Discuss About The Models Of User Involvement In Mental Health?
According to The Australian College of Nursing (ACN), the central tenet of underpinning the delivery of quality care is defined by the approach of Person-centred care or patient centred care (PCC). PCP deals with certain underlining ethical concept for instance; it provides preference in treating each person as separate individuals while framing the personalised care plan. Moreover, the concept of PCC also provides importance in protecting patients’ dignity, right and preferences via maintaining a healthy and mutually exclusive therapeutic relationship with the patient. Under this healthy relationship, the nurses are required to design the care plan via taking a informed consent from the client. Some of the notable benefits of the optimal application of PCC is reduced mortality rate following cardiac arrest or myocardial infarction, decreases in the rate of hospital acquired infection and hospital re-admission in aged care facilities (Australian College of Nursing 2014, p. 01).
This essay is based on the understanding of the PCC and underpinning the theoretical knowledge. The essay highlights interview conducted with a cardiovascular stroke accident (CVS) or stroke recovered patient with upper limb hemiparesis in regard to PCC. Upon subsequent conduction of interview, the essay critically analyse PCC under the light of the patient’s understanding and then reflects possible recommendation to refinement of PCC.
Case study overview
The respondent here have recovered stroke but is suffering from limb impairment that is essential to therapeutic planning efforts in order to restore the function (Raghavan 2015, pp. 599). Therefore the treatment is designed to target the impairment that is responsible for the particular dysfunction at the given point of time (Raghavan 2015, pp. 599).
Analysis of the person understanding of the disease process and treatment
The respondent is suffering from weakness or paralysis of the upper limb and this is leading to delayed initiation and termination of the muscle contraction along with slowness in developing forces (Raghavan 2015, pp. 599). Thus the respondent is unable to move. Thus in regards to the PCC, the respondent is referred to avail wheel chair support for locomotion (Morris and Morris 2012, pp. 347-354). However, the patient is finding the use of wheelchair, demotivating as is gradually developing poor self-esteem (Gerling et al. 2014), pp. 2201-2210). During the course of interview, the patient has also complained that this use of wheelchair is done against his consent. He has also reported that he wish to stay bed-ridden if he’s legs fail to function as usual. Under this circumstance it can be stated that the expectations of people in health care is changing as they are now taking more autonomy in their care (Mezzich and Miles 2011, pp. 20-21; Quill and Holloway 2012, pp. pp.541-543). In this case study, patient was previously informed about his physiological condition and the probable therapy plan however; patient is considering himself to be a passive recipient and is unwilling to avail wheelchair option (Mezzich and Miles 2011, pp. 20-21). Here the use of medical diagnosis going in the favour of the ethical rule of beneficience. Ethical rule of beneficence promotes positive initiatives undertaken to help others (in this case the respondent). However, this ethical principal is going against the rule of autonomy where agreement to respect other’s right is given preference (Faith 2015, pp. 2-5; Mawere 2012, pp. 1). Although PCC promotes personalised care plan for the patients, it also give preference towards elicting and respecting patients’ preferences while engaging them in the care process (Australian Commission on Safety and Quality in Healthcare 2011, pp.8). So in order to make the patient participate in the therapy plan whole-heartedly, nurses must “get inside the skin of the concerned patient via listening to them while establishing dialogue with a view to create therapeutic relationship in which the patient is the key partner of discussion. The registered nurses should keep in mind that there is no place for the “one size fits all” approach in present day PCC (Mezzich and Miles 2011, pp. 20-21; Kitson et al. 2013, pp. 4-15). So in order to make this target patient (the interview respondent) to belief in the use of the wheel chair as the best fit for the therapy plan, the nurses are required to exert competencies in the field of communication, assessment and counselling. Via the optimal application of counselling, behaviour change strategies supporting the self-management of illness along with wellness will be achieved (Mezzich and Miles 2011, pp. 20-21). Via doing this, the patient will gradually understand the importance of wheelchair in the speedy recovery of the after stroke impairment. This understanding will lead to the spontaneous participation of the patient in the therapy and thereby helping him to recover fast (Storm and Edwards 2013, pp. 313-327; Peabody 2015; pp. 868-1868).
Level of Improvement and engagement in the therapy plan
In response to second question it can be stated that, the act of exercise of the hands has been undertaken in order to avoid the chances of learned non-use. Initially after the occurrence of CVA or stroke, the affected individuals may not use the affected portion of the upper limb and this is known as non-use (Raghavan 2015, pp. 599). Generally non-use may result due to paralysis and weakness or sensory loss. However, as the time progress, this non-use gradually becomes a habit and during the course of time, this habit gets transformed into permanent physiological change and is termed as learned non-use. Here in learned non-use, the individual is unable to move to incorporate functional activities with the particular part of the body even though they are now physically fit to mover it (Raghavan 2015, pp. 599). However, in this care, though the patient is participating in the therapy plan, he is anxious to see some positive changes. When he is unable to view the same, he is getting frustrated and is gradually losing hope on the treatment. Under this circumstance, therapy plan needs to be re-designed in order to suit the patient care needs (Australian Commission on Safety and Quality in Healthcare 2011, pp. 8-9). The redesigning must be done ready accessibility of the health information (Australian Commission on Safety and Quality in Healthcare 2011, pp. 8-9). If the patients is provided with the medical data of his course of improvement and is made to understand that though he is unable to manually experience the change in his hand movements but the spasticity of the hand is actually improving via taking reference to the medical records, his level of participation in the therapy will increase (Barry and Edgman-Levitan 2012, pp. 780-781). The elements in the care environment that support PCC must be modified like appropriate staff still mix along with the observance of the transformational leadership promoting the development of the effective nurse team who work under the unique traits of shared power and motivation and innovation (Lawrence and Kinn 2012, pp.295-326). This innovation will bring change in the patient’s approach towards the monotonous therapy and shift in the nurse roster will improvise change in the nursing care skills communication approach that will help the patient to motivate and increase in the therapy participation (Chaudoir, Dugan and Barr 2013, p.22). Apart from the nursing care centred innovation, the organisation must also come forward in order to make further improvement in the PCC (Australian Commission on Safety and Quality in Healthcare 2011, pp. 8-9). In this regard, it will be the duty of the organisation officials to make positive approach towards the quality improvement. Here quality improvement can be achieved via taking feedback from the patients care experience along with clinical and operational data (Aiken et al. 2012, pp. 2012). All these data will act in collaboration to improvise the action plans. Like if the patient is anxious or failing to see any positive results, it is the duty of the organisational bodies to make refinement in the process of the exercise plan via working in sync with the healthcare professionals.
Recommendation for the area of improvement
As per my understanding about the PCC care, it is the duty of the registered nurses to place the patient’s need and interests at the core of their works. However, environmental attributes like inappropriate staff mix skills, lack of adequate funding or high treatment cost and focus on disease based model or evidence based approach on the therapy plan creates barrier towards the optimal implementation of the PCC (Australian College of Nursing 2014, p. 01).
I also believe that the most effective ways to promote patient experience is to improvise the patient-centred consultation styles (Wyer et al. 2014, pp. 881-889). The change in the consultation styles can be achieved via proper communication training among the healthcare professionals and via taking periodic patients’ feedback through surveys performed in group or interviews taken individually. Strengthening of patient consultation styles will help to cast a positive impact on the patient’s knowledge thus facilitating informed decision making and active participation in the therapy plan.
In this ground I would like to specially highlight the communication training of the healthcare professionals (Australian Commission on Safety and Quality in Healthcare 2010, pp. 26-27). Proper communication skills will help the nurses to communicate information about the therapy plan and medicines used to process of disease treatment. This will help to improve the patient’s knowledge and understanding about the disease prognosis and thereby increasing the level of participation while staying motivated (Pinto et al. 2012, pp. 77-78). Moreover, this understanding increases patient’s confidence to undertake necessary actions in relation to health. The impact of patient knowledge and informed decision making increases further, when proper educational material comes in addition to verbal information of nurses. I have also highlighted patients’ survey towards the process of effective application of PCC. While conducting this interview I have understood that one-to-one communication with the patient helps to understand the loopholes of the therapy plan and thus making provision for the quality improvements in the therapy plan. However, patient feedback surveys need to properly planned and carefully implemented and must only be performed after taking active consent from the patient (Manary et al. 2013, pp. 201-203).
Lastly I would like to recommend user centred design and redesign which is popular both in US and UK. The aim of this design is to improvise the physical care environment in order to improve patient’s experience of care. The user centred design is based on the principles of environmental psychology which gives preference to the spatial design towards promoting patient’s well-being and experience (Australian Commission on Safety and Quality in Healthcare 2010, pp. 26-27).
Proposed theoretical framework of PCC from the survey
Thus from the above essay it can be concluded that PCC is an internationally acclaimed approach of promoting quality health care. In PCC, “care is respectful and responsive to individual preference of the patients’ values and needs while ensuring the patient’s values is taken into consideration through clinical decision making. The prime approach that must be undertaken to modify PCC include improvising communication styles of the healthcare professionals, conducting proper surveys to understand the patients experience and user catered design. Moreover, the interview conducted also highlights the need of proper counselling of the patients in order to increase their participation in the therapy.
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