Case Study On Complex Care: Identifying Support Needs And Developing Smart Goals

Students  are  required to  research,  write  a  report  on,  and  present  a  case  study  on  a  client/s  with complex  needs.  Students  need  to  identify  a  case  plan  and  present  issues  for  further  program development. Students will be expecte The work must be fully referenced with in-text citations and a reference list at the end. We recommend you work with your Academic Writing Guide to ensure that you reference correctly. You will find a link to this document on the main page of every unit, under the 'Assessments' section.

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Introduction to Complex Care

Complex Care can be understood as a person-centered approach for healthcare that can be used to address the care needs of individuals suffering from a combination of medical, behavioral or social problems as a result of which they have a very high requirement of healthcare services (Ritchie et al., 2016). Clients receiving complex care can have an ongoing and substantial need for healthcare due to chronic conditions, disabilities or after hospital treatment (Woodgate et al., 2015). This type of care can also be a long term or continued care (Hong et al., 2014). The aim of this study is to present a case study of a client with complex care needs, identifying the complex support needs and developing smart goals and recommendations for implementation of actions.

The case study is of a male client whose name is Bob (name changed), aged 45 years (born on February 1973). He was diagnosed with Mild Learning Disability and eating disorder when he was 8 years old. He was under the care of his mother, who was a single parent. Bob dropped out of school at the age of 14 as he could no longer cope up with the pace of regular classes. His mother who worked as a waitress could not afford special schooling and bob continued his study in community school.

Even though Bob had learning disabilities, he was exceptionally good at art and designing. At the age of 20 years, he started freelancing from his home, designing graphic art for various companies using his computer, a work which he thoroughly enjoyed. Bob’s mother died of a heart attack at the age of 60 years, when bob was 40 years old. Since then he has been taking care of himself and staying alone. Bob has always been withdrawn from others, being shy as a kid and had only a few friends who used to visit Bob after he dropped out from school. He used to go for walks with his friends almost every day.

Since the death of his mother, Bob has become more isolated from others and have stopped meeting his friends or going for walks. Within 4 years, he was diagnosed with Obesity (BMI: 43.4) and the year after that he was diagnosed with Type 2 Diabetes (fasting blood glucose 200/mg/dl and A1C: 6.9%). He spends most of his time working on his computer at home and consuming ready to eat meals which gets delivered to his house. Since the last few days, he is getting frequent headaches and a sharp pain on his knees while moving. On diagnosis it was found that his blood pressure has increased to 140/100.

It is therefore important that the client be educated with the right choice for his diet and the amount of physical activity he needs regularly. Additionally, it is also important that the client be provided psychological support to overcome the demise of his mother and start taking care of him (Eisenberg & Burgess, 2015. Written consent was obtained from Bob for the study.

Case Scenario and Background Information

Complex support needs

Based on the case scenario above, the following support needs can be identified for the client who can be used to improve and maintain the health and wellbeing of the client:

Addressing the deficient knowledge regarding the disease process, treatment and care needs:

It is vital that the client be informed about how obesity and diabetes can impact the health can wellbeing of the client, how these conditions can be treated or its effects managed. Since the client has learning disabilities, it can be assumed that a lack of understanding of the disease and its risk factors could have increased his risks, an aspect that has been supported by many studies. As the client is currently taking care of himself, it is vital that he be made aware of the risk factors so that he can make informed decisions regarding his own health (Siegel et al., 2014).

Reducing the risks of unstable blood glucose:

Since the client has a very high level of blood glucose, it is important to mitigate its risks and prevent any further co morbidities to emerge. It has been pointed out that high concentration of glucose in the blood can increase the risks of conditions such as neuropathy, retinopathy, chronic kidney disease and hypertension. Since the client is already exhibiting signs of hypertension it is vital that the risks of other possible co morbidities be averted. The client should therefore be trained on how to self monitor his blood glucose level and administer medications (Raoufi et al., 2018; Odom et al., 2018).

Preventing risks of foot ulcers and infections:

Patients suffering from diabetes type 2 can have a high risk of foot ulcers and infections due to terminal neuropathy that causes reduced sensations of the foot as well as due to the reduced ability of the wounds to heat itself. Additionally, problematic posture and obesity can also increase the risks of foot injuries (Jeffcoate et al., 2016). It is therefore necessary that necessary precautions and preventative measures are taken to prevent the risks of such conditions for the patient and the patient be educated on strategies that can be used to care of wounds and prevent the risks of foot ulcers and infections (Dorresteijn et al., 2014; Van Netten et al., 2016).

Providing psychological and social support:

Different studies have shown that social isolation can increase risks of various mental health conditions as well as increase the risks of physical health issues. The client shown signs of social isolation, depression and anxiety due to which it is vital that he is given psychological support that can help him to overcome the negative though processes and start taking care of his own health can and wellbeing and make healthy lifestyle choices for himself (Turnbull, 2016; Himes et al., 2015).

Balanced Nutrition:

The client also need support to have access to healthy diet choices which includes diet high in fiber and low on fats and carbohydrates. It has been supported by various studies that unhealthy food can greatly increase the risks of obesity and diabetes as well as its co-morbid conditions. Since the client currently has a very high consumption of unhealthy food, it is vital that he be supported to change his food habits to a healthy diet (Franz et al., 2015; Evert et al., 2014).

Identifying Complex Support Needs

Smart Goals:

Better understanding of the health conditions and strategies to mitigate and manage its impacts:

Specific: The client can be provided information on how his lifestyle has increased his risks of obesity and diabetes and how by increasing his physical activities and changing his diet he can mitigate further complexities and improve his health and wellbeing. The client can also be educated on the medications he would need to continue a healthy life and how to administer them. Exercise routines can be taught to the client, which he can perform every day.

Measurable: The effectiveness of the strategy can be measured through the ability of the client to follow a healthy diet and exercise routines. A reduction in sedentary time, increase in physical activities, reduced consumption of unhealthy food and increased consumption of healthy food with high fiber content can be the measures for the success of this strategy.

Attainable: Since the client already shows concerns regarding his health and wellbeing, it is possible that he will follow the strategies to improve his health. Additionally, the instructions shall be given in a simple way, supported by printed handouts to aid his memory and regular visits from the nurse to ensure he is following the same (Spassiani et al., 2016).

Relevant: The relevance of the goal is that it can help the client to take care of himself in a better manner.

Timely: The intervention will continue for 12 weeks..

Better ability to self monitor blood glucose levels and administer medications:

Specific: The client will be provided blood glucose monitor and trained on how to use it regularly. Support will also be given to the client to remember how frequently he needs to take the test and how to report the findings to the healthcare provider. Training will also be given to the client to administer some of the medications safely.

Measurable: The efficacy of this strategy can be measured through the ability of the client to monitor his own blood glucose and record them regularly as well as through the ability of the client to take his medications on time.

Attainable: Success can be attained in this strategy by ensuring that the client remembers how and when to check his blood glucose levels and the medications he needs to take (Freckmann et al., 2014).

Relevant: Being able to monitor blood glucose levels can be necessary to understand when the blood glucose has become very high and when to take medications to prevent any adverse impact on health. The ability to self monitor glucose levels and self administer medications can help to promote care delivery at the right time without any delay. Since the client stays alone, it is vital that he be able to monitor his own blood glucose from time to time.

Timely: The client will be trained for 2 weeks.

Better ability to prevent as well as treat foot injuries and wounds:

Specific: The client will be trained on strategies to take care of wounds and infections. Additionally, the client will also be supported to reduce the risks of foot injuries through the usage of proper footwear. Education on how to follow diabetes treatment will also be provided for the client.

Developing Smart Goals

Measurable: The outcome of the strategy can be measured trough the prevention of foot ulcers and wound infections for the client and the ability of the client to take care of any wounds.

Attainable: Positive outcomes can be attained by adequately following the care plan and utilizing the care strategies in a methodical way (Tewahido & Berhane, 2017).

Relevant: Reducing the risks of foot injury and infections can help to prevent foot ulcers and infections which are high risk factors for diabetes. Exercise routines can help the client to improve his balance and thereby prevent the risks of accidental falling. Also, wearing proper footwear can further reduce the risks of foot injuries (Hodgson et al., 2015).

Timely: The training will be provided for 3 weeks.

Goal 4: Helping the client to be more social and reducing sedentary lifestyle:

Specific: The client will be provided psychological counseling to overcome his depression and social isolation. Strategies such as joining self-help groups, gardening classes or community programs can help the client to be more social and help to maintain physical activity levels. Social support can support the client to engage more with the community (Ogden et al., 2017).

Measurable: Effectiveness of these strategies can be measured through an increase in socialization of the client and a reduction in sedentary lifestyle. The overall mental health of the client can also be a good measure of this strategy as it can help the client to overcome his depression and social isolation.

Attainable: Positive outcomes can be attained through this strategy since it involves changing the behavior of the client and overcoming the problematic behavior to instill a healthy behavior which can improve the health and wellbeing of the client (Blümel et al., 2015).

Relevant: mental health support is an important strategy since it can help the client to increase his social interactions and prevent social isolation which is adversely impacting his health. Encouraging him to walk and exercise more often and taking up hobbies such as gardening or music can further help him to increase his physical activities (Blümel et al., 2015).

Timely: The intervention will be provided for 6 weeks.

Helping the client to choose healthier diet choices:

Specific: Consultation with a diet expert can help the client to adhere to a healthy diet choice. It is also important to support access to healthy diet options, which can be done through social support groups. Educating the customers on which diet choices can be the healthiest for him as well as warning him against the foods which might adversely affect his health can help him to make informed decisions and select healthy diet for himself (Kanoski et al., 2014).

Measurable: Success of this strategy can be measured through a reduction in the consumption of unhealthy food and therefore a reduction in the consumption of fats, carbohydrates and sugarated beverages and an increase in the consumption of healthy diet rich in fiber.

Attainable: Positive outcome can be attained if the client is able to remember and follow the diet plans properly and if there is an easy access to healthy diet choices for the client. Social support system can also help in such an aspect by helping the client to purchase healthy food (Bray & Popkin, 2014).

Recommendations for Implementation of Actions

Relevant: Considering the seriousness of the client’s condition, improving the diet habit of the client is of significant importance as it can help to overcome the risks associated with the health condition (Balk et al., 2015).

Timely: Support as well as regular monitoring will be done for 24 weeks for the client to ensure he is able to follow the guidelines effectively.

Home Care Support:

Specific: Regular nursing visits will also be scheduled for the client to assess his health, vital status and nutritional status and identify any further risks or health condition for the client (Cefalu et al., 2015).

Measurable: Success of this strategy can be exhibited by an improvement in the health status of the client.

Attainable: Success can be attained by ensuring continuity of care for the client and regular monitoring of health.

Relevant: Since the client has learning disabilities it is vital that he be checked on a regular basis to monitor if he is facing any challenges following the care plan or to identify any additional support needs (Cefalu et al., 2015).

Timely: The some visits would be done at least once a week for 12 months.

Recommendations for implementation: Action Steps:

Educating the client on healthy lifestyle and diet

The client should be educated on how he can maintain his health and wellbeing through a healthy diet and how to increase his physical activities to prevent the risks of obesity. Since the client spends most of his time at home working on his computer, he is not getting any sufficient amount of exercise which has led to an uncontrolled increase in his weight.

The risks of obesity was also significantly contributed due to his learning disability due to which he had poor understanding of how his lifestyle and diet choices could have impacted his health as a result of which he failed to follow a healthy lifestyle. It has been pointed out by authors that individuals with learning disabilities have higher risks of obesity due to a reduced understanding of the etiology of the disease and its relation to lifestyle (Cook et al., 2015). Better knowledge about healthy diet and exercise levels can also help the client to follow the care plan more effectively therefore ensuring the success of the care plan (Segal et al., 2016).

Educating client on how to monitor blood glucose and administer medications.  

The client needs to be supported to monitor his own blood glucose levels from time to time and record them to be analyzed by the nurse during the home visits. Training on using the blood glucose monitor would allow the client to understand how to use it, while memory aids such as routines and stick up notes can help him to remember when to take the tests. Since the glucose level of the client is high, he has a high risk of developing other co morbid conditions such as neuropathy or retinopathy and therefore such risks should also be regularly assessed by the nurses to understand any additional complications for the patient (Vazquez-Benitez et al., 2015).

In addition, helping the client understand how to monitor medications such as insulin in case of an emergency can help to avert any serious situations (Wanner et al., 2016). The instructions can be charted out with diagrams which can help the client to follow the steps with more ease. Emergency contact for healthcare professionals can help the client with a point of contact and consultation of he is facing any trouble (Siu, 2015).

Providing psychological interventions

As the client has become socially withdrawn and recluse since the death of his mother, it is vital that he is given psychological counseling to overcome the symptoms of depression as well as anxiety. Cognitive Behavior Therapy can help the client to understand his problematic behavior and overcome the negative emotions and socialize more with people (Fairburn et al., 2015). The intervention can also help the client to overcome his eating disorders and to identify stressors which triggers the problematic behavior for the client. This can further help to avoid such stressors and thus help the client to maintain healthy diet recommendations.

Overcoming social isolation or recluse can also help to improve his mental health condition, which has been supported by studies that show how socialization can improve mental wellbeing among people (Paul et al., 2015). The intervention can also help to improve the body image of the client which could be one of the factors reducing socialization and making him more withdrawn. Therefore, it can be suggested that Cognitive Behavior Therapy can promote the long term wellbeing of the patient by supporting a healthier lifestyle and diet choices for the client (McElroy et al., 2015; Ratcliffe & Ellison, 2015).

Self-help groups:

The client can also engage in self-help groups for diabetes and obesity as well as groups for learning disabilities. These groups can help to increase self sufficiency and self efficacy of the client to take care of himself. This is an important strategy since the client stays alone and takes care of himself because of which he needs to social network and social support which can be provided through the self-help groups. The group can also provide him to additional points of contact and reinforce the development of healthy lifestyle choices. Additionally, the group can also help to increase social interactions and therefore help the client to come out of his social isolation. This strategy can also supplement the psychological intervention thereby helping to promote an overall wellbeing of the client (Evans et al., 2015).

Exercise regimen:

Activities such as gardening, yoga and tai-chi can help the client to improve his activity levels as well as help him to maintain a good mental health. Studies have shown that meditation and yoga can help to improve memory and prevent stress and anxiety and prevent hypertension (Asp et al., 2017). Thus, the client can be educated on such strategies which can help him to relax as well as strategies that can help him to increase his physical activities. Exercise routines such as tai-chi can also be useful to improve the gait and balance of the client and therefore prevent the risks of falling (Wayne et al., 2015).

This is an important recommendation for care since the obesity and knee pain could adversely impact the gait and balance of the client and increase his risks of fall related injuries (Mitchell et al., 2014). It can also be suggested that activities such as gardening can also increase the time spent outdoors and thereby promote fitness within the client (Chin et al., 2016). Therefore it can be recommended that consultation with lifestyle experts and physical exercise and yoga experts be sought to develop an exercise regimen for the client.

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