BUS4003 Healthcare Management Case Study: Marcia Jones and Family

This case study analyzes the healthcare management of Marcia Jones, a 35-year-old woman diagnosed with schizophrenia, living with her partner and three children. The assignment addresses Marcia's clinical priorities, focusing on her need for both pharmacological and psychosocial support, as well as the impact of her illness on her family. It explores the application of the APIE framework and patient empowerment models to develop a care plan, considering the roles of a multidisciplinary team, relevant legislation, professional standards, and resource constraints. The case study highlights the importance of patient-centered goals, self-care management, and addressing the psychological and social impacts of schizophrenia on both the patient and her family, including the potential effects on her children. The paper also includes a detailed care plan using the APIE framework and a discussion of the role of legislation and professional standards in patient care.

Running head: Healthcare Management
Healthcare Management
Name of the Student
Name of the university
Author’s note

1
Healthcare Management
Table of Contents
Introduction......................................................................................................................................2
Background to the case study..........................................................................................................2
Clinical priorities and needs of Marcia and her family...................................................................2
Approach..........................................................................................................................................4
Application......................................................................................................................................6
Care plan......................................................................................................................................6
Communication of good practice with the Multidisciplinary team.............................................7
Role of legislation, professional standards..................................................................................7
Resources constraints...................................................................................................................8
Conclusion.......................................................................................................................................8
Reflection.........................................................................................................................................9
Description...................................................................................................................................9
Feelings........................................................................................................................................9
Evaluation....................................................................................................................................9
Analysis.......................................................................................................................................9
Action plan.................................................................................................................................10
References......................................................................................................................................11
Appendix........................................................................................................................................15
Mental health care plan for Marcia and her families.....................................................................15

2
Healthcare Management
Assessment................................................................................................................................15
Planning.....................................................................................................................................15
Implementation..........................................................................................................................16
Evaluation..................................................................................................................................17

3
Healthcare Management
Introduction
The paper will provide a care planning of a schizophrenia patient, focusing on patient
centered goals , empowering the patient in the self-care management of the disease. The care
plan would also consider the psychological impact of the disease and the family and the possible
approaches to support them. Furthermore, the standards and the associated legislations will also
be discussed.
Background to the case study
The case study is about Marcia Jones, a 35 years old lady suffers from Schizophrenia.
She lives with her partner Ted and their three children. Marcia is not able to work outside for her
recurrent episodes of Schizophrenia. When Marcia takes medicines everyday she is able to do
her household chores, but she avoids taking medicines as she feels very fatigued after taking the
medicines. If Marcia stops medicines, she really have to struggle to keep the children in clean
clothes and cook them enough food. Ted cannot take care of Marcia as he had to do over time for
meeting the expenses of their family. Florence is of school age, but two of her brothers are three
and two year of age. Florence had recently been attending the schools hungry, wearing dirty
clothes.
Clinical priorities and needs of Marcia and her family
It is evident from the above mentioned case study, that Marcia requires serious care in
relation to the management of her symptoms, which includes both pharmacological and non-
pharmacological interventions and psychosocial support. The psychosocial functioning, which
included participation in social activities, social as well as personal relationship, taking carre of

4
Healthcare Management
the others and maintaining self-care activities are challenging issue for the ones who are
suffering from schizophrenia (Suttajit et al. 2015). Again, it has also been stated that patients
suffering from Schizophrenia bears the stigma of this disorder. Most of the Schizophrenia
patients feels to be different, insufficient or in complete. Marcia cannot work outside, as it has
been stated in studies like Goreishizadeh. (2012) that Schizophrenias patients are unable to
perform outside in occupations that requires consent without any formal support. The
psychological disabilities that Marcia had been experiencing is having a great effect on the
patients with Schizophrenia. The antipsychotic affects the positive and negative symptoms and
do not directly reduce the social disabilities like the rehabilitative and supportive programs.
Patients suffering for Schizophrenia are likely to suffer from the schizophrenia face challenges
while taking care of their families, as during the episode of Schizophrenia, the understanding and
the perception and interpretation of the outside world is totally disrupted. They might lose touch
from the reality, hold rational thoughts and beliefs (Barrantes-Vidal et al. 2013). This makes
them unable to cope up with the household chores. Hence, it is clear from the discussion, that
Marcia needs support in household chores.
Florence’s two brothers are small enough not to do their own tasks, hence it is evident
Marcia will be needing help to look after them. This can hamper the attachment relation between
Marcia and her children. Neglected child might develop an insecured attachment style. A secure
attachment is required in good health and flourishing in later life. According to British
psychiatrist and psychoanalyst John Bowlby, the founding father of attachment theory,
attachment is an emotional bond that effects the behavior “from the cradle to the grave”
(Rajkumar 2014). It has been argued by Bowlby, that development of an early attachment
process develops an early attachment process that leads to a particular mental model which

5
Healthcare Management
continues to shape the interaction of the child with other people in the future (Zimmermann and
Iwanski 2015). Hence as per this mental model, in order to develop a good relationship with
children, a parent needs to address the needs of children. It seems that Marcia also needs support
in her daily household chores, so that she can at least invest some time with her children and take
care of them. Her inability to take care of her children my develop attachment disorders in
children.
Again growing children like Florence and her brothers needs ample amount of nutrition
to cater to their growth. Poor nutrition comprises both the quality of life of the school aged
children, but also their potential from benefitting from education. In order to attain, proper
nutrition, it is necessary that children at least three meals in a day or two. Hence, Marcia’s illness
might have negative impact on her children as well. According to Herbert, Manjula and Philip
(2013) the impact of illness of the parents effects the life of the offspring in several areas of life.
They often have the vulnerability to develop social shortfalls featured by mental instability,
forcefulness and seclusion. They are likely to develop poor self-esteem, issues related to social
adjustment and attachment development. Hence, it is equally important to develop a plan of care
where interventions to address the needs of these children will be discussed (Herbert, Manjula
and Philip 2013).
Financial burden of Scizophrenia is quite high. It has been stated by Fasseeh et al. (2018)
that individuals suffering from Schizophrenia uses a substantial amount of health care services.
The cost of Marcia might include that of the medications, or visit to a psychotherapist. For a
household with low income it is difficult to cope up with the increasing costs of living (Fasseeh
et al. 2018). Hence, there is a need of community resource services who can help in the financial
management of Marcia and Ted.

6
Healthcare Management
Approach
The APIE is an acronym that stands for the assessment, diagnosis, planning,
implementation and evaluation. This framework assists the health care professionals to
remember the process required for providing proper care to the patient with Schizophrenia. The
main aim of this framework is to assist in improving the mental, emotional and physical health of
patients by thorough analysis, diagnosis and treatment (Hill 2015). It assists the medical
professionals to identify the problems, develop solutions and monitoring of the results in an
individual basis. The care plan that has been developed on the basis of this approach has been
provided in the appendix section. One of the limitation of this approach is that the assessment of
the problems are often subjective. Some of the nursing the barriers like lack of communication
and therapeutic relationship with the patient can hamper this entire assessment process.
While there are various models that can be used for providing care to the patient. There
are research studies that have proven that empowerment enable Schizophrenic patients to
improve their ability to cope up with the symptoms and to enhance their capability to have
control over their wellbeing and life (Umar and Mundy 2015).
The patient empowerment framework contains the following competencies – Identify,
connect, activate, engage and act (Dahinten et al. 2014).
Identify- This involves the identification of the risk factors of the patients. This can be
done by undertaking a risk assessment.
Connect- Marcia and her family needs to be connected and should be taught how they
should take the ownership of their health. A variety of tactics can be used to reach out to the
paients like by lie automated telephone calls, text messages and emails.

7
Healthcare Management
Activate- Next step would be to motivate the patient in seeking for the referrals and
community based programs. Social networks have been found to be very useful in motivating
people to be concerned about health and they should be informed about the sources that are
available for the patients.
Engage- After the patients have been identified, it is necessary for the social workers to provide
the tools and the confidence that is required for the success. Engagement of the patients should
be done about patient education and training. Engagement can be done by the help of alert,
remainders, assessment and the questionnaires, patient decision.
Act- Ultimately, the social worker should make sure that appropriate steps are being taken by the
patients and the family to manage their health better. This steps should be taken by the patient
himself.
A person centered care model is another approach to empower the patient against mental
illness. It is regarded as the best empowerment model for providing appropriate self –
management support. The central idea of a person centered approach is that it involves the day to
day experience of the person over time. It has been argued that PCC provides increased
understanding, capability, and confidence in approach of decision making (Puchalski 2013). It is
suggested as the strategy for empowering the patients to appraise and provide response on the
quality and the correctness of the health care services. It enhances the interaction between the
patient and the health care practitioner, based on communications and focusing on conditions
beyond the symptoms (Pulvirenti, McMillan and Lawn 2014).

8
Healthcare Management
Application
Care plan
A care plan has been developed for Marcia and his families by using the APIE
framework. the care plan for the patient would involve consultation with the doctors, providing
the patients with the necessary physical as well as the psychological support.
Communication of good practice with the Multidisciplinary team
The combination of various professions and the professions within the multidisciplinary
teams gives a rich chalice of skills overflowing the options for removing the life of someone who
had been suffering from Schizophrenia (Maddock 2015). In order to use these skills with the
greatest effectiveness, it is necessary that a strong therapeutic engagement has to be made with
person who is at the receiving end. The psychiatry team is a bit different from that of the other
multidisciplinary teams. The prime members of a multidisplinary team for Marcia would be a
psychologist, a psychiatry nurse, an occupational therapists and social workers. The core skills of
the psychologists is consultation, assessment, supervision, psychological therapies and
formulation on complex care. A psychiatry nurse would always be at the bed side the patient a
(Bháird et al.2016). They are responsible for assessing the Mental health examination, education
of medication adherence and psychological support. An occupational therapist’s job is to assess
the functional deficit and collaborative approach for the occupation based activity for improving
the functions in areas like activities of daily living, leisure and work in the environment of the
client. A social worker and a nurse can provide interventions like individual therapy, group or
family counselling, social skills training and daily living skills training.

9
Healthcare Management
Role of legislation, professional standards
Schizophrenia is one of the most common types of mental disorder in UK. Several laws
and legislations has been made by the government to ensure that these patients does not undergo
deprivation of their basic rights and treatment. There are several mental health charities like
Mind or Rethink Mental illness, that are just excellent sources of information on employment
and training. Schizophrenia patients can be held under Mental Health Act (NHS 2020). Again the
Human rights Act (1998) states that the health care professionals should respect the rights of the
patients while treating them. The European Convention and the Human Rights Act have also
focused on empowering people suffering from mental disorders. There are several nursing
guidelines of UK, that needs to be followed, while caring for the patients. NICE guidelines
provides a set of rules for managing the symptoms of Schizophrenia. The guidelines can be used
by the health care professionals. These guidelines can be used for providing an up to date
evidence based recommendations for the management of the disorders and the conditions by the
health care professionals.
Resources constraints
Resource constraints in Marcia’s family would act as a barrier to provide care to the
patient. In such case, the social care workers can liaise for the families and can provided referrals
to community based services providing support to the patients to meet up with the household
expenses. Another important barrier to care for Schizophrenia patients, is lack of proper health
literacy. Marcia and his family might deny help or Marcia might go on refusing medicines. Ted
and Marcia might not allow the counselors to have conversation with the children.

10
Healthcare Management
Conclusion
In conclusion, it can be said that an empowerment based approach needs to be
taken for caring for the patient. Marcia should be educated about the importance of medication
adherence. Finally, community based referrals can be provided for supporting the patient and the
families.

11
Healthcare Management
Reflection
Description
This is case study is about Marcia Jones who had been suffering from Schizophrenia and
is unable to care for the family. In order to provide care to Marcia Jones, I would have used a
person centered care approach to care for Marcia. I would have also developed a care plan for
Marcia Jones’ family as it is her children who will be affected mist by their mother’s illness, as
they have to depend on their mother for food and grooming. The medical interventions as a
social care workers would include referral to a GP or a psychiatrist, nurses and other community
based services. I also feel psychological support to the family needs to be provided.
Feelings
I feel that any plan of care for patients with mental illness should focus on the concept of
empowerment, which allows the patients to recognize, promote and enhance their abilities to
meet their own needs.
Evaluation
One of the good thing about working on this case study is that it provided a useful experience of
working with a patient, where provision of care is not only confined to the patient itself but also
to their families. I could easily differentiate between the models of empowerment, which I hope
will be important for my future professional practice.
Analysis
Analyzing the above information, it can be said that an empowerment model is the ideal way to
provide care to the mental health patients. In the past, the health care professionals had to remain

12
Healthcare Management
compliant with the directive of the health care professionals – which is the biomedical model.
This practice is totally in contradiction with the models of empowerment. Empowerment of
Marcia would include self-management of her own symptoms, such that she can take care of her
children. In order to support her in the self-management, a home support can be recommended
for Marcia.
I have also felt the importance of a community based approach to assist the patient cope
up with the illness. It has been stated by Kohrt et al. (2015) that incorporation of mental health
services in to the public can promote accessibility, acceptability, scalability and affordability. It
is to ensure that the patients are adhering to the treatment which increases the likelihood of the
positive clinical outcomes. I have also understood importance of the concept of patient centered
care that can be used to provide a holistic care to the patients involving the patient itself as well
as the families. Families of schizophrenic patients are subjected to considerable emotional
burden and hence psychological support should be provided to them as well.
Action plan
I intend to solve more cases like this in future and to continue with lifelong learning. I
will remain updated by the current guidelines and the evidence based researches about the
current interventions of schizophrenia and empowerment models.

13
Healthcare Management
References
a Bháird, C.N., Xanthopoulou, P., Black, G., Michie, S., Pashayan, N. and Raine, R., 2016.
Multidisciplinary team meetings in community mental health: a systematic review of their
functions. Mental Health Review Journal.
American Geriatrics Society Expert Panel on Person‐Centered Care, Brummel‐Smith, K.,
Butler, D., Frieder, M., Gibbs, N., Henry, M., Koons, E., Loggers, E., Porock, D., Reuben, D.B.
and Saliba, D., 2016. Person‐centered care: A definition and essential elements. Journal of the
American Geriatrics Society, 64(1), pp.15-18.
Barrantes-Vidal, N., Gross, G.M., Sheinbaum, T., Mitjavila, M., Ballespí, S. and Kwapil, T.R.,
2013. Positive and negative schizotypy are associated with prodromal and schizophrenia-
spectrum symptoms. Schizophrenia research, 145(1-3), pp.50-55.
Chatterjee, S., Naik, S., John, S., Dabholkar, H., Balaji, M., Koschorke, M., Varghese, M.,
Thara, R., Weiss, H. A., Williams, P., McCrone, P., Patel, V., and Thornicroft, G. 2014.
Effectiveness of a community-based intervention for people with schizophrenia and their
caregivers in India (COPSI): a randomised controlled trial. Lancet (London, England),
383(9926), 1385–1394. https://doi.org/10.1016/S0140-6736(13)62629-X
Chatterjee, Sudipto et al. “Effectiveness of a community-based intervention for people with
schizophrenia and their caregivers in India (COPSI): a randomised controlled trial.” Lancet
(London, England) vol. 383,9926 (2014): 1385-94. doi:10.1016/S0140-6736(13)62629-X
Dahinten, V.S., Macphee, M., Hejazi, S., Laschinger, H., Kazanjian, M., McCutcheon, A.,
Skelton‐Green, J. and O'Brien‐Pallas, L., 2014. Testing the effects of an empowerment‐based

14
Healthcare Management
leadership development programme: part 2–staff outcomes. Journal of nursing management,
22(1), pp.16-28.
Fasseeh, A., Nemeth, B., Molnar, A., Fricke, F.U., Horvath, M., Koczian, K., Götze, Á. and
Kalo, Z., 2018. A systematic review of the indirect costs of schizophrenia in Europe. European
journal of public health, 28(6), pp.1043-1049.
Goreishizadeh, M., Mohagheghi, A., Farhang, S., and Alizadeh, L. 2012. Psychosocial
disabilities in patients with schizophrenia. Iranian journal of public health, 41(5), 116–121.
Grover, S., Chakrabarti, S., Kulhara, P., and Avasthi, A. 2017. Clinical Practice Guidelines for
Management of Schizophrenia. Indian journal of psychiatry, 59(Suppl 1), S19–S33.
Herbert, H. S., Manjula, M., and Philip, M. 2013. Growing Up with a Parent having
Schizophrenia: Experiences and Resilience in the Offsprings. Indian journal of psychological
medicine, 35(2), 148–153.
Hill, R., 2015. Assessment, Planning, Implementation and Evaluation (APIE). Essentials of
Nursing Practice, p.197.
Kohrt, B. A., Asher, L., Bhardwaj, A., Fazel, M., Jordans, M., Mutamba, B. B., Nadkarni, A.,
Pedersen, G. A., Singla, D. R., and Patel, V. 2018. The Role of Communities in Mental Health
Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies.
International journal of environmental research and public health, 15(6), 1279.
Maddock, A., 2015. Consensus or contention: an exploration of multidisciplinary team
functioning in an Irish mental health context. European Journal of Social Work, 18(2), pp.246-
261.

15
Healthcare Management
NHS, 2020.Mental Act. Access date: 6.4.2020.Retrieved from: https://www.nhs.uk/using-the-
nhs/nhs-services/mental-health-services/mental-health-act/
Puchalski, C.M., 2013. Integrating spirituality into patient care: An essential element of person-
centered care. Pol Arch Med Wewn, 123(9), pp.491-497.
Pulvirenti, M., McMillan, J., and Lawn, S. 2014. Empowerment, patient centred care and self-
management. Health expectations : an international journal of public participation in health
care and health policy, 17(3), 303–310. https://doi.org/10.1111/j.1369-
7625.2011.00757.xEmpowerment, patient centred care and self-management. Health
expectations : an international journal of public participation in health care and health policy,
17(3), 303–310.
Rajkumar, R.P., 2014. Childhood attachment and schizophrenia: the “attachment-developmental-
cognitive”(ADC) hypothesis. Medical hypotheses, 83(3), pp.276-281.
Rajkumar, R.P., 2014. Childhood attachment and schizophrenia: the “attachment-developmental-
cognitive”(ADC) hypothesis. Medical hypotheses, 83(3), pp.276-281.
Suttajit, S., Arunpongpaisal, S., Srisurapanont, M., Thavichachart, N., Kongsakon, R.,
Chantakarn, S., Chantarasak, V., Jariyavilas, A., Jaroensook, P., Kittiwattanagul, K., and
Nerapusee, O. 2015. Psychosocial functioning in schizophrenia: are some symptoms or
demographic characteristics predictors across the functioning domains?. Neuropsychiatric
disease and treatment, 11, 2471–2477.
Umar, A. and Mundy, D., 2015. Re-thinking models of patient empowerment. Stud Health
Technol Inform, 209, pp.175-181.

16
Healthcare Management
Zimmermann, P. and Iwanski, A., 2015. Attachment in middle childhood: Associations with
information processing. New Directions for Child and Adolescent Development, 2015(148),
pp.47-61.

17
Healthcare Management
Appendix
Mental health care plan for Marcia and her families
Assessment
In order to assess the symptoms of Schizophrenia, a doctor can be hired for conducting a health
checkup for Marcia, who might order a scan or physical examination in order to understand the
problems in Marcia. A doctor might check the mental status of the patients just by observing the
appearance and the demeanor of the patient asking about moods, delusions, hallucinations,
thoughts, substance use and the potential violence for suicide and violence. It is also necessary to
assess Marcia’s needs and her feelings. It is necessary to obtain and tally both the subjective as
well as the objective data. Again, it is also necessary to understand the current knowledge of the
family members and the medications used in the disease. The clients family should assessed
about the current knowledge of the disease as families often have misconceptions and
misinformations about Schizophrenia.
Planning
The planning for the patient requires the establishment of some clearly set goals.
The goals are as follows:-
 To restore the impaired thought process of Marcia
 To increase the social interaction of the patient with the families and friends
 To participate in the self-care activities.
 To be able to carry out the basic household chores for the children an husband

18
Healthcare Management
 To remain adhered to the medication regimen and to remain
 To refer Marcia to some community services that would arrange home support for
Marcia.
 To provide psychological support to the patient as well as his family.
 To refer the family to some community based support for getting financial support.
Implementation
It is necessary to understand Marcia’s symptoms that he experiences when he or she
begins to feel anxious around others. Increased anxiety has been found to intensify
aggressiveness, agitation and suspiciousness. It is necessary to avoid pressure on the clients and
any sense of failure on the part of the family. This sense of failure might develop anxiety and
depression in the patient. The household work and the activities needs to be structured as per the
pace of the patient. Marcia should be free to choose his level of interaction, however,
concentration might help to minimize the distressing periods of paranoia. Marcia can be educated
about the adaption of the social skills in a non-threatening environment. The initial social
training can include the basic social behavior like maintenance of the eye contact, calm manner
and behavior. Marcia should be educated about the importance of medication adherence.
Finally, Ted can be given the contact of some important referrals who can be contacted
with for getting help regarding home support at minimum cost, who would take care of the
household chores or will assist Marcia to look after her children. Community bases services
provides a combination of facility-based care and collaborative community based care that would
be more effective than facility based care and collaborative community based care that would be
more effective than the facility –based care for people suffering from severe schizophrenia for
changes in the disabilities and symptoms. The services can also liaise for the patients as financial

19
Healthcare Management
advocates providing facilities to them at low cost (Chatterjee et al. 2014). Florence can be
provided with a counselling to assess her cognitive status and any possible impact occurring on
her due to Marcia’s illness.
Evaluation
 Marcia would show some improvement in the management of the symptoms
 Marcia would adhere to the medication regimen and should show improvement
 The home support would assist Marcia, in taking care of the health of her children.
 Marcia might get GP or nurse visit in a month for having a follow up.