Community Care in Nursing: Family Pressures of Caring for a Chronically Ill Client

This report discusses community care in nursing in context to the topic ‘family pressures of caring for a chronically ill client’ and the related aspects. It enlists the characteristic of the care at two facilities, facilitators and barriers influencing health outcomes, referral and data sharing, regular team-meetings, and facilitators and barriers in chronic care of the patient.

Running Head: NURSING
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Nursing
3/1/2019

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Contents
1. Introduction...................................................................................................................................2
2. Patient care experiences and needs....................................................................................................2
Facilitators and Barriers influencing health outcomes.......................................................................4
3. Referral and data sharing...................................................................................................................4
Facilitators.........................................................................................................................................5
Barriers..............................................................................................................................................6
4. Regular team-meetings......................................................................................................................6
Importance of regular-team meetings................................................................................................6
Facilitators and barriers.....................................................................................................................7
5. Facilitators and Barriers in chronic care of the patient.......................................................................7
6. Conclusion.........................................................................................................................................8
References.............................................................................................................................................9

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1. Introduction
The report brings about the discussion on the aspect of community care in nursing in
context to the topic ‘family pressures of caring for a chronically ill client’ and the related
aspects. The condition of a health that is termed as chronic or a chronically ill- person is the
one who is unable to perform or carry out their basic activities of daily life. The topic is
worth of carrying out an extensive research through different perspectives, i.e. providing a
literature review on the scenario and the relative impacts. Chronic health condition may
include dementia, cancer, diabetes, HIV/AIDS, heart disease, and others, which depicts a
growing trend and concern for the public across nations (Carson et al., 2016). The rationale
behind choosing this topic for the study is to understand and analyse the role of family in
undertaking care of the patient, as family plays the crucial role in hospital treatment of
patients. Therefore, it states about identifying the importance of contribution of the family
through using multiple sources. Thus, the paper will determine the prevalence, and the impact
of burden on the family members of the patient leading to psychological distress.
2. Patient care experiences and needs
To understand the aspect of the patient care experiences and needs in two different
settings such as home or at hospital setting, it is first essential to enlist the characteristic of
the care at two facilities. Chronic care referred to medical care, which lasts for a longer
period, in contrary to other acute health diseases, through their impact on the health of the
patient and their family. Thus, it requires different perspectives and methodology to treat the
patient at home and at a health institution (Clarke et al., 2017).
Home-based health care to the person aims at providing effective and compassionate
care to the person by meeting their needs through personalized and timely services, emotional
support, and ensure assistance to the patient in their daily activities. Moreover, it also aids the
client in terms of financial support, as caring for the sick at home will reduce the cost of
medical services, and also leads to assurance for the absence of any burden of infection, and
provides full freedom to look after the patient’s health and state of recovery. This may also
mean no issues of restriction from the nurses as members in the family feel free to
visit/approach to the patient anytime (Johnsen, Fruhling & Fossum, 2016).

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According to Clarke et al (2017), it has stated that the patients with the chronic
diseases like dementia and stroke treated effectively at their homes, by the care received from
their family members. The authors through their research mentioned the aspect that home-
care leads to both positive and negative impacts on the health and wellbeing of the person.
The negative aspect of the home-based care also includes unavailability of medical resources
in the case of emergency, and further there is no such method or resource to monitor the
change or progress in patient’s health condition (Mondor et al., 2016).
On the other hand, an individual treated at the facility or health care institution,
received a specific, competent and effective care in accordance to their health condition.
Nurses, in all practice settings need to collaborate with their patients and families in order to
ensure them best health outcomes, and treatment for their chronic illness. In addition, to state
about the positive impacts or factors of the hospital environment or facility helping the
patient recover from the health problem, certain aspects play an important role. These aspects
include the contribution of nurses, as they keep an eye or observe the status of the health of
patient. Besides, it also provides supportive care through the availability of any resources
required for the purpose of treatment, in case of any deterioration in the health, therefore, it
leads to best health care services to the patient (Kingma, 2018).
To describe the aspects of the care provided to the patients, at home it has been
understood that home-based care leads to many disadvantages, than the care at facility. One
of the most commonly identified advantage of the caring of the client at home, economic
advantage, derived from the unpaid contribution of the family members towards the patient.
Despite of the economic benefit, emotional assistance and support to the patient, there are
few disadvantages or limitations of the care at homes. These limitations may be in respect to
the aspects of recovery, economical gains, latest medical technology, and discretion for
treatment, as there is higher freedom to the senior-patients who stay at homes, and receives
care. Individuals or the patients can easily rely on the home-based care. Looking at above
scenario, there is more positive factor of home-based care, as it does not only provide the care
to bedridden, but it also reduces the stigma, discrimination, and aids providing psychological
support. Thus, care at home provided to the patients leads to an improvement in the health
condition with the support of family members and emotional support (Rogers et al., 2017).

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Facilitators and Barriers influencing health outcomes
Coordinators have identified barriers and facilitators in their work setting, i.e. both
home and hospitals that may hamper or enhance the level of care provided to the patients
respectively. Freidman et al (2016) were of the view after a research on the patients affected
by a number of chronic health conditions determined some factors which leads to positive
health outcomes, such as effective communication and teamwork. The barriers and
facilitators in the area of patient care coordination categorized into three levels,
organisational, interpersonal, and individual, which affect the patient’s health in different
manner. For the family under the pressure of caring for a chronically ill person, there are
some barriers enlisted such as, lack of time, high-quality referrals, lack of competence,
financial issues, sharing of clinical information, patient resistance, technology systems, and
resources leading to negative health outcomes for the patients (Friedman et al., 2016).
3. Referral and data sharing
It has found through the research that the role of patients and family engagement in
the self-management programs or caring for a chronically ill patient is essential.
Communication is a crucial factor for the families under pressure caring for a patient at home.
Thus, aspect of communication has been associated with the sharing of information, and
referrals for patients at home. The term referral means the process in which the health worker
at one level of health system with insufficient resources obtain help of different or a high-
level facility (O’Reilly et al., 2017).
It states that as the person with the chronic health issue living at home, is under the
supervision and care of the family members, thus it shows the importance of team caring for
them, which consist of health professionals and family carers. Patient and Family-centred
care outlines four concepts, which underlie the aspect of patient-centred care. These include
respect and dignity, information sharing, participation, and collaboration. As the family
members exposed to the psychological distress and thereby they require taking effective
decisions for caring of the patient affected by chronic health condition. According to some
researchers in their study, has analysed that communication is one of the major and
significant tool in the achievement of health outcomes, thus it relates to idea of health
literacy. Health literacy determines the ability of an individual to acquire, understand, and
apply health information to take accurate decisions. Thus, this section of the paper will

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describe information shared in team, and when will be the data sharing take place, and the
discussion related to the referrals (Huygens et al., 2016
Clinical information is required shared amongst the members of family, beginning
from the initial of the treatment medications prescribed which needs to be given on the stated
time, and the food intake or food, which need to be avoided. The information related to the
progress or deterioration in the health of the patient or any need of making changes in the
method of treatment. These aspects of the information need to be shared frequently, or more
often as per the need depending on the situation. On the contrary, if referrals and team-
meetings will not be managed effectively it will hamper the unity of efforts or decision-
making of the members of team. This in turn will negatively influence health condition of the
patient due to ineffective decision-making, leading onto slower rate of recovery or wellbeing
(Carson et al., 2016).
Thus, the family under pressures requires information for these patients is the risks
and benefits associated with the treatment, patient needs, and problems in respect to the
disease or illness. A multi-disciplinary team approach needs to follow information sharing
and referring the person to the general practitioner or care coordinator for treating them using
appropriate techniques and lead to improvement. It may help in preventing any further issue
and help lower the chronic disease complications, and help the person manage their disease
through taking timely check-up, monitoring progress or change and implementing suitable
interventions (López-Espuela et al., 2018).
Facilitators
Emotional and financial support: It is one of the important factors facilitates the
aspect of information sharing. As emotional and financial stability at home will help them to
analyse and reach at a conclusion regarding the treatment of the patient. Open and effective
communication and decision-making: shared decision-making will help in making referrals
for the patient to a better and higher-level of health system (Gale et al., 2015).
Barriers
Lack of interaction with clinicians: Interaction about the health status and condition of
the patient with health professionals, as the lack of interaction will affect the process of
referrals. Resistance from other health facility/clinicians: some health care or facilities may

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not give attention and resist for the referral of the patient, thus it acts as another barrier in the
process (Gibson et al., 2015).
4. Regular team-meetings
From the above sections 1, 2, and 3 several aspects of the care provided to a
chronically-ill patient has been understood. The idea or concept of team-meetings is
important undertaking the care of the individuals or patients at their homes, thus it defines the
relevance of the team-meetings at home or health settings. Meetings conducted on regular
basis, will help in deciding what needs to be done day-by-day, or the way the patient needs to
be taken care. Moreover, it will enlist the duties or responsibilities of each member of the
team. Thus, this describes the need and importance of the regular team meetings, as these
are small things or steps, which will facilitate in developing a care plan for the patient. In
addition, it will also ensure reviewing and evaluating the plan made for the patient’s health
treatment.
However, home-based care does not always result in positive health outcomes,
therefore gaps may develop due to patient left inattentive by caregivers. This gave rise to the
importance to communication through regular team meetings, as help in attaining the goals of
reviewing the care plan formulated for the person, and the end targets or goals to achieve, i.e.
as in the above case recovery of the cancer patient (van Dongen et al., 2016).
Importance of regular-team meetings
A good team meeting does not only involve the role of team-leader, as at home but
goals attained from the combined efforts of all the other members of family. It has found
through the research that the change might occur in the health status of the patient, which
requires observing and evaluating to reach to the goals of improved health. Moreover, poor
communication amongst the family members or team can lead to distress and discouragement
towards assisting the patient to recover from the mental or physical health illness (Misra-
Hebert et al., 2015).
In addition, meetings help in analysing and making adjustments in the care plan and
goals of the patient’s health as per the change in their status. On the other hand, if regular
team-meetings will not be held than it may negatively affect the coordination, collaboration,
and process of formulating goals with the patient-centred care (van Dongen et al., 2016).

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Therefore, if the meetings would not be undertaken on regular basis it will influence the
health of patients, in a negative manner because of mismanagement, amongst themselves.
Facilitators and barriers
These are the aspects or factors that lead to successful team-meetings, such as clarity
and trust about their work, and respect for each other’s roles, are some facilitators for the
families undertaking care of the patient at homes. Frequent meetings and open-discussions
will also lead to success of the communication. Barriers are other aspects that hinder the
communication through team-meetings and these include language barriers in the team-
members.
5. Facilitators and Barriers in chronic care of the patient
Facilitators define factors that will lead to successful team-meetings clarity and trust
about their work, and respect for each other’s roles, are some facilitators for the families
undertaking care of the patient at homes. Frequent meetings and open-discussions will also
lead to success of the communication. Barriers are other aspects that hinder the
communication through team-meetings and these include language barriers in the team-
members (Nancarrow et al., 2013).
The significant role of facilitators observed in the form of effective care and goal
attainment of the chronically ill patient at the home. Economic advantage, trust and clarity,
respect for each other’s roles and open communication amongst the family members acts as
major facilitators and willingness or positive attitude of the residents towards engaging into
self-management. Less burden, psychological support, and services are rendered on time,
united efforts, preventable hospital readmissions are some facilitators, which helped the
chronic ill patient (Wolff et a., 2016).
Barriers affect the process and pace of improvement in the health of the individual
from the care plans and goals. These include language issues, insufficient time, and members
to undertake the care, difference in expectations, lack of resources, and technology and so on.
Thus, above discussion in the report has enlisted some of the facilitators and barriers in
undertaking chronic care of the patient, and attaining health outcomes (Park et al., 2015).

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6. Conclusion
To conclude the above discussion it has been analysed that chronic disease or health
condition are the most common health issues amongst public. The care and treatment of the
person affected by chronic health issues need proper care and timely treatment by their
support members and health professionals. Therefore, the paper above has described all the
relevant aspects of the chronic care, inclusive of facilitators and barriers leading to success of
implementation of methods of treatment. Thus, research findings stated that communication,
and team-meetings are an important aspect towards dealing with the health problems such as
diabetes, heart diseases, cancer, and other issues. Hence, family under pressures need to
acknowledge various aspects to analyse and understand the patient health needs and
experiences to provide them effective care and attain positive health outcomes.

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