The Impact on Mobility And Depression In Long-Term

Long-term condition is the health condition in which there are no possibilities of cure but by applying appropriate drugs and treatment process the condition can be controlled and managed. This health condition is also referred to as chronic disease in which the illness is controlled by proper treatment and medicines. Examples of other chronic condition are angina, diabetes, heart failure, high blood pressure and asthma. This assignment is going to chose Rheumatic Arthritisn (RA) as the long terms condition, which is one of the most common as well as concerning long-term conditions that affect the mobility and activities of patient. First part of this assignment is going to identify the two important impacts of RA that are mobility and depression on the patient’s activities. Moreover, this assignment would use Logan, Ropan and Tierney model to analyse the perspectives of patient with RA. Finally, this assignment would focus on multidisciplinary roles of the nurses and health professionals in order to assist patient to meet their healthcare needs.

Rheumatic Arthritis has been chosen for discussing its harmful as well as lifelong effect ion patient. Moreover, Rheumatic Arthritis is one of most common chronic conditions in aged as well as young populace around the world. As this disease directly affect the bone joints that regulate movements of our body parts, this long-term illness needs to be executed as well as analysed to make huge public concern. Another important reason behind choosing Rheumatic Arthritis as the topic is to raise the awareness about causes, outcomes, medical intervention and pathology of this disease.

Rheumatic arthritis has several harmful impacts on the physical and mental health of the patient such as morbidity, loneliness and depression. Among these impacts two major impact of RA ion patient’s health are depression and mobility (Ogdie et al. 2015). Depression is the most common negative effect of rheumatic arthritis on patient's mental health. This mental condition is commonly manifested as anxiety that not only affects the psychological strength but also poses negative impact of the physical health. When it comes to another important as well as the common impact of rheumatic arthritis, mobility comes into the list first. According to Beck et al. (2015), mobility is the ability to move freely without any physical constraints. However, in case of patient with rheumatic arthritis, free movement is quite impossible. Rheumatic arthritis affects the bone joint and causes severe inflammation in the joint is which deteriorate the mobility of patient. In the UK, most of the middle age people with rheumatic arthritis suffer from severe problem in moving freely. These two impacts of RA have potential influence on the patient’s activities of living, for example, patient cannot attain social functions and they are unable to maintain everyday hygiene during doing their regular activities. In this aspect, practitioners can implement Ropan- Logan -Tierney Holistic model in their clinical practice for understanding the patient’s perspectives regarding their long terms illness. As stated by Smolen et al. (2014), this based on the nursing care, activities of living and improving the health as well as wellbeing. this model is highly appreciated in UK healthcare framework, in which NHS staffs, Health and Safety Executives (HSE) and health professionals implement the concept of this model in conducting high-quality medical care setting for the patient. UK professionals generally use this model for treatment of rheumatic arthritis by applying into concept in the treatment process. Implementation of this model assists health providers to understand patient’s psychology regarding the impact of RA and other long-term condition on their mental and physical health. According to Okada et al. (2014), this model is based on promoting different Activities of Living (ALs) such as communication, safe environment, breathing, drinking, eating elimination, playing, exercising and working. UK based health professional can apply these aforementioned ALs in improving the physical as well as psychological well-being of the patient. ONS has reported that most of the Cardiac Arrest cases in the UK show integration of group of diseases, of which rheumatic arthritis is common. Moreover, NHS professional shows in database that, rheumatic arthritis not only damage the bone joints but also pose an indirect effect on heart, kidney and lungs. Ropan- Logan -Tierney Holistic model is one of the effective concepts that can be used for UK based rheumatic arthritis patient to provide them proper best care, proper medical opportunities and positive as well as motivating environment. By applying this model, practitioners can evaluate the actual needs of patient with RA and thus provide proper clinical support to them for improving their mental and physical health. However, there are some criticism and controversies regarding the application of this model into the medical treatment process. As stated by Kelly et al. (2014) although this model is well-used by the UK based health professionals in treating patient successfully, it is effective only for improving the psychological, spiritual and emotional strength of the patient.

NHS states that Rheumatic Arthritis is the chronic health condition that develops inflammation in the bone joints thereby instigating pain, slow joint damage and disability of the normal body movements (nhs.uk, 2018). Statistical database from the UK shows that Rheumatic Arthritis is the erosive as well as chronic inflammatory disease that affects approximately 1% of eth UK adult population. From the healthcare database of Department of Health (UK), it is seen that around 11 million people in each year seek medical help from their GP each year for treatment of arthritis. Of these approx, 400,000 people have rheumatic arthritis (nras.org.uk, 2018). Moreover, the UK healthcare statistics, 2017 also shows that more than 16,000 children, as well as adolescent, suffer from juvenile form of arthritis. For conducting proper medical intervention, Arthritis Research UK and NHS Choice Website offer effective information regarding the treatment and diagnosis of rheumatic arthritis. Due to the irregular lifestyle, lack of calcium and poor nutritional consumption in UK leads to shape increase in occurrence rate of rheumatic arthritis. Based on the guidelines of National Institute of Health and Care Excellence (NICE), emphasize the management and care of the patient with rheumatic arthritis. The guidelines focus on applying both the pharmacological as well as a non-pharmacological treatment process for rheumatic arthritis patient in the UK. By following eth guidelines of NICE and NHS, rheumatic arthritis patient in UK has been provided with better medical intervention process that assists health professional to assess the actual healthcare need of patients. Office of National Statistics (ONS) shoes has reported that approx 32 million UK people suffer from the deteriorating musculoskeletal condition, which not only damages their personal health as well as wellbeing but also damage their professional lives. The UK government to support the equal rights and medical entitlement of all individual suffering from rheumatic arthritis has conducted National Arthritis Week, 2017.

Multidisciplinary roles of the health providers are important for providing proper healthcare facilitiesand clinical support to RA patient in order to improve the health and living standard. NICE has set important guidelines for health professionals in order to meet the individual needs, values and preference of patient with long-term illness. Such as as per NICE guidelines, psycho as well as occupational therapist are responsible to conduct proper counselling for the patient with RA which not only can develop their mental starngth but also improve their physical ability to perform regular activities. Some theories can be applied as per the UK based cases of rheumatic arthritis, which are Health Belief Theory, Personal Investment Theory, and Self-efficiency Theory, which assist teh health professional to make proper clinical settings for the treatment of RA patient. Therapist and health providers need to prioritise the physical exercise and development of the rheumatic arthritis patient which can be possible by implementing the Personal Investment Theory. On supporting this viewpoint, Souto et al. (2015) stated that this model can assist the UK based professionals and practitioners to apply non-pharmacological process such as exercise, physical activities and yoga to improve the mobility of patient. This theory will assist professional in order to focus on instigating the desire and effort of patient in involving onto physical activities to improve their mobility. On the contrary, Combe et al. (2015) argued that Health Belief model is the important psychological model, which is highly used in the UK to treat the mobility and physical fitness of rheumatic arthritis patient. With application of this model, practitioners can access the behavioural change, personal belief and attitudes of the individual. By reinforcing positive behaviour and optimistic attitude, it is possible to involve the rheumatic arthritis patient into regular physical activities. Self-efficiency Theory can be able to meet the criteria of professional standard in Nursing and Midwifery Council (NMC), in which nurses and health staffs are obliged to reinforce the capability of arthritis patient to engage in positive behaviour. In this aspect, rheumatic arthritis patient not only needs the psychological support but also more than that they need proper medication, innovative treatment and high-quality medical intervention that can control the deteriorating condition of their bone joint. In this aspect, Costello et al. (2016) stated that the model emphasizes on the care planning and the nursing intervention that needs to offer the best treatment process to patient. However, rheumatic arthritis needs execution, evaluation and analysis of the cause as well as symptom, which need more than the traditional nursing approaches that are described in Ropan- Logan -Tierney Holistic model. In most of the cases of rheumatic arthritis, the patient needs knee-replacement surgery. As stated by Nikiphorou et al. (2014), this model cannot be used for major surgical process as this model deals with the short-stay setting that is irrelevant to pre and post-operative health condition. However, this model can assist the health professionals in identifying the effect of rheumatic arthritis on patient.

This theory will help the UK based professional and NHS staffs to generate their inner confidence and problem-solving skill for dealing with the joint pain. On this contrary Primdahl et al (2014) argued that, Self-efficiency theory, although is able to assist professionals in developing self-efficiency and mental strength, it is unable to develop the physical strength this is more important in improving the mobility in rheumatic arthritis..

Role of nurses are important for the treatment of the patient with Ra and other long term condition. NMC guidelines for nurses and midwives regarding the treatment of rheumatic arthritis represent their responsibilities to provide proper care and support to the patient with RA (nice.org.uk, 2018). According to Van Nies et al. (2014), Nursing and Midwifery Council (NMC) code of practice focuses on the duties as well as obligations of UK based nurse and midwives in diagnosing, investigating and reviewing the health condition of the rheumatic arthritis patient. In order to manage the long-term condition such as rheumatic arthritis, National Institute of Health and Care Excellence (NICE) sets proper guidelines for managing the health condition of patient by providing both the pharmacological and non-pharmacological treatment to patient (nice.org.uk, 2018). Based on the NHS guidelines nurses need to take the patient-centred approach in order to offer high-quality treatment process that will redeem the mobility, physical strength and self-confidence in arthritis patient. NICE guidelines for dealing with rheumatic arthritis patient includes diagnosis, education and self-management, non-pharmacological management process, appropriate referral for joint surgery, follow up and review process. NMC Codes of conduct is associated with the nurse's duty in improving the quality of patient's life (nmc.org.uk, 2018). As stated by Matcham et al. (2014) for providing better clinical setting to rheumatic arthritis-patient, nurses would undertake innovative treatment process through which they can make proper investigation through their diagnosis. NICE has developed the Technology Appraisal Guidance in case of drug treatment for rheumatic arthritis. This guidance assists the UK based professionals and health practitioners to conduct treat-to-target surgery, primary care for reducing joint pain and symptom control as well as monitoring process. NMC Codes set the clinical standard, which needs to be followed by the nurse and midwives in order to deal with the different aspect of rheumatic arthritis treatment such as raising public concern about this disease, develop social media guidance and manage the professional duties throughout the treatment process (nmc.org.uk, 2018). Jointly with the General Medical Council, NMC provides clinical guidance to nurses and midwives in evaluating the disease, dealing with the cause and then take proper clinical action to manage and control the disease. Nurses, practitioners and health professionals need to follow the new code of NMC that is published in 2013, in which they can get proper guidelines regarding maintaining the professional responsibilities in managing critical disease. NICE provides proper assistance to NHS professional in terms of conducting anti- rheumatic arthritis treatment process (nhs.uk, 2018). Moreover, NICe guidelines also assist UK based health professionals to understand the risk and benefits of the treatment process in case of rheumatic arthritis patient. Verbal and written communication is one of the important interactive ways as per eth guidance of NMC and NICE, which eth nurse and healthcare professionals need to implement in their treatments process. Based on NICE guidelines conventional antirheumatic arthritis treatment can be conducted through applying conventional disease-modifying anti-rheumatic drug (cDMARD). Based on the NMC code of practice, nurse and midwives can also use non-steroidal anti-inflammatory drugs (NSAID) in treating the chronic arthritis disease. As opined by Primdahl et al. (2014) in terms of dealing with rheumatic arthritis, it is not enough to offer the best pharmacological treatment process, rather the patient needs proper psychological support. Regarding psychological support to rheumatic arthritis patient, NHS sets guidelines for practitioner and health professionals, which support the equal opportunities, rights and entitlements of patient. NMC code focuses on compatibility of nurses and midwives to meet the psychological, emotional and spiritual need of patient. According to Eriksson et al. (2017), nurses and midwives need to maintain protect the patient of rheumatic arthritis from any kind of abuse, neglect and discrimination. The patient will be encouraged to involve in physical activities, which can enhance their self-confidence to improve mobility. NMC codes focus on the rights and limitations of the nurse and midwives in terms of providing person-centred care. In this aspect, nurses need to identify their doings, limitations and obligation while dealing with the rheumatic arthritis patient. If the rheumatic arthritis patient is unable to move due to joint pain, nurse needs to understand the health condition and never force the patient to take physical exercise. In this aspect, Van Nies et al. (2014) mention that, there needs to be strong coordination between health professional and nurses, which will assist them to form strong information sharing process. In case of dealing with arthritis, patient nurses need to make proper communication with the health professional regarding regular health status of eth patient. This process will assist the nurses and midwives to set proper clinical planning to provide best support and care for patent (nice.org.uk, 2018).

UK based healthcare professionals implement different UK base Models and theories that assist them to reduce depression of arthritis patient. Hopelessness Theory of depression is one of the most preferred theory by the NHS staffs and UK based healthcare professional that assist them to deal with patient’s mental status and deteriorating psychological stability. As stated by Williams et al. (2015) this theory, emphasizes on responsibilities NHS staffs, Health and Safety Executives (HSE) in terms of providing innovating mental health treatment process that will redeem their self-confidence and psychological strength. Major depression and anxiety are highly prevalent in rheumatic arthritis patient across the UK. NICE guidelines of rheumatic arthritis overview focus on specialist opinion, investigation and proper medical support after diagnosis of rheumatic arthritis (nice.org.uk, 2018). In this aspect, Jilani and Mackworth-Young (2015) argued that, although Hopelessness Theory of depression has been used by the UK based professionals over the past several years for treatment of rheumatic arthritis, it is unable to provide information to NHS professionals regarding the innovative treatment process of rheumatic arthritis (nhs.uk, 2018). Based on the National Institute of Health and Care Excellence (NICE) guideline on rheumatic arthritis, it can be stated that most of the UK based adults and young people suffering from this illness, shows similar characteristics such as worry, tension and irritability. Joint pain in case of rheumatic arthritis leads to severe psychological disability, which leads patient towards depressive mood, behavioural disorder and poor decision-making ability. Cognitive Theory is one of eth most applicable theoretical approach that can assist the UK health professional to deal with depressive mood and psychological condition of the patient. According to Siebert et al. (2016) when it comes to control and manage the depression in rheumatic arthritis patient, health professional need to redevelop the thinking ability in the context of providing proper clinical guidance to patient. Cognitive Theory is a commonly used theory in the UK that cab assist eth health professionals to use sequence of techniques focusing on improving self-confidence, behavioural approach, decision-making ability and problem-solving ability. On the contrary, van Herwaarden et al. (2015) argued that dealing with depression can be administered in a better way by applying Self-Control Theory in place of Cognitive theory. Based on this perception, although cognitive theory improves the decision-making ability and problem-solving skill of the patient, it is unable to motivate the self-assessment process, that is important for developing proper encouragement towards involving arthritis patient into different activities. NHS guidelines in terms of managing depression in rheumatic arthritis patient approve the perception of Self-Control Theory in order to assist the UK health professional to manage the behaviour, mental status and thinking ability of patient.

From the aforementioned discussion, it can be concluded that rheumatic arthritis is the chronic or long-term illness that cannot be cured but controlled and managed by application of drugs. Patient with this chroming illness needs not only physical support but also psychological, emotional and spiritual support to improve their overall health and wellbeing. This discussion also concludes that NICE guidelines assist the health professionals in order to manage and investigate the long-term disease. Through following the NICE guidelines UK based practitioners and professional can deal with different aspect of rheumatic arthritis treatment, such as diagnosis, education and management of disease, referral for joint surgery, review and follow up, pharmacological management and non-pharmacological management process. NMC Code sets the clinical standard for the nurse and midwives to understand their obligations and limitation while dealing with long-term disease as rheumatic arthritis; they will respect values, belief and decision of patient. Moreover, NHS guidelines also assist the practitioner in order to develop the care plan for rheumatic arthritis patient whom they can offer best therapeutic process and counselling for developing the mental and physical strength of people. Although rheumatic arthritis disease is chronic; it can easily be managed and controlled through conducting quality treatment process, proper clinical support and effective self-management system.

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