Patient centred care-planning, delivering and auditing the journey

Introduction

In this paper, I am going to reflect on a clinical care plan that was provided to a mental illness patient under home care placement. My critical evaluation, clinical implementation and outcome will be structured using Kolb’s reflective cycle. Kolb’s cycle is a four phase process that describes how to acquire and embed new knowledge. It embraces the idea that change occurs as a result of reflection, experience, conceptualization and experimentation (Din et al, 2020). Kolb argues that for a new knowledge to be effectively assimilated, an individual must progress through all these stages. Learning stems from experience then reflects upon it leading to analysis and formation of concepts and generalization which are later used when experimenting to test the hypothesis. The obvious description of learning has been dismissed. The school of thought that suggests that we all learn by trial and error suggests what Kolb has described.

Assessment

Person centred care begins with the valuing of the experience of being present with a human being and trying to understand that persons experience and exploring their uniqueness. The national institutes for health and care excellence guidelines are centred around quality care provision on the best available evidence. It is important to ensure that a patient receives the best care to avoid harm and improve treatment outcomes. Assessment and care planning are processes that are informed not only by research but also by clinical expertise (Esterhuizen, 2019). Person centred care must incorporate openness to experience and relationship unfolding at present. In person centered care, the main purpose is to support individuals and families to live the best life the standards for proficiency in nursing associates are underlined by person centred care and a holistic approach. It includes pain assessment, mood assessment, effects on social situation and presence of social support (NICE, 2020). Holistic assessment for this case was done following the guidelines set out by the NICE in 2020.

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Mrs. Doe is a 60 year old patient who had recently moved to a mental health care institution I work at. The patient could not perform any duties as her mental health was deteriorating. She is widowed and was diagnosed with dementia 4 years after the death of her husband. She has one son named john, who is a doctor in a nearby cancer centre in United Kingdom. Dementia is a general term that describes memory loss and language problem. The patient had trouble speaking out clearly which made it difficult to make a conversation. Her thinking ability was low which had interfered with her daily life. This condition is caused by abnormal brain changes that are triggered by an event. Emotional changes can trigger a decline in thinking skills severe enough to impair the daily life and independent functions that are performed by an individual (Bianchetti et al., 2020). Therapy is recommended as treatment for dementia as it reduces the cognitive and functional decline in patients. Drug therapy was also recommended for Mrs. Doe as they help to reduce the symptoms of this mental disorder. Strong therapeutic relationships in person centred care are based on trust and good rapport which require time. I often sit with Mrs. Doe and try to make a conversation to assess the sociological dimensions.

Planning

A critical evaluation of Mrs. Doe’s believes and attitudes using my concrete experience made her irritated which made it difficult to assess her emotional state. Kolb’s cycle allows for more advanced practitioners to achieve mastery and innovate new ideas as solutions to problems in clinical practice. This stage involves physically experiencing the patient which allowed me to understand Mrs. Doe’s emotions and mood at that time (Glanz, 2015). I noticed that to improve and minimize the patient’s emotional breakdowns, I used reflective observation. This allows for one to think about different ways and assess what is working while taking note of what is not working. Upon reflecting on this incidence, it was clear that the patient was disturbed and irritated whenever I attempt to bring up a conversation.

Abstract conceptualization is a third phase of Kolb’s cycle that allowed me to consider different aspects of how I could improve my communication with the patient. This allowed for provision of strong and quality care as strong communication allows for nurses to gain a deeper insight and understanding of patients and meet their needs. Health inequalities are prevalent at old age, several framework constructs, self efficacy and barriers were relevant to this case after the application of health belief model. Active experimentation stems from experience which is reviewed, analyzed and evaluated systematically (Secheresse et al, 2020). Once the process has been completed, the new experience forms the starting point for another cycle. It involves practicing the newly acquired knowledge by taking reflections and thoughts and theories back into practice. New strategies are tried where some will work while others won’t work. The best evidence practice recommendation and support for my plans for Mrs. Doe included finding different ways to communicate with her without distracting her. I was able to understand more about dementia which enabled me to empower her by challenging her to develop further self management strategies.

This experimental learning theory provides a comprehensive foundation for approaching mental health issues. It shows how experience is translated through reflection into concepts which are used as guides for active experimentation. It affirms the importance of experimental activities that are used in laboratory sessions as well as mental health institutions. The choice of a learning style reflects the individual abilities, environment and learning history (Din et al., 2020). The model works in two levels, a four stage cycle and four different learning styles. It helps learner to apply their ideas and concepts into the real world. It involves feeling and watching things from a different perspective this learning stage is followed by assimilation which involves critical thinking, converging which helps in solving the problem at hand and later accommodation which is hands on and relies entirely on intuition rather than logic.

Implementation

To improve Mrs. Doe’s condition, I talked to other medical practitioners. Working as a team is an important element of person centred holistic care. It allows experts to come together with different ideas that have been sanctioned so as to better support a patient and improve the care quality available. In the context of complex care systems, effective teamwork positively enhances patient safety and teamwork (McCormack McCance, 2016). This is a new evolution in health care and a global demand for quality patient. It can only be achieved by placing patients at the centre of care. In this cases scenario, Mrs. Doe’s needs were centralized. Aiming towards such goals, motivation of team members should be backed by strategies and skills that enable overcoming of challenges. Integrated care is part of nurse’s responsibility. These practitioners had spent some time with the patient since joined our unit which allowed for familiarization.

An informal chart about the patient gave more information and alternative ways of handling the patient’s issues (Pirtle & Ehrenfeld, 2018). This chart provided a trail of evidence for Mrs. Doe’s case that was used for future reference. The records also showed how often the patient felt agitated whenever a conversation was made. It acted as a roadmap that showed how the patient was fairing on. The visits made by her son also helped to improve the patient’s condition as she felt more secure and was calm whenever her son was around. Mrs. Doe had different therapy sessions with a psychiatrist who constantly assessed her situation and advised further on what was recommended. Family members play an important role in taking care of patients. They contribute to decision making, assist in care provision and improves the patient’s general outcome societies vary in structure and family hierarchy . Family dynamics are greatly affected by religion, cultural, legal variability and prevailing health care as well as family involvement.

Apart from psychotherapy sessions that Mrs. Doe had, medications were used in order to improve her situation. Through therapy, a patients emotions their ideas are understood. One can tell the factors that contribute to a mental illness cases and learn to modify them. Understanding of major problems in the family helps to understand which aspects of those problems may be solved and how. Medication does not stop the damage in the brain cells but helps to stabilize and lessen the symptoms for some time (McCormack & McCance, 2016). Mrs. Doe was give cholinesterase inhibitors that helped to improve her memory, thinking language and other thought processes. These drugs worked by preventing the breakdown of acetylcholine and support nerve communication. These drugs were generally tolerated well by Mrs. Doe’s body and had minor and lesser side effects such as nausea and vomiting. Active implementation from Kolb’s framework was applied when patient was taken outside for a walks in the garden during morning hours and in the afternoon. This reduced Mrs. Doe’s fear, anger and stress which helped her in the path towards recovery.

Evaluation

In this case scenario, the main issue was how to help the patient improve her present condition. Different strategies were employed in order to help the patient cope. The most important strategy was family involvement which allowed for greater improvements. Spending time with her son helped with her sanity case, she was seen to be struggling and making an effort to converse with her son. The patient felt lively while with her immediate family. Her episodes were seen to lessen after her son visited often. The need for a strong therapeutic relationship between Mrs. Doe and medical staff helped in solving the nursing problem at hand. This relationship helped her find her physical balance and her physical activity improved.

Strong therapeutic relationship and physical balance are important elements of person centred care( McCormack & McCance, 2016). Trust and good communication between a patient and care givers helps to build these strong therapeutic relationships. These relationships consists emotional bond of trust, care and respect, agreement on goals and collaboration on tasks assigned during treatment. A shared sense of ownership in treatment is essential. The manner in which therapists and patients handle these problems together is an important part in the success of these relationships. It is expected for therapists and patients to share any negative feelings that may arise in order to work together in resolving them. Person centred care does not only underline the creation of therapeutic relationship, it also centres on better outcomes (Santana et al, 2018). There was overall improvement of Mrs. Doe since she incorporated therapy with combined medication. She was able to speak and maintain conversations with lesser episodes agitation. Her fear has decreased and the garden morning and evening walks have improved het anxiety and depression. She is comfortable around care givers and seems to have fully familiarized with her immediate environments. She at times tendered for the plants and flowers in the garden during her evening walks. The patient made new friends with other staff and residents, the personal relationship with her son improved and she is now able to walk freely and converse with other people. I partly contributed to Mrs. Doe’s recovery process which was facilitated by holistic approach towards person centred care. However, focusing on supporting the patient’s and employment of reflective frameworks showed that communication and clinical practice was improved in mental care unit.

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Conclusion

There is good evidence that person centred holistic approach to care can improve the safety, quality and cost effectiveness in patients and staff satisfaction. This approach has been recognized widely as a foundation for safer and higher quality care. This care is responsive to the needs and values of patients. It involves focusing and seeking out what is important to the patients enhancing trust and working together to plan and share decisions. Communication, care coordination and family involvement in care is a key dimension of person centred care. Without person centred acre in this approach, Mrs. Doe would probably not have shown improvements in communication and her functional abilities.

References

Bianchetti, A., Rozzini, R., Guerini, F., Boffelli, S., Ranieri, P., Minelli, G., ... & Trabucchi, M. (2020). Clinical presentation of COVID19 in dementia patients. The journal of nutrition, health & aging, 1.

Din, W. M., Idris, F., & Tajuddin, M. (2020). Adapting Kolb’s Experiential Learning Cycle in Enhancing Attitude and Skills Among Undergraduates through Volunteerism. Asean Journal of Teaching and Learning in Higher Education (AJTLHE), 12(2), 122-139.

Esterhuizen, P. (2019). Reflective practice in nursing. Learning Matters.

Glanz, K., Rimer, B.K. & Viswanath, K. (2015). Health Behavior: Theory, Research, and Practice.New York: John Wiley & Sons.

McCormack, B. & McCance, T. (2016). Person-Centred Practice in Nursing and Health Care: Theory and Practice. New York: John Wiley & Son.

NICE (2020). Osteoarthritis: care and management. CG177. https://www.nice.org.uk/guidance/cg177[Accessed5 June 2021]

Pirtle, C., & Ehrenfeld, J. (2018). Blockchain for healthcare: The next generation of medical records?.

Santana, M. J., Manalili, K., Jolley, R. J., Zelinsky, S., Quan, H., & Lu, M. (2018). How to practice person‐centred care: A conceptual framework. Health Expectations, 21(2), 429-440.

Secheresse, T., Pansu, P., & Lima, L. (2020). The impact of full-scale simulation training based on Kolb’s learning cycle on medical prehospital emergency teams: a multilevel assessment study. Simulation in Healthcare, 15(5), 335-340


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