Contextual Factors in the Case Study

Discuss about the Nursing Case Study for Journal of Nursing Education.
 

It is crucial for the nurses to be able to provide safe and effective care to the patients and provide adequate assistance and health educational support to the patient. However, there are various contextual factors associated with health condition of a patient and the nursing care needs to address all the mentioned factors in order to be able to provide a care plan that not only addresses the physical health needs of the patient but also provides an overall support. For the culturally diverse patient population, the need for overall assistance support is even more heightened (Watson, Hewett & Gallois, 2012). This essay will discuss the case of an aboriginal patient living named Doug and will outline the contextual factors in this case study, communication methods used, model of teamwork demonstrated, and how the clinical reasoning was implemented in the care scenario.

The contextual factors can have a significant impact on the health status of a patient and as a result for a care plan to be affective and functional (Cabassa, Siantz, Nicasio, Guarnaccia & Lewis-Fernández, 2014). In this case study, patient had been a 19 year old man named Doug belonging to the aboriginal cultural background. The patient had been suffering from type 1 Diabetes mellitus since the age of 13. He had moved away from his home before even completing the year 8 of his education. It has to be mentioned in here that the lack of education has a significant impact on the employment and the financial status of the individuals which in turn affects the living conditions and resultant heath outcomes. In this case, Doug had been a patient of type 1 diabetes which is associated with many restrictions precautions. Doug had not been able to acquire a job and had a negligible income; hence he did not have the financial capabilities to address his health needs due for diabetes and it had a significant impact on facilitating the insulin shock that he suffered from. Another key contextual factor in this case study had been the homelessness, it has to be understood that living without a shelter is equivalent to not having a nutritious dietary habit or a hygienic living (Elder & Tubb, 2014). Now a type 1 diabetic is needed to have a high fiber high antioxidant diet to maintain the basic glucose requirements. The lack of a proper and balanced diet can lead to rapid and frequent fluctuations in the blood glucose levels leading to hypoglycemic attacks or insulin shock. The third and final contextual factor in the case study had been the depression and reduced mental health for the patient. It has to be mentioned here that he had moved away from his house at a tender age without completing his education and struggled fruitlessly to get a job. The isolation from his family, loneliness, difficult acculturation process and the very little income has contributed significantly to the constant feeling of unhappiness that the patient had been feeling. Another contextual factor that has contributed to the deterioration of the health condition of the patient had been the fact that he had not been seeing the same doctor for his diabetes and had been seeing facilities nearby wherever he had been living (Kim et al., 2017). Hence, the past medical history and the medical management which can have deteriorated his health to a point of having insulin shock. 

Communication Methods in the Health Care Setting

There are a lot of different communication methods in place in the health care setting that can play a pivotal role in defining and designing the care strategies and implementing the care strategies that have been planned (Street, 2013). The communication can be among the health care workers, between the patients and the health care providers, and between the patient family and the health care providers and each of them have a significant impact on the health condition of the patient, both verbal and nonverbal communication. With respect to the case study, there have been many mistakes made in the communication that has occurred between the different members of the heath care team in the case scenario. First and foremost, when the patient was assessed by the emergency department he had not been interviewed properly regarding his knowledge and literacy level on how to manage diabetes. Along with that, the handover that had been prepared for the patent had been lacking as well regarding the subjective and objective data discovered if the patient. As a result the nursing staff discovered much late regarding the limited awareness and knowledge in the patient regarding proper management of his type 1 diabetes including where to access support and advice, and how to monitor his glucose levels and adjust his insulin dose properly (Cappelletti, Engel & Prentice, 2014). Along with that, while in the neurology ward the nurse depended entirely on the emergency admission records and did not communicate with the respective ward regarding the brief information available in the records. They based the entire care planning procedure on the limited information available in the brief handover given by the emergency ward and hence the care planning and delivery for Doug in that ward had not been safe or optimally affective due t the lack of proper communication among the health care providers. In the rehabilitation centre that the patient had been visiting, the care providers depended entirely in the brief discharge summary prepared by the junior nurse and they had not taken any initiative ti communicate with the acute hospital, where Doug was shifted from. Along with that, it has to be mentioned that according to the good medical practice, a multidisciplinary tem must collaborate and co-operate with each other in a manner that is both effective and efficient to ensure optimal safety of the patient and recovery focused care delivery. Hence, it has to be mentioned that formal, professional, and effective communication and interaction is a very important aspect for good medical practice. In this case, the multidisciplinary team for Doug never formally met and discussed the needs of the patient either, instead only communicated via the notes written in the medical record of the patient, which affected the care delivery for the patient. Lastly, the Rehab nurse decided on her own to discharge the patient without priory discussing the same with the rest of the care team members which had been a huge lapse in effective professional communication and clinical judgment (Street, 2013).

Model of Teamwork Demonstrated

In case of teamwork, it has to be mentioned that the case study represents a scenario where there had been a huge and lacking teamwork along the multidisciplinary teams appointed for care delivery to Doug. The inadequate teamwork dysfunction in this case can be illustrated by the help of the Lencioni’s Five Dysfunctions of a Team (Lencioni, 2013). The scenario matches three elements of the model, avoidance of accountability, lack of commitment, and inattention to results. Firstly, the care team of neurology ward had failed to communicate with the emergency team ward effectively and depended only on the handover due to the lack of resources for the care planning and implementation, which shows avoidance of accountability in the care team members which affected the patient significantly (Berlin, Carlström  & Sandberg, 2012). Secondly, the neurology ward gave the task of preparing the discharge summary to a junior doctor with very limited understanding of care delivery and complexities of the patient’s care needs. However the positive points had been using the information from the ED admission, undertaking the assessments by the team of health professionals, and including Doug in all their decisions. For the second team in the Rehabilitation the teamwork had been poor. The professionals did not meet up with the care professional and never had any effective interaction and discussion about the care needs and the recovery progress. They rather resorted to writing notes on the medical records and communicated via the notes which can be easily misinterpreted. Hence, they showcased an extreme lack of commitment in this scenario showing dysfunctional teamwork. Lastly, the rehab nurse or Nurse unit manager decided on her own to discharge the patient without consulting with the rest of the team members on the basis of Doug being able to independently toilet and ambulate. Hence she violated the shared decision making framework for multidisciplinary care team and showed inattention to results which led to Doug being admitted to the ED within 4 days of discharge (Valentine, Nembhard & Edmondson, 2015).

Clinical reasoning cycle was violated throughout the case scenario. the first step of clinical reasoning is to collect cues of the patient care needs by the means of patient situational analysis which had been flawed as the ward nurse in neurology department discovered about the lack of health literacy and diabetes management knowledge to be very low. The next couple of steps of the reasoning cycle focuses on processing the information, synthesizing the care needs with respect to evidence based resources to identify the care priorities and care goals. This step had also been violated as both the neurology ward care team and the rehab care team focused only on handover and discharge summary due to lack of resources without attempting to gather additional resources (Forsberg, Ziegert, Hult & Fors, 2014). Although in the implementation step the care goals planning and implementation had involved the patient. The last step is evaluation of the care implementation and reflection, the evaluation had been flawed for both the neurology ward and the rehab centre. The discharge summary was prepared by a junior doctor who lacked expertise and experience to evaluate the outcome of the care interventions. In the rehab ward the patient was considered fit judging just by his ability to independently toilet and ambulates, disregarding the other evaluation outcomes for him which resulted in ineffective care delivery. Lastly, there had been no account of reflective practice performed by the health care professionals either hence thus step can be considered incomplete as well (Cappelletti, Engel & Prentice, 2014).

Clinical Reasoning Cycle in the Case Scenario

The physical health of a human being is not limited to the individual biological and inherited properties; instead it is dependent on the socio-cultural factors including the cultural norms, learned behaviors, and interactions with the human-built environment as well. Hence, it can be concluded that physical health is associated intricately with the contextual; factors from the broader ecology surrounding the individual. Hence the care planning should be focused on all the mentioned contextual factors. This essay discussed the different factors and their impact on the health outcomes and the care delivery of the patient including broad contextual factors, communication by the care team, teamwork of he multidisciplinary team and the adherence to clinical reasoning cycle. 

References:

Berlin, J. M., Carlström, E. D., & Sandberg, H. S. (2012). Models of teamwork: ideal or not? A critical study of theoretical team models. Team Performance Management: An International Journal, 18(5/6), 328-340. doi: 10.1108/13527591211251096

Cabassa, L. J., Siantz, E., Nicasio, A., Guarnaccia, P., & Lewis-Fernández, R. (2014). Contextual factors in the health of people with serious mental illness. Qualitative health research, 24(8), 1126-1137. doi: 10.1177/1049732314541681

Cappelletti, A., Engel, J. K., & Prentice, D. (2014). Systematic review of clinical judgment and reasoning in nursing. Journal of Nursing Education, 53(8), 453-458. doi: 10.3928/01484834-20140724-01

Dreifuerst, K. T. (2012). Using debriefing for meaningful learning to foster development of clinical reasoning in simulation. Journal of Nursing Education, 51(6), 326-333. doi: 10.3928/01484834-20120409-02

Elder, N. C., & Tubb, M. R. (2014). Diabetes in homeless persons: Barriers and enablers to health as perceived by patients, medical, and social service providers. Social work in public health, 29(3), 220-231. doi: 10.1080/19371918.2013.776391

Forsberg, E., Ziegert, K., Hult, H., & Fors, U. (2014). Clinical reasoning in nursing, a think-aloud study using virtual patients–A base for an innovative assessment. Nurse Education Today, 34(4), 538-542. retrieved from https://www.nursingplus.com/article/S0260-6917(13)00261-X/fulltext

Kim, M. T., Kim, K. B., Ko, J., Jang, Y., Levine, D., & Lee, H. B. (2017). Role of depression in diabetes management in an ethnic minority population: a case of Korean Americans with type 2 diabetes. BMJ Open Diabetes Research and Care, 5(1), e000337. retrieved from https://drc.bmj.com/content/5/1/e000337?utm_source=TrendMD&utm_medium=cpc&utm_campaign=BMJ_Open_Diab_Res_Care_TrendMD_1

Lencioni, P. (2013). Conquer team dysfunction. The table group. retrieved from https://sandiegoeducationreport.net/Conquering_Team_Dysfunction.pdf

Street, R. L. (2013). How clinician–patient communication contributes to health improvement: modeling pathways from talk to outcome. Patient education and counseling, 92(3), 286-291. doi: https://doi.org/10.1016/j.pec.2013.05.004

Valentine, M. A., Nembhard, I. M., & Edmondson, A. C. (2015). Measuring teamwork in health care settings: a review of survey instruments. Medical care, 53(4), e16-e30. doi: 10.1097/MLR.0b013e31827feef6

Watson, B. M., Hewett, D. G., & Gallois, C. (2012). Intergroup communication and health care. The handbook of intergroup communication, 293-305. retrived from https://books.google.co.in/books?hl=en&lr=&id=qy59z3Mu3ZgC&oi=fnd&pg=PA293&dq=communication+in+health&ots=viTLN4clIR&sig=ulL4Q5EEBYiSYjs7bIKEE8UlC7I#v=onepage&q=communication%20in%20health&f=false