Providing Holistic and Person-Centered Care for Keisha

Introduction

The role of the nurses is leading and managing care for the service users which is important as in most cases the service users or patients are unable to take their own care or lack knowledge about the actions to be taken for their effective well-being. In the given scenario, Keisha is a 20-year-old female living with Down’s syndrome and Type-1 diabetes. She has currently got into a relationship with Kemal who also has Down’s syndrome and gifts her expensive chocolate which by eating Keisha has developed increased weight. In the process to lose weight, Keisha has ignored taking meals and has faced hypoglycaemia for which she is currently admitted to the hospital for nursing care. In relation to this scenario, holistic care of Keisha is to be discussed and the importance of the nurses is delivering value-based care to the individual. Moreover, the legal policies and principles to be followed in providing person-centred care to Keisha are to be discussed. The theoretical concepts and leadership tools to be used in supporting Keisha are to be explained. Further, the interpersonal skills to be managed by the nurses in providing care to Keisha are also to be discussed.

Analysing legal, professional and ethical framework of person-centred care

The key principles of nursing practice include accountability, confidentiality, record keeping and advocacy. The accountability indicates that nurses are to be committed to their work and advocacy is that nurses are to practice support in helping patients promote their health (Srulovici and Drach-Zahavy, 2017). In case of Keisha, the nurses are to follow the nursing principle of advocacy and accountability by showing effective interest and commitment in care to improve her health. The confidentiality in case of Keisha is to be maintained by the nurses by avoiding disclosure of any healthcare information to the mother or others. The confidentiality in care is important as it leads the patient trust the nurses that they value their personal interest and ensure safeguarding of their personal data (Barnable et al., 2018). According to NMC Code of Conduct, the nurses are to keep well-structured and detailed records of the patient care (NMC, 2018). This is required to be later used as reference for similar patients or for analysis of the health actions taken for the patient. Therefore, a detailed care record of Keisha is to be maintained during her care by the nurse to act professionally and abide by the rules of NMC.

The NMC Code of Conduct mentions that nurses are to act in best interest of the people for promoting their health condition (NMC, 2018). In this respect, it is the legal duty of the nurse supporting Keisha on hospitalisation to take care actions that are in best interest of the individuals. The case study mentions that Keisha is admitted to the hospital after experiencing a hypoglycaemic episode in the public. According to NHS guidelines, intake of sugary drink or snacks required to be taken by an individual who has suffered hypoglycaemia and the blood sugar level is to be checked after 15 minutes to ensure the level of glucose in blood is normalised (NHS, 2019). In case of Keisha, it is seen that she has fainted due to hypoglycaemic condition and the nurse to act in best interest of the patient require to immediately provide her glucose on hospitalisation to improve her health condition. The nurse caring for Keisha is required to consider her Down’s syndrome condition and communicate with her in polite along with compassionate manner to make her develop trust towards her in availing care.

The principles of person-centred care are to protect the privacy of the individuals, allow them have independence of choice of care, treated with dignity and respect and partnership in care (McCormack and McCance, 2016). The case study indicates that on admission of Keisha irrespective of her sound ability to answer most care questions instead of having Down’s syndrome, her mother is continuously interfering that not supported by Keisha. This indicates that the privacy of Keisha is compromised as most of the care decision and queries are made publicly in front of her mother. In this condition, to professionally provide person-centred care, it is the duty of the nurse caring for Keisha to ask questions regarding her in a closed room without her mother’s presence. This is because she has mostly sound mental capacity to answer queries for health without requiring assistance from her mother. As criticised by Kadri et al. (2018), lack of dignity and respect in person-centred care leads the patient avoid participating in their care. This is because they feel disrespected and lack of value in care. Thus, to professionally deliver person-centred care to Keisha, the nurse require to act in a dignified and respected manner while communicating with her and providing care.

The partnership between patient and the healthcare professionals along with nurses are required to deliver person-centred care. This is because it leads the health professionals and nurses to keep the patient in the centre of the care to decide specific treatment solely required according to their health (Wolf et al., 2017). In addition, NMC Code of Conduct informs that nurses are to provide freedom to decide their care and access informed consent from them (NMC, 2018). Therefore, nurse caring for Keisha is to form close partnership with her in determining the specific person-centred needs to be fulfilled while taking the person-centred care approach. Moreover, Keisha is to be provided detailed information regarding treatment available for meeting her different health needs so that she can have freedom to decide and provide informed consent regarding her care. Thereafter, the intervention of Keisha’s mother in influencing her care decision is to be avoided by politely asking her to give space to Keisha in mentioning her needs as she is capable to do so. The case study mentions that Keisha’s mother show concern for her daughter to experience unwanted pregnancy or STD while being in relationship with Kemal. The people with Down’s syndrome have hindered cognitive ability and the psychiatrists are specialist individuals who are able to successfully communicate with them to help them memorise and understand vital information (Lautarescu et al., 2017). In this context, to safeguard Keisha, the nurse is to provide her detailed knowledge with the help of psychiatrist about the way to avoid unwanted pregnancy and STD while in being relationship with her partner.

The Mental Health Act 1983 informs that mentally-ill person has ability to make own decision unless it is provided otherwise. In this condition, the mentally-ill people are to be provided assistance in deciding their own care (legislation.gov.uk, 1983). The nurses in relation to the Act are to avoid Keisha’s mother to interfere in her decision-making regarding care as she is mentioned to show mostly sound health in responding rightly to any query. The issues with violation of confidentiality and privacy of the patient lead them to become vulnerable to be harmed or abused by others (Demirsoy and Kirimlioglu, 2016). This is because revelation of the personal health data of the patients may provoke others to abuse them to take their advantage. Thus, in case of Keisha, who is suffering from Down’s syndrome are to ensure confidentiality is maintained. This is because people often take advantage of cognitive disability of Down’s syndrome individual to harm them. The Data Protection Act 1998 mentions that no information is to be shared without prior consent of the patients (legislation.gov.uk, 1998). Thus, the nurse while providing care to Keisha in the hospital is to abide by the Act and safely store her personal health information to maintain confidentiality as violation of the Act would lead the nurse to face legal actions.

Identifying and discussing management of Holistic and Person-Centred Care for Keisha

In nursing, Holistic care is referred to the care philosophy which guides that the care to be received by the patients is to originate from the concept of holism and humanism. This means that the care provided required to provide support to the mind, spirit and body of the patients that indicates the support required to meet social, emotional, physical, intellectual and spiritual needs of the service users (Rajabpour and Rayyani, 2019). In order to deliver holistic person-centred care to Keisha, the biopsychosocial care model is to be followed to identify her key needs based on which the care is to be framed. This is because it allows identifying and understanding influence of all the factors such as psychological, social and biological influence on overall health behaviours and health of individuals (Santos et al., 2018). The psychological needs are referred to the emotional, mental and intellectual requirements of the individuals (Dekker et al., 2018). The psychological needs of Keisha include cognitive support for helping her cope with Down's syndrome, behavioural support needs for appropriately helping her in responding to her weight issues, emotional support needs to help her communicate on welfare issues with her mother and emotional support needs from her boyfriend Kemal.

The individuals suffering from Down’s syndrome are seen to show delay in cognitive action such as developing expressive language and speech, hindrance in comprehending information, memorising data and others. This is because they have reduced volume of temporal lobes and expresses functional and microstructural disturbances in the hippocampus which are responsible for managing cognitive functioning in individuals (Lao et al., 2019). The case study mentions that Keisha is suffering from Down syndrome, thus she expresses cognitive disability such as impulsivity. The cognitive impulsivity leads people unable to compare the immediate consequences and future events to be faced as a result of their behaviour (Chawla et al., 2020). In case of Keisha, cognitive impulsivity is seen as she is found to avoid taking proper meals with the intension to lose weight irrespective of being administered with insulin injection for her Type-1 diabetes that requires intake of enhanced meals for positive impact on the body. The action has been executed because she is unable to compare the current and future consequences as a result of her behaviour to be suffered that is hypoglycaemia.

According to NICE guidelines, the active cognitive assistance and therapeutic intervention is to be provided under the supervision of psychiatrist for improving cognitive ability of the people suffering from Down’s syndrome (NICE, 2016). Thus, in this respect, to provide person-centred care to Keisha, a psychiatrist is to be involved who would provide her specific cognitive therapy so that she can understand the consequence of her current action in her health and show compliance in changing it. Moreover, the nurses caring for Keisha are to form partnership with psychiatrist in this regard so that they can collaboratively provide psychological assistance needed by her. The Down’s syndrome individuals are found to be overly affectionate towards their near ones (Ersoy et al., 2018). In case of Keisha, it is seen that her overly affectionate behaviour towards Kemal has led her to feel worried about her body image and take drastic action in losing her weight by avoiding eating irrespective of her health issue of Type-2 diabetes. The person-centred care required in this case for Keisha is involvement of her boyfriend Kemal by the psychiatrist to make her understand the negative consequences of her action and avoid performing them. This is because out of affection towards Kemal, Keisha may listen to him regarding eating which she ignored to listen from her mother.

In the case study, it is seen that Keisha is not supportive of the notion that her mother decides her care on her behalf and answers questions regarding her health to the nurse thought she has enhanced ability in providing her opinion on her own. According to NICE guidelines, the people with Down syndrome with growing age are to made actively involved in deciding care and support for their needs with the help of health professionals (NICE, 2019). Thus, according to NICE guidance, in this case, the nurse attending Keisha requires to arrange separate discussion session regarding her care where her mother is not involved. As mentioned by Habib-Hasan et al. (2020), psychiatrists are seen to provide therapeutic assistance to parents of Down’s syndrome individuals. This is to educate the parents regarding the way to manage their emotions and intellect in supporting their children to make their own decision with growing age. Therefore, involving psychiatrist to provide assistance to Keisha’s mother would make her understand the reason she require to provide space to her daughter and allow her take own decision. Moreover, involvement of psychiatrist would also help Keisha to understand the reason behind her mother's action, in turn, assisting her to develop better emotional relation with her. Thus, it indicates that multi-disciplinary care team consisting of psychiatrist and the nurse caring for Keisha is to be formed in providing her person-centred care to assist her overcoming psychological issues related to her health.

On analysis of holistic care needs by following biopsychosocial model for Keisha, it is found that her social needs include presence of independent exposure in the society, self-discovery and active lifestyle such as meeting friends, involving n social gatherings and others. This is evident as the case study mentions that Keisha’s mother is overly protective of her as Keisha is suffering from Down syndrome and wish to interfere in her social life because her mother thinks Keisha is personally incapable to make decision. The nurse to support Keisha’s social needs on the basis of person-centred approach is required to involve her in occupational therapy. According to NICE, occupational therapy for individual with intellectual disability leads them to get educated about the actions to execute self-care and avoid being dependent on others for support (NICE, 2016; Raj et al., 2020). Thus, involvement of Keisha in this therapy would assure her mother that she is able to learn and execute her self-care. It would eventually lead her avoid to get worried and interfere in Keisha's social life in making decision for her. Moreover, it would make Keisha become self-dependent in making her own decision to socially lead her life.

The nurses required to directly involve in communication with family member of the patient to inform the actions they are to execute to promote well-being of the patients (Caples et al., 2018). In case of Keisha, the nurse caring for her also require to effectively communicate with her mother to make her understand the way her interference in causing Keisha to avoid her. Moreover, the nurse caring for Keisha is required to work along with a psychiatrist to help Keisha’s mother understand the way she required to manager her emotions so that it does not unnecessarily interfere in disrupting Keisha’s social life. The nurse caring for Keisha to provide her person-centred care is required to form partnership with local communities who are involved in arranging social gatherings and talk sessions for Down syndrome individuals. This is because it would create opportunity for Keisha to involve more in the society and explore her social life beyond her mother and boyfriend Kemal.

According to the biospyhcosocial model of care, the biological needs of Keisha include support from Type-1 diabetes; overcome hypoglycaemia, mange weight issues and others. The type-1 diabetes is the condition in which immune system of the individual personally destroys insulin production cells in the pancreas which leads the body develop increased blood sugar. The high blood sugar level in the body causes risk of damage to the healthy cells of the body making individuals to suffering wide nature of health complication (Mortimer and Gillespie, 2020). Therefore, type-1 diabetes of Keisha is required to be controlled with effective administration of insulin from time to time. However, the case study mentions that the action is already been executed for Keisha by her mother but her irresponsible behaviour of avoiding to take foods has led her to be hypoglycaemic. This is because presence of high amount of insulin in the blood with less food intake leads the body lack presence of enough carbohydrates to create increased blood sugar for allowing the extra insulin to act in normalising glucose level in the blood (Karges et al., 2017). Thus, in this condition, to provide holistic person-centred care to Keisha, the nurse initially require to lower the dose of insulin injection so that her type-1 diabetes remained controlled and hypoglycaemic condition is not experienced.

In order to manage weight issues for Keisha, in the person-centred care, strategies of physical activity are to be communicated to her by physical therapist. This is because physical therapist has specialisation on the nature of physical exercise to be executed by specific individuals in overcoming their issues with health and body weight (Ptomey et al., 2018). Thus, with the intervention of the physical exercise, Keisha would be able to manage her weight issue and involving in having proper food require to manager her current hypoglycaemic condition. According to NICE guidelines, the dietician in case of caring for type-1 diabetes is to be involved who would provide specific diet charts as per health condition of the patients to be followed in managing enhanced health (NICE, 2015). This is because dieticians are expert individuals who have enhanced knowledge regarding the nature of foods and drinks required specific to the health condition of individual to support their well-being (Scott et al., 2020). Thus, in person-centred care for Keisha, a dietician is to be involved who would provide effective diet charts required for reducing her weight and avoiding hypoglycaemic condition. Thus, multi-disciplinary team including physical therapist, dietician and the nurse caring for Keisha is to be included in framing care for her in meeting her biological needs.

Appropriate, compassionate and effective communication skill in person-centred care

In order to deliver person-centred care to Keisha, the nurses are to show effective interpersonal skills and knowledge related with the care delivery. According to Hardman and Howick (2019), demonstration of empathy to understand the patient’s views, feeling and perspective is essential. This is because empathy leads the nurses develop a strong and trustful relationship with the patients by focussing on the view point of the patient. Thus, nurse to deliver enhanced person-centred care to Keisha required having effective empathetic skill. As mentioned by Boström et al. (2020), presence of effective communication skill is important for the nurses in delivering person-centred care. This is because through effective interaction with the patients, the nurses are able to share information to the patients, know choice regarding their care and recognise their emotional concerns to be resolved regarding care. Thus, the nurses to provide person-centred care to Keisha, they are required to have effective verbal and non-verbal communication skills. As argued by Wheat et al. (2018), lack of effective coordination skill for the nurses and healthcare professionals in person-centred care leading them to fail in providing the care. This is because without coordination between patients and the nurses along with other professionals, specific are for the patient cannot be organised. Therefore, coordination skills to be able to work in multi-disciplinary team and through partnership with patients are essential for the nurses to deliver person-centred care successfully to Keisha.

Conclusion

The above discussion informs that NMC Code of Practice along with Mental Health Act 2015 and Data Protection Act 1998 are to be abided in delivering legal and ethical nursing care to Keisha. In addition, the principles of person-centred care such as treating patients with dignity, personalised care delivery, freedom of choice and others to be abided to deliver successful person-centred care to Keisha by the nurse on hospitalisation. The biopsychosocial model of care is been abided to determine holistic care needs of Keisha regarding her health. The multi-disciplinary team who are required to act with the nurse caring for Keisha in delivering successful person-centred care to her includes physical therapist, dietician, psychiatrist and others. The development of effective partnership with Keisha is required to be developed by the nurse in delivering person-centred care. The interpersonal skills such as empathy, compassion, communication and others are essential to be present for the nurse to deliver successful person-centred care to Keisha.

References

• Barnable, A., Cunning, G. and Parcon, M., 2018. Nursing students’ perceptions of confidentiality, accountability, and e-professionalism in relation to facebook. Nurse Educator, 43(1), pp.28-31.
• Boström, E., Ali, L., Fors, A., Ekman, I. and Andersson, A.E., 2020. Registered nurses’ experiences of communication with patients when practising person–centred care over the phone: a qualitative interview study. BMC nursing, 19(1), pp.1-8.
• Caples, M., Martin, A.M., Dalton, C., Marsh, L., Savage, E., Knafl, G. and Van Riper, M., 2018. Adaptation and resilience in families of individuals with down syndrome living in Ireland. British Journal of Learning Disabilities, 46(3), pp.146-154.
• Chawla, J.K., Burgess, S. and Heussler, H., 2020. The impact of sleep problems on functional and cognitive outcomes in children with Down syndrome: a review of the literature. Journal of Clinical Sleep Medicine, pp.30-86.
• Dekker, A.D., Sacco, S., Carfi, A., Benejam, B., Vermeiren, Y., Beugelsdijk, G., Schippers, M., Hassefras, L., Eleveld, J., Grefelman, S. and Fopma, R., 2018. The behavioral and psychological symptoms of dementia in down syndrome (BPSD-DS) scale: comprehensive assessment of psychopathology in down syndrome. Journal of Alzheimer's Disease, 63(2), pp.797-819.
• Demirsoy, N. and Kirimlioglu, N., 2016. Protection of privacy and confidentiality as a patient right: physicians' and nurses' viewpoints. Biomedical Research 2016, 27 (4), pp.1437-1448.
• Ersoy, S.A., Güler, H.A. and Çetin, F.H., 2018. Psychopathology in Down syndrome. Advances in Research on Down Syndrome, p.17.
• Habib-Hasan, Z., Sheikh, M.S., Hoodbhoy, Z., Azam, I. and O’Neil, M., 2020. Early intervention physical therapy using “Parent Empowerment Program” for children with Down syndrome in Pakistan: A feasibility study. Journal of Pediatric Rehabilitation Medicine, (2), pp.1-8.
• Hardman, D. and Howick, J., 2019. The friendly relationship between therapeutic empathy and person-centred care. European Journal for Person Centered Healthcare, 7(2), pp.351-357.
• Kadri, A., Rapaport, P., Livingston, G., Cooper, C., Robertson, S. and Higgs, P., 2018. Care workers, the unacknowledged persons in person-centred care: A secondary qualitative analysis of UK care home staff interviews. PLoS One, 13(7), p.e0200031.
• Karges, B., Schwandt, A., Heidtmann, B., Kordonouri, O., Binder, E., Schierloh, U., Boettcher, C., Kapellen, T., Rosenbauer, J. and Holl, R.W., 2017. Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes. Jama, 318(14), pp.1358-1366.
• Lao, P.J., Handen, B.L., Betthauser, T.J., Cody, K.A., Cohen, A.D., Tudorascu, D.L., Stone, C.K., Price, J.C., Johnson, S.C., Klunk, W.E. and Christian, B.T., 2019. Imaging neurodegeneration in Down syndrome: brain templates for amyloid burden and tissue segmentation. Brain imaging and behavior, 13(2), pp.345-353.
• Lautarescu, B.A., Holland, A.J. and Zaman, S.H., 2017. The early presentation of dementia in people with Down syndrome: a systematic review of longitudinal studies. Neuropsychology review, 27(1), pp.31-45.
• legislation.gov.uk 1983, Mental Health Act 1983, Available at: https://www.legislation.gov.uk/ukpga/1983/20/contents [Accessed on: 25 September 2020]
• legislation.gov.uk 1998, Data Protection Act 1998, Available at: https://www.legislation.gov.uk/ukpga/1998/29/contents [Accessed on: 25 September 2020]
• McCormack, B. and McCance, T., 2016. Underpinning principles of person-centred practice. Person-centred practice in nursing and health care: Theory and practice, 2, pp.13-36.
• Mortimer, G.L. and Gillespie, K.M., 2020. Early Onset of Autoimmune Diabetes in Children with Down Syndrome—Two Separate Aetiologies or an Immune System Pre-Programmed for Autoimmunity?. Current Diabetes Reports, 20(9), pp.1-9.
• NHS 2019, Low blood sugar (hypoglycaemia), Available at: https://www.nhs.uk/conditions/low-blood-sugar-hypoglycaemia/#:~:text=A%20low%20blood%20sugar%2C%20also,usually%20treat%20it%20easily%20yourself. [Accessed on: 25 September 2020]
• NICE 2015, Type 1 diabetes in adults: diagnosis and management, Available at: https://www.nice.org.uk/guidance/ng17/ [Accessed on: 25 September 2020]
• NICE 2016, Mental health problems in people with learning disabilities: prevention, assessment and management, Available at: https://www.nice.org.uk/guidance/ng54/evidence/full-guideline-pdf-2612227933 [Accessed on: 25 September 2020]
• NICE 2019, Learning disability: care and support of people growing older, Available at: https://www.nice.org.uk/guidance/qs187/chapter/quality-statement-1-person-centred-needs-assessment#quality-statement-1-person-centred-needs-assessment [Accessed on: 25 September 2020]
• NMC 2018, Professional standards of practice and behaviour for nurses, midwives and nursing associates, Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on: 25 September 2020]
• Ptomey, L.T., Szabo, A.N., Willis, E.A., Greene, J.L., Danon, J.C., Washburn, R.A., Forsha, D.E. and Donnelly, J.E., 2018. Remote exercise for adults with down syndrome. Translational Journal of the American College of Sports Medicine, 3(8), p.60.
• Raj, S., Stanley, M., Mackintosh, S. and Fryer, C., 2020. Scope of occupational therapy practice for adults with both Down syndrome and dementia: A cross‐sectional survey. Australian Occupational Therapy Journal. 67(3). pp.20-34.
• Rajabpour, S. and Rayyani, M., 2019. The relationship between Iranian patients’ perception of holistic care and satisfaction with nursing care. BMC nursing, 18(1), pp.1-7.
• Santos, J.C., Bashaw, M., Mattcham, W., Cutcliffe, J.R. and Vedana, K.G.G., 2018. The biopsychosocial approach: towards holistic, person-centred psychiatric/mental health nursing practice. In European Psychiatric/Mental Health Nursing in the 21st Century (pp. 89-101). Springer, Cham.
• Scott, S.N., Christiansen, M.P., Fontana, F.Y., Stettler, C., Bracken, R.M., Hayes, C.A., Fisher, M., Bode, B., Lagrou, P.H., Southerland, P. and Riddell, M.C., 2020. Evaluation of factors related to glycemic management in professional cyclists with type 1 diabetes over a 7-day stage race. Diabetes Care, 43(5), pp.1142-1145.
• Srulovici, E. and Drach-Zahavy, A., 2017. Nurses’ personal and ward accountability and missed nursing care: A cross-sectional study. International journal of nursing studies, 75, pp.163-171.
• Wheat, H., Horrell, J., Valderas, J.M., Close, J., Fosh, B. and Lloyd, H., 2018. Can practitioners use patient reported measures to enhance person centred coordinated care in practice? A qualitative study. Health and quality of life outcomes, 16(1), p.223.
• Wolf, A., Moore, L., Lydahl, D., Naldemirci, Ö., Elam, M. and Britten, N., 2017. The realities of partnership in person-centred care: a qualitative interview study with patients and professionals. BMJ open, 7(7), p.e016491.

Continue your exploration of promoting language learning and cultural exploration in esol education with our related content.