Biopsychosocial Care Analysis for Thomas

Introduction

A 63-year-old patient named Thomas who has long history of COPD is admitted to the hospital following chest infection of 2 weeks and showing of peripheral cyanosis along with tachypnoea with lower concentration of oxygen. In this respect, the current study will inform the care needs of Thomas by using Engel (1977) biopsychosocial model. The model is to be used for examination of care offered to Thomas from biological, social and psychological aspects for analysis and efficiency of the care and treatment provided to him. Further, recommendations are to be provided to improve the care for Thomas.

Engel (1977) Biopsychosocial Model

Engel’s Biopsychosocial model mentions that an individual’s medical condition cannot only be understood by exploring the biological factors but also requires consideration of the psychological and social factors affecting their condition (Gatchel et al., 2020). This is because biological factors represent the physiological pathology of the disease, but the psychological factors explain the emotional and behavioural condition that is contributing to the worsening of the condition along with the way socio-economic circumstances and cultural factors are influencing heir health condition (Lugg, 2021). The model aims to determine care needs of the patients in a holistic manner and it is useful because it supports effective person-centred care be provided to the patients for enhancing their health and well-being (Lugg, 2021).

The disadvantage of the model is that it considers all mental illness to be biopsychosocial which lead to increase the stigma regarding the illnesses instead of reducing it. This is because perceiving all mental illness to be cause of society and physical factors leads to wrong treatment as all mental illness are not caused by physical issues as well as societal factors (Lehman et al., 2017). The other disadvantage is that the model is tough to be applied in psychiatric care setting for deciding care needs of the patients (McLaren, 2021). In this study, the care is provided in physical health context due to which the disadvantage would not be experienced.

Patient’s Health Need

The patient named Thomas has health issue of exacerbated COPD and the health need focussed for discussion in the study is shortness of breath. The study by Kadowaki and Yano (2021) mentions that airflow obstruction leads to the development of breathlessness. The obstruction is developed due to airway inflammation or pulmonary arterial remodelling and hypersecretion of sputum along with reduced lung recoiling as a result of obstruction of the small airways resulting in expelling of incomplete air and dynamic hyperinflation.

Biological

The ABCDE assessment framework is followed to discuss the actions taken by the nurses and health professionals caring for Thomas to be analysed (resus.org.uk, 2018). The airway obstruction assessment in COPD patients is important to determine any risk regarding air passage (Alter et al., 2018). In case of Thomas, airway assessment is made where it was seen that he was able to talk effectively with no wheezing noise indicating he is not facing obstruction in the airways. The breathing assessment in COPD patients is important to determine the breathing efficiency of the patients (Blanco-Almazan et al., 2020).

In case of Thomas, the nurses performed breathing assessment which indicated that his breathing rate is 28 breaths/min and oxygen saturation in the blood is 89%. The normal oxygen saturation of COPD is required to be 88-92% whereas saturation below the level is serious condition (NICE, 2016). Moreover, the normal breathing rate of COPD patients is 20 bpm and rates above 20 breaths per min is considered as the person suffering from shortness of breath (Zhang et al., 2018). The chest X-ray is important in COPD as it helps to conform the condition of the lungs which is leading to the rise of the symptoms (Hurst, 2018).

The circulation assessment in COPD patients with rapid breathing is important because increased breathing leads to accelerate heart rate to disrupt heart rhythm and create risk for heart attack (Chen et al., 2019). This is because increased breathing is developed in the body when enough oxygen-rich blood is not pumped to the organs and muscles as per their need. It creates risk for the heart failure as the heart may not be able to cope with the pumping demand of the oxygen-rich blood placed on it by the rest of the body (Rocha et al., 2019). Thus, the nurse executed circulation assessment of Thomas which informed Thomas’s heart rate is116 beats/min that is beyond the normal rate which is 100 beats/min (Morita et al., 2018).

The disability and exposure assessment are made in COPD to determine if the condition led to any additional health issue in the patients (Sonobe et al., 2019). In Thomas’s case, the disability created by COPD is inability to get good sleep, smoothly drink and eat and inability to maintain hygiene. This is because breathlessness caused by COPD condition interferes with his ability to perform physical activities such as washing clothes to maintain hygiene, walking long distance and others. Moreover, the shortness of breath creates breathlessness during sleeping leading Thomas to remain awake at night and face barrier to rest. The breathlessness also causes Thomas to gasp for breath which interfere with his ability to gulp food and rink water smoothly.

The administration of oxygen at 24-28% through the venturi mask is common protocol followed to improve oxygen saturation in COPD patients to help them overcome breathlessness. This is because the oxygen percentage helps to attain oxygen saturation of more than 90% and venturi mask is used as it helps in titrating Po2 level helping to minimise the risk of carbon dioxide retention (Stoller, 2020). Thus, the use of the oxygen administration to Thomas was appropriate action performed by the nurse. In caring for Thomas, the nurses use Amoxicillin (500mg) and Prednisolone (30mg) is appropriate for enhancing breathing efficiency of the patient (Kramer, 2019). This is because amoxicillin helps in resolving infection in the lungs whereas Prednisolone assist in lowering inflammation of the airways which collaboratively contributes to improve breathing of the patient (Moran et al., 2020; Bagge et al., 2021). In case of Thomas, he is mentioned to be suffering from chest infection and is facing rapid breathing due to COPD condition. Thus, the use of both the medication would improve his breathing efficiency by resolving breathing difficulty out of airway inflammation and infection of the lungs.

Psychological

In COPD patients, breathlessness condition leads the brain to react by sending signals of distress that trigger anxiety in COPD people (Faull et al., 2019). Thus, due to rapid breathing Thomas is experiencing anxiety. However, the nurses did not intervene to resolve the psychological condition of the patient which puts the patient at risk. Thus, the patient is to be trained to perform breathing exercise as it would help him control anxiety by being relaxed (Li et al., 2020).

Social

The way condition of breathlessness in Thomas influenced his social condition is not evaluated by the nurses and actions are not taken to manage the situation. It is evident as the social behaviour of Thomas mentioned he is an active smoker even being a COPD patient. However. the nurses did not mention any form of treatment or services to be provided to him in overcoming the situation which is vital for achieving his stable COPD condition. This is because smoke from the cigarettes causes irritation of the airways and increased destruction of alveoli in the lungs leading to worsen breathlessness in COPD (Sigurgeirsdotti et al., 2019). Thus, Thomas was informed to be included in smoking cessation program where he would be provided physical resources and emotional support in completely overcoming the habit (Barbosa et al., 2020).

Recommendation for Care

The purpose of evaluating care is to determine the strength and weakness regarding the support. It is important in nursing practice so that effective improve in care plan for the patient is developed so that their care needs are holistically resolved (Vozoris et al., 2017). The evaluation of care revealed that appropriate actions were taken by the nurses for Thomas to resolve his breathlessness condition due to COPD and chest infection, but his disability condition along with psychological and social condition needs are ignored. According to NMC Code, the physical, psychological social needs of the patients are to be addressed by the nurses and care is to be provided in best interest of the patient (NMC, 2018). Thus, to abide by the Code, the nurses are recommended to recruit Thomas to a Smoking Cessation Program with the help of social workers. This is because the program would involve him in Talk Therapy and delivery supportive medication to gradually overcome his social habit of smoking which is needed for his stable COPD condition. In addition, it is recommended that if breathing exercise does not help him to reduce anxiety, anti-anxiety medication of proper dose suitable for his health is to be prescribed with the help of physicians in controlling his anxiety. The other recommendation is that nurses are to interact with social workers to arrange a carer for Thomas at home who would assist him in cooking, maintaining hygiene and eating. This is because effective nutrition and avoidance of infection by maintaining hygiene is essential to control COPD as infection and lack of nutrition adversely affect the lung performance (Sonobe et al., 2019).

Conclusion

The above discussion mentions that Thomas is a COPD patient and is currently suffering from rapid breathing with low oxygen level. The health assessment through Engel’s model mentions he is experiencing disability to maintain effective hygiene, sleeping and walking along with experiencing low mood due to inability to socialise. Thus, the social workers, carers and nurses have planned to involve in delivering him pharmacological intervention and assistance with his daily life activities to ensure his better well-being.

Take a deeper dive into Biomedical Scientist Position at NHS Salisbury via Reed.co.uk with our additional resources.

References

Alter, P., Watz, H., Kahnert, K., Pfeifer, M., Randerath, W.J., Andreas, S., Waschki, B., Kleibrink, B.E., Welte, T., Bals, R. and Schulz, H., 2018. Airway obstruction and lung hyperinflation in COPD are linked to an impaired left ventricular diastolic filling. Respiratory Medicine, 137, pp.14-22.

Bagge, K., Sivapalan, P., Eklöf, J., Hertz, F.B., Andersen, C.Ø., Hansen, E.F., Jarløv, J.O. and Jensen, J.U.S., 2021. Antibiotic treatment in acute exacerbation of COPD: patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients. Respiratory Research, 22(1), pp.1-9.

Barbosa, G.W. and Müller, P.D.T., 2019. Non‐COPD smokers: The occult face behind exercise physiology in heart failure. Experimental physiology, 104(5), pp.775-776.

Barbosa, M.T., Sousa, C.S., Morais-Almeida, M., Simões, M.J. and Mendes, P., 2020. Telemedicine in COPD: an overview by topics. COPD: Journal of Chronic Obstructive Pulmonary Disease, 17(5), pp.601-617.

Blanco-Almazan, D., Groenendaal, W., Lozano-Garcia, M., Estrada-Petrocelli, L., Lijnen, L., Smeets, C., Ruttens, D., Catthoor, F. and Jané, R., 2020. Combining bioimpedance and myographic signals for the assessment of COPD during loaded breathing. IEEE Transactions on Biomedical Engineering, 68(1), pp.298-307.

Chen, J., Dai, L., Wang, T., He, J., Wang, Y. and Wen, F., 2019. The elevated CXCL5 levels in circulation are associated with lung function decline in COPD patients and cigarette smoking-induced mouse model of COPD. Annals of medicine, 51(5-6), pp.314-329.

clinicalcorrelations.org 2017, Oxygen Saturation Target Of 88-92% In COPD: Evidence-Based Medicine?, Available at: https://www.clinicalcorrelations.org/2017/04/12/oxygen-saturation-target-of-88-92-in-copd-evidence-based-medicine/ [Accessed on: 10 December 2021]

Faull, O.K., Subramanian, H.H., Ezra, M. and Pattinson, K.T., 2019. The midbrain periaqueductal gray as an integrative and interoceptive neural structure for breathing. Neuroscience & Biobehavioral Reviews, 98, pp.135-144.

Gatchel, R.J., Ray, C.T., Kishino, N. and Brindle, A., 2020. The biopsychosocial model. The Wiley Encyclopedia of Health Psychology, pp.1-8.

Gaytán, D.A.C., Andrade, Y.P. and Valenzo, Y.E., 2021. Pneumothorax due to COVID-19: Analysis of case reports. Respiratory Medicine Case Reports, 34, p.101490.

Hurst, J.R., 2018. Consolidation and exacerbation of COPD. Medical Sciences, 6(2), p.44.

Kadowaki, T. and Yano, S., 2021. Morphine in acute chronic obstructive pulmonary disease exacerbation. BMJ Case Reports, 14(4).pp.34-67.

Kramer, E.S., 2019. How long should the steroid burst be in patients with a COPD exacerbation?. Evidence-Based Practice, 22(9), p.15.

Kusnanto, H., Agustian, D. and Hilmanto, D., 2018. Biopsychosocial model of illnesses in primary care: A hermeneutic literature review. Journal of family medicine and primary care, 7(3), p.497.

Lehman, B.J., David, D.M. and Gruber, J.A., 2017. Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Social and Personality Psychology Compass, 11(8), p.e12328.

Li, Z., Liu, S., Wang, L. and Smith, L., 2020. Mind–body exercise for anxiety and depression in copd patients: a systematic review and meta-analysis. International journal of environmental research and public health, 17(1), p.22.

Lugg, W., 2021. The biopsychosocial model–history, controversy and Engel. Australasian Psychiatry, p.10398562211037333.

McLaren, N., 2021. The biopsychosocial model: Reality check. The Australian and New Zealand Journal of Psychiatry, pp.4867420981409-4867420981409.

Moran, A.M., Ramakrishnan, S., Borg, C.A., Connolly, C.M., Couillard, S., Mwasuku, C.M., Pavord, I.D., Hinks, T.S. and Lehtimӓki, L., 2020. Blood eosinophil depletion with mepolizumab, Benralizumab, and prednisolone in eosinophilic asthma. American Journal of Respiratory and Critical Care Medicine, 202(9), pp.1314-1316.

Morita, A.A., Silva, L.K., Bisca, G.W., Oliveira, J.M., Hernandes, N.A., Pitta, F. and Furlanetto, K.C., 2018. Heart rate recovery, physical activity level, and functional status in subjects with COPD. Respiratory care, 63(8), pp.1002-1008.

NICE 2019, COPD, Available at: https://www.nice.org.uk/guidance/ng115 [Accessed on: 10 December 2021]

NMC 2018, The Code, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 10 December 2021]

Peckens, S., Adelman, M.M., Ashcraft, A.M., Xiang, J., Sheppard, B. and King, D.E., 2020. Improving chronic obstructive pulmonary disease (COPD) symptoms using a team-based approach. The Journal of the American Board of Family Medicine, 33(6), pp.978-985.

resus.org.uk 2018, The ABCDE Approach, Available at: https://www.resus.org.uk/library/abcde-approach [Accessed on: 10 December 2021]

Rocha, A., Arbex, F.F., Sperandio, P.A., Mancuso, F., Marillier, M., Bernard, A.C., Alencar, M.C.N., O'Donnell, D.E. and Neder, J.A., 2019. Exercise intolerance in comorbid COPD and heart failure: the role of impaired aerobic function. European Respiratory Journal, 53(4).pp.34-67.

Sigurgeirsdottir, J., Halldorsdottir, S., Arnardottir, R.H., Gudmundsson, G. and Bjornsson, E.H., 2019. COPD patients’ experiences, self-reported needs, and needs-driven strategies to cope with self-management. International journal of chronic obstructive pulmonary disease, 14, p.1033.

Sonobe, S., Inoue, S., Nishiwada, T., Egawa, J. and Kawaguchi, M., 2019. A case of subcutaneous emphysema/mediastinal emphysema during the use of humidified high-flow nasal cannula. JA clinical reports, 5(1), pp.1-3.

Stoller, J.K., 2020. COPD exacerbations: Management. UpToDate. Retrieved March, 31, p.2021.

Vestbo, J., Vogelmeier, C.F., Small, M., Siddall, J., Fogel, R. and Kostikas, K., 2019. Inhaled corticosteroid use by exacerbations and eosinophils: a real-world COPD population. International journal of chronic obstructive pulmonary disease, 14, p.853.

Vozoris, N.T., Wang, X., Austin, P.C., Lee, D.S., Stephenson, A.L., O’donnell, D.E., Gill, S.S. and Rochon, P.A., 2017. Adverse cardiac events associated with incident opioid drug use among older adults with COPD. European journal of clinical pharmacology, 73(10), pp.1287-1295.

Zhang, Q., Haider, D., Wang, W., Shah, S.A., Yang, X. and Abbasi, Q.H., 2018. Chronic obstructive pulmonary disease warning in the approximate ward environment. Applied Sciences, 8(10), p.1915.

Appendix

Patient Case:

Thomas has just been admitted to a respiratory ward following a 2-week history of chest infection. He was treated with oral antibiotics at home however made little improvement. When he was visited by a community nurse, he was tachypnoeic with low O2 saturations. He was using accessory muscles and appeared to have peripheral cyanosis. As a result, he was admitted to hospital for treatment of acute exacerbation of COPD.