NRSG366 Semester 1 Case Study: Partnership in Chronicity Analysis

This case study focuses on the concept of partnership in chronicity, particularly within the context of community health nursing. The assignment centers on a patient, Peter Mitchell, who suffers from multiple chronic conditions including obesity, type 2 diabetes, hypertension, sleep apnea, and GERD. The primary goal is to prioritize Peter's care based on his health outcome goals, care preferences, and the application of clinical reasoning. The analysis identifies the fragmented nature of current healthcare systems and emphasizes the importance of a patient-centered approach. The paper details Peter's health issues, lifestyle factors, and the need for interventions such as dietary changes, exercise, and potential therapies like nicotine replacement and animal-assisted therapy. The case study stresses the importance of clear communication between the patient and caregivers, with the primary caregiver coordinating care decisions. The conclusion underscores the need for integrated treatment systems and patient-oriented care plans, optimizing interventions to align with the patient's objectives and preferences. It recommends interventions like a high-protein, low-energy diet, regular exercise, and weekly monitoring to improve patient outcomes, emphasizing the necessity for a holistic approach.

Running head: PARTNERSHIP IN CHRONICITY 1
Partnership in Chronicity
Name
Institution

PARTNERSHIP IN CHRONICITY 2
Partnership in Chronicity
Patients priority care is an approach developed with a patient’s health outcome goals. It
is directed to the older population with multiple chronic conditions. The patient receives
numerous treatments from multiple providers of care. This method can be burdensome and may
not meet the patient’s healthcare goals. Receiving care from multiple care providers may leave
patients unclear who is responsible for their care. There was a need for an approach that was
centered on patient’s goals and needs. The patient’s priority care was developed to address the
situation.
The current healthcare system is often fragmented, this patients then receive poor
quality care and at high cost. The priorities of care will be centered on: health outcome goals,
they are the personal health outcomes the patient hopes to achieve through their healthcare
and care preferences, these are the activities that are involved with being a patient that patients
can be able to do and they also are willing to do. Communication between the caregivers and
the patients is important. In the nursing practice, it is vital to know the skills of prioritization of the
patients needs and be able to apply the clinical reasoning to maximize the care of the patient.
This paper presents a case study, it shows the how care will be prioritized based on the
patients needs using clinical reasoning.
The primary caregiver has to first indentify the issue. Peter Mitchell suffers from obesity.
His weight is at 145kgs. This makes him feel uncomfortable and unable to socialize. He feels
generally fatigued. He is also finding it difficult to perform activities of daily living. Peter also
suffers from Type 2 diabetes, hypertension, sleep apnoea and Gastro esophageal reflux
disease.
Analyzing the evidence his obesity could be linked to the type 2 diabetes he suffers
from. Peter has poorly controlled diabetes which could be fatal if not managed. He is at high risk
because of his weight. The more fatty tissue that he has could cause his cells became resistant
to insulin. Obesity is considered a complex disorder. It increases his peter’s risk of hypertension,
type 2 diabetes and sleep apnea. His work as a forklift driver could have contributed to his obese
state. This is due to the type of work offered little room for physical exercise as he was mostly in
a sitting position. He is also unable to secure a job as a result of fatigue. He is unwilling to lose
weight as it seemed too hard about him. He lives alone and is socially isolated. His sons rarely
visit him, this leaves him feeling lonely.
Peter is known to be a smoker, smoking approximately 20 cigarettes a day. The
oxidizing chemicals in cigarettes will react with cholesterol which eventually results in the build-
up of fatty layers on artery walls. This will cause hypertension as a result. Type 2 diabetes which

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he suffers from is also linked to his smoking addiction. Peter is finding it difficult to perform
activities of daily living. With no one to depend to at home, he might not be able to take care of
himself.
Considering the evidence provided, Peter requires care using an approach that will
decrease both fragmentation and the recipient of unwanted care of unclear benefit (Blaum et al,
2018) priority to care will be guided based on: peters health outcome goals; care preferences
and communication. The primary care giver schedules peters care to meet his preferred outcome
and care preferences. Peter’s outcome and care preferences are shared with communication
with the care giver. Health outcome goals are should be measurable. Peter’s health outcome
goals include, losing at least seven percent of his current weight that is 10.15kgs. Cut the
number of smoking 20 cigarettes a day to 10 cigarettes a day. He also wants to be able to walk
fifteen minutes to the store without experiencing shortness of breath.
Care preferences, they are what the patient is willing to do when undergoing specific
treatment. They are the behavioral goals of the patients. Peters care preferences include,
quitting smoking, to ensure to do regular light exercises consistently as prescribed by the
physiotherapist. He also needs to follow the dietary recommendation by the dietician of a low
energy, high protein diet to assist weight reduction.
With both the peters health outcome goals and care preferences we have got his
priorities of care. His values underlying these priorities include the need to be able to secure
work and earn a living. He hasn’t been able to get work due to feeling fatigued during daytime.
He also wants to be social and not feel ashamed of going in public. He maintains his activities of
daily living so he may remain free of dependency of others. His priorities will be documented into
his health records. These priorities will provide guidance when choosing his care options.
Using an analysis of the evidence provided and weighing up various options in alignment
with peter’s goals, several actions should be taken. The dietician has recommended a low
energy, high fat diet. The diet consists of 30% protein. This diet has a tremendous effect on
weight loss. It keeps the metabolic rate at high levels. A high protein diet suppresses ghrelin,
the hunger hormone for a while. This enables peter to cut down on amount of food
consumption. This diet has proven to be much effective. This is a good start to check on his
weight.
The physiotherapist commenced Peter on light exercises. The caregiver and Peter
should put up a schedule to provide a guideline on Peter’s exercise. It is important that Peter
does at least 300 minutes of light exercises a week. He can do so by fast walking. Sticking to
the plan that he and the caregiver will come up is important. There is an increased chance of

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success in the long run. Peter should have regular appointments with the primary caregiver, at
least once every week to check his weight levels. Monitoring his weight regularly will enable him
and the caregiver check if his efforts are working. This can also motivate peter to being
consistent with his workout plan.
It is recommended that peter tries nicotine replacement therapy to reduce his tobacco
craving. Use of nicotine patches and gum will help peter cut down the number of cigarettes he
smokes in a day physical activity has also shown to be effective in eliminating tobacco craving.
A quick jog or walk when he gets the urge to smoke will change his focus to the physical
activity.
Animal-assisted therapy can be very helpful to peter. A study conducted by the wellness
institute at Chicago’s northwestern memorial hospital, shows that people who exercised with
their pets were more likely to stick their works outs than people who work out alone. Peter did
not give thought to the idea of losing weight as he considered it “too hard” for him. Having a pet
companion is therapeutic and provides a social link with peter. Peter’s feeling of being lonely
and socially isolated will subside.
Examining peter’s medical conditions and the various options available, Peter’s two main
priorities include a workout program to check his weight and commencing on a high protein, low
energy diet. A lifestyle change could prove useful even more than relying on medication.
However, unless following direct instructions from the doctors, he should still continue with his
medications.
In consideration to peters priorities of care, the following would be the best option of care
for peter. He should commence on light exercises. He should have at least thirty minutes walk
every day. Physical exercise will enable him check on his weight. Peter obesity does have a link
with the other chronic diseases he suffers from: type 2 diabetes; hypertension and sleep
apnoea. Animal-assisted therapy will help him be consistent with his daily workout routine. Peter
had complained that the process of weight loss seemed to be “too hard” for him. That was the
reason he did not give it much thought. Also having a pet companion will provide him with a
sense of social inclusion.
He should also commence on a high protein, low energy diet which has proven to be
helpful in reduction of weight. Research has shown a high protein diet provides rapid and
positive results in weight reduction. Peter should get an appointment with the caregiver at least
once a week to monitor is weight and check on his progress with the caregiver.

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Conclusion
The current healthcare system is too fragmented and it is a huge burden to patients with
multiple chronic illnesses. Most patients are put through treatments which provide little benefits
to their overall conditions. There has been the growing need to integrate the treatment system
and develop one which is patient centered. The patient centered approach will focus on the
health outcome goals and care preferences. There are the priorities of the patient.
The care plan should be patient oriented. It should be optimized to suit the patient’s
goals. Good communication between the patient and the caregivers, through the primary
caregivers is important as all the care givers take part in the care decisions.

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