Introduction What is casebased discussion and what areas it focus on? Focus Positive indicators Medical record keeping Legible; signed; dated; appropriate to the problem; understandable in relation to and in sequence with other entries; helps the next clinician give effective and appropriate care.
Clinical assessment Understood the patient’s story; made a clinical assessment based on appropriate questioning and examination. Investigation and referral Discusses the rationale for the investigations and necessary referrals; understands why diagnostic studies were ordered or performed, including the risks and benefits in relation to the differential diagnosis. Treatment Discusses the rationale for the treatment, including the risks and benefits. Follow-up and future planning Discusses the rationale for the formulation of the management plan including follow-up. Professionalism Discusses how the care of this patient, as recorded, demonstrated respect, compassion, empathy and established trust; discusses how the patient’s needs for comfort, respect, confidentiality were addressed; discusses how the record demonstrated an ethical approach, and awareness of any relevant legal frameworks; has insight into own limitations.
(“TheFoundation Programme – Homepage”, 2018)In the tableabove we can see that the case based study in medical field focuses on various sectors,but for this particular assignment we will be looking more into theprofessionalism side. This table also provide a good insight of the thingsexpected from the student in order to successfully complete the CBD (Case BasedDiscussion) of a chosen field. Healthprofessionals need to develop analytic and diagnostic thinking therefore CBD hasbeen used in the medical field for this particular reason. CBD will allow studentsto be exposed to the ethical/management problems, medical problems anddifferent problems associated with the patient, this will in return helps themto develop analysing abilities. By such exposure students will also improvetheir interpreting and problem-solving skills and in the course of doing thisthey will develop interest in the subject. CBD can be used in future, if we getsimilar scenario we would be aware of the policies and law in place.
Considering theimportance of Case Based Discussion, I have decided to look upon the keyaspects of intervention that needs to be followed by the nurse and health professionalswhen looking after reduced capacity patient. I will also be looking at theethical implications on the topic and how this can be set in to safeguard andpromote the interest and well-being of the patient. Background of the patient For the purposeof patient and staff confidentiality and to protect patient’s identity all thenames will be altered and provided pseudonyms. Consent has been obtained fromthe patient’s families and the nurse (who was looking after the patient) tocarry out this case study (NMC 2015). The patient will be referred as pseudonym”James”.James is a 76-year-oldgentleman who has been married to his second wife for 22 years. James has beendiagnosed with many long-term conditions and lives with Arthritis, Stroke,Gout, Vascular dementia and benign prostate cancer as well as otherillnesses. His needs and care are verycomplex and requires input from different healthcare professionals.
This assignment will focus on ethical ormanagement problems in delivering James’s care and also the importance ofworking in partnership with all the healthcare professionals to provide thebetter quality of care. Living with stroke can affect the patient’s decision-makingcapabilities and it is a important job to ensure that this complexity isentirely addressed. James has beenchosen for this assignment because over the placement, I was involved with hiscare and had an opportunity to know James and his families closely. I haveselected this topic to research for my assignment because stroke is one of the mostcommon health problems among UK population and also this case was very uniqueand had lots of management problems and this will help me gain more knowledgeon this sort of problems and management issues that is linked with the patient.I believe this case base study will increase my understanding which willbenefit me with all the evidence based information in my future career.
Thiswill also develop my further understanding of health professional’s role whencaring for patients with complex care issues which will influence in mypractice. “Patientswho suffer from chronic illness often requires complex needs, their illnessesor diseases have a prolonged course that do not resolve spontaneously andcannot be completely cured but could only manage the symptoms of the illness toensure they receive a quality of life and care throughout their journey” (Smeltzeret al 2010). Overview of case During myplacement, I was involved with a team providing care for James. His general condition kept deteriorating overthe weeks of my placement.
James communicationwith his families and staffs decreased, before he used to respond andcommunicate even with a few words or showed facial expression or gestures suchas a nod or shake of the head. His mobilitywas drastically changed, as his pain and increased muscle spasm restricted himto transfer on a recliner or any other chair. He was bedridden as per GP (generalpractitioner) and OT (occupational therapist) decision for his own safety. Onconsultation, GP reviewed James and was aware about of his pain anddeterioration on his condition. Referrals were made by the nurse for speech and language therapist(SALT) for dysphagia.
A referral to the dietician was made to review themassive weight loss that James had endured within a short period of time,whilst the occupational Therapist (OT) was referred to review for anappropriate chair for James. He also established grade 2-3 pressure ulcer inhis sacrum and was referred to tissue viability nurse. The assessmentwas carried out by the SALT team about his ability to eat and it was decidedthat dysphagia presentation was due to his history of stroke which was exacerbatedby reduced physiological reserve and low mood. The diet was changed from fork mashable to soft diet and syrup consistency fluids. SALT advised that James shouldbe encouraged and assisted with his diet and fluids.
They advised for James toreceive nutritional and well balanced diet to maintain a healthy weight. Dieticianvisited James regarding his weight loss and asked to try out nourishing drinksmade with full cream milk such as Ovaltine, Horlicks, etc. The dieticianadvised to provide the patient with monounsaturated olive oil varieties of spreadssuch as cheese, butter, cream and custard to add good sources of calories tomonitor his weight. Tissue viabilitynurse visited and applied some dressing on James sacrum; she also carried outthe care plan for James dressing. She advised that James should be rolled overevery 2 hours to ensure that pressure relief is maintained. The wound showedsigns of improvement after few weeks.
According to NMC(2015) it is paramount that all the practices and information should beaccurately and completely documented. The nurse informed wife about all thesituation and outcomes that the MDT (multidisciplinary team) made regarding abouthis general health condition and managing his illness. GP requested the nurseto discuss with his wife about the ‘Do not resuscitate’ form as the patienthealth was not improving.
His wife fully understood about the situation andsigned the form and was happy with all the decisions and plans that were set upby MDT. “A do-not-resuscitate order, or DNR order,is a medical order written by a doctor. It instructs health care providers notto do cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or ifthe patient’s heart stops beating.
” (order, 2018) Discussion MCA is definedas “The Mental Capacity Act (MCA) isdesigned to protect and empower individuals who may lack the mental capacity tomake their own decisions about their care and treatment. It is a law thatapplies to individuals aged 16 and over.” (“What is the MentalCapacity Act? – NHS.
UK”, 2018)Thus, whenlooking after the patient who has reduced capacity this might affect the actsin connection with their care plan or treatment and should always be ensured thatall the actions taken by the professionals should be merely in the bestinterest of the patient. It can be found in MCA as “If someone is found to lack the capacity to make a decision andsuch a decision needs to be made for them, the MCA states the decision must bemade in their best interests.” .” (“Whatis the Mental Capacity Act? – NHS.
UK”,2018). NMC (2015) suggests that nurses should use different communicationskills in promoting wellbeing and preventing ill health ofpatient andmeeting the changing health care needs of the individual. Therefore, the use ofthe care plan is essential, for nurses to be able to recognise the needs of thepatients. The documented nursing intervention in the care plan of patients’needs will help the healthcare professionals recognise the unique needs of anindividual and will help to improve patient outcome. Case managementfocuses in delivering holistic health and social care to fulfil the needs ofthe vulnerable clients who have complex needs and whose care is not activelymanaged by the whole system (Carrier 2009).
According to NMC (2015) the nurse has to gaininformed consent from the patient to share any information with otherhealthcare professionals. The nurse gained consent from James and informed himabout the current situation. As James has cognitive impairment and according tomental health capacity (2005) if someone is appointed to make decision on theirbehalf they must act in patient’s best interest and still involve patients inmaking decision as much as possible. Consent was gained from James wife as welland all the information was shared and made transparent.
Collaborative andsuccessful information could only be made possible through gaining consent fromthe patient and their family member (NMC 2015). “Consulting with others is a vital part ofbest interest decision-making. People who should be consulted include anyonepreviously named by the person concerned, anyone engaged in caring for them,close relatives, friends or others who take an interest in their welfare, anyattorney appointed under a Lasting Power of Attorney or EnduringPower of Attorney, and any deputy appointed by the Court of Protection tomake decisions for the person.” (“Whatis the Mental Capacity Act? – NHS.
UK”,2018)The core of caringpatient applies same for all patients based on professional and ethical principles.NMC (2015) states that patient’s respect and dignity should be always maintained,therefore James’s other parts of the body were covered throughout the treatment.In the given scenario, I felt that all the teams worked effectively and incollaborative manner recognising each other’s roles and skills in makinginformed decision at the best interest of the patient which aimed to improvethe quality of life and wellbeing of the patient. Patient prospective James used torespond and communicate even with a few words or showed facial expression orgestures such as a nod or shake of the head but his communication with hisfamilies and staffs was deteriorated. Hence it was really hard to communicatewith him and he also suffers from cognitive impairment which didn’t help withthe communication, therefore it was very difficult to tell how he was feelingthroughout the event. I could only assume how he was feeling, he must have feltvery confused, depressed and helpless.
Conclusion I feel that thecase management should be designated more in UK healthcare system as its keyaspect is to provide personalised care and recognise the changing needs of thepeople living with long term condition. This Case Based Discussion hashighlighted that patient and families’ involvement in decision making inplanning, intervening and reviewing in delivering safe care is an integral aspectof individualised care plan. The assignment has highlighted the importance ofadapting the care plans for reduced capacity patients in delivering safe practiceof administration. The professional guidelines and policies are adhered equallyfor all the patients no matter if they have reduced capacity or not. The importanceof individualised care plan could differ with the patients that allows the careto be implemented accordingly and helps in recognising their unique needs.