NNS511 Nursing Science 1

Introduction

The global healthcare industry is faced with different challenges in the process of ensuring affordable and high-quality patient care. In their study, Zatta and Mcginnity (2016) points out that these challenges can be internal or external depending on the nature of the healthcare providers involved. For instance, the study denotes that the number of older people, individuals living with disabilities, as well as patients with long-term health complications is increasing drastically, an aspect that urgently requires strategic initiatives to deal with the situations. On the other hand, Austrom (2016) denotes that there is also an increasing pressure on the social care and health budgets. As a result, providing effective and high-quality care that can afford the patients the best quality of life possible needs a re-thinking mind on the relationship between the healthcare services provided by the healthcare organizations and the type of patients that receives the care (Caughan, 2016).

The person-centered care is often tailored and coordinated to the individual needs and hence crucially ensures that individuals are always served with compassion, respect, and dignity. However, Zachos (2013) points out that this nature of care is often seen as a common sense vision for every form of healthcare but not often a standard practice by many healthcare providers. The same study denotes that most of the healthcare providers do ‘for’ or ‘to’ people rather than working with them. The resulting impact is hence the difficulty of including patients in their views, goals, and decisions as the services are given only towards achieving a particular clinical outcome. In his review, this is often a challenging situation for patients living with long-term health conditions such as depression, diabetes, stroke, etc. This paper hence focuses on the evaluation of person-centered collaborative care on cases of patients with stroke and depression as a long-term health complication.

The concept of person-centered collaborative care

According to Slowther (2011), person-centered collaborative care can be defined as a way of making decisions and doing things in a manner that views the persons receiving the care as an equal partner in the development, planning, and monitoring care to ensure it meets their needs. In other words, this type of care puts the patients and their family central in decision-making and viewing them as experts who are working with the healthcare professionals to ensure the best outcomes. In supporting this assertion, Zatta and Mcginnity  (2016) point out that person-centered collaborative care is not only focused on giving patients the care or information they want but considering their values, social circumstances, desires, and lifestyles. It is a care that views the person receiving the care as an important part of the successful process and working together with them to achieve appropriate solutions to their health conditions according to Zachos (2013). The care hence calls for compassion from the healthcare professional while making decisions while considering the point of view of the patients as important and respectful as well.

In his study, Berg (2017) denotes that in the past, patients were always expected to fit in and adopt the practices and routines of social services that were most appropriate to the healthcare providers. However, with the increasing knowledge and patients’ awareness towards what is important for their health, person-centered collaborative care calls for the providers to share decisions with patients. Creasy et al. (2015) point out that the services are currently changing and becoming more flexible to effectively meet the needs of patients in a way that is best for their needs. In other words, it involves working with the patients and their family so as to make decisions on the health conditions of the patient in a way that pleases both parties as it gives a clear understanding on the choice of healthcare decision results. Sidani and Fox (2013) points out that other terms that can be used include patient-centered, user-centered, personalized, individualized, or family-centered collaborative care. However, the basic concept is to understand the importance of collaboratively involving the patients regardless of the term used. The same study points out that the aspects of person-centered collaborative care include;

• Working together to ensure effective communication, education, and information
• Involving friends and families for positive emotional support to the patients
• Ensuring there is continuity within and between the services while taking into accounts the expressed needs and preferences.
• Integrating and coordinating care that takes into account respect to the patient values and putting them in the center of care
• Ensuring the safety and physical comfort of accessing appropriate care by the patient wherever they need it.

In his study, Creasy et al. (2015) denote that person-centered collaborative care is important and is currently recognized globally as a key aspect of high-quality care delivery. As a result, helping the healthcare providers and professionals to be collaboratively person-centered has become a priority for the global health industry. The same study denotes that person-centered collaborative care improves the quality of available healthcare services and to help patients get the relevant care they need and whenever they need it. It also helps individuals to be more active in looking after their health despite the complication of stroke and depression often experienced by patients. In that manner, the pressure on social services and health on long-term chronic conditions is reduced.

People living with stroke and depression

In his study, Slowther (2011) points out that stroke and depression are often related in many cases. It is often understood that after stroke, patients are often undergoing more than just a recovery process but are also learning new skills and a way of life they were never used to living before. Many stroke survivors are also identified to experience the feeling of frustration, sadness, anger, fear, anxiety, as well as hopelessness in various levels. These emotional stress conditions are often common in post-stroke situations hence causing depression that affects more than a half of the stroke survivors. In their study, Patchell (2013) denotes that emotional health is often as important as the physical health of an individual and can disrupt or promote stroke discovery.

Any healthcare given to such patients and their families should be designed to meet the physical, cognitive, medical, and emotional needs of the patients in support and coordination with the families of the patients (Doty, 2014). Stroke patient care also integrates the use of high-tech therapeutic equipment that helps in maximizing independence and recovery with the aim of supporting the return to a productive life. Bailey and Gordon (2016) also denote that depression can set in days, weeks, months, or at times years after suffering from stroke and can stop the progress of a patient to recovery and rehabilitation. The resulting effect is a negative impact on the quality of life in an individual as well as the family.

Slowther (2011) also asserts that the sudden nature of stroke on patients can also lead to a life-changing impact on an individual. The damage that stroke attack causes to the brain often affects the physical, emotional, psychological, and social responsibility and activeness of the patient, an aspect that greatly leads to depression. Hover, the symptoms often vary with duration, severity, and frequency according to Miller et al. (2011). These symptoms include persistent sadness, anxiety, and emptiness, sleep disturbance, change in appetite and eating patterns, loss of interest in hobbies or normal activities, social withdrawal, and irritability.

Enablers and barriers facing person-centered collaborative care for people living with depression

Post-stroke depression is often defined as the feeling of hopelessness that interferes with the quality and functionality of life and can slow down the recovery of a patient when not appropriately treated or effectively managed.  It is a process that is often accompanied by stress and depression as patients are struggling with accepting their new health condition according to Creasy et al. (2015). In their study, Lutz et al. (2011) point out that there are several barriers that challenge the adoption of the model in healthcare for a patient living with long-term stroke and depression. For instance, the clinical level barriers to the person-centered collaborative care for stroke and depression involve a complex mixture of ethical considerations and attitudinal or interpersonal factors.

Grobe (2011) points out that the family is often considered the basic unit of care. However, healthcare providers are expected to remain vigilant that the competent individual rights of a patient are not overruled by the preferences of the family. In such cases, providers are faced with the dilemma of who needs to be served, the family unit or the patient hence affecting the responsibility strategies for such individuals. There are also provider specific barriers that often affect person-centered collaborative care thus indicating a need for the provider to buy-in before any success in the implementation of the person-centered approach (Valois, 2014).

Steinberg et al. (2014s) point out that most healthcare provider is often effective when working with the biomedical model and often have the very insufficient knowledge and skills when it comes to patients, family-, or person-centered collaborative models of care. Creasy et al. (2015) also point out that there are often possible disagreement and mismatch between the needs of the patients and the goals of the collaborative care during the treatment process such as financial constraints.  The same study denotes inconsistency in communication as a major in the act of reaching decision-making towards the expectations and roles of the care providers in the care process. Even though adopting an effective person-centered care requires a collaborative partnership among the patient, family, providers, Orlin et al. (2014) denotes that organizational support and the provision of resources is also necessary. Without redesigning such systems, providers may face barriers in delegating their duties.

According to Young (2011), a better stay and self-management for a patient can be achieved by effective communication. As an enabler, effective communication is a step that enables the patient to share their feelings towards the stroke and depression issues with the family, friends, as well as the healthcare providers. Even thought relationship may change after stroke as post-stroke always comes with social detachment, there is a need for counseling to the patients so as to make them understand that the condition is not their fault and can only be handled effectively when they develop an open heart to share with the caregivers. In a systematic review by Billinger (2010), the study denotes that effective communication enables effective monitoring on the progress of the patient and the steps to take for better further treatment.

The role of interdisciplinary team in facilitating patient and family centered collaborative care for long-term conditions

According to Galvin, Valois, and Zweig (2014), long-term conditions for patients come with a high economic impact hence placing a significant burden on caregivers, provider, patients, and healthcare delivery systems. It hence fosters the need for evaluating alternative approaches to healthcare services that can be effective to such group of patients. The national plans and healthcare reforms to deal with long-term conditions and promote person-centered collaborative care need to adopt preventive and health promotion services and integrate quality care to best meet the needs of the patient and the desire of the family (Halili, Hall, & DeLuca, 2014).  An interdisciplinary team is often made up of a diverse group that coordinate to ensure person-centered collaborative care is achieved for patients with long-term conditions. They include social workers, health and occupational therapists, psychologists, and physicians each of which has a specific duty to attend to during the healthcare provision process. Galvin, Valois, and Zweig (2014) denote that the centerpiece of person-centered collaborative care model is the initial evaluation process that provides expert clinical evaluation, patient diagnosis and needs, caregiver assessments, and supportive counseling provision.  It also requires community sources referrals and planning for an effective development strategy with long-term, intermediate, and short-term goals (Pascoe et al., 2013). These components can only be achieved by team members who inject in unique perspectives and expertise to be integrated within the person-centered collaborative care model.

Role of physicians

• Carrying out diagnosis of the initial condition of the patient such as memory and activeness while initiating the care plan
• Reviewing of laboratory tests and brain imaging in case of indication
• Evaluating patients with unexpected changes in a condition unusual or atypical
• Attending to patient emergencies
• Making referrals to home care or hospice depending on the federal regulations

Role of the physician assistants or nurse practitioners

• Re-evaluating plan for care and providing assessment progress on associated symptoms and cognition
• Coordinating care with other medical providers and disciplines
• Making referrals outpatient services
• Following up on all the testing results and imaging
• Provident patient and family education on both non-pharmacologic and pharmacologic interventions
• May at times be the clinician that makes initial diagnosis and identifying the plan of care

Role of health educators

• Coordinating the distribution of the relevant health information materials
• Maintaining health records for health information
• Training on neuropsychological test performance
• Preparing individuals with training in social work and psychological counseling

Role of the physical and occupational therapists

• Assessing home safety
• Offering training on cognitive skills
• Balancing training and fall prevention
• Evaluating the activities of the daily living for the patients such as effective nutrition and activeness
• Driving evaluation
• Providing education to caregivers

In a person-centered collaborative care, social care and health professionals coordinate with the people who use the services. In their study, Martz and Creasy (2011) point out that person-centered collaborative care supports people in developing their skills, knowledge, and confidence they require for the effective management and informed decision-making about their health and the servers they receive. Other patients also show fatigue, irritability, difficulty in remembering details or concentration, aches, pain, digestive complication, and even suicidal thoughts in extreme cases (Mueller & Hong, 2016). As a result, person-centered collaborative care is one of the best models that can be adopted for care to ensure effective progress. Collaboration with family members, friends, co-workers, and caregivers can thus be very helpful in recognizing the symptoms as well as seeking for healthcare.

Strengthening self-management support for better stay 

In their study, Lutz et al. (2011) point out that providing an effective person-centered collaborative care requires nurses to ensure that the depression and stroke patients, as well as family care providers, are together engaged in ways that are consistent with the conceptual framework of the model. A systematic review by Creasy et al. (2015) also asserts that delivery and planning of collaborative care needs to be determined through a collaborative partnership among the stakeholders involved. Such strategies will be essential in ensuring a positive improvement towards the recovery of the patient. However, treatment alone is not sufficient in fighting not only stroke and depression but even other long-term chronic health complications such as diabetes (Lasater et al., 2016). A variety of effective management strategies should hence be adopted to help find the difficult emotions brought by the disease as well as promoting self-management aimed at achieving a better stay by the patients.

The condition of the patient also requires better or improved nutrition that is balanced enough to meet the functional needs of the body. Martz and Creasy (2011) denotes that foods that are rich in omega-3 fatty acids, vitamin B, complex carbohydrates, and folic acids can improve the mood of a depressed patient fighting with stroke. The same study denotes that foods such as fish, walnuts, and flaxseed contain omega-3 fatty acids that promote brain health. Brown rice, whole wheat, and oatmeal help in boosting neurotransmitter chemicals within the veins and blood vessels of the brain hence affecting the mood. Dark chocolate is also suitable for fighting fatigue so as to reduce stress. In his study, Billinger (2010) also denotes that foods like beans, broccoli, and oranges are often deficient in folic acid and hence linked to depression. In other words, stroke and depression patients require folic acid boosters and neurotransmitters that can promote recognition thus should not be fed much on beans, broccoli, and oranges.  Vitamin B12 rich foods such as liver, milk, and eggs help in increasing the energy and alertness of the body (Lerdal, 2016).

According to Lutz et al. (2011), all patients dealing with long-term chronic health complications such as depression, stroke, diabetes, etc, should often join the relevant support groups within their community or locality. For instance, a stroke patient should join a stroke support group so as to acquire more skills and knowledge on how to deal with their conditions in a positive way that promotes recovery. Young (2011) denotes that such support groups can be rehabilitation centers where rehabilitation programs are admitted depending on the medical requirement and the severity of the illness of the patients. The same study denotes that effective person-centered collaborative care is often practiced in such rehabilitation centers as it brings together professionals with different ideas on how to deal with different patient conditions (Gay, 2010). Such support groups and rehabilitation centers also give a platform for the patients to share their experiences in dealing with the condition, an aspect that can re-energize the social life and eliminate the social detachment as they learn to positively deal with the situation through self-management (Talley et al., 2015).

Post-stroke patients can also join the community to help in creating awareness so as to eliminate the societal stigmatization that often affects patients. Creasy et al. (2015) denote that stroke and depression can be very traumatizing and the recovery time maybe longer depending on the recovery of the illness. However, self-management and better stay require the patients to be as active as possible by using braces, canes, and walkers that can stroke survivors effectively improve their physical fitness (Lewin, Jobges, & Werheid, 2016). Walking, swimming and yoga have a low-impact effect and can promote recovery, hence should be adopted with close supervision from the caregivers or and the family. The use of drugs such as alcohol should also be minimized as possible not only for stroke and depression but even among patients dealing with long-term health conditions (Kouwenhoven et al., 2013).

Conclusion

Person-centered collaborative care is a model adopted in healthcare that encourages the partnership and collaboration among families, patients, and providers with respect to evaluation, planning, and effective delivery of healthcare. Providing care with such a model helps in expanding the knowledge of the providers on the impact of the illness any issue that can affect the eventual transition. From the analysis presented in this manuscript, it is evident that adopting person-centered collaborative care as a usual business in healthcare requires fundamental changes in how services are delivered. It should also be focused on the roles of both the patients as well as the healthcare professionals based on the relationship between the teams, healthcare professionals, and the patients.

 Post-stroke depression is often defined as the feeling of hopelessness that interferes with the quality and functionality of life and can slow down the recovery of a patient when not appropriately treated or effectively managed.  It is a process that is often accompanied by stress and depression as patients are struggling with accepting their new health condition. Even though there are challenges in making a shift towards person-centered collaborative care, this type of care does not exist or is often neglected to be performed in a modest way within the growing number of health challenges that can lead to a positive outcome. However, it can be achieved when more effort is put towards the goal of achieving person-centered collaborative care for patients. As a result, rehabilitation nurses and healthcare providers need to view stroke and depression patients and the family caregivers as a single unit.

Using person-centered collaborative care can thus help nurses to provide individualized and appropriate collaborative care that can greatly improve the conditions of the patients. However, the treatment process alone cannot be sufficient for the effective recovery of the patients. It is hence encouraged that with the help of the care providers and the families, patients need to have good nutrition, communicate effectively, attend rehabilitation centers and join support groups, stay as active as possible, and reduce and totally eliminate on the usage of drugs such as smoking and use of alcohol.

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