal care for chronic illnesses include organizational factors, individual nurse or patient factors, and Interpersonal factors. Organizational factors include nursing leadership, the context of care delivery and the availability of time. Individual nurse and patient factors include the specific care needs of the patient and the individual nurse and patient characteristics. Interpersonal factors include the nurse-patient relationship; involving the patient in their care, ensuring understanding and respecting choices; communication; and setting care priorities.” In light of this, it can be seen that optimal care for chronic illnesses require a holistic person-centered plan, which would include careful assessment of not just the physical aspects of the illness but also the comorbidities that come with it, as well as the individual unique case scenarios. 

Cardiac rehabilitation would require Jean to participate in therapeutic treatment regimens in order to ensure a considerably normal life even under strenuous circumstances. An effective treatment plan would involve multifactorial intervention from various health professionals with nurses at the epicenter. Typical priorities include physical and cognitive functions, symptom control, self-management, reduced burden of therapy, health-related quality of life, maintenance of independence, and overall well-being.

As per Dryer, D. E. (2007), patients who are enduring powerlessness may seem like they have no control over their situation and may act out with indifference, anger, violent behavior, or passivity. Also, patients who are suffering from chronic, debilitating, or terminal illnesses may have continuing perception of powerlessness because they are incapable of changing their inevitable outcomes. 

According to Bos, L., Marsh, A., Carroll, D., Gupta, S., & Rees, M. (2008, July), patient empowerment on the other hand, in the health care context means to promote autonomous self-regulation so that the individual’s potential for health and wellness is maximized.

Patient empowerment entails supporting self-management, which as per McCorkle, R., Ercolano, E., Lazenby, M., SchulmanGreen, D., Schilling, L. S., Lorig, K., & Wagner, E. H. (2011) is defined as the tasks that patients must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management and emotional management of their conditions. 

According to McCormack, B., & McCance, T. (Eds.). (2016), person-centered care consists of five core components: consideration of the patient’s beliefs and values, engagement, shared decision making, a sympathetic presence, and provision of holistic care which forms the basis for self-management and empowerment. Based on this, the role of nurses in supporting patient’s self-management can go a long way in effective outcomes. This includes: 

Davidson, P., Driscoll, A., Huang, N., Aho, Z., Atherton, J., Krum, H., ... & Stewart, S. (2010), Assessment of the current self-management status:

According to Keene, L. (n.d), one of the pivotal points in patient centered care is inquiring about the patient habits, especially those that counter act with the treatment plan and makes their condition worse. In this case, Jean is an avid smoker, averaging on 10 cigarettes a day. What makes her habit worse is the codependency she potentially has with her husband who is also a chain smoker and hence makes abandoning the habit much harder. She also consumes soft drinks, about 6 cans a day and has a diet consisting mostly of takeaway with few vegetables and fruits.

Nicotine dependence should be viewed as a chronic disease, with multiple possible comorbidities. For someone with CHF, this habit can be the last nail in the coffin, as it aggravates heart diseases. Lancaster, T., & Stead, L. F. (2017), stated in their systematic review that “there is high-quality evidence that individually-delivered smoking cessation counselling can assist smokers to quit”. Rice, V. H., & Stead, L. F. (2008), suggests that as a nurse, it is important to not only advice the patient to cease smoking but actually carve a practical path for them to do so. In order to provide a setting that would encourage Jean to quit, the nurse should also engage her husband in the smoking cessation program.

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