Person Centred Care for Orthopaedic Patient with Psychological Problems

Person Centred Care
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Introduction:
Case of Evelyn Goldstone is chosen for the care plan. Interest in providing care to the
complex cases and expertise in the similar cases made to choose case of Evelyn Goldstone.
This case is about the orthopaedic old female patient who is also having psychological
problems like short term memory loss and confusion. For Evelyn Goldstone, it is necessary to
provide person centred care because involvement of family members is necessary in her care.
Usually, patient need to be incorporated in the person-centred care; however, due to age
factor it would be difficult to involve Evelyn Goldstone in her care (Moore et al., 2017).
Jane, Evelyn Goldstone’s daughter need to be at the centre of her care and she need to work
alongside healthcare professionals in the decision making for care of Evelyn Goldstone.
Involvement of Jane is important in the care of Evelyn because along with providing medical
care to her psychological and emotional intervention need to be provided to her.
Psychological and emotional intervention is necessary because she is not cooperating for
treatment and reluctant to take food also (Ross et al., 2015).
From the collected objective data like left hip fracture, osteoarthritis and osteoporosis and
subjective data like pain; it is evident that acute pain is the most significant problem for
Evelyn. As a result of pain, she is also having problem of mobility. Left hip fracture, pain and
orthopaedic condition might increase chances of fall in her. Hence, risk of fall is another
problem for Evelyn. Hence, pain, mobility and risk of fall are the three problems for Evelyn.
Since, she is having very severe pain, care plan for pain would be written in this assignment.
Confidentiality about name and health condition of Evelyn would be maintained. Maintaining
confidentiality of patients is important because dignity and self-respect of the patient would
be maintained (McHale and Tingle, 2007).
Discussion:
Person-centred care : Framework of person-centred care (PCC) comprises of structure,
process and outcome. Structure is related to components of health-care system, deliverables
to the patient, health-care resources and organisational characteristics. In the hospital, it is
necessary to build person centred culture to provide PCC to Evelyn. Health education, health-
promotion and prevention plan need to be established for Evelyn and opportunity need to be
given to Jane for these establishments. Hospital need to support staff members for
implementation of PCC. For the promotion of PCC, it is necessary to provide health
information to family members. Hence, health information technology needs to be
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established in the hospital. It is necessary to provide supportive and accommodating
environment for PCC implementation. Applicability of PPC in case of Evelyn, need to be
evaluated. Hence, hospital need to adopt established structure to measure and monitor PCC.
PCC process includes communication between healthcare professionals and Jane.
Communication in PCC include cultivating communication, respectful and compassionate
care, engagement of patients in their own care and integration medical care with
psychological and social intervention (Kennedy, 2016; Stickley, 2011).
Outcome exhibit benefits of PCC implementation and interaction among patient family
members and healthcare providers. There should be relationship and alignment among
structure, process and outcome of PCC. Different aspects like medical, social, cultural,
psychological and emotional are being considered in PPC; hence, it is considered as
multidimensional concept. As a result, it is useful in providing holistic care to Evelyn because
she also needs intervention for medical, emotional and psychological aspects. It indicates
complexity of concept of PCC. Hence, it is necessary to use established framework for
assessment of patient in PCC (Ross et al., 2015).
PCC promotes self-determination for Evelyn and Jane. It also establishes mutual respect and
understanding among nurses and Evelyn and Jane. It is also helpful in providing power to
Jane and giving responsibility to her. It would be helpful in improving her self-esteem and
her involvement in her mother’s care. It is also helpful in establishing common therapeutic
goals in concordance with the Evelyn. It would provide more comfort to both Evelyn and
Jane (Moore et al., 2017). Nurse need to establish interpersonal relationships with patient and
family members to implement PPC. John Heron's six-category intervention analysis is useful
in understanding interpersonal relationships and providing effective clinical services to the
patients. These six categories are classified into authoritative and facilitative. Authoritative
type of nurse should provide information, challenge the other person, play a dominant role
and should take responsibility on behalf of client. Authoritative categories include
prescriptive, informative and confronting. In facilitative model, nurse should draw ideas, find
solutions, and build self-confidence. Facilitative categories include cathartic, catalytic and
supportive. This model is also useful as supervision model and improving clinical
competency of nurse in implementing PPC (Heron, 2001).
Assessment: For effective assessment, nurse and patient collectively need to identify needs
and concern of patient. Patient assessment need to be patient focused. Patient assessment is
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useful in obtaining information which is required for planning intervention, achieving goals
and facilitating evaluation of the care plan. McCormack and McCance’s framework is useful
for the patient assessment. Patient assessment should be respectful and individualised,
permitting negotiation, and allowing patient and family members to participate in the
decision making. Steps involved in patient assessment are observation, data collection and
clinical judgement (Wolstenholme, et al., 2017; Thim et al., 2012).
Assessment of Evelyn need to be performed for both subjective and objective data. Objective
data comprises of observable and measurable data. It also includes data related to lab and
diagnostic tests. Objective data include BP- 121/73, Pulse- 96, Saturation Level 98%,
Temperature- 37.6 and VAS pain score 10/10 on movement. Objective assessment data also
include concurrent health conditions like gastric reflux, osteoarthritis, osteoporosis,
Alzheimer’s Disease and short-term memory loss. X-ray examination revealed fracture in her
left neck of femur. Subjective assessment data include pain, moaning and disorientation.
Roper, Logan and Tierney assessment tool need to be used for assessing daily activities of
living. In case of Evelyn, Roper, Logan and Tierney assessment tool would be useful in
assessing mobilisation, communication, breathing, eating and drinking. McCormack and
McCance framework is useful making PCC more tangible for implementation in the actual
practice (McCormack et al., 2017; McCormack, B. and McCance, 2016).
This framework uses empirical data for the assessment of patient. Hence, it is considered as
valid method for the assessment of patient. This framework is useful in establishing caring
relationship among service provider and recipient. Caring relationship is necessary in case of
Evelyn because medical, psychological and emotional intervention need to be provided to her
and her family members. Nurse need to acknowledge emotions and compassion of Evelyn
and her daughter to establish mutuality in her care. According to this framework, it is
necessary for the nurse use values like trust, involvement and humour in her care. Trusting
relationship among the nurse and; Evelyn and Jane is important aspect because patients need
to believe in the care provided by the nurses. Moreover, trusting relationship facilitate PCC
(McCormack et al., 2017; McCormack, B. and McCance, 2016).
Nursing Problems: Based on the collected subjective and objective assessment data; it is
evident that Evelyn is having specific nursing problems. These problems include acute pain,
mobilising, risk of falls, confusion and eating and drinking. It is essential to identify problems
in the patient to provide care to the patient.
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