Contemporary Issues in Health and Social Care
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This essay discusses the multidisciplinary approach towards the care plan of an elderly man with mental problems, highlighting the importance of shared decision-making, psychosocial therapy, and social media support. It emphasizes the need for effective communication, good patient-physician r...
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Contemporary Issues 1
CONTEMPORARY ISSUES IN HEALTH AND SOCIAL CARE
By (Name)
Course
Professor’s name
University name
City, State
Date of submission
CONTEMPORARY ISSUES IN HEALTH AND SOCIAL CARE
By (Name)
Course
Professor’s name
University name
City, State
Date of submission
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Contemporary Issues 2
Contemporary Issues in Health and Social Issues
Introduction
The quality of health care is not only limited to its accessibility and affordability but also
to care for an individual’s physical, social, emotional, and psychological well-being. This cannot
be achieved without integrating various disciplines within the health care system like nurses,
medical doctors, physiotherapists, relatives who take care of the patients and pharmacists. There
is need to establish the continuity of patient care, locate the workforce that will help in patient
care, find out the patient’s model of integration, get to know the approach to patient’s care and
how the integration was made available to the patient. For instance, for a patient like Mr. D to
have an integrated care that leans towards the health and social well-being, he needs to have the
above tennets to provide a framework to understand the reason for need of multidisciplinary
action towards care (Cohen et al. 2015)
This essay is based on Mr. D, and elderly man with a mental problem. He lives in a
nursing home where the author works as a care manager. As a course of action in his interest, a
multidisciplinary approach towards his care plan has been developed. Those involved includes
the one giving the medication, physiotherapist and a personal caregiver. His care plan needs him
to consent but because of being mentally ill, he cannot do so. The caregivers and the nurses who
administer medication to him have to rely on the care plan.
Mr. D could not consent to his care plan. What if he could have been involved in his own
care plan by any method available? This would have had a positive impact in improving his
quality of life and treatment plans. It is important to acknowledge that patients and care providers
Contemporary Issues in Health and Social Issues
Introduction
The quality of health care is not only limited to its accessibility and affordability but also
to care for an individual’s physical, social, emotional, and psychological well-being. This cannot
be achieved without integrating various disciplines within the health care system like nurses,
medical doctors, physiotherapists, relatives who take care of the patients and pharmacists. There
is need to establish the continuity of patient care, locate the workforce that will help in patient
care, find out the patient’s model of integration, get to know the approach to patient’s care and
how the integration was made available to the patient. For instance, for a patient like Mr. D to
have an integrated care that leans towards the health and social well-being, he needs to have the
above tennets to provide a framework to understand the reason for need of multidisciplinary
action towards care (Cohen et al. 2015)
This essay is based on Mr. D, and elderly man with a mental problem. He lives in a
nursing home where the author works as a care manager. As a course of action in his interest, a
multidisciplinary approach towards his care plan has been developed. Those involved includes
the one giving the medication, physiotherapist and a personal caregiver. His care plan needs him
to consent but because of being mentally ill, he cannot do so. The caregivers and the nurses who
administer medication to him have to rely on the care plan.
Mr. D could not consent to his care plan. What if he could have been involved in his own
care plan by any method available? This would have had a positive impact in improving his
quality of life and treatment plans. It is important to acknowledge that patients and care providers

Contemporary Issues 3
have different goals and that patients like Mr. D need information and support guidance
(Rajabiyazdi et al. 2016).
For better care, consent is needed. This helps the patient understand the process, risk,
benefits, and alternatives of a procedure, in an autonomous way. Consent is only possible if one
is competent to do so. Mr. D is an exception in this case due to his mental illness. The capacity to
comprehend the consenting process reduces with age (Sherlock and Brownie, 2014). This could
have further explained the need for a multidisciplinary approach to manage Mr. D since he is
elderly, adding to his mental issues.
Because Mr. D did not consent to his medical care plan, there is a possibility of not
achieving an improved patient satisfaction, management and clinical outcomes, thus shared
decision making with other health care providers and relatives is necessary in this case.
Shared decision-making has been shown to help the patient choose their preferred method
of care relating to the available options, its risks and benefits, available options, and need to
change to another one if need be. One treatment option for patients with mental problems like
Mr. D is through psychosocial involvement like behavioral therapy, besides medication (Gühne
et al. 2015) In this case, another approach called motivational interviewing can be used as it
focuses on changing behaviors using four steps: engaging the client, focusing on the preferred
method, evoking and planning for the process to continue. Therefore integrating shared decision
making and motivational interviewing is a prerequisite for a multidisciplinary approach to patient
care (Elwyn et al. 2014)
Gühne et al. (2015) acknowledges the high burden of mental illness and a need for
psychosocial therapy, with best evidence leaning towards multidisciplinary team. This involves a
have different goals and that patients like Mr. D need information and support guidance
(Rajabiyazdi et al. 2016).
For better care, consent is needed. This helps the patient understand the process, risk,
benefits, and alternatives of a procedure, in an autonomous way. Consent is only possible if one
is competent to do so. Mr. D is an exception in this case due to his mental illness. The capacity to
comprehend the consenting process reduces with age (Sherlock and Brownie, 2014). This could
have further explained the need for a multidisciplinary approach to manage Mr. D since he is
elderly, adding to his mental issues.
Because Mr. D did not consent to his medical care plan, there is a possibility of not
achieving an improved patient satisfaction, management and clinical outcomes, thus shared
decision making with other health care providers and relatives is necessary in this case.
Shared decision-making has been shown to help the patient choose their preferred method
of care relating to the available options, its risks and benefits, available options, and need to
change to another one if need be. One treatment option for patients with mental problems like
Mr. D is through psychosocial involvement like behavioral therapy, besides medication (Gühne
et al. 2015) In this case, another approach called motivational interviewing can be used as it
focuses on changing behaviors using four steps: engaging the client, focusing on the preferred
method, evoking and planning for the process to continue. Therefore integrating shared decision
making and motivational interviewing is a prerequisite for a multidisciplinary approach to patient
care (Elwyn et al. 2014)
Gühne et al. (2015) acknowledges the high burden of mental illness and a need for
psychosocial therapy, with best evidence leaning towards multidisciplinary team. This involves a

Contemporary Issues 4
team of specialists within the health institution and the family and close friends of the patient.
They can work towards community care and ensuring that the client is rehabilitated in a
vocational institution. The type of rehabilitation option suitable for Mr. D can only be elicited
through efficient communication with him as this would improve his health care plan (Gausvik et
al. 2015) Another method would be to offer single intervention like the ones Mr. D has on his
care plan like art therapy, in addition to occupational therapy and psych education.
Gausvik et al. (2015) states that timely and accurate communication leads to job
satisfaction and improves the patient health care. Mr. D’s caregivers cannot engage in an
accurate communication with him because of the concept of disorientation in time, person, and
place in some mentally ill patients. Not working in tandem might lead to untimely administration
of drugs especially at home where the family has to receive instructions on drug administration
from the health facility. The overall effect is inability to achieve job satisfaction, but this can be
improved by collaborative interdisciplinary relationships.
Financial constrain is a major hindrance to offer quality care, where good care is
available. However, health care cost can be reduced by reducing the number of hospital stay that
will in turn reduce the daily costs incurred in the facility, use of right choice of medication,
health promotion, and personal care. If Mr. D could have been consulted on the type of care he
needed, an idea of the exact problem would have been found. This in turn would have reduced
the burden of managing an unknown condition. However, in his best interest, personal care was
included in the care plan. According to Chiauzzi, Rodarte and DasMahapatra (2015), patient
monitoring helps them advocate for their personalized care. Health promotion programs for Mr.
D like the use of physiotherapist and art therapy reduces the number of sick days and
hospitalization.
team of specialists within the health institution and the family and close friends of the patient.
They can work towards community care and ensuring that the client is rehabilitated in a
vocational institution. The type of rehabilitation option suitable for Mr. D can only be elicited
through efficient communication with him as this would improve his health care plan (Gausvik et
al. 2015) Another method would be to offer single intervention like the ones Mr. D has on his
care plan like art therapy, in addition to occupational therapy and psych education.
Gausvik et al. (2015) states that timely and accurate communication leads to job
satisfaction and improves the patient health care. Mr. D’s caregivers cannot engage in an
accurate communication with him because of the concept of disorientation in time, person, and
place in some mentally ill patients. Not working in tandem might lead to untimely administration
of drugs especially at home where the family has to receive instructions on drug administration
from the health facility. The overall effect is inability to achieve job satisfaction, but this can be
improved by collaborative interdisciplinary relationships.
Financial constrain is a major hindrance to offer quality care, where good care is
available. However, health care cost can be reduced by reducing the number of hospital stay that
will in turn reduce the daily costs incurred in the facility, use of right choice of medication,
health promotion, and personal care. If Mr. D could have been consulted on the type of care he
needed, an idea of the exact problem would have been found. This in turn would have reduced
the burden of managing an unknown condition. However, in his best interest, personal care was
included in the care plan. According to Chiauzzi, Rodarte and DasMahapatra (2015), patient
monitoring helps them advocate for their personalized care. Health promotion programs for Mr.
D like the use of physiotherapist and art therapy reduces the number of sick days and
hospitalization.
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Contemporary Issues 5
Mr. D’s mental condition poses a challenge for him to access health care in an
appropriate way since he cannot consent to his desired form of medication. This needs a social
worker expert to handle him. Social change in behavior is a determinant for health. Health
inequalities pose a challenge, as there is close link between social condition and health. It is also
prudent to know that health and health care differ. For better health care, you need both health
stakeholders like the nurses, physiotherapists like Mr. D has and also non-health stake holders
like the community, social worker, family and relatives (Marmot and Allen, 2014) Involving
both groups will see the gap in the health sector closed. For instance, in Mr. D’s condition,
involving both the health and non-health stakeholders would mean that Mr. D would be taken
care of holistically, for better outcome.
A good care plan is a prerequisite for good health practice, which will ensure both staff
and patient satisfaction. Mr. D has a comprehensive care plan that was made without involving
him, but in his best interest. The nurses and support workers need to adhere to the care plan to
offer Mr. D’s medication. This means that there is need for effective supervision. The family and
relatives also need to be supervised in the social care they give. According to Carpenter et al.
(2017), effective supervision ensures work effectiveness due to increased critical think,
professional development and positive feedback among others.
When medical and social services are integrated, health care provision becomes more
efficient and satisfactory. Integration occurs in three levels being linkage, coordination, and full
integration. Mr. D’s medical services needs to be integrated with social services like social
therapy. Although the initial cost of integration is high, long terms benefits are always there. The
hospital staff like nurses involved in Mr. D’s management plan together with other support
systems can be involved in clinical and management levels for long-term benefits. This can be
Mr. D’s mental condition poses a challenge for him to access health care in an
appropriate way since he cannot consent to his desired form of medication. This needs a social
worker expert to handle him. Social change in behavior is a determinant for health. Health
inequalities pose a challenge, as there is close link between social condition and health. It is also
prudent to know that health and health care differ. For better health care, you need both health
stakeholders like the nurses, physiotherapists like Mr. D has and also non-health stake holders
like the community, social worker, family and relatives (Marmot and Allen, 2014) Involving
both groups will see the gap in the health sector closed. For instance, in Mr. D’s condition,
involving both the health and non-health stakeholders would mean that Mr. D would be taken
care of holistically, for better outcome.
A good care plan is a prerequisite for good health practice, which will ensure both staff
and patient satisfaction. Mr. D has a comprehensive care plan that was made without involving
him, but in his best interest. The nurses and support workers need to adhere to the care plan to
offer Mr. D’s medication. This means that there is need for effective supervision. The family and
relatives also need to be supervised in the social care they give. According to Carpenter et al.
(2017), effective supervision ensures work effectiveness due to increased critical think,
professional development and positive feedback among others.
When medical and social services are integrated, health care provision becomes more
efficient and satisfactory. Integration occurs in three levels being linkage, coordination, and full
integration. Mr. D’s medical services needs to be integrated with social services like social
therapy. Although the initial cost of integration is high, long terms benefits are always there. The
hospital staff like nurses involved in Mr. D’s management plan together with other support
systems can be involved in clinical and management levels for long-term benefits. This can be

Contemporary Issues 6
achieved through working together between health care providers and the social workers. Glasby
and Dickinson, (2014) supports the need for integration for good outcome in care and as a tool
for better resource utilization. Mr. D and the nursing home will both benefit from the united
services by his caregivers, family, and the community.
Mental health problems like Mr. D’s pose a global burden and has an impact both
economic and social costs, (Funk, 2016). Mental health patients are often stigmatized, thus
health authorities need to work in collaboration with other stakeholders like the family and social
workers. This opens an avenue by the health facility to use appropriate surveillance networks
that includes social determinants of health to evaluate the trends in mental disorders. This might
improve care in the future.
Since Mr. D is at the mercy of his health care providers, he could be exposed to
numerous risks. Nevertheless, as part of social support, the team could link him up with a social
media platform. Social media has had a variety of usage in the past with both positive and
negative impacts on individuals. The caregivers handling Mr. D could post his story about his
mental illness on twitter or a Facebook group for him to find peers. Peer to peer support on social
media is the future for mental health care ( Naslund et al. 2016) In these platforms, the peers can
interact online, enjoy the feeling of group belonging, share stories and strategies for coping up.
Mr. D would enjoy these benefits and also be empowered and change the stigma around him. In
overall, it will help promote treatment engagement.
Because of the potential risks in Mr. D’s treatment, health audit and monitoring should be
done during and at the end of the treatment course to ascertain potential gaps. According to
Bowling (2014), audit in the health system improves patient outcome in addition to developing
cost effective use of resources and encouraging continuous education of professionals. In case a
achieved through working together between health care providers and the social workers. Glasby
and Dickinson, (2014) supports the need for integration for good outcome in care and as a tool
for better resource utilization. Mr. D and the nursing home will both benefit from the united
services by his caregivers, family, and the community.
Mental health problems like Mr. D’s pose a global burden and has an impact both
economic and social costs, (Funk, 2016). Mental health patients are often stigmatized, thus
health authorities need to work in collaboration with other stakeholders like the family and social
workers. This opens an avenue by the health facility to use appropriate surveillance networks
that includes social determinants of health to evaluate the trends in mental disorders. This might
improve care in the future.
Since Mr. D is at the mercy of his health care providers, he could be exposed to
numerous risks. Nevertheless, as part of social support, the team could link him up with a social
media platform. Social media has had a variety of usage in the past with both positive and
negative impacts on individuals. The caregivers handling Mr. D could post his story about his
mental illness on twitter or a Facebook group for him to find peers. Peer to peer support on social
media is the future for mental health care ( Naslund et al. 2016) In these platforms, the peers can
interact online, enjoy the feeling of group belonging, share stories and strategies for coping up.
Mr. D would enjoy these benefits and also be empowered and change the stigma around him. In
overall, it will help promote treatment engagement.
Because of the potential risks in Mr. D’s treatment, health audit and monitoring should be
done during and at the end of the treatment course to ascertain potential gaps. According to
Bowling (2014), audit in the health system improves patient outcome in addition to developing
cost effective use of resources and encouraging continuous education of professionals. In case a

Contemporary Issues 7
serious audit is done in the hospital taking care of Mr. D, the cost of care would be reduced as
potential areas of high financial input may include the long hospital stay and use of wrong drugs.
Bickman, Lyon and walpert (2016) backs up the need for monitoring, feedback and
evaluation as a necessity for precision medicine in mental health. The needs, preferences and
prognostic capabilities of Mr. D should be well understood before undertaking any management
procedure on him. For good treatment plan to be initiated, it must go beyond signs and
symptoms. We need personal data of Mr. D that not only focuses on his age, gender and family
but also genetics, social and environmental experiences as these can predispose, precipitate or
relieve his mental problems. The service preference for this patient should also be known, that is
possible through a good and collaborative communication approach, the progress in treatment
and the risks and side effects of the care being given.
A research done by Norman et al. (2016) on Routine Outcome monitoring (ROM) had
more advantages than disadvantages in both private and public hospitals. The physicians
acknowledged that ROM was important in helping monitor their works, set goals, useful in
keeping them focused and validating the treatment methods. This would have been even more
advantageous in Mr. D’s case as the caregivers would get more focused in helping him get better,
set other goals like engaging the social workers more and beating a deadline of getting other
treatment methods like cognitive therapy. It also helps in finding out the drug side effects,
monitoring the liver function and kidney tests since they function sub optimally in such an old
age.
In the United Kingdom, health care benefits for the elderly is universal national
entitlement but the long-term effect is out of pocket responsibility that leads to bankruptcy. In
this situation, the community, family, and relatives can come to the patient’s rescue. A
serious audit is done in the hospital taking care of Mr. D, the cost of care would be reduced as
potential areas of high financial input may include the long hospital stay and use of wrong drugs.
Bickman, Lyon and walpert (2016) backs up the need for monitoring, feedback and
evaluation as a necessity for precision medicine in mental health. The needs, preferences and
prognostic capabilities of Mr. D should be well understood before undertaking any management
procedure on him. For good treatment plan to be initiated, it must go beyond signs and
symptoms. We need personal data of Mr. D that not only focuses on his age, gender and family
but also genetics, social and environmental experiences as these can predispose, precipitate or
relieve his mental problems. The service preference for this patient should also be known, that is
possible through a good and collaborative communication approach, the progress in treatment
and the risks and side effects of the care being given.
A research done by Norman et al. (2016) on Routine Outcome monitoring (ROM) had
more advantages than disadvantages in both private and public hospitals. The physicians
acknowledged that ROM was important in helping monitor their works, set goals, useful in
keeping them focused and validating the treatment methods. This would have been even more
advantageous in Mr. D’s case as the caregivers would get more focused in helping him get better,
set other goals like engaging the social workers more and beating a deadline of getting other
treatment methods like cognitive therapy. It also helps in finding out the drug side effects,
monitoring the liver function and kidney tests since they function sub optimally in such an old
age.
In the United Kingdom, health care benefits for the elderly is universal national
entitlement but the long-term effect is out of pocket responsibility that leads to bankruptcy. In
this situation, the community, family, and relatives can come to the patient’s rescue. A
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Contemporary Issues 8
multidisciplinary approach to Mr. D would be beneficial as the access to health is determined by
physicians and access to long-term care benefit is determined by nurses and social workers. The
importance of economic evaluation in health and social care cannot be underestimated. In his old
age, it would be in order to argue that Mr. D is being taken care of not to be fit again but to
improve his quality of life. Well-being measure is suitable for economic evaluation of older
people (Makai et al. 2014) thus every intervention must be well thought through and make sure
its cost is commensurate to the quality of life desired.
Although Mr. D is receiving care, he must be communicated back to about the milestones
his providers have achieved. This needs communication. Fuertes et al. (2017) brings out the idea
of physician-patient working alliance as a guarantee to patient adherence, satisfaction and
improved outcomes. Some of the physician behaviors like ability to show empathy and indulging
with patient in an emotional talk are linked to the above advantage.
Therefore, all of Mr. D’s caregivers including his family should undergo training in
health and social care. This will equip them with skills that would support Mr. D’s behavior, by
doing the client-centered counseling approach for supporting behavior change. The support
workers in Mr. D’s care have a duty of communicating with him each time they do a procedure.
This type of communication, albeit good, should not be limited to advice giving only as the
traditional methods of care giving were. Each person in question especially the physicians and
the social workers should have an exploratory conversation with the patient by understanding his
world. This would give an idea of the mood, affect, orientation, appearance and behavior thus a
recipe for supporting the client to plan for solutions (Lawrence et al. 2010)
The concept of good patient physician relationship is a core principal in provision of care.
Mr. D’s caregivers have to establish a good relationship with him despite of his condition. Good
multidisciplinary approach to Mr. D would be beneficial as the access to health is determined by
physicians and access to long-term care benefit is determined by nurses and social workers. The
importance of economic evaluation in health and social care cannot be underestimated. In his old
age, it would be in order to argue that Mr. D is being taken care of not to be fit again but to
improve his quality of life. Well-being measure is suitable for economic evaluation of older
people (Makai et al. 2014) thus every intervention must be well thought through and make sure
its cost is commensurate to the quality of life desired.
Although Mr. D is receiving care, he must be communicated back to about the milestones
his providers have achieved. This needs communication. Fuertes et al. (2017) brings out the idea
of physician-patient working alliance as a guarantee to patient adherence, satisfaction and
improved outcomes. Some of the physician behaviors like ability to show empathy and indulging
with patient in an emotional talk are linked to the above advantage.
Therefore, all of Mr. D’s caregivers including his family should undergo training in
health and social care. This will equip them with skills that would support Mr. D’s behavior, by
doing the client-centered counseling approach for supporting behavior change. The support
workers in Mr. D’s care have a duty of communicating with him each time they do a procedure.
This type of communication, albeit good, should not be limited to advice giving only as the
traditional methods of care giving were. Each person in question especially the physicians and
the social workers should have an exploratory conversation with the patient by understanding his
world. This would give an idea of the mood, affect, orientation, appearance and behavior thus a
recipe for supporting the client to plan for solutions (Lawrence et al. 2010)
The concept of good patient physician relationship is a core principal in provision of care.
Mr. D’s caregivers have to establish a good relationship with him despite of his condition. Good

Contemporary Issues 9
patient physician relationship has both emotional and informational component. It has been
shown to improve patient outcome. (Kelley et al. 2014). For Mr. D, the nurse in charge,
physiotherapists and the family at large have to have a good relationship with him, in terms of
communicating verbally and non-verbally, not under estimating him and equally treating him
like other patients. Failure to do this may lead to patient and staff demotivation in practice and
behavior.
It is not easy to achieve a successful collaboration between health care providers. Things
like government funding for the necessary infrastructure, (Leathard, 2004). Collaboration
between health care providers taking care of Mr. D will help look at his problems in a new
perspective.
By allowing him to be taken care of in the health institution despite not participating in
consent and decision-making, Mr. D shows a high level of trust in his health care providers that
have to follow the care plan. He also shows a level of self-trust by following the care plan. His
trust is embedded in the risks the caregivers will pose him to, since it’s a psychological state. The
patient physician relationship is strengthened by patient trust in the physician (Zhao, Rao and
Zhang, 2016). This patient trust in physicians has been declining. Increasing level of mistrust
between his caregivers may result in Mr. D involving in physical fight with his colleges and
caregivers given his mental problems.
Various reasons have been shown to lead to patient-physician mistrust. They include
conflict of interests and perception by patients that medical practitioners are there to monger
money from them (Tucker, 2015) Incase such an incidence happens, this will ruin the reputation
of those involved and the institution. Physicians need to be trained in conflict resolution to
prevent such incidences. Nonviolent processes like hospital mediated conflict resolution.
patient physician relationship has both emotional and informational component. It has been
shown to improve patient outcome. (Kelley et al. 2014). For Mr. D, the nurse in charge,
physiotherapists and the family at large have to have a good relationship with him, in terms of
communicating verbally and non-verbally, not under estimating him and equally treating him
like other patients. Failure to do this may lead to patient and staff demotivation in practice and
behavior.
It is not easy to achieve a successful collaboration between health care providers. Things
like government funding for the necessary infrastructure, (Leathard, 2004). Collaboration
between health care providers taking care of Mr. D will help look at his problems in a new
perspective.
By allowing him to be taken care of in the health institution despite not participating in
consent and decision-making, Mr. D shows a high level of trust in his health care providers that
have to follow the care plan. He also shows a level of self-trust by following the care plan. His
trust is embedded in the risks the caregivers will pose him to, since it’s a psychological state. The
patient physician relationship is strengthened by patient trust in the physician (Zhao, Rao and
Zhang, 2016). This patient trust in physicians has been declining. Increasing level of mistrust
between his caregivers may result in Mr. D involving in physical fight with his colleges and
caregivers given his mental problems.
Various reasons have been shown to lead to patient-physician mistrust. They include
conflict of interests and perception by patients that medical practitioners are there to monger
money from them (Tucker, 2015) Incase such an incidence happens, this will ruin the reputation
of those involved and the institution. Physicians need to be trained in conflict resolution to
prevent such incidences. Nonviolent processes like hospital mediated conflict resolution.

Contemporary Issues 10
Ethical issues in the medical field should be adhered to, though sometimes it poses a
challenge when dilemma exists. Mr. is an elderly patient, who should be handled in a special
way. He also has a mental illness and his care plan was made without his consent also poses a
challenge to ethics, especially if he chooses to refuse health care. Patient autonomy and consent
is a center stage in clinical practice. Occupational code also suggests that help should be given
voluntarily and with a consent, which Mr. D did not give owing to his mental problem. This
poses a risk of abuse, paternalism and coercion to him (Brodtkorb et al. 2015) Being an elderly
person, Mr. D may qualify for physical restraint, in addition to his mental illness. This is usually
necessary where the patient poses a risk to themselves and to others, helps in controlling
behavior and makes treatment easier. However, it is increased with a risk of negative behavioral
change, impaired mobility and cognition and even psychological retardation.
Decision-making and competency are also part of legal issues when it comes to patient
care. A competent individual is able to make decisions and perform tasks. The overall rule is that
they should be able to understand the information, understand the situation at hand and its
consequences, considering the information rationally and making informed decision (Rincon and
Lee, 2015) Mr. D has no capacity to give consent. The health care providers have a responsibility
of finding out if he has drafted will or a durable power of attorney. The setbacks of these
methods are that the physicians cannot get clear instructions to guide his treatment thus deemed
suboptimal.
Mr. D qualifies for legal exception of consent because of his incompetency to do so.
Therefore, it was reasonable to invoke the principle of best interest standard in formulating his
care plan. It’s important in determining a wide range of issues. It is possible that the family of
Ethical issues in the medical field should be adhered to, though sometimes it poses a
challenge when dilemma exists. Mr. is an elderly patient, who should be handled in a special
way. He also has a mental illness and his care plan was made without his consent also poses a
challenge to ethics, especially if he chooses to refuse health care. Patient autonomy and consent
is a center stage in clinical practice. Occupational code also suggests that help should be given
voluntarily and with a consent, which Mr. D did not give owing to his mental problem. This
poses a risk of abuse, paternalism and coercion to him (Brodtkorb et al. 2015) Being an elderly
person, Mr. D may qualify for physical restraint, in addition to his mental illness. This is usually
necessary where the patient poses a risk to themselves and to others, helps in controlling
behavior and makes treatment easier. However, it is increased with a risk of negative behavioral
change, impaired mobility and cognition and even psychological retardation.
Decision-making and competency are also part of legal issues when it comes to patient
care. A competent individual is able to make decisions and perform tasks. The overall rule is that
they should be able to understand the information, understand the situation at hand and its
consequences, considering the information rationally and making informed decision (Rincon and
Lee, 2015) Mr. D has no capacity to give consent. The health care providers have a responsibility
of finding out if he has drafted will or a durable power of attorney. The setbacks of these
methods are that the physicians cannot get clear instructions to guide his treatment thus deemed
suboptimal.
Mr. D qualifies for legal exception of consent because of his incompetency to do so.
Therefore, it was reasonable to invoke the principle of best interest standard in formulating his
care plan. It’s important in determining a wide range of issues. It is possible that the family of
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Contemporary Issues 11
Mr. D did not know his explicit wishes to treatment thus this s principle can guide in treatment.
This method has its own shortcomings like physicians being seen as authoritarian.
Health should be provided to all and sundry disregarding age, gender, race, political
affiliation or economic status. It should be well distributed with an aim of doing well to people
and with proper goals, proper prioritization, and being sufficient. (Judith, 2015). Inganski and
Mason, (2018) also support this by taking about racism, equal opportunity, social change and
health care agenda and lining policy, politics and health care. Mr. D must be given equal care as
others regardless of his old age, social issues that he might have being mentally challenged and
physical disability.
Education for both medical personnel and the society should be encouraged to help
eliminate stigma related to health conditions like mental illness. Shen et al. (2014) did a research
that showed that training in psychiatric condition greatly reduce the stigma toward the mentally
ill. The nursing home in which Mr. D is should embark on a program to educate their workforce
and the community around regarding mental health issues. This will benefit other people like
Mr., making them appreciate whom they are and not feel guilty of their situation.
In conclusion, this essay is highlighting the need for multidisciplinary approach in health
and social care. This includes shared decision making with health care providers and social
workers, social support and good communication strategies. This case study highlights Mr. who
is mentally challenged but lacks the capability to consent to his own treatment, thus leaving the
medical personnel apply the principle of best interest. The nurse, physiotherapists, family, and
the social workers must work in tandem to help Mr. D realize better health care and improved
quality of life. Patient physician trust must also be ensured since Mr. D is a special case, and
would need someone who has empathy towards him. Ethical issues prove to be a challenge in
Mr. D did not know his explicit wishes to treatment thus this s principle can guide in treatment.
This method has its own shortcomings like physicians being seen as authoritarian.
Health should be provided to all and sundry disregarding age, gender, race, political
affiliation or economic status. It should be well distributed with an aim of doing well to people
and with proper goals, proper prioritization, and being sufficient. (Judith, 2015). Inganski and
Mason, (2018) also support this by taking about racism, equal opportunity, social change and
health care agenda and lining policy, politics and health care. Mr. D must be given equal care as
others regardless of his old age, social issues that he might have being mentally challenged and
physical disability.
Education for both medical personnel and the society should be encouraged to help
eliminate stigma related to health conditions like mental illness. Shen et al. (2014) did a research
that showed that training in psychiatric condition greatly reduce the stigma toward the mentally
ill. The nursing home in which Mr. D is should embark on a program to educate their workforce
and the community around regarding mental health issues. This will benefit other people like
Mr., making them appreciate whom they are and not feel guilty of their situation.
In conclusion, this essay is highlighting the need for multidisciplinary approach in health
and social care. This includes shared decision making with health care providers and social
workers, social support and good communication strategies. This case study highlights Mr. who
is mentally challenged but lacks the capability to consent to his own treatment, thus leaving the
medical personnel apply the principle of best interest. The nurse, physiotherapists, family, and
the social workers must work in tandem to help Mr. D realize better health care and improved
quality of life. Patient physician trust must also be ensured since Mr. D is a special case, and
would need someone who has empathy towards him. Ethical issues prove to be a challenge in
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Contemporary Issues 12
such situations, but with good medical practice, informed decisions that will not harm the patient
and caregivers should be made.
such situations, but with good medical practice, informed decisions that will not harm the patient
and caregivers should be made.
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Contemporary Issues 13
References
Barr, B., Taylor-Robinson, D., Stuckler, D., Loopstra, R., Reeves, A. and Whitehead, M., 2016.
‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A
longitudinal ecological study. J Epidemiol Community Health, 70(4), pp.339-345.
Bickman, L., Lyon, A.R. and Wolpert, M., 2016. Achieving precision mental health through
effective assessment, monitoring, and feedback processes.
Bowling, A., 2014. Research methods in health: investigating health and health services.
McGraw-Hill Education (UK).
Brodtkorb, K., Skisland, A.V.S., Slettebø, Å. and Skaar, R., 2015. Ethical challenges in care for
older patients who resist help. Nursing ethics, 22(6), pp.631-641.
Carpenter, J., Webb, C., Bostock, L. and Coomber, C., 2017. Effective supervision in social
work and social care. Health.
Chiauzzi, E., Rodarte, C. and DasMahapatra, P., 2015. Patient-centered activity monitoring in
the self-management of chronic health conditions. BMC medicine, 13(1), p.77.
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Miller, W.L., Crabtree, B.F., England, M.J. and Clark, K., 2015. Understanding care integration
from the ground up: Five organizing constructs that shape integrated practices. The Journal of
the American Board of Family Medicine, 28(Supplement 1), pp.S7-S20.
Elwyn, G., Dehlendorf, C., Epstein, R.M., Marrin, K., White, J. and Frosch, D.L., 2014. Shared
decision making and motivational interviewing: achieving patient-centered care across the
spectrum of health care problems. The Annals of Family Medicine, 12(3), pp.270-275.
References
Barr, B., Taylor-Robinson, D., Stuckler, D., Loopstra, R., Reeves, A. and Whitehead, M., 2016.
‘First, do no harm’: are disability assessments associated with adverse trends in mental health? A
longitudinal ecological study. J Epidemiol Community Health, 70(4), pp.339-345.
Bickman, L., Lyon, A.R. and Wolpert, M., 2016. Achieving precision mental health through
effective assessment, monitoring, and feedback processes.
Bowling, A., 2014. Research methods in health: investigating health and health services.
McGraw-Hill Education (UK).
Brodtkorb, K., Skisland, A.V.S., Slettebø, Å. and Skaar, R., 2015. Ethical challenges in care for
older patients who resist help. Nursing ethics, 22(6), pp.631-641.
Carpenter, J., Webb, C., Bostock, L. and Coomber, C., 2017. Effective supervision in social
work and social care. Health.
Chiauzzi, E., Rodarte, C. and DasMahapatra, P., 2015. Patient-centered activity monitoring in
the self-management of chronic health conditions. BMC medicine, 13(1), p.77.
Cohen, D.J., Balasubramanian, B.A., Davis, M., Hall, J., Gunn, R., Stange, K.C., Green, L.A.,
Miller, W.L., Crabtree, B.F., England, M.J. and Clark, K., 2015. Understanding care integration
from the ground up: Five organizing constructs that shape integrated practices. The Journal of
the American Board of Family Medicine, 28(Supplement 1), pp.S7-S20.
Elwyn, G., Dehlendorf, C., Epstein, R.M., Marrin, K., White, J. and Frosch, D.L., 2014. Shared
decision making and motivational interviewing: achieving patient-centered care across the
spectrum of health care problems. The Annals of Family Medicine, 12(3), pp.270-275.
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Contemporary Issues 14
Fuertes, J.N., Toporovsky, A., Reyes, M. and Osborne, J.B., 2017. The physician-patient
working alliance: Theory, research, and future possibilities. Patient education and counseling,
100(4), pp.610-615.
Funk, M., 2016. Global burden of mental disorders and the need for a comprehensive,
coordinated response from health and social sectors at the country level.
Gausvik, C., Lautar, A., Miller, L., Pallerla, H. and Schlaudecker, J., 2015. Structured nursing
communication on interdisciplinary acute care teams improves perceptions of safety, efficiency,
understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary
healthcare, 8, p.33.
Gilson, L., 2003. Trust and the development of health care as a social institution. Social science
& medicine, 56(7), pp.1453-1468
Glasby, J. and Dickinson, H., 2014. Partnership working in health and social care: what is
integrated care and how can we deliver it?. Policy Press.
Gühne, U., Weinmann, S., Arnold, K., Becker, T. and Riedel-Heller, S.G., 2015. S3 guideline on
psychosocial therapies in severe mental illness: evidence and recommendations. European
archives of psychiatry and clinical neuroscience, 265(3), pp.173-188.
Iganski, P. and Mason, D., 2018. Ethnicity, equality of opportunity and the British National
Health Service. Routledge.
Juth, N., 2015. Challenges for principles of need in health care. Health Care Analysis, 23(1),
pp.73-87.
Fuertes, J.N., Toporovsky, A., Reyes, M. and Osborne, J.B., 2017. The physician-patient
working alliance: Theory, research, and future possibilities. Patient education and counseling,
100(4), pp.610-615.
Funk, M., 2016. Global burden of mental disorders and the need for a comprehensive,
coordinated response from health and social sectors at the country level.
Gausvik, C., Lautar, A., Miller, L., Pallerla, H. and Schlaudecker, J., 2015. Structured nursing
communication on interdisciplinary acute care teams improves perceptions of safety, efficiency,
understanding of care plan and teamwork as well as job satisfaction. Journal of multidisciplinary
healthcare, 8, p.33.
Gilson, L., 2003. Trust and the development of health care as a social institution. Social science
& medicine, 56(7), pp.1453-1468
Glasby, J. and Dickinson, H., 2014. Partnership working in health and social care: what is
integrated care and how can we deliver it?. Policy Press.
Gühne, U., Weinmann, S., Arnold, K., Becker, T. and Riedel-Heller, S.G., 2015. S3 guideline on
psychosocial therapies in severe mental illness: evidence and recommendations. European
archives of psychiatry and clinical neuroscience, 265(3), pp.173-188.
Iganski, P. and Mason, D., 2018. Ethnicity, equality of opportunity and the British National
Health Service. Routledge.
Juth, N., 2015. Challenges for principles of need in health care. Health Care Analysis, 23(1),
pp.73-87.
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Contemporary Issues 15
Kelley, J.M., Kraft-Todd, G., Schapira, L., Kossowsky, J. and Riess, H., 2014. The influence of
the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis
of randomized controlled trials. PloS one, 9(4), p.e94207.
Leathard, A. ed., 2004. Interprofessional collaboration: from policy to practice in health and
social care. Routledge.
Makai, P., Brouwer, W.B., Koopmanschap, M.A., Stolk, E.A. and Nieboer, A.P., 2014. Quality
of life instruments for economic evaluations in health and social care for older people: a
systematic review. Social science & medicine, 102, pp.83-93.
Marmot, M. and Allen, J.J., 2014. Social determinants of health equity.
Naslund, J.A., Aschbrenner, K.A., Marsch, L.A. and Bartels, S.J., 2016. The future of mental
health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences, 25(2),
pp.113-122.
Norman, S., Dean, S., Hansford, L. and Ford, T., 2014. Clinical practitioner’s attitudes towards
the use of Routine Outcome Monitoring within Child and Adolescent Mental Health Services: A
qualitative study of two Child and Adolescent Mental Health Services. Clinical Child
Psychology and Psychiatry, 19(4), pp.576-595.
Rajabiyazdi, F., Perin, C., Babione, J., Santana, M., Kaufman, J., Ghali, W., Sargious, P.,
Carpendale, S. and Tropiano, J., 2016, May. Involving Patients in their Care Plan: Patients' and
Care providers' Perspectives. In Proceedings of the CHI Workshop on Interactive Systems in
Healthcare (WISH'16).
Kelley, J.M., Kraft-Todd, G., Schapira, L., Kossowsky, J. and Riess, H., 2014. The influence of
the patient-clinician relationship on healthcare outcomes: a systematic review and meta-analysis
of randomized controlled trials. PloS one, 9(4), p.e94207.
Leathard, A. ed., 2004. Interprofessional collaboration: from policy to practice in health and
social care. Routledge.
Makai, P., Brouwer, W.B., Koopmanschap, M.A., Stolk, E.A. and Nieboer, A.P., 2014. Quality
of life instruments for economic evaluations in health and social care for older people: a
systematic review. Social science & medicine, 102, pp.83-93.
Marmot, M. and Allen, J.J., 2014. Social determinants of health equity.
Naslund, J.A., Aschbrenner, K.A., Marsch, L.A. and Bartels, S.J., 2016. The future of mental
health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences, 25(2),
pp.113-122.
Norman, S., Dean, S., Hansford, L. and Ford, T., 2014. Clinical practitioner’s attitudes towards
the use of Routine Outcome Monitoring within Child and Adolescent Mental Health Services: A
qualitative study of two Child and Adolescent Mental Health Services. Clinical Child
Psychology and Psychiatry, 19(4), pp.576-595.
Rajabiyazdi, F., Perin, C., Babione, J., Santana, M., Kaufman, J., Ghali, W., Sargious, P.,
Carpendale, S. and Tropiano, J., 2016, May. Involving Patients in their Care Plan: Patients' and
Care providers' Perspectives. In Proceedings of the CHI Workshop on Interactive Systems in
Healthcare (WISH'16).
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Contemporary Issues 16
Rincon, F. and Lee, K., 2015. Ethical considerations in consenting critically ill patients for
bedside clinical care and research. Journal of intensive care medicine, 30(3), pp.141-150.
Shen, Y., Dong, H., Fan, X., Zhang, Z., Li, L., Lv, H., Xue, Z. and Guo, X., 2014. What can the
medical education do for eliminating stigma and discrimination associated with mental illness
among future doctors? effect of clerkship training on Chinese students' attitudes. The
International Journal of Psychiatry in Medicine, 47(3), pp.241-254.
Sherlock, A. and Brownie, S., 2014. Patients' recollection and understanding of informed
consent: a literature review. ANZ journal of surgery, 84(4), pp.207-210.
Tucker, J.D., Cheng, Y., Wong, B., Gong, N., Nie, J.B., Zhu, W., McLaughlin, M.M., Xie, R.,
Deng, Y., Huang, M. and Wong, W.C., 2015. Patient–physician mistrust and violence against
physicians in Guangdong Province, China: a qualitative study. BMJ open, 5(10), p.e008221.
Zhao, D.H., Rao, K.Q. and Zhang, Z.R., 2016. Patient trust in physicians: empirical evidence
from Shanghai, China. Chinese medical journal, 129(7), p.814.
Rincon, F. and Lee, K., 2015. Ethical considerations in consenting critically ill patients for
bedside clinical care and research. Journal of intensive care medicine, 30(3), pp.141-150.
Shen, Y., Dong, H., Fan, X., Zhang, Z., Li, L., Lv, H., Xue, Z. and Guo, X., 2014. What can the
medical education do for eliminating stigma and discrimination associated with mental illness
among future doctors? effect of clerkship training on Chinese students' attitudes. The
International Journal of Psychiatry in Medicine, 47(3), pp.241-254.
Sherlock, A. and Brownie, S., 2014. Patients' recollection and understanding of informed
consent: a literature review. ANZ journal of surgery, 84(4), pp.207-210.
Tucker, J.D., Cheng, Y., Wong, B., Gong, N., Nie, J.B., Zhu, W., McLaughlin, M.M., Xie, R.,
Deng, Y., Huang, M. and Wong, W.C., 2015. Patient–physician mistrust and violence against
physicians in Guangdong Province, China: a qualitative study. BMJ open, 5(10), p.e008221.
Zhao, D.H., Rao, K.Q. and Zhang, Z.R., 2016. Patient trust in physicians: empirical evidence
from Shanghai, China. Chinese medical journal, 129(7), p.814.
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Contemporary Issues 17
Appendix 1
CASE STUDY
Mr D, an elderly man, has serious mental health problem. He lives in the nursing home whise the
author works as a care manager. Mr D’s care plan has been prepared by the multi-disciplinary
team, in consultation with his relatives in deciding what course of action would be in Mr D’s best
interests. The care plan covers the medication he has been prescribed, the physiotherapy he
needs, help with his personal care and other therapeutic activities such as art therapy he needs
help with.
Although attempts were made to involve Mr D in the planning process, he has been assessed by
the doctor responsible for his care as lacking capacity to consent to most aspects of his care plan.
The care plan can be relied on by the nurse or support workers who administer the medication,
by the physiotherapist and art therapist, and by the care assistant who helps with Mr. D’s
personal care, providing them with reasonable grounds for believing that they are acting in his
best interests.
However, as each act is performed, the support worker must take reasonable steps to
communicate with Mr D to explain what they are doing and to ascertain whether he has the
capacity to consent to the act in question. If they think he does, they must stop the treatment
unless or until Mr. D agrees that it should continue.
Appendix 1
CASE STUDY
Mr D, an elderly man, has serious mental health problem. He lives in the nursing home whise the
author works as a care manager. Mr D’s care plan has been prepared by the multi-disciplinary
team, in consultation with his relatives in deciding what course of action would be in Mr D’s best
interests. The care plan covers the medication he has been prescribed, the physiotherapy he
needs, help with his personal care and other therapeutic activities such as art therapy he needs
help with.
Although attempts were made to involve Mr D in the planning process, he has been assessed by
the doctor responsible for his care as lacking capacity to consent to most aspects of his care plan.
The care plan can be relied on by the nurse or support workers who administer the medication,
by the physiotherapist and art therapist, and by the care assistant who helps with Mr. D’s
personal care, providing them with reasonable grounds for believing that they are acting in his
best interests.
However, as each act is performed, the support worker must take reasonable steps to
communicate with Mr D to explain what they are doing and to ascertain whether he has the
capacity to consent to the act in question. If they think he does, they must stop the treatment
unless or until Mr. D agrees that it should continue.
1 out of 17
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