Barriers To Effective Transition Of Care Planning: A Case Study
The Ecological Systems Theory and Its Relevance in Healthcare
As healthcare in the contemporary era is facing evolution in its diverse reforms, nurses play a pivotal role in bringing improvements in the health outcomes of the patients coming from a diverse population. Nurses while advocating for patients with complex needs are faced with a number of barriers that hinders the smooth care delivery (Scales 2014). Barriers in delivering adequate care services include literacy level, religious and cultural beliefs, financial aids, treatment side effects, desire to take part in care coordination, ability of the patient to self-care, visual and hearing deficits and interpersonal relationships with care team, care provider, family, forming a triad of health literacy, linguistic and cultural barriers (Abookire et al. 2016).
The present essay aims to highlight the potential barriers to effective planning for the transition of care for the patient Elizabeth in the chosen case study. The barriers encompass economic, political, psychological and social aspects. The essay highlights the adequacy of the information provided in the case study and further information required by a nurse for developing a plan for the ongoing care of the patient post hospitalisation. This analysis draws on contemporary theories of health and social care.
The next section of the essay discusses how assumptions about cultural, psychological, pathophysiological, social and spiritual processes have an impact on the care of the patient and individuals in general who suffer from long-term health needs in a care setting. The requirement for community health services and the accessibility to such services and government subsidies for the patient in the case study and for individuals in general forms the next part of the essay. The essay ends with a summary of the whole discussion and draws a logical conclusion from it.
The patient in the present case study is Mrs. Elizabeth Green, who is a 78 year old lady living alone in her single storey home. She has one daughter and one son and five grandchildren. Her weight was 80 kg and her BMI was 33. She had been a smoker and had a past medical history of hysterectomy, gastro-oesphageal reflux disorder (GORD), hypertension, hypercholesterolaemia, osteoarthritis, type 2 diabetes (diet controlled).
The patient was doing her chores in the morning when she had an unrelieved central chest and left shoulder pain that lasted for 10 minutes. She called for an ambulance and was admitted to the emergency department. She was referred for an agiogram and subsequently had a stent inserted. At the time of discharge she had been prescribed with a medication regimen and a follow-up check up was done 14 days after she was discharged.
A renowned psychologist Urie Bronfenbrenner had formulated the Ecological Systems Theory for explaining how inherent qualities and the external environment interact to influence the developmental stages and courses of life. Through the theory, the psychologist has stressed upon the significance of the context of multiple environments, known as the ecological systems, attempts to influence the individual developments and well-being. The theory helps in understanding why humans behave in such manner when such behaviour is compared in different settings (Neal & Neal 2013). The ecological systems theory holds that humans encounter a variety of environment throughout the life span that has a major impact on the behaviour of humans to a greater degree.
Potential Barriers to Effective Transition of Care Planning for Mrs. Elizabeth Green
The systems include the micro system, the mesosystem, the exosystem, the macrosystem and the chronosystem. The microsystem setting is the direct environment an individual has in his own life. Family, friends, neighbours and other people with whom a direct relation has been established is a part of the microsystem. It is the setting in which social interactions take place with the social agents. As per the theory, individuals not only get experiences when socialising but also contribute to the environment.
The mesosystem is the relationships between the Microsystems in the life of an individual. This means the family experiences may be related to any experience out of the family, preferably workplace. The exosystem is the setting in which there is a link between the context where a person does not have an active role and the context where there is an active role. The macrosystem is the actual culture of the individual. The cultural contexts involve the socioeconomic level of the individual. The chronosystem involves the transitions and the shifts in the lifespan of an individual. This involves the socio-historic contexts (Burns, Warmbold-Brann & Zaslofsky 2015).
In the present case study, Elizabeth’s immediate social contacts consist of her family members, daughter, son and five grandchildren who are the social agents in the environment. Interactions with them contribute towards the social engagement Elizabeth has. The patient is known to be a retired person. This implies that she had been a working women and the, therefore, the social interactions are influenced by the interactions she has had outside her home, in her workplace. The death of a spouse is a major life transition in an individual’s life. It has an impact on the relationship of an individual with the children and family members.
At initial phases of relationship the relationships may be unstable, slowly achieving stability. In the present case, Elizabeth is a widow. The death her spouse ten years back may have a significant impact on the emotional well-being of the patient. The socialisation of the patient with her family members may be hindered due to this major life transition. For patient care approach it is necessary that this life transition state is considered and intervention are planned in order to fulfil the needs of the patient.
Patient-centered care has been the key nursing theme of the contemporary health care industry. The foundation of individualistic patient care lies upon the elimination of possible barriers for healthcare service delivery for a patient. The reduction of barriers is necessary for achieving a holistic care valued for the patient. If every need of the patient is to be addressed, it is obvious that all barriers are to be overcome, and a patient is given optimal care. Caring for a patient in situations when the patient shows signs of refusal to adhere to the instructions may be problematic, and therefore strategies are to be applied for improving the patient’s compliance with the care plan (Hain & Fleck 2014). The first barrier that is highly possible for the present case is inadequate health literacy.
The Impact of Inadequate Health Literacy on Patient Care
The patient is 78 years old, and therefore there is high chance that the patient may not be understanding the basic health information provided to her. A person’s health literacy status has the deep impact on the ability of patient of thto utilise health information and services, and their health outcomes. Reasons for limited literacy skills include lack of educational opportunity that is people with a high school education or cognitive decline in older adults. Elizabeth might, therefore, have difficulty in taking the apposite heath decisions for her recovery. Elizabeth may not have the ability to understand and communicate the health information above a certain level and therefore might have difficulty in completing the paper works like hospital registration, completing insurance forms and having a complete understanding of prescriptions and care instructions.
This decreased comprehension may lead to poor medical care and subsequent poor health (Munoz 2015). The strategy, in this case, would be to write the instructions in a simple language and lower reading level. By using clear illustrations, simple sentences and word the instructions can be verbally reinforced. The second barrier is financial constraints. The patient is a widow and is in the position to pay for all the medical expenses she is advised for. Although arrangements for financial help for patients suffering from chronic conditions like heart complications may be worked out in advance, there may be issues if the insurance company changes the policies applied for only have the provision for some medical services and not all.
The approach in this case would be to approach the patient in a respectful and tactful manner (Campbell 2017). Arrangements can be made after consulting with the physician and pharmacist for prescribing drugs at reduced prices. Since the patient has diabetes, she can be explained that she can save money by using diagnositic tools that are generic.
A very crucial barrier in delivering care services to older patients is cultural barriers. This pertains to the age of the patient as elder people have the tendency to follow customs and traditions. Though the instructions provided to the patients are in friendly tone, a language barrier remains. Some patients are stoic and do not admit to having a feeling of pain. Moreover, certain patients coming from different cultures do not have a proper understanding of the need of proper medical care for recovery. Elizabeth might not be having understanding of the importance of modern medicine. As a result of this care, process may be delayed (Blais 2015).
In the present case, the patient Elizabeth may be avoiding the initiation of certain aspects of her care plan due to her cultural beliefs and viewpoints. The care process would therefore be postponed. The patient may also highlight monetary concerns before starting her care plan. In such cases, communication is to be improved and the patient is to be made comfortable so that she can express her pain and other concerns. The patient would be made to understand that a delay in treatment adversely affects health, leading to increased health costs and reduced body functions.
Addressing Financial Constraints in Patient Care Planning
Emotional concerns and lack of motivation form to be other significant barriers in providing care. Patients, after a medical procedure like stent implantation, are left with a feeling of hopelessness and depression and their mental status may not be optimistic. Lack of motivation and the positive spirit to comply with the care process, till the end, is a potential barrier in the way of post-operative care (Mullins et al. 2016). In the present case, since the patient has undergone a major surgery, she might be having bouts of depression and might be feeling low and distressed. This might hamper her enthusiasm to abide by the care plan. The patient would therefore be encouraged to discuss her feelings and have her family as a support system (Mullins et al. 2016).
The different models of healthcare explain the economic and social conditions of a patient that might impact the provision for health care services for them. One such theory is the social determinants of health. As per the theory, a number of factors act as the determinant for medical status. These include stress, social gradient, social exclusion, addiction, unemployment, food and shelter and religion. For Elizabeth, the related factors are stress, social gradient, social exclusion. An in-depth knowledge of these factors for a patient is crucial for a nurse to set up the care plan as per the patient’s need. Any gap in such information leads to an inappropriate care plan (Perrin 2013).
In the present case, there are some gaps in patient information that if present would have enhanced the care plan by integrating those valuable aspects of patient details. The first aspect is regarding the religious views of the patient. The religious beliefs of a patient may lead her to ask for a certain medical treatment for religious or cultural reasons. Treatment may also be refused to Elizabeth if judgement is made of the benefit of the treatment based on religious views. As stated by Braveman and Gottlieb (2014) having information about ethnicity, race, and language helps in understanding all the needs of the patient served and measuring the disparities in care. Processes can thereby be initiated that can have a positive impact. These would include communication in a simple language and avoiding medical jargons while communicating.
As opined by Grol et al. (2013) assumptions made by healthcare professionals about the social, spiritual, cultural, psychological and pathophysiological processes of patients have the potential to have an impact on the care delivery for the individuals who have complex health needs. As per the authors, nurses interpret the behaviours of patients and make up negative assumptions about them since thy lack a proper understanding of the value system of the culture of the patient. It is a natural tendency for nurses and other professionals to assume that the customs and values they have are right and more sensible (Grol et al. 2013).
In the present case, the nurse may be giving rise to a similar condition where the values and beliefs of the old patient may not be valued for and well understood. This would compel the nurse to have a rigorous approach towards the patient and the advancements made by the nurse would be guided by the thought that additional care is needed for the patient. Assumptions made about life orientation and personal conviction have an impact on spiritual care provided to Elizabeth (Education 2014).
The Need for Accessible Community Health Services
According to Potter et al. (2016) good and effective planning processes strive to recognise assumptions made about the patient explicitly. It is the assumptions that nurses do not recognise and does not take into consideration, leading to the problems. This holds more true when a clinical care planning is being done. A number of studies indicate that what nurses believe patients desire is more often reflective of the thoughts and wishes of the nurses than the desires of the patients. Unrecognised assumptions can never be eliminated from different care processes.
However, with a proper share of information with the patient, it is likely that fewer errors or undesirable situations would occur. Making assumptions about the patient’ background and vulnerability is a way nurses sort provided information in a swift manner. The criteria commonly used encompass age, gender, race, ethnic background and education level. Assumptions are often some taken-for-granted truths that nurses follow while outlining care plan. If such assumptions are followed then in most cases, the response to the needs of the patients is not appropriate. In cases of crisis, there is a tendency to not consider attitude and value bases, leading to poor patient outcomes.
A number of community health services and government subsidies are useful in the aid of patients with multiple needs. Elizabeth’s multiple needs are in relation to physical as well as psychological need. Care services have a one-to-one care approach and build up a strong patient-care professional relationship that fosters good management of diseases (Mills 2014). The patient in the present case is in need of a number of health services, like patient education, monitoring of vital signs and diet plan, that can guide her recovery and help her achieve better outcomes.
Cardiac services would include a rehabilitation service that would offer exercise program after discharge from secondary care when a patient has undergone a heart event. A team of community heart specialist nurses would arrange for home visits for attending patients of older age and delivering care services. An exercise physiologist would recommend exercises that the patient can do at home for remaining fit (Berra, Franklin. and Jennings 2017). A number of community health care services in Australia provide support for cardiac diseases through information and encouragement, peer support. They help people affected by heart conditions achieve excellent health outcomes (heartnet.org.au 2017). These have been discussed below.
The patient has also been suffering from type 2 diabetes and community health services for diabetes care would be highly appreciated. Diabetes care services hold a very crucial role in patient’s life as a comprehensive care approach is received from such services. Working closely with diabetic specialist nurses, physicians, endocrinologists, podiatrist, eye doctors, dietician, the care centre would provide for best possible chance to maintain good health conditions. Professionals would help patient with self-care management recommendations, physical activities, insulin administration, medication routine and emotional support.
Adequate guidance is provided by the professionals for carrying out self-care. Regular assessments with diagnostic aids help in keeping the sugar level at a controlled level. Check-ups of feet would ensure that no complications occur in the feet as a result of neuropathy. Eye checkups would help in an early detection of cataract and any other possible infections (Huguet et al. 2017). Diabetes Australia is the best community health service available in Australia for helping the Australian population prevent and treat the disorder, as reported in organisational reports. In case of poor control of sugar levels, or diabetes related complications the patients are given additional support from the services alongside your primary care giver (diabetesaustralia.com.au 2017).
Patient-Centered Care: Eliminating Barriers and Improving Compliance
Elizabeth can avail government subsidy for health care if she has the financial burden in paying her health care costs. Government subsidies for medical expenses would enable the patient to pay for huge hospital bills with ease at a discounted amount. Patients having a low income can avail such subsidies can gain medical benefits. The government subsidies cover a wide range of medical needs like critical care, surgery, orthopedics, mental health, radiology and pharmacy. Elizabeth is in need of critical care. Different classes of subsidies can be chosen from depending on the financial condition. Patients requiring services, therefore, have an effective treatment for injuries and prevent future health issues that may potentially improve the functional abilities and enhance their quality of life (Si, Chen & Palmer 2016).
Medicare provides free or subsidised treatment by some health professionals and free treatment and accommodation as a public patient in a public hospital (Humanservices.gov.au 2017). The Australian health care system has provision for access to an inclusive range of services. The system covers free treatment in public hospitals and subsidies for medical services. There is government support (subsidies) for private health insurance where both hospital inpatient treatment and out of hospital services are included. There is a strong focus on elective surgery and private patients benefit from subsidized insurance (Commonwealthfund.org 2017).
Coming to the end of the essay it is to be stated that the paper has highlighted some of th major elements of healthcare services- appropriate care model for patient, barriers in effective care delivery, how assumptions about cultural, psychological, pathophysiological, social and spirtitual processes have an impact on care, and the requirement for community healthcare services and government subdsidies. Patient-centred approach has become the centre of attraction for good quality care. This is in response to the complex care needs of the patient and urge to have tailor made care plan as per the preferences and unique needs.
Different models of care have emerged that can cater the different forms of needs. For the present case study the appropriate model of care would be beneficial for addressing the health concerns of Elizabeth. In the present case study the restorative model of care has been judged to be appropriate. A number of obstacles and barriers come up in the way of delivering care that are from sociological, economical and psychological perspectives. It is to be remembered that these barriers are to be reduced to the extent possible for progress of care. Utilising community health resources and government subsidies would enhance the care and help the patient access their desired services. On the whole, collaboration of patient and healthcare professional can align the care process with the care needs.
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