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Discuss about the Effect Of Person-Centred Care On Resident And Staff.

Relevance of Issue

PHC Nursing Ix

Evidence Based Practice Rationale

Referral

Issue One: Impact of Diagnosis

Parkinson's disease (PD) is a debilitating and a complex condition that needs an individualised nurse care fitted to symptoms and improves the life. The disease affects mostly old people of over 60 years old. The effect of Parkinson's disease are both motor and non-motor symptoms makes it difficult for the patient to undertake his or her daily living activities. Parkinson's disease is known to be a movement disorder as it impairs movement. What it causes is known to be a result of insufficient dopamine which is produced by the death of nerve cells in the brain. Change becomes slower in the absence of dopamine.  Such a case affects the patient's personal and social duties a lot (Halter, 2017).

            Medication is the best option of treatment in such a situation in which Patrick has just commenced to medicines like levodopa 500 grams three times a day and clonazepam 0.5 grams nocturnal. The disease affects person's emotional, mental and physical wellbeing and it brings impact to one's lifestyle. Due to a wide range of service needed for Patrick's care regarding his age and the disease condition, a nurse specialist is required to act as a coordinator of Patrick's hospital and community services.   Patrick needs a GP and pharmacist intervention to provide with all essential primary healthcare services.

1a. The nurse has to stay close to Patrick's environment to monitor and manage instances like sleep disorder. At early stages of the disease, sleeping disorders have a significance on caregivers and also to the patient's nurse. The moods and other influential effect reveal the fundamental issues of distress and depression which interferes with quality sleep.

            Clear communication is a factor to consider when handling a Parkinson's disease patient. Asking the patient about rigidity, stiffness, balance, tremor and slow movement is very important. The language in which a nurse uses in asking such questions matters a lot (Wildevuur & Simonse, 2015).

1b.   For example, the patient would relate the term "shake" with the term tremor of "feeling dizzy" with "falling backward". Old people like Patrick lose their balance quickly especially when they stand up or stand for too long. It is the role of the medical practitioner to know if the patient feet become stuck when he is trying to walk if he feels stiff, achy or is experiencing any pain while moving. Asking readily obvious questions assesses the motor symptoms and provides significance effect on daily functions. Referring a patient for further medical treatments and instructing him and his family to prefer shoes with even gliding soles to shoes that are tricky and sticky to the floor (Olde-Rikkert, Long, & Philp, 2013). Good communication enables both the patient and family members to understand and have a knowledge of disease progression. 

WHO: A GP and pharmacist.

WHY: For Patrick’s clinical management. Accurate diagnosis, initiate treatment and devise a treatment plan. A pharmacist to help Patrick on the medicinal prescription and advice on any change in dosage according to the disease conditions.

WHEN: At the early stage of Parkinson’s disease.

HOW: Booking an appointment as the patient’s condition is not too severe.

2a. In medication considerations, registered nurse should ensure the patient take medicine prescribed by the pharmacist and guide him to avoid the risk of forgetting. The best way for Patrick to prevent further complications or side effect is to follow the pharmacist medical instructions.

2b. The nurse should adjust the medication timing to help in eliminating troubling symptoms. It's always recommended to ask the patient about the type of medications that useful in managing rare case like trembling for example levodopa (Kuntz et al, 2014).

3a. The nurse is supposed to evaluate and examine the feeling of Patrick after his physical exercises (Young, Miyamoto, Ward, Dharma, Tang-Feldman, & Berglund, 2014). Running 5 kilometres a day is a good physical exercise to Patrick. The nurse has to find some companions or some people most probably his husband or age mates to encourage and accompany him in such running activities. The purpose of running mates is to help Patrick on the way in case of any arising complications. A particular study showed that in the middle if Parkinson's disease moods and motor functioning can be improved through sports activities.  

3b. The timing of a PD medication about physical health exercises according to the age of the patient helps in achieving maximum benefits from the program. As a nurse, one's supposed to seek for a senior exercise program in the community recreation centres to promote specialisation and give the caregivers and the family a relief. The referral is necessary to a Parkinson's patient if the symptoms management are at optimum and are not easily controlled through nurse close contact interventions with the patient. Patrick's husband who is very supportive is made aware of the referral to be responsible (Hibbard & Greene, 2013).

4a. In such a case of Patrick condition, the role of the nurse to use Parkinson's disease Rating Scale for assessment and plan and document on the care required.  It is the nurse specialist to have direct or indirect contact with Patrick behaviours from the time of diagnosis to the time of palliative care.   

4b..  A nurse plays a role in primary healthcare intervention by providing emotional support and when necessary see the patient to a professional counsellor. Well, documentation and planning strategies help the nurse in planning the essential care and quality healthcare services. Treatment starts with accurate assessment (Entwisted & Watt, 2013).  

Issue Two: Safety Considerations for Patrick

 In helping a Parkinson's patient, the health professionals need to work and be collaborative as a multidisciplinary team. The condition of Patrick where he is experiencing symptoms of slight tremor, poor sleep quality and decreased the sense of smell require a registered nurse for proper monitoring and medication purpose. Other effect that a PD patient experiences are depression, anxiety and cognitive impairment and they require a specialist care such as registered nurse to help the patient in management and control.

5a. A Parkinson's disease patient experiences depression. It occurs both at early and advanced stages of the disease resulting in significant disability. The fundamental way of managing depression in a PD patient include; counselling of both caregivers and the patient and involving non- pharmacological interventions. Use of Parkinson's disease (PD) medication with the antidepressant ability is recommended.

5b. In a randomised study, it was shown that dopamine agonist pramipexole evaluated in a 12- week control PD patient depression conditions. Nefazodone and venlafaxine are some of the antidepressants that are recommendable to Patrick condition. If the situation becomes severe or resistance to depression, he is referred to higher medical practitioners.

WHO: Psychiatrist

WHY: Psychiatrist helps the Parkinson’s patient who has mental problems such as dementia, depression and anxiety.

WHEN: The best time to refer the Parkinson patient to a psychiatrist is when a nurse notices some change in cognitive behaviour and emotional effect.

HOW: The patient has visit the doctor so transport arrangement are done through a local transport vehicle according to financial capability of the family.

6a. Anxiety experiences of Parkinson's disease range in seriousness from mild to full-blown attacks. As in Parkinson's patient with depression, non- pharmacology intervention such as cognitive, counselling and behaviour therapy are given the considerations.

6b. Exercise daytime napping is discouraged. Little exercise programs the PD patient with insomnia. The condition of Patrick as it advances to Excessive Daytime Sleepers (EDBS) and sudden-onset slumber hurt the quality of his life. There is a need to encourage him and his family to seek constant assistance advice from consulting neurologist. The presence of several disorders alarms Patrick to halt his job as a primary school teacher to maintain his health. It is because PD patient does not require strenuous exercises (Brownie & Nancarrow, 2013).

Referring the patient a psychiatrist counsellor to help Patrick in cognitive behavioural therapy such as anxiety is the best way of handling the emotional effect. This can be achieved through assessment of the carers needs.

7a. Cognitive impairment and dementia which are likely to affect Patrick brought significance effect on occupation and social activities and increased a burden to the caregiver.

7b.One research has shown that dementia of PD is heterogeneous which reflect a wide range of cognitive deficits. Art therapy, music and cognitive therapy in connection with physical activity are some of the non-pharmacological interventions.  The study report showed that 50-mg dose in nocturnal sleep time improves the overall sleep quality by 5-mg dose. No taking of caffeine at evening and after menus (Olsson, Jakobsson, Swedberg, & Ekman, 2013).

8a. Patrick tremor condition can be execrated by Acetylcholinesterase (AChELs). While offering treatment with (AChEIs), a Parkinson’s practitioner has to ensure careful monitoring of some adverse events and worse motor symptos. Patrick's neurologist recommended his to start using levodopa 50mg three times a day, and clonazepam 0.5 mg nocturnal carbidopa and placebo are both administered during bedtime improves nocturnal akinesia and increase sleep time.

8b. The Parkinson's condition includes problems with planning, working memories and learning.  Patrick does experiences sleep disorders, ocular movement and acting out of dreams (Gil-Montoya, de Mello, Barrios, Gonzalez-Moles & Bravo, 2015). In a study non- significance increase in the sleeping period due to hypnotic agent eszopicion and placebo. It was found that the quality of sleep and the number of awakening were improved by eszopiclone group.

Issue Three: Maintaining Patrick’s Dignity

. The disease lowers the dignity of an individual as it results in different family problems of life such as loss of occupation, marital conflict, social isolation, low income and early retirement. Also, the PD progress brings about a burden to the patient and the caregivers. Relevance databases have been assessed to investigate the appropriate document on active aging in neurogenerative disease notably Parkinson's disease. PD symptoms such as depression, anxiety and stigma affect social interaction and communication of the patient.

9a. Parkinson's disease is involves several management actions: self-centred care, interdisciplinary and multidisciplinary care, palliative, patient-centred care and personalised care. It is advisable to engage the patient of social media groups such as Facebook that discusses about Parkinson’s disease for him to be more aware. The nurse should encourage Patrick to Participate in planned senior community recreation activities. The nurse has to direct and give instructions on how the patient engages in sport activities to avoid any harm  (Hiremath & Mankodiya, 2014, November)..

9b. Motor disabilities can restrain the patient from physical activities together with motor symptoms they worsen the quality of someone's life. In case of Patrick's sleep disturbances, studies shown that melatonin supplement is used to the treatment of Patrick ( Quill & Abernethy, 2013).

WHO: Dietician and occupational therapist.

WHY: Dietician encourages the patient on measures and nutrition-related challenges. Occupational therapist advises the patient on the way that Parkinson’s disease affect one’s everyday life. He or she provides the carers of patient on support information and advices.

WHEN: Dietician is important when the patient age requires more clinical intervention and has shown eating or swallowing difficulties.

HOW:  Booking an appointment with such professional is the best way due to the age of the patient. A Parkinson’s disease has to request for therapist and organize on transportation means for the required therapist.

10a. As a community nurse it is important to consult some community organisations that deals with activities of chronic disease management like In Patrick's situation  (Ballard,  Aarsland,  Francis  & Corbett, 2013). Organising with men’s community groups or Parkinson’s clubs to help Patrick in socialising activities.  

10b.  According to the notion of old age it is revealing to have a well-planned, protected and secure evidence-based care for PD patient whenever they need. The healthcare system is supposed to have well planned, protected and reliable evidence-based care for PD patient to assist them in improving the potential physical activities (Dorsey et al, 2016).

11a. As a nurse, it is essential to encourage Patrick and his family to believe in religious guide power.

11b. Spirituality can give a PD patient strength and hope of improvement to their mental wellbeing. Recent research has shown that patient with PD often relies on religion and spirituality to aid them in coping with physical illness (Reuben et al, 2013). 

12a. The nurse should refer Patrick to a dietary specialist for diet consultation to give a guide and recommend the best diet that improves his life. The dietician will identify on how to minimise some cases like difficulties in swallowing and eating. Dietician will educate Patrick on the importance of foods like increasing vegetables, fibre, fruits and fluid intake which reduces constipation. 

12b. Malnutrition is a prevalent factor shown in PD patient and patient is at high risk of being malnutrilised.  At a time of severity in PD patient where the patient lacks supports at the workplace chances of retirement lead to the early retirement of Patrick. Patrick's family and employer at early stages of the disease had to cope with his condition as he intends to continue with his job before advised to retire by the neuropsychiatric (Tan, Vehviläinen?Julkunen, & Chan, 2014).

References

Ballard, C., Aarsland, D., Francis, P., & Corbett, A. (2013). Neuropsychiatric symptoms in patients with dementias associated with cortical Lewy bodies: pathophysiology, clinical features, and pharmacological management. Drugs & aging, 30(8), 603-611.

Brownie, S., & Nancarrow, S. (2013). Effects of person-centred care on residents and staff in aged-care facilities: a systematic review. Clinical Interventions in Aging, 8, 1.

Dorsey, E. R., Vlaanderen, F. P., Engelen, L. J., Kieburtz, K., Zhu, W., Biglan, K. M., ... & Bloem, B. R. (2016). Moving Parkinson care to the home. Movement Disorders, 31(9), 1258-1262.

Entwistle, V. A., & Watt, I. S. (2013). Treating patients as persons: a capabilities approach to support delivery of person-centred care. The American Journal of Bioethics, 13(8), 29-39.

Gil-Montoya, J. A., de Mello, A. L. F., Barrios, R., Gonzalez-Moles, M. A., & Bravo, M. (2015). Oral health in the elderly patient and its impact on general well-being: a nonsystematic review. Clinical interventions in aging, 10, 461.

Halter, M. J. (2017). Varcarolis' Foundations of Psychiatric-Mental Health Nursing-E-Book: A Clinical Approach. Elsevier Health Sciences.

Hibbard, J. H., & Greene, J. (2013). What the evidence shows patient activation: better health outcomes and care experiences; fewer data on costs. Health Affairs, 32(2), 207-214.

Hiremath, S., Yang, G., & Mankodiya, K. (2014, November). Wearable Internet of Things: Concept, architectural components and promises for person-centered healthcare. In Wireless Mobile Communication and Healthcare (Mobihealth), 2014 EAI 4th International Conference on (pp. 304-307). IEEE.

Kuntz, J. L., Safford, M. M., Singh, J. A., Phansalkar, S., Slight, S. P., Her, Q. L., ... & Hommel, K. (2014). Patient-centered interventions to improve medication management and adherence: a qualitative review of research findings. Patient Education and Counseling, 97(3), 310-326.

Olde-Rikkert, M. G., Long, J. F., & Philp, I. (2013). Development and evidence base of a new efficient assessment instrument for international use by nurses in community settings with older people. International journal of nursing studies, 50(9), 1180-1183.

Olsson, L. E., Jakobsson Ung, E., Swedberg, K., & Ekman, I. (2013). Efficacy of person?centred care as an intervention in controlled trials–a systematic review. Journal of clinical nursing, 22(3-4), 456-465.

Quill, T. E., & Abernethy, A. P. (2013). Generalist plus specialist palliative care—creating a more sustainable model. New England Journal of Medicine, 368(13), 1173-1175.

Reuben, D. B., Evertson, L. C., Wenger, N. S., Serrano, K., Chodosh, J., Ercoli, L., & Tan, Z. S. (2013). The University of California at Los Angeles Alzheimer's and Dementia Care Program for Comprehensive, Coordinated, Patient?Centered Care: Preliminary Data. Journal of the American Geriatrics Society, 61(12), 2214-2218.

Tan, K. K., Vehviläinen?Julkunen, K., & Chan, S. W. C. (2014). Integrative review: salutogenesis and health in older people over 65 years old. Journal of Advanced Nursing, 70(3), 497-510.

Wildevuur, S. E., & Simonse, L. W. (2015). Information and communication technology–enabled person-centred care for the "big five" chronic conditions: scoping review. Journal of medical Internet research, 17(3).

Young, H., Miyamoto, S., Ward, D., Dharmar, M., Tang-Feldman, Y., & Berglund, L. (2014). Sustained effects of a nurse coaching intervention via telehealth to improve health behaviour change in diabetes. Telemedicine and e-Health, 20(9), 828-834.

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