Delivering Compassionate Person-Centred Care

Introduction

In this assignment, the way to deliver compassionate and effective person-centred care is to be discussed based on a case study. Person-centred care is important because it allows the patients to trust the nurses as they are assured that the provided care services planned by considering their needs and are best for them. This, in turn, makes it easier for nurses and health professionals to lead patients to easily comply with them for availing determined clinical intervention and care services (Moore et al. 2017). Moreover, in this assignment, the health determinants and the way they contributes to the health needs and beliefs of a person will be discussed. The bio-psychosocial health determinants influencing the common health condition of a person in their lifespan in respect to be the case study will be explained. The way nursing care delivered across different sectors in case of the patient will be discussed.

Case Study

The Nursing and Midwifery Commission (NMC) Code of Conduct (2018) informs that nurses are to maintain the personal health records of the patients in a confidential manner, so that it cannot be accessed by the public. Moreover, the specific individual with the prior permission of the patients is allowed to access it to ensure safety of the patient (NMC, 2018). Thus, in this study, the pseudonym T is to be used for the patient, so that the individual's identity can remain confidential and ensure the person's safety as per the NMC code. T is a 72-year old South Asian female who has been suffering from type-2 diabetes for the last 10 years. T has reduced mobility due to age-related issues and has a daughter who is currently married and lives with her husband along with two sons overseas. T lives alone in her two-roomed apartment and her husband, who used to completely support her care (perform household chores, regularly assess her blood sugar, provide her medication) died in a road accident 3 months ago. T's daughter connects with her mother once a week by telephone and ensures services are available to her for enhanced well-being. T is a retired school-teacher and her expenses are managed with the help of her pension along with support from her daughter.

In general, T accesses community care through telephonic conversations and monthly visit by a community nurse to monitor her health regarding type-2 diabetes. In the past three months, T’s blood sugar has increased and appropiate medications were suggested for her health condition to be improved through community care. However, deteriorated impact on T’s health was seen to exist irrespective of the care provided which led her admitted to the inpatient unit in hospital. This was evident as her blood sugar level between her meals was found to be 145 mg/dl and 2-3 hours after was nearly 210 mg/dl. Moreover, unintended weight loss for the past three months was seen and she reported feeling fatigued. She reported of urinary incontinence and all the symptoms led the community nurses in discussion with her daughter admit her for adequate care in the hospital.

Person-Centred Care delivery

In order to deliver effective and compassionate person-centred care, nurses require making the patients actively involved in deciding their healthcare. The active involvement indicates that patients are to be allowed to make decision for care, planning of healthcare and set goals of care for their well-being (Santana et al. 2018). This indicates that for effective person-centred care regarding T, she is to be allowed by the nurses to make decision regarding her care to control the current relapse in her type-2 diabetic condition. As commented by Sjögrenet al. (2017), effective involvement of patients in person-centred care is made when they are provided adequate information to make decisions. This is because the information allows the patients to understand and analyse the nature of healthcare suited for their health and accordingly discuss with the healthcare professionals to declare choice of specific intervention appropriate for them. Thus, to deliver adequate person-centred care for T, she should be provided detailed information regarding the care services that could be availed by her and mention the limitation of each of the intervention for type-2 diabetes. This is to assist her effectively decide and plan her care based on her needs. In effective and compassionate person-centred care, nurses are to provide a safe environment for patients to reveal their needs and demands regarding care as well as while offering care. This is to make the patients develop confidence to share their information and avoid fear of being harmed or abuse during care (Buckley, McCormack & Ryan, 2018). Thus, in the case of T, she is to be provided a safe care environment by the nurses which is free of any harm or abuse as mentioned in “Prioritise People” and “Practice Effectively” sections in the NMC to ensure effective and compassionate delivery of person-centred care. As argued by Hobson (2019), active involvement of patients leads to effective person-centred care as it helps the healthcare team to prioritise and plan the treatment according to the satisfaction of the patients. This allows the patients as well as the nurses in determining the reason behind the specific care to be provided in turn ensuring establishment of compliance in care.

According to NHS Constitutional values, effective and compassionate person-centred care is able to be delivered by showing adequate respect and dignity to the patients (NHS, 2018). Respect includes maintaining privacy along with confidentiality regarding health information while offering care (Bullen et al. 2019). As argued by Rice (2016), lack of privacy of patient’s health information during care leads them to perceive that the nurses are unable to understand their emotions and adverse health impacts that could be created with revealing their care information in the public. This leads the patients to understand the nurses are not concerned regarding their confidentiality making them show non-compliance in care out of dissatisfaction and lack of value. Thus, the nurses while caring for T should maintain her confidentiality and privacy related to her type-2 diabetic condition to show value towards her during care. According to NHS values, for compassionate and effective person-centred care, the nurses are to offer care and treatment as personally selected by the service users (NHS, 2018). This is because personalised care leads the nurses to support patients in overcoming the specific difficulty regarding their health in turn ensuring their enhanced well-being. As argued by Kendall & Reid (2017), lack of personalised care approach in person-centred care leads the specific concern of the service users to remain unresolved. This leads the patients to face deteriorated health condition. Thus, in the case of T, based on her health condition her personalised need would be continuous assistance in taking medication, checking blood sugar level and managing depression to enhance her type-2 diabetes. Therefore, in making the care plan for T, to offer her effective person-centred care the nurses should include intervention in meeting the personalised needs.

Health assessment of patient

According to WHO, the health is referred as the state of complete mental, social and physical well-being of the individual and not just the lack of presence of the disease (WHO, 2020). In relation to T, her health would be referred to the condition in which her blood sugar level is to be normal along with have effective physical efficiency for being able to take her own care. T’s health also indicates her to be emotionally and psychologically enhanced to be able to take her own care along with supportive social condition to ensure her good health. The health priority for T is to access social support and effective healthcare services to enhance her type-2 diabetic condition and avail assistance to emotionally cope with her husband’s death to be able support her own care. The social determinants of health include the condition in which individuals develop, grow and live to age. The determinants include the social support network, education, neighbourhood, the physical environment and access to healthcare (Artiga& Hinton, 2019). T he social support network is beneficial in healthcare because they help people to overcome stressful situations, alleviate mental distress and ensure effective support for managing theira person’s physical health (Adler et al. 2016). In the case of T, it is seen that there is lack of presence of social support network to help her care for her type-2 diabetic condition and mental trauma of losing her husband. This is evident as the community nurse is available to monitor her health only once a week which indicates that there is lack of regular checking of her blood sugar to ensure its effective control. In the case of T, her husband before his death was solely responsible to take her care for Type-2 diabetes, but after his death, there are no other individual present to take daily care of her type-2 diabetic medications and health monitoring of T. Moreover, her only daughter is not regularly or physically in controlling her health and emotion which has led towards the relapse of her type-2 condition. This is indicates that there is lack of effective family support for T to help her overcome the deteriorated health condition.

Bio-psychosocial determinants of health

The relapse of type-2 diabetic condition that has resulted high blood sugar, urinary incontinence, fatigue and blurred vision in T has lead her to currently access healthcare and get admitted to the hospital. The bio-psychosocial determinants of health include biological (gene), behaviour (stress, lifestyle, healthcare beliefs) and social (social support, family, cultural influences) factors that influence health of the individuals (Lowry et al. 2019). As mentioned by Bădescu et al. (2016), stress and depression lead to increase the counter-regulatory hormone level mainly the adrenalin, cortisol and noradrenaline. The increased level of these hormones in persistent manner leads to relapse of diabetes among individuals with the pre-disposed condition. This is because counter-regulatory hormones are responsible for increased blood sugar level by opposing insulin management in the body (Bădescu et al. 2016). In case of T, she currently lives alone and her only support which is husband has currently died. Thus, these conditions may have led T to develop depression and stress regarding the way she would lead her life without support contributing to relapse of her type-2 diabetes. The study by Chai et al. (2017) mentions that the exact mechanism through which type-2 diabetes leads to urinary incontinence is still unknown. However, it is considered that increased blood sugar level leads towards higher production of urine creating urgency, frequency and possible incontinence (Taghaddom et al. 2017). In case of T, she is suffering from type-2 diabetes as long-term condition and in the past three months it has worsened leading the individual to show uncontrolled blood sugar level and symptoms related with the health issue. This increased level of blood sugar that leads to higher urine formation and frequency may have led T to experience urinary incontinence. The health beliefs among people with type-2 diabetes are that they lack self-efficacy in monitoring and controlling their blood sugar level (Alatawi et al. 2016). This is because of lack of education among the people suffering from the disease regarding the way they can effectively analyse their blood sugar level regularly and control it. In case of T, it is seen that her husband was responsible to assess her blood sugar level to monitor any fluctuations and offer her medication to ensure control of her condition. However, without her husband, T’s health belief regarding lack of knowledge to monitor her blood sugar level and taking medication in scheduled manner may have led her develop relapse of her type-2 diabetic condition. The hindered intake of food and lower physical exercise leads individuals unable to control effective blood sugar level while suffering from type-2 diabetes. This is because intake of fatty and unhealthy foods and lack of well-balanced diet leads the body unable to lower blood sugar level. Moreover, hindered physical exercise leads the body incapable to use extra glucose as energy to control blood sugar in turn leading them to have controlled blood sugar level in type-2 diabetes (Kolb & Martin, 2017). In case of T, it is seen that her only support, that is her husband, is currently deceased and there are no other people to support her everyday needs. This may have lead her unable to take balanced diet along with medication to keep her type-2 diabetes in controlled manner. Moreover, her age-related issues have led her to face issues with mobility making her unable to execute physical exercise to enhance her body cells to use extra blood sugar in the body and assist her in controlling type-2 diabetes. Thus, in this way, her lifestyle factor may have contributed to relapse of her condition regarding type-2 diabetes.

The social support is effectively required by the type-2 diabetic patients in availing effective care assistance to control her condition (Chatterjee, Khunti & Davies, 2017). However, in case of T, it was seen that there was hindered social support present as the community nurse even after detecting increased blood sugar level of T since her husband’s death did not arrange any active care to support T in improving her health. As argued by Piccolo et al. (2016), effective family support is required by the elderly type-2 diabetic patients as they are unable to take their own care. This leads to hindered intake of medication and foods which may have occurred for T due to lack of personal support from the family members contributing to her relapse health condition regarding type-2 diabetes. The biological condition of ageing is seen to contribute towards relapsed and uncontrolled type-2 diabetes among people. This is because with ageing the cells of the body becomes highly insulin resistance and hindered functioning of the pancreatic islets are experienced that are responsible to produce insulin and manage glucose concentration in the body (Scott, de Courten & Ebeling, 2016). Since T is nearly 72 years, thus her progressing age-related reduced body functioning could have contributed to her uncontrolled and relapse type-2 diabetic condition. The person-centred care for T is required to initially include a regular community nurses who would assess her blood sugar level and ensure effective along with timely intake of medications. Moreover, T is to be gradually educated regarding the way she can personally monitor her blood sugar level to ensure keeping type-2 diabetes under control. This is because it would make T avoid to be burden of care and develop self-efficacy to manage her own health (Beck et al. 2017). A social support worker is to be provided to T under person-centred care to support her in executing everyday chores. This is because she currently has reduced mobility and lack family support to care on her own. The dieticians are professionals who provide expert advice regarding the nature of food to be taken based on the health condition of individuals (Viswanathan et al. 2019). In person-centred care for T, a dietician is to be involved who would provide detailed information about the nature of food to be taken by T to ensure control of her type-2 diabetes in enhanced manner. The diet chart for T is to be followed by the social support worker to help T identify the foods to be taken to control her condition in everyday life. Moreover, mental support is to be provided to T to overcome her emotional condition regarding loss of her husband which is deteriorating her type-2 diabetic condition.

Nursing care delivered across different sector

The patient T access care from the hospital and community services to ensure control of her type-2 diabetic condition. In hospital, the care for the patient is delivered by initially assessing their vitals by practice nurse to determine the symptoms and health issues being faced by them. On the basis of the diagnosis, the individuals are later transferred to specialised nurses who are responsible to deliver care by consulting with the multi-disciplinary team (Doshi & Friedman, 2017). In case of T, on admission to the hospital, the practice nurse performed initial diagnosis of her health condition. On the basis of the information, T was allocated to be cared by a specialist diabetic nurse who has expertise in managing patients with diabetes. The individual delivered care to T by consultation with the health professionals and dieticians to ensure enhanced condition of T regarding her type-2 diabetic condition. During the caring of T in the hospital, effective and compassionate person-centred approach for care is taken by the nurses and health professionals. This is evident as T was initially asked to mention her preference of care and was involved in sharing decision for each of the intervention being offered to her by the specialist nurses and others. Moreover, care specific towards her health condition is delivered by considering her social and physical health efficiency. In the community services, a regular health visitor is determined to be allocated to T for the initial two months after being released from the hospital. This is to ensure her health regarding type-2 diabetes remains stable and further relapse of the condition can be controlled. A community nurse was determined to be allocated to T for 6 months during which the professional would aware T the way to regularly assess her blood sugar to keep check of type-2 diabetes along with the food to be taken and medication to be taken in timely manner to ensure adequate health condition. The community services also are to provide a social care worker as previously thought for T to help her in her everyday chore. In the process, person-centred care is been effectively abided. This is because in providing care to T by community services she is effectively involved in each step to share her decision and plan her healthcare. The nursing care accessed by T in the hospital as well as in community services was easier to be used by T. This is because there was no financial barrier as her daughter totally supported her care as well as ensures the community services are adequate for T ensures her good health and well-being.

Conclusion

The above discussion informs that T is a 72-year individual who is suffering from relapsed type-2 diabetes condition and is currently admitted to the hospital. The delivery of effective and compassionate person-centred care includes making detailed communication with patients, offering patient respect and dignity, creating safe care environment and active participation in care. In case of T, to follow the aspects of person-centred care it is determined that she is to direct interaction with the nurses responsible for her to mention her care needs and discuss with them about care to develop shared decision for her healthcare plan. The social support, ageing, stress of caring alone, depression of losing loved one and others are bio-psychological factors that contributed to deteriorated health condition of T. In person-centred care for T, a dietician, social care worker and specialised diabetic nurse are involved. T received care from the hospital and community services which were easily accessible as her daughter support her through finances and verbal assistance.

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