Analysis of Healthcare Studies and Assignments

This assignment involves analyzing various healthcare-related studies and assignments, including articles from The Lancet, Annals of Internal Medicine, Social Psychiatry and Psychiatric Epidemiology, Neurology, Health Policy, and BMC Health Services Research. It also includes a summary of websites related to aged care funding and support services in Australia. The task requires extracting relevant information, identifying key findings, and presenting it in a structured format for easy reference.

ASSIGNMENT -2
NURSING ASSIGNMENT
(CRITICAL ANALYSIS)

Table of Contents
Introduction/Identification of the patient..................................................................3
Identification of patient needs.....................................................................................4
Understanding of potential barriers to care and underlying assumptions.............6
Identification of care plan, community resources and hospital avoidance
strategies.......................................................................................................................7
Conclusion...................................................................................................................10
References...................................................................................................................10

Introduction/Identification of the patient
The virtual case world scenario for this essay is the case of Mr. Harold
Graeme Blake, he is an 83years old male residing in SA. His physical appearance
introduces a slim, calm person with the body weight of 81kg and height 179cm. Mr.
Harold is a family oriented male having a beautiful wife, two children and a stable
life. However, the health condition of Mr. Harold is a complicated scenario, he is
suffering from many critical medical issues that involve Ischaemic heart disease
(IHD), angina, left cerebrovascular accident (CVA), Gastro-oesophageal reflux
disorder (GORD) and spinal injury along with many other complicated issues.
Mr. Harold had various serious surgeries in past that are cholecystectomy,
appendectomy, two hip replacements and coronary artery bypass graft. According to
Feigin et al. (2014) research angina is considered as one of the major complications of
coronary artery bypass graft. Mr. Harold is on critical medication where he takes
more than eight medicines on daily basis. In the present case study, Mr. Harold is
admitted to the emergency department after his confrontation with an angina episode
while taking a taxi as normal daily activity. He was admitted to cardiology unit and
further transfer to the surgical ward. Mr. Harold was identified with serious symptoms
of angina involving shortness of breath, pain 8.5/10, choking sensation, chest
tightness, nosebleed etc.
The present situation of Mr. Harold along with his medical history makes his
case a complicated one to initiate care and overcome his sufferings. In the present
case scenario, Mr. Harold underwent a 60days treatment process to overcome his
present critical encounter with angina. Cardiologist, speech pathologist, occupational
therapist and physiotherapist reviewed Mr. Harold. He underwent CT scan,
neurological observation and percutaneous endoscopic gastronomy along with
insertion of a nasogastric tube (NG) and for feeding. The case study indicated that it
was a complicated task to handle the situation of Mr. Harold. Even after five months
of the accident he was fully dependant on others for his daily activities. Mr. Harold
was in continuous tough with dietician after seven months of surgery in the nursing
home.
This situation indicates that Mr. Harold specifically needs special care to
overcome his present complex health situation. After discharge from the nursing

home, it is required to indulge Mr. Harold in care process that will avoid his further
readmission to hospital. Therefore, in the present situation it is required to adopt
certain specific care strategies, processes, resources etc. providing Mr. Harold proper
care at home. This essay involves a step-by-step process for planning care for Mr.
Harold that involves identification of his specific needs, care plan and potential
barriers to this care plan. The essay structures complete information that is essential to
implement a proper nursing care plan for case study patient Mr. Harold.
Identification of patient needs
As per case study description about Mr. Harold condition at the hospital and
after the transition to a nursing home it is clear that he needs a high level of care for
his basic as well as certain complex needs. The major basic needs for which Mr.
Harold will be requiring care involves shortness of breath at exertion (SOBOE),
speaking difficulties, care for his right arm and help in daily living activities (ADLs).
In the background information about Mr. Harold hospital admission symptoms, his
pain rate was 8.5/10. According to Kissela et al. (2012) studied that any kind of
severe pain before or after surgeries requires a proper nursing case. The painful
conditions if not managed with proper care can lead to degradation in quality of life.
Further, Schafer et al. (2012) indicated that pain management through proper care
also helps in liberating the dependency of the patient for his ADLs. Therefore, the
most basic of Mr. Harold is care for his pain that will help to overcome his issue of
dependence for ADLs because even after seven months of discharge from hospital he
is still fully dependent for his daily living activities. Alongside, care is needed to
improve and overcome his dependency on daily living activities to make him more
independent.
Another most important need for Mr. Harold is care and treatment for his right
arm that was identified as unable to move during his first month of hospitalisation.
There was increased tone and reflexes in his right arm. Further, Mr. Harold was
having speaking difficulties in the initial stage of his hospitalisation. However, his
speaking issue was very well handled and resolved by speech pathologist but still
further care plan will help more in the proper improvement of this issue. Mr. Harold
has a problem with breath shortness at exertion. Shortness of breath if not taken care
can lead to serious hazards for a heart patient. Black et al. (2014) studies that

shortness of breath is a common complication for the patient suffering heart disease.
As Mr. Harold is a patient of Ischaemic heart disease (IHD) followed by an episode of
angina, he needs care for this issue of breathing shortness while exertion. However, it
is better to minimize exertion in his lifestyle but still, some care strategies are needed
to improve this condition.
Above these basic needs, another important need of Mr. Harold care is the
management of his eating and drinking schedule. As per case details, Mr. Harold was
induced with PEG tube also provided with a proper fluid intake process. In months
after hospital surgeries, his diet intake was very well improved as per reviews from
the dietician. But still, proper intake of food and fluid is very important to get proper
health betterment. Therefore, need to manage food and fluid intake is an essential
component of Mr. Harold care process.
Moving forward from basic needs mentioned in the case, there are also some
complex needs based on the past medical situation of Mr. Harold for which he needs
care plan. Some of the risky and complicated needs in his medical history that require
special care are his spinal injury and gastro-oesophageal reflux disorder. In the
present case, Mr. Harold uses a wheelchair for movement and walk only with the help
of the walker. This indicates the complexity of his spinal injury indicating a need for
special care attention. This spine injury, if not taken care of can be a hurdle in nursing
interventions for other basic needs in his case. According to Gunn et al. (2012)
research about few major complications related to spine injuries that involve
neurogenic pain, regular fall etc. leading to hospitalization, pressure ulcers and
urinary track infections, respiratory complications and reduced quality of life. More
than 50% the patients having mismanaged care after spinal cord injury leads to
rehospitalisation. As the medical condition of Mr. Harold is already very critical as
per his case data, any kind of carelessness in managing his spine injury can lead to
life-threatening complications. Further, to improve his dependency on ADLs his spine
injury is required to be handled with special care.
Lastly, one major complex need for Mr. Harold is control over his Gastro-
oesophageal reflux disorder (GORD). GORD is acid reflux disorder in the body
where stomach acid is reflected back to oesophagus due to the defect in sphincter
muscle of the oesophagus. The avoidance and control of this order depend very much
on the lifestyle modification, diet, sleeping and eating habits. However, acid reflux

still remains a risky life-threatening disorder that can lead to hazards if not managed
properly. As the health condition of Mr. Harold is already very depraved which makes
management of GORD also remains a complex needs for Mr. Harold.
Understanding of potential barriers to care and underlying assumptions
Age is one of the important components to determine the type and cost of care
needed for the patient. Often old people are neglected because more effort and less
compensation are received for providing health care to them (LeMone et al. 2015).
Usually, long-term care for elders leads to the development of negative attitude in
cares providers because a lot of patients, effort, strength etc. is needed in providing
proper care (Bruera et al. 2015). In the present case of Mr. Harold, his old age can be
a potential barrier affecting his care process. His old age is a stereotypic barrier
because the level of care required in his condition is very high, however contrary he is
very old to cope up easily. The care provider should have a lot of competence to
provide care for Mr. Harold is this age. Therefore, age can be a potential barrier in
Mr. Harold’s case.
Further, the verbal issue Mr. Harold developed, as a symptom of angina will
also work as another stereotype barrier in his care process. However, Mr. Harold was
attempting very well to talk and almost recovered untill the time of discharge from the
hospital. But still, in the process of providing daily nursing care at home, this
potential barrier to speaking disorder can hurdle in care process for the care provider.
Zaman et al. (2014) indicated that psychological capacity is a key to achieve good
health. However, in case of Mr. Harold, his medical condition is very complicated and
barrier like speaking issues can lead to lot disturbance in his care process harnessing
him both physically and psychologically.
On basis of mere assumption, complicated health condition of Mr. Harold can
create psychological issues like depression, anxiety etc. in his care process. As he is
an old age person it is difficult for him to take a care schedule for such critical issues.
Therefore, there are many chances of developing psychological issues like depression.
Any kind of psychological imbalance will also create a barrier in his critical care
process. Further, from the case details, it is identified that Mr. Harold it consuming
more than eight medicines daily because of his critical medical condition. In such
scenario, his medication needs can also create a barrier to care process because the

working duration of medicine (sleeping, relaxing) can lead to mismanagement in the
care process.
Lastly, the most important barrier to care process of Mr. Harold shall be his
socio-economic status that can develop financial crisis in the care process. Mr. Harold
is an average retired elder living a normal life with his wife in a unit. Such high level
of nursing care leads to a lot of financial burdens (Duckett and Willcox, 2015).
However, there are people mentioned in the case study that will help Mr. Harold to
manage the financial concerns of a high level of care process along with aged care
assessment team (ACAT) arranging placement and guardianship board application for
Mr. Harold. With this application Mr. Harold can get financial support but still for an
average man like Mr. Harold care cost would remain a potential barrier in his
treatment process.
Identification of care plan, community resources and hospital avoidance
strategies
As per basic and complex needs for Mr. Harold identified in the previous
section of the essay, this section deals to identify most suitable care strategies and
hospital avoidance strategies keeping in mind the detected potential barriers. Firstly,
the basic need of relaxation from pain involves a care intervention to provide periodic
care. This periodic care means providing rest periods promoting relief, relaxation and
sleep. As Mr. Harold is under severe medication process, this periodic care
intervention will also help in better results through medication as well as help in relief
from pain (LeMone et al. 2015). Further, mild relaxation exercises and music therapy
can also help an elder person like Mr. Harold as per studies by (Bruera et al. 2015).
Further, mild breathing exercises would be most suitable care process to resolve the
issue of breath shortness faced by Mr. Harold. These interventions are developed
keeping in mind the age of Mr. Harold so that the potential barrier of age can be
overruled in the care process.
According to Feltner et al. (2014) research data old age patients generally,
face difficulty in their activity daily living (ADLs) process even after providing them
proper care. Some of the smart care strategies are specially designed to help elders
who face major difficulty in their daily activities. The care strategies to help Mr.
Harold overcome the need for dependency in his ADLs are developed as per this

research data. The strategies involve developing short-term realistic exposure goal so
that shortness of breath does not take place and he learns to perform his own work.
Further, Mr. Harold to feed him using his unaffected hand, utilize stationary chair and
wheelchair and use of one size larger clothes for comfort. Further, suggest the use of
smart dressing sense like elastic shoelaces, elastic pants, t-shirts instead of shirts and
Velcro closures in footwear (Duckett and Willcox, 2015).
Verhaegh et al. (2014) opine that defect in right arm is a major consequence of
heart diseases. A dual combination of proper care along with medication can result in
miracles overcoming these defects. Some of the most workable care strategies that
can work along with medication in case of Mr. Harold involve use of semi-Fowler’s
position, oxygen therapy, periodic rest, mild arm exercises, regular monitoring of
blood pressure and heart rate. Further, the need to resolve speaking difficulties can be
overruled by care strategies like understanding patient’s non-verbal cues, maintaining
eye contact while talking to them followed by framing short questions that patient can
answer easily. Talking and discussing in front of the patient to catch his involvement
and correcting his errors along with active listening (LeMone et al. 2015). These
minute strategies would surely work for Mr. Harold because he showed the positive
response for speech difficulties during his time of hospitalization. Lastly, another
basic need is managing the food and fluid intake of Mr. Harold. This can be achieved
through care strategies like scheduling his fluid and food intake (small amount in
short duration of time), monitoring maximum fluid intake, scheduling the visit to a
dietician, adopting healthy eating habits and foods in meals (Bruera et al. 2015).
Now moving to complex needs of Mr. Harold that are control over his reflux
and spinal injury defects. Firstly, for managing the issue of reflux, Feltner et al.
(2014) mentioned some important interventions that are applicable to the case of Mr.
Harold care as well. This involves regular measurement of weight, small frequent
meals with high protein and carbohydrates, guiding patient to eat small and slowly,
guiding to remain in upright position till 2hours after meals and avoid eating 3 -4
hours before bed. These strategies help to maintain the issue of acid reflux in Mr.
Harold case. Further, spinal injuries involve care like encouraging fluid intake, refer
regularly to the physical therapist, perform mild spine exercises and providing
assistance with coughing, walking etc. (Bruera et al. 2015).
The residing location of Mr. Harold as per his socioeconomic details in the

case has community support care in place that involves DOM care and Veterans’
Homecare. These community care services can help to avoid readmission to hospital
in case of Mr. Harold. Some of the most workable community resources and services
for him are Home Care Packages, Post-acute Services and After hospital care
(Transition care) (Verhaegh et al. 2014). The Home Care Packages provide care for
people having complex needs and have to live independently at their residence. Mr.
Harold care plan can be adopted from these packages, as the services offered are
suitable for his present condition. Further, Post-acute care involves services for people
discharges from public hospitals, acute services, sub-acute services and emergency
departments (Mossialos et al. 2015). However, this care is a short-term community
care but this can help Mr. Harold in the emergency situation to avoid readmission to
hospital (LeMone et al. 2015). As Mr. Harold is facing many different kinds of
health-related issues, post-acute care can help to focus on emergency care for one
specific issue resolving it in short duration of time. Lastly, transition care is another
recommended community care option for Mr. Harold. In transition care old age
people requiring further recovery care after discharge from hospitals are handled
providing them benefits to live long term of life. For this service, patients need to be
assessed from aged care assessment service (Duckett and Willcox, 2015). As Aged
care assessment team handled Mr. Harold after discharge, this transition care will be
beneficial for his transition to his home providing care services for recovery and long
life.
Australian government offers different options of subsidies and supplements
for people unable to afford proper medical care due to the financial crisis. These aged
care subsidies and supplements are the payment done to care providers by the
Australian Government for each care recipient as per their support care needs
(Agedcare.health.gov.au., 2018). From various aged care funding schemes of the
Australian government, the most recommended once for Mr. Harold is Home care
subsidy and Residential care subsidy. Feltner et al. (2014) opine about Residential
care subsidy in which Australian Government pays approved care providers for
providing care to the recipient an amount of residential care. The Government on
monthly basis pays it to the care provider. This subsidiary implies on the basis of a
high or low level of care recommended to the recipient (Agedcare.health.gov.au.,
2018). As Mr. Harold is recommended high level of care, this subsidy scheme will

suit him the best. Further, Home Care Subsidy is one more Australian Government
subsidy where care providers are paid for providing home care to recipient. As per
Mr. Harold case, he is eligible for this subsidy as well. He can apply for anyone
recommended subsidy to overcome the financial burden of high-level care. A proper
Government subsidy along with community care resources and nursing care
intervention will completely help in his recovery process providing better and longer
living conditions for Mr. Harold.
Conclusion
The provided virtual case world study of Mr. Harold is not at all a common
type of patient case study rather it is a very complex case study of old age person
suffering critical health conditions and needs a proper care process. this study
involves a process to study Mr. Harold’s case, his needs, care requirements, care plan
and potential barriers in his care process after hospitalization. Mr. Harold as per case
details was discharged from hospital after his encounter with angina. He is a victim of
serious health hazards like ischaemic heart disease, angina, acid reflux and left
cerebrovascular accident. His identified care needs are care for speaking difficulties,
shortness of breath, right arm pain, surgery pain, and dependency for ADLs, food and
fluid management. His complex needs involve care for acid reflux and spinal cord
injury.
Further, the study identifies the potential barrier that can hinder the care
process of Mr. Harold; this involves his old age, communication issues, psychological
inabilities (depression), medications and socio-economic status (financial status).
These potential barriers can hinder his care process. Lastly, the study involves
identification of care plan, community resources and hospital avoidance strategies
along with Government subsidies. These Government subsidies can help to overcome
his financial barrier in the care process. The residential care subsidy and home care
subsidy are best suited once for Mr. Harold. Further, community resources like post-
acute care, home care packages and transition care can help for avoiding readmission
to hospital. Lastly, the study involves various nursing intervention and care plans that
can help to fulfil his basic and complex care needs identified to provide Mr. Harold
with a better and longer life.

References
Books
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palliative medicine and supportive care. CRC Press.
Duckett, S. and Willcox, S., 2015. The Australian health care system (No. Ed. 5).
Oxford University Press.
LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L. and Reid-Searl, K.,
2015. Medical-surgical nursing. Pearson Higher Education AU.
Journals
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Kaplan, S.H. and Ong, M.K., 2014. A remote monitoring and telephone nurse
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E.J., Arvanitis, M., Lohr, K.N., Middleton, J.C. and Jonas, D.E., 2014. Transitional
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review and meta-analysis. Annals of internal medicine, 160(11), pp.774-784.
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Dowrick, C.F., 2012. The association between chronic illness, multimorbidity and
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Verhaegh, K.J., MacNeil-Vroomen, J.L., Eslami, S., Geerlings, S.E., de Rooij, S.E.
and Buurman, B.M., 2014. Transitional care interventions prevent hospital
readmissions for adults with chronic illnesses. Health affairs, 33(9), pp.1531-1539.
Zaman, M.J., Stirling, S., Shepstone, L., Ryding, A., Flather, M., Bachmann, M. and
Myint, P.K., 2014. The association between older age and receipt of care and
outcomes in patients with acute coronary syndromes: a cohort study of the Myocardial
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Websites
Agedcare.health.gov.au. (2018). Aged care funding | Ageing and Aged Care.
Available at: https://agedcare.health.gov.au/aged-care-funding [Accessed 23 Mar.
2018].
Agedcare.health.gov.au. (2018). Support services | Ageing and Aged Care. Available

at: https://agedcare.health.gov.au/support-services [Accessed 23 Mar. 2018].