Effective Decision-Making for the Care of Edith

The proper decision-making process is important in mental and physical health assessment because it leads to develop effective organisation and planning of care as well as provide clear direction to the nurses regarding the way they are to work to ensure better health of the patient. In this assignment, Edith needs are to be identified by effectively establishing communication with her through use of SOLER model and Welsh language interpreter. The identified needs are to be addressed and care is to be implemented for Edith through multi-disciplinary and collaborative approach along with using clinical reasoning, evidence-based practice, ADPIE model and others. In the given case study, it has been found that Edith is showing confusion and agitated behaviour due to dementia along with UTI (urinary tract infection) which is making her behave in an improper way as well as it is hindering her health condition. Thus, development of effective decision-making for the care of 72-year-old patient named Edith is significant in this assignment because it would help her develop improved cognitive and emotional skill, resolves her agitation, improve her memory skills and others that are going to create better holistic health condition for her to live a better life.

The theory of decision-making informs that nurses and health professionals are required to develop effective decision regarding care for the patients based on rational thinking and shared judgement made by involving various professionals, patients and family members of the patients (Shaban, 2015). This is because such care decisions are developed based on the preferences of patients as well as effective ideas of experienced professionals which ensures proper satisfaction and improved health of the patient. In the UK, it is informed that 42,000 people out of 850,000 individuals are affected by dementia and most of the people affected are above the age of 65 years. It is predicted that by 2015 the numbers are going to rise to 1 million (alzheimers.org.uk, 2018). Thus, the figures inform that wide incidence of dementia is to be faced in the UK in the coming years. The case study presented in the assignment is of an elderly patient named Edith of 72 years age affected with dementia and UTI. The case study is important as it is to be used for the development of evidence-based holistic care for the person providing scope to get informed about the way to care for dementia patients so that the increased prevalence can be reduced in the UK.

According to Data Protection 1998, the personal data of the individuals are to be protected effectively and not to be made public without the prior information of the owner (legislation.gov.uk, 1998). Thus, to protect the identity of the patient the pseudonym Edith Jones has been used in the case study. The decision-making for Edith’s care is to be executed through the collaborative approach of the multi-disciplinary team, health practitioners, local authority and social services as well as others. The key aim of care decision-making for Edith is to meet her biological and social needs as well as reduce co-morbid health issues seen in her as a result of dementia. The dementia is referred to the diseased condition in which the individual's brain cells are damaged leading the person to develop inability to solve problem, memorise, execute everyday activities and others (Ueno et al. 2016). As mentioned by Jack Jr et al. (2018), the biological needs of individuals involve those that are essential for the person to live in a healthy way. This means it involves the needs that are related to the proper functioning of the biological system of the body. The case study of Edith Jones informs that the person is not taking proper amount of food required to ensure her nutrition. Moreover, she is reported to spill water over her dress and has left the half glass of water on the table. The situation indicates that she may also be avoiding intake of proper amount of water to maintain her hydration.

The intake of proper amount of food is required to ensure the presence of essential nutrient in right amount required by the individual for proper functioning of the body organs (Papachristou et al. 2017). Thus, one of the biological needs of Edith is that she is required to be provided proper amount of food. In addition, she needs proper intake of water to maintain hydration of the body. The case study informs that Edith is facing UTI (urinary tract infection). The Urinary Tract infection (UTI) is the presence of microbes mainly bacteria in the urinary tract of individuals (Saint et al. 2016). As commented by Whiteside et al. (2015), intake of increased amount of water helps to avoid UTI. This is because the increased water helps to flush out bacteria avoiding them to remain in the bladder to cause infection. Thus, Edith’s one of the biological needs at the present is intake of proper amount of water to avoid further relapses of UTI.

The social needs are referred to the relationship of love, intimacy, family and others (Laybourne et al. 2016). In the case study, it is seen that Edith is experiencing issues with social communication with the carers as they are not fluent in the Welsh language. Thus, one of the key social needs of Edith is that she is to be provided with a language interpreter through liaising with the social services so that the interpreter can speak in the language to be understood by Edith to make an informed decision regarding her care. The case study informs that Edith is showing agitated and restless behaviour as well as unable to remember her grandchildren which are leading her son Brain to experience distress in communicating with her. Thus, the current social need of Edith is that she is to be assisted to improve her behaviour and memory skill to ensure maintaining better relationship with Brian.

The Mental Health Capacity Act 2005 informs that people affected by mental illness are to be included in the care decision-making and empowered to decide so that their needs and demands can be effectively fulfilled. In case the mentally ill individual is unable to make informed decision, the family members of the patient are to be allowed to take care decision on the patient’s behalf (legislation.gov.uk, 2005). Thus, according to the Act irrespective of mental health of Edith she is to be allowed and empowered to take care decision on her own. This is to be done by explaining her in details regarding the need as well as the care types available to resolve her health condition so that she can accordingly make informed decision regarding which are to avail to ensure her good health. In order to provide care to Edith, the confusion in decision-making is going to rise because she is found to be unable to think and memorise properly in making proper decision regarding her care plan. Moreover, she is reported being unable to understand English due to which information sharing to make proper decision through the involvement of Edith would lead to confusion in deciding care for her. This is because she may not be able to make the right choice regarding her care being unable to understand the information for care types and needs.

The case study informs that Edith is suffering from dementia and is recently released from the hospital after treatment of UTI and acute confusion. According to NICE, the people affected by delirium shows features such as impaired memory, disorganised thinking and fluctuating awareness regarding surroundings (NICE, 2010). The older people with dementia develop delirium on getting affected by UTI because the bacteria in the urine cross the blood-brain barrier which leads them to infect the brain functioning of the individual making them show hindered cognitive skills (Steis et al. 2015). Thus, the information indicates that Edith is suffering from delirium as she is showing agitated and confused behaviour which also indicates that she is suffering from UTI for which she requires immediate assistance. In order to offer effective care to Edith to meet her needs, person-centred care approach through evidence-based practice is to be implemented. The NMC Code informs that person-centred care is to be provided by keeping the patient in the middle of the care decision and acting in their best interest. The Code also informs that health professionals are to develop their care based on the currently available best evidence (NMC, 2015). Thus, it informs that to provide evidence-based person-centred care to Edith the nurses requires analysing the current evidence regarding care for dementia and UTI as well as use the information to access informed decision from Edith and her family regarding her care.

The Care Act 2014 informs that patients are to be empowered to take personal decision, preventive actions are to be taken before harm to the patients, least intrusive responses are to be made for the risk, patients are to be protected and through partnership as well as effective accountability health professionals are to offer effective care to the patients (legislation.gov.uk, 2014). Thus, according to the Act, the nurses need to make sure Edith’s safety is ensured so that any risk or harm to the individual can be avoided. They can ensure the safety of the patient during emergency and risk by immediately reporting the incidence and causes which lead to make the patient vulnerable to harm to their manager and responsible authorities who are able to take effective action to ensure safety of the patient. Moreover, the nurses required to immediately remove the patient from the surrounding which is violating the individual’s safety (Jongsma et al. 2016). The case informs that Brian who is Edith’s son is distressed with the current condition of her mother Edith where she mentions forgetting about his marriage and children. The patients with dementia develop memory issues because the brain cells are damaged (Ueno et al. 2016). This information is to be presented to Brian through proper evidence to mention him that he need not be distressed as it a common symptom of dementia and require to make sure he takes effective steps to ensure his mother’s care to improve her condition.

The clinical reasoning informs the process through which health professionals by identifying signs and symptoms of health of patients understand their medical condition and accordingly plan effective medical intervention by evaluating the outcome to ensure improved health to the individuals (Alfaro-LeFevre, 2015). The effective clinical reasoning is essential so that specific health complications of the patient can be understood based on which evidence-based person-centred care is to be arranged. As stated by Kales et al. (2015), people suffering from dementia shows symptoms such as forgetfulness, increased confusion, inability to execute everyday task and others. In case of Edith, it is seen that she is unable to remember days or her grandchildren express agitated behaviour, unable to do everyday chores such as bathing and cooking food without help and others. Thus, the clinical reasoning of Edith informs that she is suffering from dementia as she shows most of the symptoms of the disease. (Refer to Appendix 1)

The nurses to ensure providing holistic care to Edith require using the ADPIE process. The ADPIE process involves assessing, diagnosing, planning, implementing and evaluating the care process to ensure offering proper treatment to the patients (Lindo et al. 2016). In order to make effective assessment is made through participation of the patient, Egan's SOLER communication model is to be used. The SOLER model informs that person while communicating with others require to sit squarely, maintain open posture, lean forward, maintain eye contact and relax (Kay, 2018). This is because it ensures the person is actively listening to the information mentioned by the speaker. Thus, the nurses and health professionals while assessing Edith require communicating with her in the mentioned ways in SOLER model so that she understands that she is being actively listening ensuring effective participation before and during assessment. This is because when people are actively listened they feel being valued and respected making them show cooperation with the health professionals in accessing care (Mohammadipour et al. 2017). (Refer to Appendix 2)

The assessment includes a thorough examination of the patient to identify the individual's health complication (Oostra et al. 2019). The health assessment of Edith informs that she avoids eating, showing memory issues, unable to perform daily activities, expressing delirium and others. The patients when feel depressed avoid eating and showing proper compliance to accept care (Lopez and Molony, 2018). Thus, Edith’s non-compliance to accept care and eat properly may be because she is depressed as a result of her current health condition. The diagnosis involves identifying the nature of the disease the patient is suffering through analysis of the identified symptoms (Oostra et al. 2019). As mentioned by Park et al. (2017), delirium can rise among patients due to polypharmacy which means simultaneous delivery of many drugs to treat a single health complication. This leads to the assessment that Edith may have developed delirium as a result of polypharmacy and UTI. Thus, a single effective medication is to be offered to her at the present along with indicating ways she can treat UTI.

The Mini Mental State Examination (MMSE) is developed by the Alzheimer's Association who has the key objective to develop advanced research so that enhanced care and support can be provided to patients suffering from dementia to reduce the incidence of the disease as well as promote better brain health. The MMSE score of 13-20 indicates that the individuals are suffering from mild dementia (ALZ, 2019). The case study informs that Edith has 19 which led to the assessment that she is suffering from mild dementia. The Montreal Cognitive Assessment (MoCA) Scale is used for examining the extent of cognitive impairment present among individuals. The benefit of using this scale is that it offers reliable and simple testing for Alzheimer’s disease along with it is cost-effective tool to be used (Goldstein et al. 2014). Thus, the nurses require using MoCA assessment tool instead of MMSE to diagnose the extent of cognitive impairment in Edith as it is cost-effective, reliable and simpler tool to be used.

The urine culture test is to be performed and body to identify urinary tract infection (Puig-Asensio et al. 2017). Thus, the nurses require performing urine test for Edith to ensure her UTI. Moreover, it is informed that elderly people suffering from dementia shows delirium when they are affected by UTI due to damage of the brain functioning (Haruta et al. 2019). Thus, it informs that she is suffering from UTI (urinary tract infection). The Malnutrition Universal Screening Tool (MUST) is a nutrition screening tool for the elderly which includes five steps that are measuring BMI rate, noting percentage of unplanned weight loss, develop acute disease score, add the scores from1, 2 and 3 steps and finally develop care plan (Sandhu et al. 2016). The MUST tool is to be used for diagnosis of the nutritional health condition of Edith to help the dietician and nurses in the MDT in developing an effective diet plan for Edith to ensure her good health.

The planning is the process of developing care support that is to be put into action in the implementation phase (goode Jr and O’Donnell, 2015). This informs that nurses and health professional according to the diagnosis of Edith require planning to offer her accurate medication to control dementia and treat UTI. Moreover, in this phase, they are to consult with the Multi-disciplinary team to determine the nature of diet to be provided to Edith to ensure her improved physical and mental health. The Mental Health Capacity Act 2005 informs that informed consent from the patient along with whom the patient wish to include from the family in decision-making for their care is to be known by the health professional and nurses (legislation.gov.uk 2005). Thus, while planning care for Edith she is to be properly communicated about the care options she can avail so that she can make informed decision. Moreover, she is to be asked if she wish to include her son in making decision regarding her care during planning. The case study informs that Edith is not fluent in English and speaks welsh. Thus, the nurses require arranging a language interpreter for her to ensure effective communication with her and her family is made in framing the care plan.

During planning to offer medication to Edith, the CHMT is to be consulted. The Community Mental Health Team (CHMT) is referred to the multidisciplinary team including psychologist, psychiatrist, medical officers and others who offer effective services to the mentally-ill individuals for improving their health (Piercy et al. 2018). The CHMT is to be consulted before prescribing rivastigmine to Edith so that they can ensure whether it is effective to be prescribed to Edith and the nature of care in respect to the medication is to be provided to Edith to control the side effects. This is because rivastigmine is provided to patients to resolve the confusion which arises as an effect of dementia and its side effects include weight loss, vomiting, headache, abdominal pain and others (Kandiah et al. 2017). The case study informs that Edith is not taking proper amount of food and fluid as food is left at the kitchen uneaten and tea is left in the pot along with water is left in the glass with half of it being spilled in her dress. Thus, while planning care the nurses require collaborating with the social services to recruit a social carer who can monitor the food and fluid intake of Edith to ensure her proper nutrition is maintained. The nutrition chart and fluid intake amount are to be recommended by the dietician by evaluating the health condition of Edith.

The foods such as raw leafy greens, nuts, beans, whole grains and others are to be provided to patients to help them fight dementia (Fischer et al. 2018). The intake of a minimum of 2 litres of water is suggested to elderly patients to avoid them from developing UTI (Al-Berfkani et al. 2016). Thus, the diet plan for Edith is required including the foods mentioned for fighting dementia and UTI to ensure her good health. The plan is to be framed by the dietician by consulting with Edith when she is less agitated to identify her preferences. Moreover, the dietician needs to consult with Brian who would inform about his mother's preferences food that is to be included in the diet chart to ensure Edith takes in proper amount of food. The food preferred for Edith from the diet chart is to be identified through discussion by the carer while she is less agitated to be able to develop meals that are wished to be eaten by her to ensure good nutritious health. In the implementation stage, the care plan developed through consultation of MDT, health professional, Edith and her family is to be implemented to offer her support. In the evaluation stage, the care offered is analysed to identify its effect on the patient and the further changes to be made to ensure better care (goode Jr and O’Donnell, 2015). Thus, in evaluation stage, the carer offering support to Edith require to evaluate her health condition on receiving the care and develop information about the changes to be made to ensure better well-being of the patient.

The National Early Warning Score (NEWS) 2 is referred to as an evidence-based tool that is developed to advocate the system for standardised examination and response to patients with acute illness. The NEWS 2 focuses on providing score for six psychological parameters which are oxygen saturation, respiration rate, systolic blood pressure, temperature, pulse rate and level of consciousness (rcplondon, 2017). The NEWS 2 tool is to be used for Edith to evaluate her body temperature after care for identifying whether she is still affected by UTI or not. This is because patients suffering from UTI are found to have high body temperature due to the presence of bacterial infection in the bloodstream (Schultz et al. 2016). Moreover, in the evaluation stage, the blood pressure of Edith is to be checked. This is because rivastigmine raises the blood pressure of the patient as a side-effect which may lead the patient to experience heart attack or stroke (Suzuki et al. 2017). Thus, based on the information the medicine can be changed accordingly to ensure better health of Edith.

The assessment of the vital signs of the patient is important to understand their health performance and diagnose their health complications (van den Elsen et al. 2015). However, it is found that Edith often avoids allowing her vital signs to be taken by the nurses. The Mental Health Capacity Act 2005 informs that it is the right of patient to avoid any form of care and it is to be accepted (legislation.gov.uk, 2005). Thus, the health professionals require consulting with Brian to determine when Edith remains calm so that at that time her vital signs may be recorded to help them assess her health condition. As mentioned by Tobiano et al. (2016), patients prefer accepting care from a certain individual and avoid cooperating when the care is provided by others. This informs that Edith is to be asked regarding her preference of the person who can check her vital signs so that effective evaluation of her health can be made before and after the care administration for understanding the way further care is to be provided to her to ensure her well-being.

Conclusion

The above discussion informs that Edith is the pseudonym used by the health professionals to indicate the patient to maintain confidentiality. Edith is mentioned to be suffering from depression, dementia and UTI and the evidence-based person-centred care is offered to her to ensure her better health condition. The evidence-based person-centred care is important to avoid medication errors and better health improvement along with the satisfaction of needs of the patient. The ADPIE process is to be used for offering holistic care to Edith and in the process SOLER model is used for developing communication with the patient. Moreover, it is suggested that language interpreter is to b used to communicate with her as cannot fluently speak or understand English. The Mini Mental State Examination (MMSE) tool and Montreal Cognitive Assessment (MoCA) tool are used along with urine test and body temperature examination is done for health diagnosis of Edith. In the planning stage, the MDT, CHMT, dieticians, health professionals, Edith’s family members and Edith are included to develop the care plan. Edith is provided rivastigmine to treat dementia and proper food, as well as fluid intake directions, is provided to meet her nutritional needs and resolve UTI. The NEW2 tool is used to understand which vital psychosocial parameters are to be assessed to evaluate the health condition after the care delivery to Edith.

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Appendix 1

The elderly individual with UTI show delirium which indicates the person shows sudden mood changes, agitation, refusal in cooperating with care and others (Chae and Miller, 2015). Thus, the clinical reasoning also informs that Edith is suffering from UTI as she is reported to show agitated behaviour and often show mood changes along with avoid cooperating to access support from the carers by pushing them away. As commented by Mukaetova-Ladinska et al. (2017), critical thinking in care decision is essential as it helps to analyse and evaluate the health issues of the patient to reach an effective judgement of care. The nurses can apply critical thinking to develop proper decision regarding the care of patients like Edith by effectively identifying, examining and analysing her health condition to reach proper decision regarding which care is to be offered for which health complication identified to ensure improved health of the individual.

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