Implementing Family-Centered Care for Older Adults with Motor Neuron Disease

In modern nursing and healthcare field, the family-centred approach is highly crucial for children and young people, through which healthcare-support to children and young people can be provided based on their family needs (Shaheen et al. 2020). In the case study of the older adult with age 40+ suffering from Moton Neuron Disease (MND), family-centred care needs to be applied by the carers and nurses in which they can discuss the overall care plan with the family members of this person. In this family centred care process, the family members of this person would be encouraged as well as supported to make 24 hours observation on this person when he receives the care. Under NMC (2019) guidelines, health care providers must ensure that the family members receive the support, information and guidance that they request and need throughout the care process (Isenberg et al. 2018.). In case of the older adult with MND, family members would be involved in sharing their opinion and knowledge about the current health condition, premedical history, preference, pain, experience and current psychological condition of that person. this information can assist the healthcare providers to set a highly relevant and effective care plan for this person to reduce his stress and improve his mental state.

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While it comes to protect the right is children and adults’ people while providing them care, healthcare providers must respect the preference, dignity and autonomy of patients (Sperling and Pikkel, 2020). under NICE (2019) guideline, healthcare providers must ensure that they maintain the privacy and confidentiality of personal and professional details of the person suffering from MND [NICE, 2019]. Under NHS Codes of Conduct, carer needs to treat the person with MND with proper kindness, compassion and respect. Carers also listen as well as respond to the current needs of this person throughout the care process. the care providers also assure that they would share the important information regarding the health of the person with other healthcare professional in such a manner that will never interfere with the guidelines of privacy and confidentiality.

In healthcare, informed consent is the process of taking permission from patient as well as his or her family members on applying any treatment or care plan (Katz et al. 2016). Under NICE (2019) guidelines, healthcare providers must take informed consent from the patient and family members before starting the treatment, in which healthcare providers must inform the family members as well as patients about the purpose, objectives and associated health outcomes of the care plan or treatment process that is going to be implemented [NICE,2019].

Medico-legal and ethical aspects are associated with the principles and Codes that healthcare providers need to follow to maintain their professional accountability as well as integrity throughout their work (Martin-Fumadó et al. 2020). Under NHS (2019) Codes of Conducts, care providers must know their professional boundaries beyond which they will not take any decision regarding health and social care. Healthcare providers must work under their professional competencies and knowledge in terms of assuring the safety to patients throughout the care [NHS, 2019].

In case of the older adult with MND, the care providers need to take informed consent from sis family members regarding applying the specific treatment for this mental health condition such as CBT (cognitive behavioural therapy) and psychotherapy. On the other hand, care providers need to followed the professional ethnic and legal guidelines set by NICE (2019), under which they need to ensure the safe and high-quality and compassionate care as per the current health needs of this person will be provided to him.

Based on the Erick Erickson psychosocial theory there are eight phases through which an individual passes throughout his or her lifespan. Erickson (1963) believed that each of these stages is concerned with developing professional and personal skill in the human being that assists them to lead a quality life (Tamanna and Tassimova, 2019). This psychosocial hypothesis of Erick represents that how an individual learns and develop new skill, behaviours, thoughts, decision making and interpersonal ability in the early stages of life since his or her birth that assist the individual to have a positive outcome throughout the lifespan. This theory is widely used by a modern healthcare provider in terms of improving the mental, emotional and physical wellbeing in patients suffering from a mental disorder.

As mentioned by Syed and mclean (2017) in case of patients suffering from psychological illness such as dementia, depression and Motor Neuron Disease (MND), the application of relevant stage of Erick Erickson theory can be highly effective in improving their decision making, cognitive ability, psychology and behaviour.

In case of the person with MND, as the person is above 40, the seventh stage of Erick Erickson theory, Generativity vs Stagnation can be applied by health care providers in terms of reducing his stress and depression (Abrutyn, 2019). Though applying this stage care provider can support the person the way he is in his present health condition thereby motivating him to have positive thoughts, good decision-making skill and optimistic viewpoint.

On the other hand, by applying Generativity vs Stagnation, health care providers can allow the person with MND to learn the process of self-management which will assist the person to become self-dependent in performing his regular function by maintaining effective time-management skill, thereby leading a quality life.

Chronic diseases are the non-communication health condition that cannot be cured entirely but their effective ca be reduced through proper medicines and self-management (Proyer, 2018). MND is the neurological chronic health condition which poses an adverse impact on patients’ decision making, cognitive ability and problem-solving skill thereby affecting their behaviour and quality of life. For promoting positive health and wellbeing in the person with MND, healthcare providers need to emphasize on a manifold aspect such as

Education the patients’ about effectively managing his health and lifestyle,

Improvement his quality of life by improving his eating habits, sleeping pattern, lifestyle, thoughts and decision making

Recommending proper antidepressant medicines to him

Conducting psychotherapeutic treatment for him.

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Here the fifth stage the Identity and Role confusion can be applied by the healthcare providers in terms of promoting positive behavioural transformation in the above-mentioned patient with MND. Through using the something of this stage, care providers can motivate and encourage the patient about his regular duties such as bathing, dressing, meeting friend and family members, taking and listening to others advise, cooking, eating ad taking medicines. Through applying this stage, care providers can also reinforce the posted thousand and behaviour in the patients that will assist this to have a healthy and quality life.

Disease dementia is a progressive disorder. It worsens the process of reasoning, conduct, mental retention power, and the physical functioning capacity of the individual. It can occur due to varied disease which affects the brain (WHO, 2019).

Two types:

Alzheimer's disease

Vascular dementia

Three things:

Excessive forgetfulness

Unable to relate with time

Becomes blank in a known environment (WHO, 2019)

Ensuring physical health, cognitive activity and overall well being by health promotion activities among dementia patients:

Physical activities improve the balance and strength of grip which promotes independence among individuals with dementia (Bowes, Dawson, Jepson, & McCabe, 2013).

Healthy nutrition habits augment the quality of life among the patients of dementia such as preventing the development of tiredness, weight-related disorders, and constipating disorders (Pascucci, Chu, & Leasure, 2012).

The services required by the patients of dementia focuses mainly on augmenting the quality satisfaction of life and independence. In this regard, social services play a major role to offer care and support to people with dementia. The amalgamation and proper coordination between the medical and social services help to manage the care approach for the individuals to lead a comparatively better quality life in all aspects. The MDT consists of psychiatrists for the elderly adults, mental health nurses, occupational physiotherapists, speech and language therapists, psychologists, pharmacists, social workers and support workers (Gould, 2011) who take care of the respective areas of the patient for healthy living.

Barriers to collaborative working in the clinical setting:

Absence of proper training for collaborative working

Ambiguity about leadership

A team lacking skilled professionals (Ryan, Gardiner, Bellamy, Gott, & Ingleton, 2012)

Suggestions for effective collaboration in the clinical setting:

Good correspondence: It helps in the effective exchange of information among skilled professionals and also formulates effective decision making.

Assigning roles: With the absence of ambiguity about roles it helps to keep balance among the team (McInnes, Peters, Bonney, & Halcomb, 2015).

References:

Abrutyn, S., 2019. Toward a General Theory of Anomie The Social Psychology of Disintegration. Archives Européennes de Sociologie, 60(1), pp.109-136.

Bland, A.M. and DeRobertis, E.M., 2020. Maslow’s unacknowledged contributions to developmental psychology. Journal of Humanistic Psychology, 60(6), pp.934-958.

Bowes, A., Dawson, A., Jepson, R., & McCabe, L. (2013). Physical activity for people with dementia: a scoping study. BMC geriatrics, 13(1), 129.

Brunkhorst, J. and Lantos, J.D., 2019, December. Ethics and Medico-legal implications in delivery room emergencies. In Seminars in Fetal and Neonatal Medicine (Vol. 24, No. 6, p. 101029). WB Saunders.

Gould, N. (2011). Guidelines across the health and social care divide: the example of the NICE-SCIE dementia guideline. International Review of Psychiatry, 23(4), 365-370.

Isenberg, S.R., Crossnohere, N.L., Patel, M.I., Conca-Cheng, A., Bridges, J.F., Swoboda, S.M., Smith, T.J., Pawlik, T.M., Weiss, M., Volandes, A.E. and Schuster, A., 2018. An advance care plan decision support video before major surgery: a patient-and family-centred approach. BMJ supportive & palliative care, 8(2), pp.229-236.

Jones, S.R. and Stewart, D.L., 2016. Evolution of student development theory. New Directions for Student Services, 154(2016), pp.17-28.

Karkouti, I. M. (2014). Examining psychosocial identity development theories: A guideline for professional practice. Education, 135(2), 257-263.

Katz, A.L., Webb, S.A. and Committee on Bioethics, 2016. Informed consent in decision-making in pediatric practice. Paediatrics, 138(2).

Kemppainen, V., Tossavainen, K., & Turunen, H. (2013). Nurses' roles in health promotion practice: an integrative review. Health Promotion International, 28(4), 490-501.

Martin-Fumadó, C., Gómez-Durán, E.L. and Morlans-Molina, M., 2020. Medico-legal and ethical considerations on resource limitation and clinical decisions during the COVID-19 pandemic. Spanish Journal of Legal Medicine.

McInnes, S., Peters, K., Bonney, A., & Halcomb, E. (2015). An integrative review of facilitators and barriers influencing collaboration and teamwork between general practitioners and nurses working in general practice. Journal of advanced nursing, 71(9), 1973-1985.

Mitchell, M. L., & Chaboyer, W. (2010). Family Centred Care—A way to connect patients, families and nurses in critical care: A qualitative study using telephone interviews. Intensive and Critical Care Nursing, 26(3), 154-160.

Moore, M. H., Mah, J. K., & Trute, B. (2009). Family‐centred care and health‐related quality of life of patients in paediatric neurosciences. Child: care, health and development, 35(4), 454-461.

Nursing and Midwifery Council (Great Britain). (2015). The Code: Professional standards of practice and behaviour for nurses and midwives. NMC.

Ochieng, J., Buwembo, W., Munabi, I., Ibingira, C., Kiryowa, H., Nzarubara, G., & Mwaka, E. (2015). Informed consent in clinical practice: patients’ experiences and perspectives following surgery. BMC research notes, 8(1), 765.

Pascucci, M. A., Chu, N., & Leasure, A. R. (2012). Health promotion for the oldest of old people. Nursing older people, 24(3).

Pettoello-Mantovani, M., Campanozzi, A., Maiuri, L., & Giardino, I. (2009). Family-oriented and family-centered care in pediatrics. Italian journal of pediatrics, 35(1), 12.

Ryan, T., Gardiner, C., Bellamy, G., Gott, M., & Ingleton, C. (2012). Barriers and facilitators to the receipt of palliative care for people with dementia: the views of medical and nursing staff. Palliative medicine, 26(7), 879-886.

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