Working In Partnership

Introduction

The nurses often work in partnership to provide care to the service users as it helps them to share ideas as well as skills to enhance care services for the patients. In this assignment, a case study is to be presented based on which the nursing care working in partnership are to be discussed. Moreover, the framework to be used for evidence-based practice for delivering care to the patient is to be examined. The principles of care activities and teamwork are also to be discussed about the patient mentioned in the case study. The discussion regarding inter-professional care and challenges faced in collaborative care delivery for the patient is also to be explained. .

Case Study of the patient

The NMC Code of Practice informs that confidentiality of the patients under the care of the nurses is to be ensured so that they can be protected from abuse and harm regarding their health condition (nmc.org.uk, 2018). Thus, in the mentioned case study to maintain confidentiality of the patients the pseudonym, Betty is to be used for indicating the patient. The patient named Betty is a 60-year old woman, who is admitted to rehabilitation ward of the hospital with reports of type-2 diabetes, hypertension and developed leg ulcer. The type-2 diabetes is the chronic health condition in which the blood sugar level increases as the body develop insulin resistance. This is because insulin hormone which helps glucose to be transferred to the cells to be used for energy is resisted by the body leading to create deposition of glucose in the blood to be unable to get converted into energy (Mann et al. 2017). Type-2 diabetes often leads individuals to develop leg ulcer as a result of peripheral neuropathy, venous insufficiency or peripheral occlusive disease developed by the body as a result of increased glucose in the blood (Mantovani et al. 2017). Thus, it can be determined that developed leg ulcer of Betty is as a result of her uncontrolled type-2 diabetes.

The home and family circumstances of Betty informs that she has been living with her husband who is 70-years old and has medical history of kidney failure and depression. Betty is reported to have no children and currently, her husband is supporting her needs irrespective of his health condition. This is because development of leg ulcer has led Betty to feel frequent pain in the legs due to which her mobility is reduced creating challenges in managing her household and everyday care. Moreover, it is reported by Betty on admission to the hospital that she did not continue her medication for diabetes in proper manner and often took frequent breaks during medication.

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In the study by Malhi et al. (2017), it is mentioned that poorly controlled diabetes often leads patients to develop leg ulcer. This is because high blood sugar level acts to stiffen the arteries which restrict their expansion in delivery of blood. Thus, the restricted blood flow in certain parts of the body disrupts the natural healing abilities making individuals develop leg ulcer. In case of Betty, her uncontrolled type-2 diabetes may have result her to face leg ulcer as a result of the condition. Betty is found to have effective mental condition irrespective of high blood pressure and is found to have no hearing issues as well as she is fluent in speaking English. Thus, the complex health needs of Betty is effective to control of her type-2 diabetes, hypertension and management of leg ulcer are to be made so that she can take care of her everyday needs and household responsibilities. Moreover, Betty’s family need a social carer who would help her husband in managing the household and personal chores.

Evaluating Evidence-Based Framework underpinning practice :

The John Hopkins Model is regarded as an effective evidence-based practice framework which assists to resolve issues in nursing care by promoting proper clinical decision-making. The framework informs the three-step process for evidence-based care which is PET (practice question, evidence and translation) to be used by the nurses. The model is developed in 2005 and currently used in nursing practices for executing evidence-based care (Dang and Dearholt, 2017). The focus of the model is ensuring consideration of latest research and identifying best practices appropriately and more quickly to be incorporated in delivering successful and quality patient care (Friesen et al. 2017). In John Hopkins Model, the practice question is the query to be made for evaluating and collecting evidence regarding the care decided for the patient (White et al. 2019). This aspect is useful for Betty as nurses can develop the practice question “What care actions are required to resolve and manage leg ulcer in diabetic patients?” to gather required evidence in planning her care. .

How to deal with the issues arising the searching resources in the dental practices:

In the study by Kaufman et al. (2016), it is mentioned that people from multi-ethnic and black communities in the UK suffer from negative psychological conditions such as lack of identity, ambiguity and lack of normal reception in the society. This is because they are found regarded not to fit the proper categories of white individuals and their communities. It leads the ethnic individuals to face isolation and alienation in the society making them develop increased stress and anxiety along with failure to progress in life. This makes them develop substance abuse such as smoking to get relief and overcome psychological distress being suffered due to inappropriate treatment in society (Keith et al. 2016). As criticised by Tabb et al. (2020), smoking is regarded in few ethnic communities as the way to develop social communication. This indicates that the customs among the ethnic communities regarding smoking makes the individuals show greater prevalence regarding substance abuse. The men are found to be involved in smoking because they try to use tobacco as the way to overcome their deteriorated emotions and frustrations in life (McNeill and Robson, 2018). The fact is evident as nicotine present in the tobacco is found to provide sense of relaxation to the brain along with lower anxiety and stress by promoting the release of dopamine which the hormone released to happiness feeling among individuals (Srinivasan et al. 2016). The women are found to be involved in smoking because they try to overcome stress and anxiety regarding family management, hindered relationship with the spouse during divorce, loneliness and others (Liu et al. 2017). In the study by Hult et al. (2018), it is mentioned that unemployed people are more involved in smoking activities compared to employed individuals to cope psychological distress out of unstable future. This is evident as unemployed people experience depression, stress and anxiety regarding their ability to develop proper status and have finances to support their and family needs at the present as well as in future. The young people are more likely to smoke tobacco due to varied reason such as peer influence, experimentation, stress and others. The study by Rozi et al. (2016) informs that influence from peers and friends makes young people involved in smoking. This is because they avoid being humiliated in society and get accepted among the groups in the society the young people initiate to smoke. The peers also influence young people to smoke for experimentation mentioning they are not going to develop addiction which later makes the young people avoid having intention to quit smoking (Idris et al. 2016). The young people mention they are involved in smoking to overcome stress and anxiety regarding their unstable future, hindered career development, pressure from academics and others (Idris et al. 2016). (Refer to Appendix 1)

The John Hopkins Model is regarded as an effective evidence-based practice framework which assists to resolve issues in nursing care by promoting proper clinical decision-making. The framework informs the three-step process for evidence-based care which is PET (practice question, evidence and translation) to be used by the nurses. The model is developed in 2005 and currently used in nursing practices for executing evidence-based care (Dang and Dearholt, 2017). The focus of the model is ensuring consideration of latest research and identifying best practices appropriately and more quickly to be incorporated in delivering successful and quality patient care (Friesen et al. 2017). In John Hopkins Model, the practice question is the query to be made for evaluating and collecting evidence regarding the care decided for the patient (White et al. 2019). This aspect is useful for Betty as nurses can develop the practice question “What care actions are required to resolve and manage leg ulcer in diabetic patients?” to gather required evidence in planning her care.

The LOWA Model for evidence-based practice (EBP) is developed by Marita in 2007. The steps mentioned in the LOWA model includes at first selection of topic (Buckwalter et al. 2017). In this step, Betty's needs are fulfilled by making nurses select the key factors to be focussed in evidence collection to improve the patient’s health. This means that nurses develop the topic that is ways to resolve hypertension, manage type-2 diabetes and cure leg ulcer of Betty. The LOWA Model informs formation of team who are to be involved in collecting evidence as the second step to EBP (Lloyd et al. 2016). This indicates nurses caring for Betty form a team with other care staff to collaboratively gather evidence based on the care topic they selected for Betty. The LOWA model informs evidence gathering as the third step and grading them as the fourth step. The grading of the evidence is required to determine the most potential evident care to be provided for the patient to ensuring them highest quality care support (LoBiondo-Wood et al. 2018). Thus, nurses after gathering evidence are to grade them to determine which of the evidential practice are more effective according to the condition of Betty to offer her best care to enhance her health. The other steps mentioned by LOWA model are developing evidence-based practice standards, implementing the EBP and examination of the evidence (Lloyd et al. 2016). This indicates nurses caring for Betty while providing EBP care maintain proper standards of support and after its implementation evaluates their efficiency in offering enhance health condition to the patient, in turn, acting to determine whether the EBP meet identified needs of Betty.

Discussing the principles of care organisation, management and leadership for the patient

The Roper-Logan-Tierney model of nursing approach is to be used for health management of Betty. The Roper-Logan-Tierney model is beneficial as it leads the nurses to deliver consistent and effective care to the patients that fulfil effective management of most of their key daily activities required to lead a healthy life (Gultas, 2017). This model is also the widely used nursing approach for patients in the UK and has provided positive help to the nurses in delivering quality care (Stonehouse, 2017). However, the limitation in using the model is that nurses at times fail to properly recognise the specific needs for daily activities of living of the patients according to their health condition creating development of hindered care plan (Wilson et al. 2018). Thus, to avoid the limitation, nurses caring for Betty are to develop effective therapeutic communication and detailed diagnosis of her health. .

The Roper-Logan-Tierney model mentions 12 key daily activities of living to be fulfilled for the patient that are breathing, managing safe environment, communication, eating and drinking, washing, controlling body temperature, mobilisation, working, expressing sexuality, sleeping and death (Gultas, 2017). The following activities of daily living (ADLs) are to be examined for Betty by the nurses to determine in which aspect the person is facing hindrance and needs support. According to Roper-Logan-Tierney model, breathing is an essential physical process to help individuals remain alive (Gultas, 2017). The nurses caring for Betty evaluated her breathing condition by counting her breathing rate per minutes which indicates to be normal informing she is not facing any issues with breathing. The case study informs Betty has fluency in English and has no hearing problem. This indicates she is not going to face any issues with communication with the nurses as he can hear and respond to nurses who are also proficient in English. The eating and drinking efficiency is required for helping the patient take in proper diet to gather require nutrient needed to fight against the disease and manage healthy life (Mohammadi et al. 2018). As criticised by Thornton (2016), dehydration is faced in individuals suffering from type-2 diabetes which can cause kidney damage. In case of Betty, it is seen that she has proper swallowing ability and the nurses thus took approach to ensure she is taking meals as per referred

by dieticians and ensure increased amount of water is taken by her to avoid dehydration as she is suffering from type-2 diabetes where it is one of the health issue being experienced by patients. The mobility of Betty is found to be reduced as result of leg ulcer. Thus, the nurses while arranging care ensured to gather evidence in offering her assistance in making movement. The study Tate et al (2018) mentions that antibiotics and proper bandage of wound could help to heal leg ulcers. Thus, nurses took the approach to determine the nature of bandages to be used and antibiotics to be provided to Betty for improving her leg ulcer as it is hindering her mobility. On evaluating of Betty’s health as per Roper-Logan-Tierney model, it was identified by nurses that she required assistance with washing, dressing and elimination due to her restricted mobility. However, no issues with controlling body temperature, expressing sexuality, sleeping or death were identified.

Discussing the principles of teamwork and decision making in patient care :

The first principle of person-centred care is to show dignity, respect and compassion towards the patients (Rice, 2016). It indicates that while offering person-centred care to Betty the nurses are to communicate and treat her with value and communicate with empathy to show her compassion regarding her condition. This is because it makes patients show compliance in interacting and accepting care from the nurses out of felling of value. The person-centred care principle mentions that coordinated support and care is to be established. However, lack of coordination in person-centred care leads nurses unable to act as a team with involvement of the patients in turn making hindered shared decision regarding their care (Gardsten et al. 2017). This is because coordinated approach establishment makes patients feel included in informing their opinions regarding their care. The principle of person-centred care is that personalised support and treatment is to be delivered to patients. In order to execute it, conflict resolution between nurses and patients is to be established as otherwise, the nurses would be unable to determine personalised needs of the patients to be fulfilled (Bullen et al. 2017). Thus, in delivering person-centred care to Betty the nurses are going to resolve any conflict between them to ensure successful personalised care and support as required by Betty is effectively provided. The principle of person-centred care is that patients are to be allowed to determine their strength to be able to live an independent life. .

However, lack of independent care makes patient feel being burden of care on the family, in turn, losing empowered feeling to improve their health (Wildevuur et al. 2019). Thus, nurses caring for Betty are going to offer her ability to determine her strengths so that she feels empowered and boosted to take her own care. In family-centred care, effective communication and rapport between the nurse and patient’s family are to be established. This is because it would lead the patient’s family trust the nurses and develop two-way interaction to inform specific needs of patients based on which the nurses would develop family-centred care for enhancing health of the patient (Tervaskanto-Mäentausta et al. 2017). Thus, to offer family-centred care to Betty, the nurses are going to develop effective communication and rapport with her husband so that he informs specific needs to be fulfilled for Betty to ensure her good health. As argued by Allen et al. (2018), lack of proper delegation of power and decision-making leads to hindered family-centred care. This is because family members feel lack of value by the nurses making them develop conflict with the nurses in allowing delivering care to the patients. It indicates that power of decision-making regarding care for Betty is to be delegated between nurses and her husband to ensure her good health through family-centred care.

Discussing working in partnership use and importance :

The working in partnership with other professionals helps the nurses caring for the patients share opinions and skills of experts from diverse fields to decide quality care plan for the patients (Kreider et al. 2017). This is evident as while planning EBP care for Betty, the nurses by working in partnership with dieticians and physiotherapist would be able to gather specific information regarding dietary regulations and physical activity to be followed to effectively improve her type-2 diabetes, leg ulcer along with manage hypertension. However, lack of inclusion of expert opinions in partnership working leads nurses to make generalised care delivery to patients (Finer et al. 2017). This is because in case of Betty the dieticians and physiotherapist would have better knowledge compared to the nurses in rating the evidence regarding dietary inputs and physical exercise to be included in resolving her health complications.

he working in partnership with professionals enhances the impact of care on patients as it leads nurses to have assistance in resolving any confusion in delivery of care (Finer et al. 2018). This is because knowledge of the experts is shared among professionals to resolve the problems faced in delivering care. It is evident as through partnership working the nurses could be able to decide the way better control of type-2 diabetes care for Betty is to be made so that any further relapse of the disease and risk such as leg ulcers are avoided. Moreover, partnership working of the nurses caring for Betty with the family would help them to identify unreported personalised needs of the patient to ensure them better person-centred care. Further, working in partnership is essential to determine most effective medications to be offered for improved health of the patient (Kirkham et al. 2017). This is evident as in EBP for Betty the nurses through working in partnership with experienced health professional would be able to make selection of best evidence that indicates most effective antibiotics and nature of bandages to be used for helping Betty cope with pain and mobility issues reading her leg ulcers at the earliest.

Planned assessment and intervention for the patient

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The overall health assessment and diagnosis of the patient is essential to determine the root causes and extent to which the determined disease has adversely affected their health (Parakh et al. 2020). The Duplex ultrasound is the diagnostic tool used for assessment of leg ulcer where the nurses determine ankle-brachial pressure to determine to what extent arteries are blocked in the leg. This is because lower pressure in the ankle compared to the arm suggests that there are blocked arteries present in the leg (Elgayyar et al. 2019). Moreover, clinical features such as shallow and painful wounds, presence of granulation and bony prominences in gaiter area are examined to assess condition of leg ulcer (Melikian et al. 2018). Thus, to plan assessment of leg ulcer for Betty the clinical symptoms and use of Duplex ultrasound are to be made by the nurses. The regular monitoring of blood sugar is done in type-2 diabetes by using blood glucose meter (Chaudhury et al. 2017). Thus, blood glucose meter is to be used by the nurses to monitor and manage blood sugar level of Betty who is suffering from type-2 diabetes. The study Rajan et al. (2019) mentions that use of ACE inhibitors, diuretics, beta-blockers and other medication are effective to manage hypertension. However, the study by Wiysonge et al. (2017), mentions that use of medication to control hypertension results patient to face side-effects of medication such as nausea, dizziness, headache and others. In contrast, the study

by Sharman et al. (2019) mention that regular exercise and intake of proper diet assists to effectively control hypertension avoiding intake of medication. Thus, shared decision is to be made by the nurses with involvement of Betty to determine which nature of care is to be provided to her for controlling her hypertension. The Metformin is effective medication suggested by the NHS to be delivered in controlling type-2 diabetes. Moreover, low carbohydrate diets are suggested by dieticians for type-2 diabetes as low carbohydrates in the body would lead to produce less glucose, in turn, helping to control blood sugar level (nhs.uk, 2018; McArdle et al. 2019). Thus, the nurses through consultation with the family are to delegate and share responsibility with Betty's husband that blood sugar level of Betty is regularly checked and intake of low carbohydrate food and Metformin in right amount is ensured to control her blood sugar level of normal. Moreover, antibiotics for leg ulcer and way bandage of affected areas in Betty’s leg are to be done to be determined by the nurses by consulting with health professionals. This is because antibiotics and proper bandage of wounds in leg ulcers help to heal them ensuring regain of effective mobility by the patients (Young et al. 2017).

Issues related to collaboration and inter-professional working

The inter-professional working for Betty is required to include professionals such as dietician, physiotherapist and diabetic nurse. The issues related to inter-professional working in rise of conflict of care to be delivered to the patient. This is to be resolved through proper discussion between professionals and delegation of care responsibilities for the patient (Bissett et al. 2020). The physiotherapist is essentially required in treatment of leg ulcer as they deliver compression therapy and inform specific activities such as flexing leg to be done to help individuals ease blockage of the arteries in the leg and ensure faster healing as well as regain effective mobility (Obermayer et al. 2016). Thus, they by working in partnership with nurses caring for Betty would be able to ensure better healing of her leg. The dieticians are required to treat type-2 diabetes and hypertension as they inform the specific foods to be taken and those that are to be avoided to ensure proper blood glucose and blood pressure level (Benson et al. 2019). Diabetic nurses are specialised nurses who have expertise in providing care and treatment to patients suffering from type-2 diabetes (Spurr et al. 2018). Thus, they are to be involved in caring for Betty by the general nurses to develop expert knowledge and skills to be used for accomplishing effective control of diabetes of Betty.

Conclusion

The above discussion informs that Betty is suffering from type-2 diabetes along with hypertension and is hospital due to hindered mobility as a result of rise of leg ulcer. The use of John Hopkins model and LOWA model is to be done to determine ways to gather evidence in meeting the needs of Betty. The needs assessment of Betty is to be done by using the Roper-Logan-Tierney Model of nursing according to which mobility is adversely affected for Betty. The inter-professionals such as dietician, physiotherapist and diabetic nurse along with person-centred care and family-centred care are to be included in supporting Betty’s healthcare needs to ensure her well-being.

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References :

Allen, D., Scarinci, N. and Hickson, L., 2018. The nature of patient-and family-centred care for young adults living with chronic disease and their family members: a systematic review. International journal of integrated care, 18(2). Pp.90-111. .

Benson, G.A., Sidebottom, A., Hayes, J., Miedema, M.D., Boucher, J., Vacquier, M., Sillah, A., Gamam, S. and VanWormer, J.J., 2019. Impact of ENHANCED (diEtitiaNs helping pAtieNts CarE for diabetes) telemedicine randomized controlled trial on diabetes optimal care outcomes in patients with type 2 diabetes. Journal of the Academy of Nutrition and Dietetics, 119(4), pp.585-598.t.

Bissett, S.M., Preshaw, P.M., Presseau, J. and Rapley, T., 2020. A qualitative study exploring strategies to improve the inter-professional management of diabetes and periodontitis. Primary Care Diabetes, 14(2), pp.126-132.

Bhat, N.A. and Ganaie, S.A., 2016. Use of e-resources by users of Dr. YS Parmar University of Horticulture and Forestry. DESIDOC Journal of Library & Information Technology, 36(1).

Bullen, B., Young, M., McArdle, C. and Ellis, M.J., 2017. Visual and kinaesthetic approaches to pragmatic, person-centred diabetic foot education. Diabetic Foot J, 20(1), pp.29-33. .

Chaudhury, A., Duvoor, C., Dendi, R., Sena, V., Kraleti, S., Chada, A., Ravilla, R., Marco, A., Shekhawat, N.S., Montales, M.T. and Kuriakose, K., 2017. Clinical review of antidiabetic drugs: implications for type 2 diabetes mellitus management. Frontiers in endocrinology, 8, p.6.

Dang, D. and Dearholt, S.L., 2017. Johns Hopkins nursing evidence-based practice: Model and guidelines. Sigma Theta Tau.

Elgayyar, M.A., Abdelmoneim, A., Mowafy, K., Elsaied, M.A., Faqe, M.H. and Gaballah, M.A., 2019. Evaluation of chitosan impregnated with silver nanoparticles in the treatment of chronic venous leg ulcer: An open-label controlled study. Clinical Dermatology Review, 3(1), p.84. Finer, S., Robb, P., Cowan, K., Daly, A., Robertson, E. and Farmer, A., 2017. Top ten research priorities for type 2 diabetes: results from the Diabetes UK–James Lind Alliance Priority Setting Partnership. The Lancet Diabetes & Endocrinology, 5(12), pp.935-936.


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