Collaborative Care Planning and Person-Centred Care in Integrated Working

This article discusses the benefits and challenges of collaborative care planning and person-centred care in integrated working for managing chronic illness. It includes a case study of an obese patient with pre-diabetes, chronic hypertension, and a leg injury, and explores the importance of patient involvement in decision-making, identifying their own values and preferences, and treating them with dignity and respect. The article also discusses the benefits of integrated working, including early diagnosis and effective care, shared access to health records, and coordinated care and clinical collaboration.

Person-Centred Care and Integrated Working

Table of Contents
Case Study:......................................................................................................................................3
Introduction......................................................................................................................................3
Main Body.......................................................................................................................................4
Conclusion.......................................................................................................................................7
REFERENCES................................................................................................................................8

Case Study:
Linda is 66 year old obese lady, Accidentally she fell down and gets a leg injury. She was
taken to the hospital by the family member for immediate treatment and advised to stay in the
hospital to heal the leg injury. As she arrived, family member were asked to fill some forms and
wait in the waiting portion for some follow ups. When Linda was sitting, she was told that she
would be seen soon. Linda was greeted by a friendly practitioners and told to follow her to one of
the available ward. When they entered the ward, nurse introduced herself and said that she is
going treat her and wanted to know some more details about her. Nurse ask questions like “how
she is feeling?” and “what are the diseases and medication she is going through”. After analysing
the previous medical condition, the nurse gets to know that Linda was a Pre-diabetic patient,
chronic hypertension and has a Post transient ischaemic arrhythmia (TIA) 3 months earlier.
Linda had some symptoms of depression, agitation and irritability are also sometime seen by the
family member. An orthopaedic surgeon, an endocrinologist, a psychiatrist and a nurse. The
nursing professional carries out the treatment in collaboration with other health professionals and
ensures that Linda are supported with the right decisions. The nursing professional always
encouraged and support Linda to manage her ongoing medical conditions, and always try to
manage a good communication so that Linda will feel connected and cared.
Introduction
Now a days, there has been a positive shift, that account for placing patients as a
workable partner in health sector instead of unworkable beneficiaries. This ongoing partnership
is more successful in treating those patients who are managing multiple chronic disorder for the
reason that these patient has expertise their own body, symptoms and its management. This shift
bring up the two concepts; Person Centred Care (PCC) and Integrated Care (IC). Both have
Endorsed as authentic solution in managing multiple chronic disease. A Patient Centred Care
means instead of disease, setting people and communities at the centre of healthcare and
encouraging people to take control of there own health conditions as an alternative for being a
impassive beneficiary to the service (Paananen and Majlesi, 2018). An integrated care is an
approach of planning together to understand the services provided to the patient and coordinately
control the services to get the best outcome.

Main Body
A Patient Centred Care is exercise in which patients effectively participate in their own
health management in close association with their health professionals. For providing services,
Patient Centred care works integrally. When a person suffering from several chronic illness, this
practice is very effective as this Practice work with consideration of all the factors and
medication prescribed by the professionals. Patients Centred Care include different aspects like
always consider patient needs and preferences, get assured the patient is comfortable and safe,
work in integrated manner, surety of getting appropriate care to patient when needed (Siebinga,
Driever, Stiggelbout and Brand, 2022). A vigorous ongoing procedure that comprises of
complexity of various factors are called Chronic illness. Emotional wellness, motivation and
patients education have important role in patient life and are major challenges for healthcare
professionals. In spite of the fact that patients have different interaction and preference style.
Patient Centred Care provide satisfaction and better treatment while managing the chronic
illness. Effective chronic Disease treatment involves coordinated continuous management by the
physician and the patients also.
Patient Centred Care for managing the chronic illness includes some major objectives like
initiating from the patients situation, validating the illness, admitting the patients expertise,
development of partnership, giving real hope, advising patients in healthcare management. A
obese person suffering from pre-diabetic and have chronic hypertension and recently have a leg
fracture and medical history shows that Post transient ischaemic arrhythmia (TIA) 3 months
earlier and few sign of depression with continuous irritation (Morley, 2018). For the leg injury,
there is need of orthopaedic surgeon along with the physiotherapist. In order to control the
diabetes, a good endocrinologist can help better. In addition for the management of hypertension
and irritability, the patient must visit to physician for adequate medication and also take the stress
therapy. The Patient centred care should plan a collaborative care planning as different
professional are included. The nurse should plan the treatment by considering all different
treatments prescribed. The Nursing professional should ensure support to the patient in their
decisions about the treatments. Better conversation with the patients will help the Nursing
Professional to better support the patients need and manage their lives with the illness. The
nurses should have arrange a common meeting with the patients and several other health worker
to decide the proper planning for the patients, as it includes different type of planning such as

Collaborative Care planning which includes enhanced multidisciplinary evaluation of bio-
psychosocial factors which are beginning for the persons distress (Lloyd, 2018). The nursing
professional should consult all the health professional and plan persons diet accordingly to avoid
drug-drug interactions and drug- food interactions. The nurses are liable for the support and
encouragement to people to manage their continuing physical and mental health by themselves.
Some of the legislation identified in patient centred care are, the care and treatment
provided to the user must be appropriate and meet their preferences. Dignity and respect of the
patient should be maintained while providing the treatment along with the privacy of patient. The
consent of the significant patient is important while providing the treatment and care. The patient
safety must be considered while treatment, and patient must be protected from improper and
abusive treatment. The person providing the services must have the qualification, capability and
skills. In order to investigate effectively against any allegation or abuse, a proper system and
processes must be established. All the surrounding area and the equipment used by the patients
must be clean, secure and maintained properly. The health service provider must work in an open
and transparent way. A person guilty for breaking the regulations are liable to punishment and
fine.
The patients centred care requires true approach from both the sides, from individual as
well as from healthcare professional. This system worth exploring because it works with some
theory which shifts the patients thinking and enables them to take part in their action plan. These
theories are: Involvement of patients in decision- making, identifying their own values and
preferences and treat them with dignity and respect (Bacorro, 2021). During illness, patients are
Vulnerable and this can be reduced with proper coordination and integration of care which
includes coordination between front-line patient care, clinical care and ancillary and support care.
As the patients are also worried about their health condition, proper communication is needed
regarding the information related to clinical progress, and information to facilitate autonomy and
self care. The physical comfort of the patient is also monitored by proper management of pain,
providing assistance with daily activities and needs. Care provider also pay attention towards
anxiety over physical status, financial impacts and impact of illness on family thus providing
emotional support (Saplacan and Torresen, 2022). This system also involve the families and
close friends in decision making and recognizing their needs also. Care provider give the detailed

information including medications, dietary supplements, physical limitation and information
regarding access to clinical, social and financial support on continuing basis.
Patients centred care is more complementary as it not only count on physical and mental
needs but also on environment and lifestyles. Major benefits of patients centred care is, It makes
the individual flexible as they can easily decide and gets involve in their own treatment. Due to
engagement in their own treatment, patients feel responsible and emotionally attached in their
own well being. This approach makes the individual contented and independent as they are less
dependent on health services (Ahmed and Rajput, 2020). The care provider also gets a feeling of
attainment as healthier and happier patients get well soon. A better relationship is developed
between individual and the care giver due to delivering treatment in a pleasant environment.
Along with the benefits there are some of the disadvantages also, Patients centred care requires a
fair amount of time for nursing care and strong leadership to mange treatments. While focusing
on patients and their rights in patient centred care, the nursing staff and their individuality is
neglected. Their is constant risk of healthcare staff of being in compassion fatigue which include
feeling of hopelessness, constant stress or sleeplessness.
From the effectiveness perspective, an integrated health working provide multiple
benefits which includes medical, pharmacy and workers assistance. The patients will appreciate
and the simple and clear procedure that comes from one point. Early diagnosis and effective care
is possible in integrated working as it provide coordinated care and clinical collaboration.
Integrated working saves a considerable amount of money over time. This practice provide a
shared access to all the maintained health records at one click. This will effectively manage the
health outcomes. This system makes the process easier for both the provider and the service user.
Integrated working highly engage the individual in health initiative and provide resources to take
charge of their own well being (Zhang, 2019). Some of the barriers are also included in
integrated working practices like conflicts over budgets, difficulties in workforce planning and
complex administration arrangements.
The patients centred care practice is not so comforting as it may look. There are carious
challenges faced by the service provider as well as service user. Some time the healthcare
professionals have to deal with over shielding parents and relatives or friends who thinks
activities may be dangerous to the person (Corcoran, Benavides and Cecchi, 2019). This
behaviour make the health professional feel unwelcomed. Some time the health professional

have to face some problem in funding and raising money for activities in which the user does not
want to participate. The service user is also at risk when they severe health problem as epilepsy
or diabetes which creates barrier and delay in planning the patient centred care. On the other
hand, the service user or patients are struggling for clinical appointments due to their office hour.
The hectic schedule of doctors will affect the patients treatment generate a feeling of negligence
among patients (Baicker and Chandra, 2018). Patients living in rural area have to struggle for
their access to clinical benefits and if they are able to get appointment and access, then
transportation become the leading issue. In addition to this hurdles, many patients have to face
social discrimination that made it more tough to reach the clinical access. In addition to this,
major problem is communication, as it leads to language difficulties, conflicts between patient
and professional, ineffective policies and procedure.
Conclusion
From the above discussion, it can be concluded that, an integrated care is an approach of
planning together to understand the services provided to the patient and coordinately control the
services to get the best outcome. Patients Centred Care include different aspects like always
consider patient needs and preferences, get assured the patient is comfortable and safe, work in
integrated manner, surety of getting appropriate care to patient when needed. Some of the
legislation and theory are considered while providing the integrated patient centred care. The
patients will appreciate and the simple and clear procedure that comes from one point. Early
diagnosis and effective care is possible in integrated working as it provide coordinated care and
clinical collaboration. Major benefits of patients centred care is, It makes the individual flexible,
responsible and emotionally attached in their own well being which makes the individual
contented and independent as they are less dependent on health services.

REFERENCES
Books and Journals
Paananen, J. and Majlesi, A.R., 2018. Patient-centered interaction in interpreted primary care
consultations. Journal of Pragmatics, 138, pp.98-118.
Siebinga, V.Y., Driever, E.M., Stiggelbout, A.M. and Brand, P.L., 2022. Shared decision
making, patient-centered communication and patient satisfaction–A cross-sectional
analysis. Patient Education and Counseling.
Morley, J.E., 2018. Patient-centered care and cognitive dysfunction. Clinics in Geriatric
Medicine, 34(4), pp.ix-x.
Lloyd, A., 2018. Patient centered care.
Bacorro, V., 2021. Understanding the healthcare journey from a patient's perspective.
International Journal of Integrated Care, 21(S1).
Saplacan, D. and Torresen, J., 2022, May. Healthcare Professionals´ Attitudes towards the
Organization of Care Services and the Adoption of Welfare Robots in Norway. In 2022
IEEE International Conference on Advanced Robotics and Its Social Impacts (ARSO)
(pp. 1-8). IEEE.
Ahmed, S.M. and Rajput, A., 2020. Threats to patients’ privacy in smart healthcare environment.
In Innovation in Health Informatics (pp. 375-393). Academic Press.
Zhang, B., 2019. Human Rights Value Based on the Legislation Principle of the Basic
Healthcare and Health Promotion Law. J
Corcoran, C.M., Benavides, C. and Cecchi, G., 2019. Natural language processing: opportunities
and challenges for patients, providers, and hospital systems. Psychiatric Annals, 49(5),
pp.202-208.
Baicker, K. and Chandra, A., 2018. Challenges in understanding differences in health care
spending between the United States and other high-income countries. Jama, 319(10),
pp.986-987.