Health Care Policy

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HEALTH CARE POLICY Motilal Dass Introduction: The scenario of Mr. & Mrs. Crawford is totally care oriented. The given case history reveals that Mr. Crawford has been suffering from Stroke. (Ref). The are inhabitant of rural area, probably they were deprived of easy access to health care facilities. Mr. Crawford is also a chronic smoker which led him to get affected with malignant tumour of Larynx. (Ref). In this case the existing disease condition so called stroke has deteriorated Mr. Crawford’s communication skills and he could hardly finds interests in any specific activities. Though Mr. Crawford presents himself as an independent person but in reality he fails to prove it as he finds difficulty in coping up with basic personal care needs. In order to rehabilitate his condition he was being transferred to the stroke rehabilitation centre. This case study aims to focus on the holistic approach of this client which could have been rendered.

Assessment of the care needs: Since Mr. Crawford suffered from stroke, hence his activities of daily living might have hindered. Stroke deteriorates many normal activities of a person. Neurology Channel (2008) states that signs and symptoms of stroke are difficulty speaking or understanding speech (aphasia), Difficulty walking, Dizziness or light-headedness (vertigo), Numbness, paralysis, or weakness, usually on one side of the body, Seizure (relatively rare), Severe headache with no known cause, Sudden confusion, Sudden decrease in the level of consciousness, Sudden loss of balance or coordination, Sudden vision problems (e.g., blurry vision, blindness in one eye), Vomiting. On basis of these characteristics Mr. Crawford’s need is communication, mobility, and care with day to day activities (self care needs) eating, personal hygiene. In general his needs can be identified as Eating & Drinking, Eliminating Need, personal Cleansing and Dressing, Maintaining a Safe Environment In addition to this, to ensure the holistic nursing care the psychological, intellectual, emotional and social needs can further be assessed. Since Mr. Crawford at times got frustrated hence he needed company and someone to talk to him divert his attention and engage him in some kind of activities. This in turn could have relived d him for the time being. Care Plan: To implement the appropriate care to Mr. Crawford, the Roper Logan Tierney model of care plan could be used. Roper Logan-Tierney Model of care includes twelve activities of daily living. The care plan was done on the basis of Maslow’s Highrerchy of need, here patient’s needs are prioritised accordingly and the three most Activities of Daily Livings have been explained in details:

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Eating & Drinking: Assessment: In this phase, information collected from case history, thereby the potential and actual problems were identified accordingly. From the existing condition, it was assumed that the dietary pattern of Mr. Crawford might have altered since he suffers from stroke and sometime may forget to take food. Diagnosis: Her nutritional status altered and this was less than normal requirement of her body’s need. Planning: Periodic record of her body weight. Encouraging the patient to take feeds regularly. Vitamin supplementary could be given as per the advice of the dietician. Consult a dietician or a doctor. Motivate to consume food. Implementation: To implement the care plan there should be adequate resources available to carry out the plans which were mentioned. Mr. Crawford should be given food on time and monitoring his weight is essential in this case. More over he could have been placed in a care home where more close observation could have been possible. Evaluation: Evaluation is an ongoing process and it helps to deduce conclusion pertaining to the care implemented to the patient. K.Holland et al (2004) states that when evaluating the care plan, you will need to establish if the goals have been completely met partially met or not met at all. I evaluated the care plan and found that it was effective and patient gained weight in last two months. Eliminating Need, personal Cleansing and Dressing: Assessment: As the case study suggests that Mr. Crawford is having difficulty in coping with the basic personal care. It means that he needs constantly someone to look after him. Diagnosis: Maintenance of hygiene noted and particular concentration should be given on hand hygiene as the Postnote (2005) states that probably the single most effective way of combating health care associated infections is to improve hygiene in healthcare settings, in particular hand hygiene. Planning: While dealing with Mr. Crawford his personal hygiene has to be maintained which includes bathing him regularly, cleaning him after defecation, shaving his beard and trimming his hair. Implementation: Whenever Mr. Crawford is given bath and needs to be taken to toilet his privacy and dignity needs to be maintained by keeping the door shut and not exposing the private areas without his awareness and he should be treated as an individual as Nursing and Midwifery Council (2004) states that respect the patient or client as an individual. Evaluation: All the cares which were planned needs to be implemented accordingly.

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Maintaining a Safe Environment Assessments of Mr.Crawford’s ability to maintain own safe environment was done on the basis of clinical observations and previous medical history. This patient was vulnerable to falls as she could not support himself he tried to walk or sit on a chair. He required assistance in almost every area of daily living activities but he pretends to be independent which worries Mrs. Crawford. Diagnosis: The case history reveals that there were high risks for falls and injuries. As without assistance he could hardly walk or sit or even move from one side to the other. There was also high chance of getting weakness and fragile due to confinement area and these were identified as potential factors which aggravated the physical condition of Mr.Crawford. Psychologically Mr.Crawford was agitated and depressed as his body image was altered from normal and probably became weak and vulnerable. As a result he had low self-esteem. Mr. Crawford was experiencing the restricted life style so he always looked gloomy. Planning: A general risk assessment needs to be done to ensure that unwanted injuries do not occur and hinder the normal life of Mr. Crawford. There should be provision of using the hoist and adequate assistive devices to help Mr. Crawford from other carers or nursing staffs, use of bed rails, wheel chair was provided to take patient whenever required, use of strap needs to be ensured and he should never be left alone unattended. Implementation: In the implementation stage it will be necessary to provide care to maintain and to prevent deterioration by focusing on the physical status of Mr. Crawford. Always extra care needs to be provided to him and the carer needs to be extra vigilant Evaluation: This could be effective care to render to Mr.Crawford which will ensure him safe environment to live in. This plan could be made to allow Mr & Mrs Crawford to achieve the optimum health.

Different Care Profession: Mr. Crawford suffers from stroke and was taken to stroke rehabilitation unit and this aggravates his communication needs. Hence he may require help from the Speech Therapist. Since this type of client may experience aphasia, for this reason it’s quite necessary to have help from the speech therapist who could help Mr. Crawford. Because of the existing disease condition Mr. Crawford needs to be seen by Neurologists to detect the type of stroke and its prognosis, so time to time he needs to be seen by a Neurologist. Mr. Crawford was a chronic smoker which led his larynx to get affected with malignant type of tumour and then he had laryngectomy. In this case he needs to be seen by the general surgeon if there is any occurrence with the surgical excision like bleeding or abscess formation at the site. Mr. Crawford is 79 years old man and having difficulty with the personal care, for this reason it would be essential

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to have the podiatrist to give him visits at regular interval of time. In addition to all this help from a physiotherapist, nurses and carers are also necessary. Discussion of the statutory health and social health: For the reason of health and safety and optimum quality of health care it initially depends on the choice of Mr. & Mrs Crawford which type of care they prefer to have. Again this couple is very vulnerable and Mr. Crawford is having difficulty in managing by himself and though he seems to be independent but in reality he is not. Private health care service could be advised for them if they care capable of bearing the expenses. Again the quality they receive from the social health care service has to be taken into consideration. In overall scenario it’s quite important to impart the best care to Mr & Mrs Crawford. Evaluation of the care plan: In overall evaluation of the care plan it can be said that the accurate implementation of the care to Mr Crawford will surely change his existing condition from the getting it deteriorated. His independency will be improved and his mental status will be changed positively. As in the care plan it has been mention that he had difficulties in carrying out the activities of his daily living so those are mentioned and actions are shown to impart the care. The psychological, social, emotional and intellectual needs are met. At regular interval of time he needs to be referred to multidisciplinary team members for any difficulties the couple face. Possible health promotions The case study reveals that Mr. Crawford is a chronic smoker which was the main cause of malignant tumour on his larynx. He needs to be advised on the issues that he needs to cuts off the smoking gradually. He could also be told how smoking affects the individuals’ health badly. Net doctor (2008) states Major diseases caused by smoking Cerebral thrombosis: the vessels to the brain can become blocked, which can lead to collapse, stroke and paralysis and Of the 300 people who die every day in the UK as a result of smoking, many are comparatively young smokers. So he was advised to quit smoking. To promote his independency he was given instruction on how to carry out his own activities like shaving and sometimes folding his dresses. Since he had difficulty with grip hence he could be asked to hold the pen slowly and be asked to write few words if he could do. Motivating him to take part in entertaining activities which will keep him safe and sound as well. Also regular visit by the social care worker is very much important in this context. Specific pieces of legislation:

The Care Commission was established by the Regulation of the Care {Scotland} Act 2001. It is a non departmental public body accountable to the Scottish Executive and Parliament responsible for registration, inspection and enforcement of care standards in all sectors including care at home and day care for adults. With this legislative view Mr. Crawford can be assured about quality care even at home. According to National

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Health Service Reform (Scotland) Act, health improvement and improving health was given first place in the plan. Much of this plan is about putting skills and professionalism of the NHS at the service of he people of Scotland, but improving peoples health comes first According to Data Protection Act 1998 where the processing by automatic means of personal data of which that individual is the data subject for the purpose of evaluating matters relating to him such as, for example, his performance at work, his creditworthiness, his reliability or his conduct, has constituted or is likely to constitute the sole basis for any decision significantly affecting him, to be informed by the data controller of the logic involved in that decision-taking. So any relevant information gathered should be discussed with the authorized member of the team only, it could be member of the multidisciplinary team.Manual Handling Operations Regulations (MHOR), 1992 states that the responsibility for implementing safety requirements tends to fall on personnel directly responsible for the co-ordination and supervision of work. However, where the risk reduction measures identified entail the purchase and supply of equipment, the employer may be involved in decisions about financing capital items of equipment. In such circumstances, senior managers must be involved in the risk reduction strategy. In case of Mr & Mrs Crawford Manual Handling Operations Regulations policies has to be followed to minimise any risks and to render better health care facilities to this couple. As per Management of Health and Safety at Work Regulations 1999 the managerial body that monitors the care for Mr & Mrs Crawford should clarify that employers should use competent employees in preference to external sources for competent advice and assistance on health and safety to impart quality care.

Conclusion: In conclusion it can be said that on the basis of the case study of Mr. & Mrs. Crawford and considering the health status of Mr. Crawford at the forefront the holistic approach of care could be delivered to achieve the optimum level of quality care by this couple. The pieces of legislation are very important as to monitor the quality and standard of care.

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References: Holland K, Jenkins J, Solomon (2004): Applying the Roper Logan Tierney Model in Practice, 2 ed. Edinburgh: Churchill Livingstone. p. 195 Mike Giffin 2004 Moving and Handling Legislation OT Direct 2008 London [online] available on www.otdirect.co.uk accessed on June 10th 2008. Net Doctor 2007 London [online] available on www.netdoctor.co.uk accessed on June 9th 2008 Office of Public Sector Information 2008 London [online] available on www.opsi.gov.uk accessed on June 10th 2008. The Postnote (2005) Infection control in health care setting, London. [Online]: available www.parliament.uk [accessed on April 27th 2008] Understanding the Policy Maze; A guide to Social and Health Policy in Scotland, Third Edition, Published by Health Scotland, Edinburgh, and page 41, 164.

Author: Motilal Dass Registered Nurse (India) HNC Health Care (Scotland) E-mail: [email protected]