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Learning outcome 1
The chronicity of COPD allows for self management by
sufferers. (Spencer & Barcomb 2014). The self management
goal is reduced hospital admissions and improved life quality
(Bedra et al 2013). Sufferers should have access to a wide range
of skills available from the multidisciplinary team. Those
include exacerbation limitation, respiratory failure, chronic
productive cough and anxiety and depression.
Symptom Recognition.
Patients discharged from hospital are susceptible to readmission
(Bedra et al 2013). Understanding the condition and knowing
when they are having an exacerbation is imperative for self
management, and what to do in the given circumstances, and
when and what medication to take, or realise they need hospital
treatment.
Treatment.
The main form of treatments comes from inhaled therapies and
explained below would be when they would be administered and
their understandings are a major factor in self management.
For breathlessness and exercise limitations: A short acting
Beta2 agonist (as required) or short acting muscarinic
antagonist (as required).
For exacerbations or persistent breathlessness: A long acting
beta2 agonist, long acting muscarinic antagonist, to – long
acting beta2 agonist + inhaled corticosteroid (Combination
Inhaler) OR a long acting muscarinic antagonist (must
discontinue short acting antagonist once this is commenced).
(Remember if using Corticosteroids, this has no evidence of
long terms benefits).
If experiencing persistent exacerbations or breathlessness. Long
acting Muscarinic antagonist + long acting beta2 agonist and
inhaled corticosteroid (combined inhaler).
Niesters et al, (2012) describe how oxygen therapy can also be
used, but awareness of inappropriate oxygen therapy with
COPD patients is imperative as this can cause respiratory
depression.
Self Monitoring.
The British Thoracic Society (BTS) have identified five high
impact actions that can improve outcomes for people being
discharged after an acute exacerbation of COPD. The form is a
quick way of identifying patients need for those interventions,
ensuring their needs are met. The aim is for lessened hospital
readmission rates with self monitoring patients. The five actions
are;
Review of medication and demonstration of inhalers they will
be using.
Provide a written Self Management plan and Emergency drug
pack.
Asses and offer referral for smoking sensation.
Assess for suitability for pulmonary rehab.
Arrange a follow up call within 72 hours of discharge.
Educational Interventions.
Reardon et al, (2005) explain pulmonary rehabilitation as
programs which work with patients to help manage their
condition, muscle strength, ability to cope with their disease,
help with social requirements as people can become quite
isolated.
Test includes incremental shuttle walk a 10 metre course,
consecutive runs, each time getting faster, measured how far
they got, will give idea of what they can endure on the exercise
programme they can tale part in – all hoping to improve fitness
and quality of life, breaking the cycle of not doing any exercise
at home due to fear of becoming breathless, which will just be
contributing to worsening of symptoms. The aim is to make the
patient breathless, so they can teach them how to cope when
they are having difficulty breathing at home. It also reduces the
risk of heart attack, stroke, and diabetes.
Lifestyle Modifications.
Sufferers need to be aware that regular exercise at home is
important. They need to look at their lifestyle, and stay as
healthy and positive minded as they can as this will help keep
the illness at bay. Smoking is a min contributing factor in the
disease and should be stopped. Nicotine replacement should be
offered and information on groups such as smoking sensation.
Leaning outcome 2
Any deterioration in a patient’s condition is an extremely
worrying and stressful time for all involved: Patent, families
and nursing staff alike. It is at this time when families can
extremely worried, upset and stressed with the situation and
they will be looking at the staff, expecting superlative care for
their loved ones, they will be watching and listening to
everything the Nurse says and does.
Care planning must be put in place beforehand, with the views
and opinions of the patient at the forefront of any decisions that
will be made. How they want to be nursed, where they want to
be nursed, and inventively where they want to die should all be
decided beforehand.
The National Institute of Health (NICE) has guidelines in place
named: Medicines adherence: involving patients in decisions
about prescribed medicines and supporting adherence. (NICE,
2009). This should be followed when decisions are made about
the treatments that are to be used on patients – and also when
treatment will be stopped when end of life approaching.
The topic of Concordance is related to this type of scenario.
Concordance is not to comply or to adhere to something - it is a
way of working together with people and should be seen as the
ethical goal of everyone involved. It is imperative that shared
decision making is used within the NHS and should be
undertaken without question at all times. (Coulter & Collins,
2011).
Gaining an understanding of someone’s health beliefs is not
always a priority for the nurse. Latter (2011) explains that
periodically, the chain of though can be pointing in another
direction and perhaps to real consideration is given to the
patients beliefs.
Nevertheless, Stenner et al, (2011) clarify that regardless of the
quantity of information the patient or family require, when it
comes to the decision makings on treatments – the professional
judgement of the nurse was preferred by the majority, but the
fact that the nurse has explained the various treatments
available and there is an understanding of them, gives the
patient and family a feeling of inclusion and satisfaction that
they know the best care is being given.
Although Nursing staff are not seen as qualified councillors,
one aspect of their role they need to make in response to end of
life care is to council the family, they will need and expect you
to talk them through their grief, explain in detail what
happening any why, and be there for them in whatever means
necessary in the moment following the death of the patient.
Meerabeau & Wright, (2011) describe the moment – life as that
family know it, has changed dramatically, and will never be the
same again. They may have known death was coming, but until
the moment it happens that is when it hits them and they are
suddenly confronted with the reality of the situation.
Leaning outcome 3
The Telehealth system was launched in the UK in 2008 as a way
of caring for the increasing numbers of patients using the NHS.
Targeted users were to be the likes of elderly patients and those
with a long term condition irrelevant of their age. Rural
The Department of Health (2012) insist that if it is used
properly the savings on the NHS budget are vast. Accident and
Emergency admissions are lower, as are elective admissions.
They also state that there has been a large drop in mortality
rates in areas where the system has been implemented and is
used efficiently.
Sanders et al, (2012) define Telehealth as an intervention which
will ‘allow remote exchange of data’ and additional information
between a patient and a healthcare professional assisting in the
diagnosis and management of an individual’s health condition.
Patients in remote areas of the UK and those with limited
services nearby, as well as patients who have difficulty
accessing their local services are already benefiting from the
service.
Ekeland et al, (2010) undertook a study in order to calculate the
effectiveness of the system. Results were extremely positive
throughout, and it was proved to be very cost effective, user
friendly and patient feedback was constructive and encouraging
for the service.
A second study, by Wooton, (2011) looked at patients with
various long term conditions: they included COPD, Pulmonary
Disease, Asthma, Diabetes, Hypertension and Heart Failure. The
study investigated the numbers of sufferers with each condition,
the type of Telehealth interventions used – along with
intervention timings and patient outcomes. End figures found
that 99% of the outcomes were in approval of the service, all
experiencing improved results from previous periods when the
service had not been available. Outcomes of the study had been
based on worsening, equivalent or improvement on before
implementation of the service in their homes.
More commonly recognised is the NHS 24 service,
incorporating the Scottish Centre for Telehealth and Telecare
(SCTT), it is the national provider of telehealth services in
Scotland. An alternative service form the previous emergency
number (999), it is contact point for members of the public who
are requiring medical assistance or just medical advice. Contact
to the service can be made by telephone, online and even
through digital television channels. (Johansen, 2012).
The online version of the service (nhsinform.co.uk) provides
quality assured health information, it has a sister website
specifically for care of the elderly queries,
(careinfoscotland.co.uk). The main service is the telephone
based system and has professionals available and ready to take
your call and guide you through your query – saving you from
an unnecessary trip to the doctor or even calling an ambulance
through panic of not knowing what is wrong or what to do. Staff
at the end of the phone includes nurse practitioners, health
information providers, pharmacists, dental nursing staff,
counsellors and self help coaches.
Staff provide a complete telephone triage and consultation
review and undertake high level, on the spot decision making.
Leaning outcome 4 a
As a country the government recognises the need to improve the
health of the population as well as save money, the National
Health Service (NHS) is struggling to cope with the numbers
that are already using it, people are living longer, illnesses that
go with old age are becoming more common, there are
insufficient funds to give To the NHS and it is already proving
to be working at unacceptable levels. Health improvements
need to made, improvement activities set up, primary and
secondary tertiary prevention, delivered in health care – in the
hope that a person or people will adopt and maintain a healthier
lifestyle or even be aware and have an understanding of their
health in general.
The challenges surrounding the deliverance of reliable and
approachable high quality healthcare and recuperating the
health of the population are linked with the high expectations
expected from people, with most needing implementation of
lifestyle changes, demographic change, the ageing population
and the economic climate which goes hand in hand with
financial constraints for the majority of the target users of the
service. A report by Layard et al, 2006 recognised a twelve
million pound loss of output through depression alone in UK.
This is mirrored by the World Health Organisation (2010) have
highlighted the importance of promoting mental health issues in
order to connect with people – enabling them to realise the life
changes and improvements they need to undertake to improve
their health. Explained further National Institute for Health and
Care Excellence (NICE) where they have included a model of
stepped care for depression with related outcomes of getting fit
and healthy.
The Marmot Review (2010) argues that inequalities in health
are linked with inequalities in society; therefore the degree
health inequality is indicative of ‘how far society has come.’
Inequalities in our society are numerically vast, and this alone
is proving to be a hurdle within anticipatory care planning for
those involved. The WHO initiative, Improving Access to
Psychosocial Therapies (IAPD) (2008) illustrates how such
policies, aimed at reducing health inequalities can be
implemented. Whilst the health of the population as a whole is
important and recognised, Specific areas in the country are seen
as ‘target areas’ for initiatives, areas that are seen in society as
poorer or deprived as usually statistically higher in ill health,
both mentally and physically. Increased mortality rates are also
linked to such areas. Layard et al (2006). The recognition for
health implementation is worldwide and not specific to the UK,
and the WHO describes similar execution problems which are
linked to psychosocial issues. Links with material
circumstances such as home owning, income average in specific
areas, human genetics and family history surrounding attitudes
to health and undertaking lifestyle changes.
The Healthcare Quality Strategy for NHS Scotland (2010), their
ultimate was to deliver the highest quality healthcare services to
the Scottish population ensuring that the NHS Scotland is
recognised worldwide for its standards. Delivering the best care
is at the centre of their values and has been described in Better
Health Better Care.
Through taking action they expect to see calculable
improvements in the key indicators of healthcare quality.
A project by the NHS Scotland called ‘Have a Heart Paisley’
undertook population screening for ascertainment, health advice
and reviews with recommendations to specific programmes.
Healthy eating, exercise classes and smoking sensation groups
were all involved in recruiting.
This was developed from anticipatory care strategies that had
been drawn up by the Health Service to try and improve the
health of the people of Paisley – and stop them from becoming
part of the statistics regarding sufferers of long term conditions.
(Health Scotland 2007).
Watt, O’Donnell and Sridharan (2011) describe the philosophy
of anticipatory care as going in conjunction with increased
evidence and theory regarding the health condition of the
population – government challenge to bring together the
strengths of primary medical care and the improvement of
health, health education as a whole. Anticipatory care continued
and continues to evolve in the country. The health needs of the
nation grow in par with the population numbers.
Leaning outcome 4 b
The holistic assessment of a patient, does not just take the
patient and the given illness in to account. Investigating the
bigger picture surrounding the patient is also taken into account
- this includes their given circumstances, assessment, diagnosis,
and incorporating as much about them into the plan as is
possible. This would make it easier to identify any changes in a
patient’s condition at any given time in the future.
Roper Logan and Tierney, (LRT) (2000) base their model on the
five main concepts, lifespan, daily living, dependence /
independence, influencing factors on daily living activities. The
factors which influence our undertaking of daily living
activities (psychological, sociocultural, biological,
environmental and politico economic) are included as each one
has specific influencing factors on how we undertake our daily
living skills. (Roper, Logan & Tierney 1996). This model
supports holistic assessment and care planning in anticipatory
care. Williams (2015) explains that looking at the whole patient
scenario is imperative – it follows the LRT model of nursing,
she describes it as a practice centred theoretical model
‘grounded in realism and accessibility.’ The RLT model is used
widely throughout the UK. It applies the nursing process –
assessment, diagnosis, planning, intervention and evaluation,
and is commonly used as a guide for the nurse when
undertaking a holistic patient assessment that serves as a basis
for care planning. (Williams 2015).
Roper, Logan and Tierney, (2000) Explain that lifespan is seen
as a continuum. But, nevertheless in contrary to the dependence
to dependence continuum the arrow is looking in only direction
which given the meaning of going forward only – until we reach
the end on life and die.
Barnett (2007) clarify that within a clinical environment, the
LRT model is followed when investigating research questions
regarding specific functional deficits observed in patients that
are needing skilled nursing care. Details about the model being
used this way are also given by Matter (2007) and strengthen
the relationship between the LTR model and holistic assessment
and care planning in nursing. When the given specialist areas
are investigated and addressed fully, improved patient outcomes
are met. This is not just in the acute setting but those at home
living with LTC such as COPD also benefit from following the
model. (Kara 2007).
In the academic setting the model supports nurses develop and
test a hypothesis about outcomes of care with a nursing
framework (Tierney 1998).
The inclusion of an established and methodical nursing focused
conceptual model increased the number of goals, recommends
that a holistic approach to patient centred care planning
promotes more involvement in patient care. (Dalton, Farrell &
De Souza, 2012).
Reference List.
BARNETT, M., 2007. Using a model in the assessment and
management of COPD. J Common Health. 21 (11), pp4-10.
Bedra, M., McNabney, M,, Stiassny, D., Nicholas, J. &
Finkelstein, J.,2013. Defining patient-centred characteristics of
a tele rehabilitation system for patients with COPD. Health
Technology Information. 190 (24), pp6.
BRITISH THORACIC SOCIETY, 2015. Working for Healthier
Lungs [online]. BTS. [viewed 26th April 2016]. Available
From: https://www.brit-thoracic.org.uk/clinical-
information/copd/
COULTER, A. & COLLINS, A., 2011. Making shared decisions
making a reality. No Decision about me, Without Me. London:
Blackwell.
DALTON, C., FARREL, R. & DE-SOUZA., 2012. Patient
inclusion in goal setting during early inpatient rehabilitation
after acquired brain injury. Clinical Rehabilitation. 26 (2),
pp165-173.
DEPARTMENT OF HEALTH, 2008. Access to Psychological
Therapies, [online]. Department of Health. [viewed 26th April
2016]. Available from:
https://www.gov.uk/guidance/improving-access-to-
psychological-therapies-payment-an-introduction
GREEN, J. & TONES, K., 2010. Health Promotion Planning and
Strategies. London: Sage.
HEALTH SCOTLAND, 2007. Have a Heart Paisley. [online].
Health Scotland. [viewed 26th April 2016]. Available From:
http://www.healthscotland.com/keep-
well/programmes/hahp.aspx
THE SCOTTISH GOVERNMENT, 2010. The Healthcare
Quality Strategy forNHS Scotland, [online]. The Scottish
Government. [viewed 26th April 2016]. Available from:
http://www.gov.scot/resource/doc/311667/0098354.pdf
JOHANSEN, R. 2012. NHS 24: The role of the nurse consultant.
British Journal of Mental Health Nursing. 1 (3), pp182-185.
KARA, M., 2007. Using the Roper, Logan and Tierney model in
care of people with COPD. Journal of Clinical Nursing. 16 (7b),
pp223-233.
LATTER, S., 2011. Evaluation of Nurse and Pharmacist
IndependentPrescribing. Health (San Fran cisco), London:
Eprints Soton.
Layard, R., Clark, D., Bell, S., Knapp, M., Meacher, B., Priebe,
S., Turnberg, L., Thornicroft, G. & Wright, B. 2006. The
depression report; A new deal fordepression and anxiety
disorders. [online]. The Centre for Economic Performance’s
Mental Health Policy Group, LSE. London. [viewed 26th April
2016]. Available from: http://eprints.lse.ac.uk/818/
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review of HealthInequalities in England Post 2010 [online].
Institute of Health Equity, [viewed 26th April 2016]. Available
from: http://www.instituteofhealthequity.org/media/press-
releases/consultation-on-european-review
MATTER, I. 2011. Using the Roper, Logan and Tierney model
in the management of traumatic brain injury in a critical care
setting. Singapore Nursing Journal38 (3), pp14-19.
McIvor, R., Tunks, M. & Todd., 2010. COPD. Clinical
Evidence. 06 (1),pp1502.
MEERABEAU, L, & WRIGHT, K., 2011. Long Term
Conditions: nursing care and management. West Sussex: Wiley
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NATIONAL INSTITITE FORT HEALTH AND CLINICAL
GUIDANCE, 2009. Medicines Adherence: Involving Patients in
Decisions About Prescribed Medicines and Supporting
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living. 4th ed. Edinburgh: Churchill Livingstone.
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Roper, Logan- Tierney Model of Nursing Based on Activities of
Daily Living. Edinburgh: Elsevier.
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%2F10.1007%2Fs40138-014-0051-
9&token2=exp=1461249936~acl=%2Fstatic%2Fpdf%2F728%2F
art%25253A10.1007%25252Fs40138-014-0051-
9.pdf%3ForiginUrl%3Dhttp%253A%252F%252Flink.springer.co
m%252Farticle%252F10.1007%252Fs40138-014-0051-
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  • 1. Learning outcome 1 The chronicity of COPD allows for self management by sufferers. (Spencer & Barcomb 2014). The self management goal is reduced hospital admissions and improved life quality (Bedra et al 2013). Sufferers should have access to a wide range of skills available from the multidisciplinary team. Those include exacerbation limitation, respiratory failure, chronic productive cough and anxiety and depression. Symptom Recognition. Patients discharged from hospital are susceptible to readmission (Bedra et al 2013). Understanding the condition and knowing when they are having an exacerbation is imperative for self management, and what to do in the given circumstances, and when and what medication to take, or realise they need hospital treatment. Treatment. The main form of treatments comes from inhaled therapies and explained below would be when they would be administered and their understandings are a major factor in self management. For breathlessness and exercise limitations: A short acting Beta2 agonist (as required) or short acting muscarinic antagonist (as required). For exacerbations or persistent breathlessness: A long acting beta2 agonist, long acting muscarinic antagonist, to – long acting beta2 agonist + inhaled corticosteroid (Combination Inhaler) OR a long acting muscarinic antagonist (must discontinue short acting antagonist once this is commenced). (Remember if using Corticosteroids, this has no evidence of long terms benefits). If experiencing persistent exacerbations or breathlessness. Long acting Muscarinic antagonist + long acting beta2 agonist and inhaled corticosteroid (combined inhaler). Niesters et al, (2012) describe how oxygen therapy can also be used, but awareness of inappropriate oxygen therapy with
  • 2. COPD patients is imperative as this can cause respiratory depression. Self Monitoring. The British Thoracic Society (BTS) have identified five high impact actions that can improve outcomes for people being discharged after an acute exacerbation of COPD. The form is a quick way of identifying patients need for those interventions, ensuring their needs are met. The aim is for lessened hospital readmission rates with self monitoring patients. The five actions are; Review of medication and demonstration of inhalers they will be using. Provide a written Self Management plan and Emergency drug pack. Asses and offer referral for smoking sensation. Assess for suitability for pulmonary rehab. Arrange a follow up call within 72 hours of discharge. Educational Interventions. Reardon et al, (2005) explain pulmonary rehabilitation as programs which work with patients to help manage their condition, muscle strength, ability to cope with their disease, help with social requirements as people can become quite isolated. Test includes incremental shuttle walk a 10 metre course, consecutive runs, each time getting faster, measured how far they got, will give idea of what they can endure on the exercise programme they can tale part in – all hoping to improve fitness and quality of life, breaking the cycle of not doing any exercise at home due to fear of becoming breathless, which will just be contributing to worsening of symptoms. The aim is to make the
  • 3. patient breathless, so they can teach them how to cope when they are having difficulty breathing at home. It also reduces the risk of heart attack, stroke, and diabetes. Lifestyle Modifications. Sufferers need to be aware that regular exercise at home is important. They need to look at their lifestyle, and stay as healthy and positive minded as they can as this will help keep the illness at bay. Smoking is a min contributing factor in the disease and should be stopped. Nicotine replacement should be offered and information on groups such as smoking sensation. Leaning outcome 2 Any deterioration in a patient’s condition is an extremely worrying and stressful time for all involved: Patent, families and nursing staff alike. It is at this time when families can extremely worried, upset and stressed with the situation and they will be looking at the staff, expecting superlative care for their loved ones, they will be watching and listening to everything the Nurse says and does. Care planning must be put in place beforehand, with the views and opinions of the patient at the forefront of any decisions that will be made. How they want to be nursed, where they want to be nursed, and inventively where they want to die should all be decided beforehand. The National Institute of Health (NICE) has guidelines in place named: Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. (NICE, 2009). This should be followed when decisions are made about the treatments that are to be used on patients – and also when treatment will be stopped when end of life approaching. The topic of Concordance is related to this type of scenario. Concordance is not to comply or to adhere to something - it is a way of working together with people and should be seen as the ethical goal of everyone involved. It is imperative that shared decision making is used within the NHS and should be
  • 4. undertaken without question at all times. (Coulter & Collins, 2011). Gaining an understanding of someone’s health beliefs is not always a priority for the nurse. Latter (2011) explains that periodically, the chain of though can be pointing in another direction and perhaps to real consideration is given to the patients beliefs. Nevertheless, Stenner et al, (2011) clarify that regardless of the quantity of information the patient or family require, when it comes to the decision makings on treatments – the professional judgement of the nurse was preferred by the majority, but the fact that the nurse has explained the various treatments available and there is an understanding of them, gives the patient and family a feeling of inclusion and satisfaction that they know the best care is being given. Although Nursing staff are not seen as qualified councillors, one aspect of their role they need to make in response to end of life care is to council the family, they will need and expect you to talk them through their grief, explain in detail what happening any why, and be there for them in whatever means necessary in the moment following the death of the patient. Meerabeau & Wright, (2011) describe the moment – life as that family know it, has changed dramatically, and will never be the same again. They may have known death was coming, but until the moment it happens that is when it hits them and they are suddenly confronted with the reality of the situation. Leaning outcome 3 The Telehealth system was launched in the UK in 2008 as a way of caring for the increasing numbers of patients using the NHS. Targeted users were to be the likes of elderly patients and those with a long term condition irrelevant of their age. Rural The Department of Health (2012) insist that if it is used properly the savings on the NHS budget are vast. Accident and Emergency admissions are lower, as are elective admissions.
  • 5. They also state that there has been a large drop in mortality rates in areas where the system has been implemented and is used efficiently. Sanders et al, (2012) define Telehealth as an intervention which will ‘allow remote exchange of data’ and additional information between a patient and a healthcare professional assisting in the diagnosis and management of an individual’s health condition. Patients in remote areas of the UK and those with limited services nearby, as well as patients who have difficulty accessing their local services are already benefiting from the service. Ekeland et al, (2010) undertook a study in order to calculate the effectiveness of the system. Results were extremely positive throughout, and it was proved to be very cost effective, user friendly and patient feedback was constructive and encouraging for the service. A second study, by Wooton, (2011) looked at patients with various long term conditions: they included COPD, Pulmonary Disease, Asthma, Diabetes, Hypertension and Heart Failure. The study investigated the numbers of sufferers with each condition, the type of Telehealth interventions used – along with intervention timings and patient outcomes. End figures found that 99% of the outcomes were in approval of the service, all experiencing improved results from previous periods when the service had not been available. Outcomes of the study had been based on worsening, equivalent or improvement on before implementation of the service in their homes. More commonly recognised is the NHS 24 service, incorporating the Scottish Centre for Telehealth and Telecare (SCTT), it is the national provider of telehealth services in Scotland. An alternative service form the previous emergency number (999), it is contact point for members of the public who are requiring medical assistance or just medical advice. Contact to the service can be made by telephone, online and even through digital television channels. (Johansen, 2012).
  • 6. The online version of the service (nhsinform.co.uk) provides quality assured health information, it has a sister website specifically for care of the elderly queries, (careinfoscotland.co.uk). The main service is the telephone based system and has professionals available and ready to take your call and guide you through your query – saving you from an unnecessary trip to the doctor or even calling an ambulance through panic of not knowing what is wrong or what to do. Staff at the end of the phone includes nurse practitioners, health information providers, pharmacists, dental nursing staff, counsellors and self help coaches. Staff provide a complete telephone triage and consultation review and undertake high level, on the spot decision making. Leaning outcome 4 a As a country the government recognises the need to improve the health of the population as well as save money, the National Health Service (NHS) is struggling to cope with the numbers that are already using it, people are living longer, illnesses that go with old age are becoming more common, there are insufficient funds to give To the NHS and it is already proving to be working at unacceptable levels. Health improvements need to made, improvement activities set up, primary and secondary tertiary prevention, delivered in health care – in the hope that a person or people will adopt and maintain a healthier lifestyle or even be aware and have an understanding of their health in general. The challenges surrounding the deliverance of reliable and approachable high quality healthcare and recuperating the health of the population are linked with the high expectations expected from people, with most needing implementation of lifestyle changes, demographic change, the ageing population and the economic climate which goes hand in hand with financial constraints for the majority of the target users of the service. A report by Layard et al, 2006 recognised a twelve
  • 7. million pound loss of output through depression alone in UK. This is mirrored by the World Health Organisation (2010) have highlighted the importance of promoting mental health issues in order to connect with people – enabling them to realise the life changes and improvements they need to undertake to improve their health. Explained further National Institute for Health and Care Excellence (NICE) where they have included a model of stepped care for depression with related outcomes of getting fit and healthy. The Marmot Review (2010) argues that inequalities in health are linked with inequalities in society; therefore the degree health inequality is indicative of ‘how far society has come.’ Inequalities in our society are numerically vast, and this alone is proving to be a hurdle within anticipatory care planning for those involved. The WHO initiative, Improving Access to Psychosocial Therapies (IAPD) (2008) illustrates how such policies, aimed at reducing health inequalities can be implemented. Whilst the health of the population as a whole is important and recognised, Specific areas in the country are seen as ‘target areas’ for initiatives, areas that are seen in society as poorer or deprived as usually statistically higher in ill health, both mentally and physically. Increased mortality rates are also linked to such areas. Layard et al (2006). The recognition for health implementation is worldwide and not specific to the UK, and the WHO describes similar execution problems which are linked to psychosocial issues. Links with material circumstances such as home owning, income average in specific areas, human genetics and family history surrounding attitudes to health and undertaking lifestyle changes. The Healthcare Quality Strategy for NHS Scotland (2010), their ultimate was to deliver the highest quality healthcare services to the Scottish population ensuring that the NHS Scotland is recognised worldwide for its standards. Delivering the best care is at the centre of their values and has been described in Better Health Better Care.
  • 8. Through taking action they expect to see calculable improvements in the key indicators of healthcare quality. A project by the NHS Scotland called ‘Have a Heart Paisley’ undertook population screening for ascertainment, health advice and reviews with recommendations to specific programmes. Healthy eating, exercise classes and smoking sensation groups were all involved in recruiting. This was developed from anticipatory care strategies that had been drawn up by the Health Service to try and improve the health of the people of Paisley – and stop them from becoming part of the statistics regarding sufferers of long term conditions. (Health Scotland 2007). Watt, O’Donnell and Sridharan (2011) describe the philosophy of anticipatory care as going in conjunction with increased evidence and theory regarding the health condition of the population – government challenge to bring together the strengths of primary medical care and the improvement of health, health education as a whole. Anticipatory care continued and continues to evolve in the country. The health needs of the nation grow in par with the population numbers. Leaning outcome 4 b The holistic assessment of a patient, does not just take the patient and the given illness in to account. Investigating the bigger picture surrounding the patient is also taken into account - this includes their given circumstances, assessment, diagnosis, and incorporating as much about them into the plan as is possible. This would make it easier to identify any changes in a patient’s condition at any given time in the future. Roper Logan and Tierney, (LRT) (2000) base their model on the five main concepts, lifespan, daily living, dependence / independence, influencing factors on daily living activities. The
  • 9. factors which influence our undertaking of daily living activities (psychological, sociocultural, biological, environmental and politico economic) are included as each one has specific influencing factors on how we undertake our daily living skills. (Roper, Logan & Tierney 1996). This model supports holistic assessment and care planning in anticipatory care. Williams (2015) explains that looking at the whole patient scenario is imperative – it follows the LRT model of nursing, she describes it as a practice centred theoretical model ‘grounded in realism and accessibility.’ The RLT model is used widely throughout the UK. It applies the nursing process – assessment, diagnosis, planning, intervention and evaluation, and is commonly used as a guide for the nurse when undertaking a holistic patient assessment that serves as a basis for care planning. (Williams 2015). Roper, Logan and Tierney, (2000) Explain that lifespan is seen as a continuum. But, nevertheless in contrary to the dependence to dependence continuum the arrow is looking in only direction which given the meaning of going forward only – until we reach the end on life and die. Barnett (2007) clarify that within a clinical environment, the LRT model is followed when investigating research questions regarding specific functional deficits observed in patients that are needing skilled nursing care. Details about the model being used this way are also given by Matter (2007) and strengthen the relationship between the LTR model and holistic assessment and care planning in nursing. When the given specialist areas are investigated and addressed fully, improved patient outcomes are met. This is not just in the acute setting but those at home living with LTC such as COPD also benefit from following the model. (Kara 2007). In the academic setting the model supports nurses develop and test a hypothesis about outcomes of care with a nursing
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