Integrated Nursing Care For Adults with Complex needs

This essay discusses integrated nursing care for adults with complex needs, focusing on the involvement of healthcare providers and multidisciplinary teams in planning patient care. It also explores the learning experience and its impact on future care for patients with complex needs. Recommendations to improve practice are provided.

Integrated Nursing Care For
Adults with Complex needs
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Table of Contents
ESSAY.............................................................................................................................................3
a) Introduction to the essay including NMC confidentiality statement...........................................3
b) Critically analyse and evaluate the ways you and the other members of the multi-disciplinary
team were involved in planning integrated patient care..................................................................3
c) Conclusion/reflection on how learning experience will inform practice in the future when
caring for patients with complex needs,..........................................................................................6
Recommendations to improve practice made.............................................................................6
Conclusion...................................................................................................................................7
REFERENCES................................................................................................................................8
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ESSAY
a) Introduction to the essay including NMC confidentiality statement
Over the years, individuals from the most part of the world remained untreated and
preventable constant sicknesses like hypertension, diabetes, weight, and cardiovascular ailment
that are irritated by unexpected weakness propensities, for example, deficient physical
movement, poor nourishment, smoking, and substance misuse. But, in present time healthcare
industry has formulated an effective program i.e. Integrated Care (Carey, 2018). Present essay
will be enclosed with patient scenario, evaluation of ways healthcare provider & other
individuals as well considering multi-disciplinary team were involved in planning integrated
patient care, and learning experience as well. Also, this essay is based on integrated care of an
individual whose name is Mrs. Jones (Hypothetical name) who is 67 years old dealing with
Dementia (Alzheimer's Disease), Type 2 diabetes along with a history of 20 Years regular
smoking which brought her to deal with Chronic obstructive pulmonary disease (COPD), but she
stopped smoking in 2018 (This is a developed scenario for Mrs. Jones to understand the
intergrated care). Lately from 2019 she started taking treatment in an effective Integrated Unit
of National Health Services (NHS) England. Basically, due to Alzheimer's Disease it has been
analysed that she forgets to take daily pills and insulin, which helps her in reducing the chances
of fluctuations in her health conditions and may lead her to severeness as well.
Away with this, if it is talked about the NMC Confidentiality Statement which has been
taken into consideration for Mrs. Jones then it is “Created in a joint effort with numerous who
care about great nursing and health assistance, the Code can be utilized by medical caretakers,
maternity specialists and nursing partners as a method for strengthening their polished skill.”
(Chow and Dahlin, 2018). Considering this statement, mental healthcare providers, nurses and
carers will be focusing upon confidentiality, ethics and values that are linked with the Code of
Conduct in relation to health service.
b) Critically analyse and evaluate the ways you and the other members of the
multi-disciplinary team were involved in planning integrated patient care.
At the time of treating Mrs. Jones, I (nurse) and my team members and Two carers
(Alexa and John) (All these names that are taken into consideration are based on hypothesis)
will be effectively deliver all the required medication, health related services and also will be
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delivering right amount of modifications within the medication based on Mrs. Jones medical
conditions. According to Stockwell Smith and et. al., (2018), Multidisciplinary Teams (MDTs)
are the component for sorting out and planning wellbeing and care administrations to address the
issues of people with complex consideration needs. The groups unite the aptitude and abilities of
various experts to survey, design and oversee care mutually. Situated in the network, and
coordinates with essential consideration, MDTs are required to work proactively to help people's
consideration objectives. Through getting to a scope of wellbeing, social consideration and other
network administrations, MDTs center around keeping individuals well and autonomous,
conveying the correct consideration at home or in the network to forestall superfluous clinic care
(Kupeli and et. al., 2018).
Therefore, if it is critically analysed then the primal goal of all the individuals that are
involved in the case is to get the better patient outcomes. But, sometimes due to
miscommunication and other issues, it has been analysed that a number of issues would take
place. Thus, it is needed not only to focus among Mrs. Jones considered objectives but they
should also develop a much more effective time management related plan, better communication
in between them to develop right schedule of delivering right care to Mrs. Jones and so on
(Kodner, 2018).
If it is talked about the team effort of this Multidisciplinary Team within the Integrated
Unit of National Health Services (NHS) England. Basically, there are a number of team efforts
that my team has delivered based on the guidance that has been profound by Healthcare industry
of United Kingdom (NHS) (What are the key factors for successful multidisciplinary team
working?, 2018). Some of these efforts are based around general practices that incorporate
generalists working nearby specialists, there is regularly an attention on case of Mrs. Jones the
executives and backing to give locally established carerather than optional care.Away with
this, another ultimate effort that came in front was to deliver intergrated medication and Joint
care arranging and co-ordinated evaluations of care needs for Mrs. Jones. Focused over her
personalised social insurance plans and programmes. Including this, they have also named care
co-ordinators who go about as who hold duty regarding medical consideration and encounters all
through the journey of Mrs. Jones (Medical history).Away with this, another effort that came
in front of Multidisciplinary Team for serving the best healthcare services to Mrs. Jones is
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management of clinical records that are shared and continuous updates are also being made in
order to deliver the best care (McDerby and et. al., 2018).
Evidence based individualised patient care is considered to be the faithful, express, and
reasonable utilization of current best proof, fundamentally from clinical preliminaries, in settling
on choices about the consideration of individual patients (Why Is Evidence-Based Practice in
Nursing so Important?, 2018). All in all, the objective of EBM has been to improve quality
through the institutionalization of clinical consideration. At the time of serving Mrs. Jones, it will
be needed by me and my other team members (John and Alexa) to deliver right infomration to
each other and this could effectively be done through following the democratic leadership style,
as this will help me, John and Alex and specifically start taking decisions through delivering
information to each other about medical conditions of Mrs. Jones. Awa with this, through EBP, I
can say that will directly aid nurses, carer and physician in determine an effective course of
action for care delivery for Mrs. Jones so that she can easily get treated with Dementia, her sugar
level would not face fluctuations and deliver of all the medication could effectively be delivered
(Inzitari and et. al., 2018). If it is critically analysed then, it can easily be said that EBP would
directly may involve a range of steps and these are: formulating a clinical question for the case of
Mrs. Jones. Second step is to identify the health issue faced by Mrs. Jones and then develop an
action plan and gather the best evidence, which would help patient i.e. Mrs. Jones to get treated
in much effective and in efficient manner. Third step that came in front was to analyze the
evidence, as it would lead the team to deal with the complexity of both Type 2 Diabetes and
Alzheimer's Disease, which Mrs. Jones is having.
After this, fourth step was to applying evidence to clinical practice so that right treatment
could effectively be given to Mrs. Jones based on how her body responds on medication that has
been given and so on. Away with this, assessing all the results that came in front could be
considered as the last stage of Evidence based individualised patient care as this would help Mrs.
Jones confidentiality of diseases and it will also lead her to get treated right on time.
Local Trust pathways, policies and guidelines.
Also based on local trust pathways, guidelines along with policies that came in front of
team efforts was directly to follow a number of principles while treating Mrs. Jones and some of
these are: attributes supporting compelling interdisciplinary collaboration were distinguished:
constructive authority and the executives traits; correspondence techniques and structures;
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individual prizes, preparing and advancement; suitable assets and strategies; proper aptitude
blend; steady group atmosphere; singular qualities that help interdisciplinary cooperation;
lucidity of vision; quality and results of care; and regarding and getting jobs (Brenner and et. al.,
2018).
c) Conclusion/reflection on how learning experience will inform practice in
the future when caring for patients with complex needs,
Being a nurse, I have learnt many things considering the experience which will help me
in treating patients with appropriate medication and so on. I would require to focus on my roles
and responsibilities in much effective and in efficient manner as well, Analyze complex clinical
issues by alluding to a patient's history, looking at them and directing neurological tests. Another
responsibility that is required by me to focus on advicing the patients on neurological scatters
and share my experiences with carers so that they could also learn as well.
Including this, it will also be required by me to effectively request neurological tests and
decipher the consequences of neuroimaging contemplates, so that right amount of modifications
if it is needed to be made to specifically endorse and additionally regulate treatment and
prescription. Also, it will be needed by me to focus on screening the conduct and subjective
reactions of treatment and prescription. It will also be effective for me to focus upon requesting
steady consideration administrations for patients. Communication is also another crucial element
that needs appropriate attention to take an interest in neuroscience investigate exercises
(McDonald and et. al., 2018). Liaise with clinical experts in the network and medical clinics.
Including this, it will be needed by me to stay up with the latest with different medical related
events, treatment and medicine, which would lead me to enhance my own capability of treating
individuals and this will also aid me in meeting right goal and objectives as well for the future.
Recommendations to improve practice made
Based on the above mentioned information, it is recommended to myself that, I should
keep on focusing upon different elements and strategies in relation to Risks of the Typical
Informed Consent Process, Benefits of Shared Decision Making and Patient-Centered Care, Use
of Information Technology to Feed Forward the Right Patient Information at the Right Time and
Impact of Decision Aids on Patients’ Choices as well. This would lead me in taking right
decisions in specified time frame. Also, it will be needed by me to focus in much effective and
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efficient manner on Multidisciplinary working can be approached in more than one way as the
case studies in this briefing demonstrate (Delaney and et. al., 2018).
Conclusion
Considering or focusing upon the above information, it is concluded that0 I should more
keep my focus on patient's self-announced wellbeing data as it would aid in taking right
deicisions in near future in much effective and in efficient manner. This data is combined, and
reports are made promptly to take care of data back to the patient about his/her wellbeing
practices and conditions. This equivalent programming can bolster the arrangement of modern
choice guides when patients are confronting inclination delicate treatment decisions.
Furthermore, data on patients' treatment inclinations including their comprehension of the key
realities about the treatment and how they would esteem the various potential results of care can
be gathered and taken care of forward to their treating clinician at the purpose of care. This mix
of innovation, understanding data, and proof gives a system to tolerant focused consideration and
educated decision.
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REFERENCES
Books and Journals
Brenner, M. and et. al., 2018. Management and integration of care for children living with
complex care needs at the acute–community interface in Europe. The Lancet Child &
Adolescent Health. 2(11). pp.822-831.
Carey, M., 2018. Biomedical nemesis? Critical deliberations with regard to health and social care
integration for social work with older people. International Social Work. 61(5). pp.651-
664.
Chow, K. and Dahlin, C., 2018, August. Integration of Palliative Care and Oncology Nursing.
In Seminars in oncology nursing (Vol. 34, No. 3, pp. 192-201). WB Saunders.
Delaney, K. R. and et. al., 2018. The effective use of psychiatric mental health nurses in
integrated care: Policy implications for increasing quality and access to care. The
journal of behavioral health services & research. 45(2). pp.300-309.
Inzitari, M. and et. al., 2018. Integrated primary and geriatric care for frail older adults in the
community: Implementation of a complex intervention into real life. European journal
of internal medicine. 56. pp.57-63.
Kodner, D. L., 2018. Beyond care management: the logic and promise of vertically integrated
systems of care for the frail elderly. In Long-term care: Matching resources and
needs (pp. 101-117). Routledge.
Kupeli, N. and et. al., 2018. What are the barriers to care integration for those at the advanced
stages of dementia living in care homes in the UK? Health care professional
perspective. Dementia. 17(2). pp.164-179.
McDerby, N. and et. al., 2018. Feasibility of integrating residential care pharmacists into aged
care homes to improve quality use of medicines: study protocol for a non-randomised
controlled pilot trial. International journal of environmental research and public
health. 15(3). p.499.
McDonald, S. R. and et. al., 2018. Association of integrated care coordination with postsurgical
outcomes in high-risk older adults: the Perioperative Optimization of Senior Health
(POSH) initiative. JAMA surgery. 153(5). pp.454-462.
Stockwell‐Smith, G. and et. al., 2018. Hospital discharge processes involving older adults living
with dementia: An integrated literature review. Journal of clinical nursing. 27(5-6).
pp.e712-e725.
Online
Why Is Evidence-Based Practice in Nursing so Important?. 2018. [Online]. Available through:
<https://learnonline.eiu.edu/articles/rnbsn/evidence-based-practice-important.aspx>.
What are the key factors for successful multidisciplinary team working?. 2018. [Online].
Available through: <https://www.cordisbright.co.uk/admin/resources/05-hsc-evidence-
reviews-multidisciplinary-team-working.pdf>.
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