Patient Health and Wellbeing Case Study

The purpose of this essay is to focus on the health and wellbeing of the patient that was observed during the writer’s placement, and to illustrate an understanding of health and wellbeing. The anatomy and physiology will be applied to the patient’s state of health; using ideas from biopsychosocial perspectives and theories. Furthermore, it will outline and give details of: the impact of the illness and how health promotion contributes in enhancing the quality of life. In addition, the influence of life experience on the patient physical and psychological health condition and the way they interact in order to promote the health and wellbeing of the patient will be examined. This essay will also discuss how pulmonary oedema led to the patient’s type 2 respiratory failures. In keeping with Nursing and Midwifery Council, (2018) code of conduct, confidentiality was maintained as stipulated by the professional code of conduct; the patient identity was protected and will be referred to as Mr Bowl. Rayner and Lang (2014) using deficit–based approach from the medical point of view defined health and wellbeing as feeling well, with absent of illness or disease in the body. The definition was unable to recognise that good and bad health and wellbeing might co- exist  which implies that health and wellbeing  can be handled in various aspect such as mental, spiritual, emotional, social and physical procedures  (Lang, 2012). However, in line with World Health Organisation, (2015) health and wellbeing is a state of total physical, mental, social wellbeing and not absence of diseases, (Public Health England, 2017). The definition did not consider the biomedical perspective rather; it concentrated more on holistic health and wellbeing perspective. Although, both definitions view health and wellbeing from biomedical and holistic care approach, health and wellbeing is determined on individual’s differences and phases of life to sustain physical and mental stability with positive understanding. Engel, (2012) biopsychosocial model views health and wellbeing from biological, psychological and social aspect of needs and these models can influence individual health which means that the treatment of individual physical disease can be linked with poor environments, such as inadequate social support which might result to emotional and post traumatic disorder (Livingston and Lee, 2014). Mr Bowl is, a 57 year old, who lives alone and is a heavy smoker. He presented to the hospital with shortness of breath, wheezing, coughing and sporadic confusion and anxiety that started over the past two months. He was admitted in a local hospital respiratory ward where the nurse performed an initial assessment to determine Mr Bowl’s oxygen saturation level which shows 89% room air temperature; cough with unclear sputum. Chest X-ray was carried out and it indicated signs of high increase lung inflammation which contributes to pulmonary oedema that progress to type 2 respiratory failure. Salbutamol inhaler and ipratropium was prescribed by the Doctor.  Mr Bowl’s initial response to treatment showed a remarked improvement, however, he still complained of breathlessness, the clinician advised and prescribed oral prednisolone to address this (Bourker & Burns, 2017). His health condition deteriorated over the next three days while on admission in the hospital. He had continued to smoke despite suffering from shortness of breath and increased breathing difficulties. The increase in smoking causes lung inflammation which could withstand the effect of medication into the lungs to enhance better breathing (Cohen, 2016). Lung function test, done on Mr Bowl shows progression of pulmonary oedema to type 2 respiratory failure and oxygen saturation of 89% (Royal College Physicians, RCP, 2014). According to Davies & Moores, (2015) pulmonary oedema is a disorder which causes in fluid on the lungs leading to respiratory failure. Mr Bowl’s health and wellbeing was affected by irritation due to inhaling cigarette smoke substances which affected his lungs and this resulted to pulmonary oedema. Gibson and Waters, (2016) Parenchyma lung injury can push fluid through the lung air sacks which can destroy the alveolar capillary membrane. The nurse’s observation indicates that Mr Bowl has fluid leakage through the alveolar region that resulted in blood inactivity in the pulmonary vein. (Bourker and Burns, 2017)  Pointed out that little fluid can penetrate the alveoli, however, high pressure increase in pulmonary vein enables fluid to pass through alveoli of the lungs. This action makes oxygen transfer hard from the alveoli and this results to hypoxio which implies insufficient oxygen in the blood, (Casey, 2015). Although, Mr Bowl’s pulmonary oedema is noncardiogenic, the high rise of arterial carbon dioxide level known as hypercapnia influences the exchange of gas process. Mr Bowl’s condition deprived him of needed oxygen due to inadequate exchange of carbon dioxide for oxygen which increased his chances of suffocation, (Burn, 2015). Despite the findings, the epithelial cell in the alveoli for example septal cells helped to prevent complete collapse of alveolar as a result of increase in lung compliance through phospholipids and lipoprotein mixture, (Scullion, 2016). Type 2 respiratory failure happens when inadequate alveolar ventilation that caused the lung’s inability to eliminate adequate carbon dioxide from the system of the body, (Rogers & McCutcheon, 2014) Engel, (2012) medical model of health focused on challenging Mr Bowl’s health condition based on medical approach as a tool for assisting patient’s quick recovery. However, medical model cannot be effective without considering the impact of psychological and social needs which can negatively affect the physical body. This becomes necessary because the body system functions in such a way that integrates all activities to promote Mr Bowl’s health. Although, medication helps for disease treatment and healing (Hughes & Black, 2016) but the patient’s shortness of breath frightens him and makes him panic which can lead to depression and anxiety, (Heslop et al, 2015). The writer observed that multidisciplinary professionals involved in Mr Bowl’s healthcare focused mainly on his medical perspective of illness while attention was reduced on the psychological influence. According to Gross & Kinnison (2016), psychological factors of disease if tackled can help to promote physical body healing. Mr Bowl’s experience on psychological influence of type 2 respiratory failure, can completely reduce the source of medication thereby limiting the enhancement of his health and wellbeing, (Ayers & De Visser, 2018). Despite his bronchodilator drugs treatment using Continuous Positive Airway Pressure (CPAP) which was administered to Mr Bowl in order to minimise airway resistance; but psychological influence still affected his quality of life, (Bourke & Burns, 2017). Hogg & Vaugham, (2018) psychological influence on Mr Bowl’s health condition excessively deprived him of fast recovery. For example, Mr Bowl is frightened and anxious on his ability to cope with his condition knowing fully well that he lives alone. Smoking becomes his pleasure which complicates his already compromised and poor health.  Anxiety can cause pain, inadequate sleep, isolation and inability to cope with illness, (Royal College of psychiatrists, 2016). The writer found out that Mr Bowl’s type 2 respiratory failure can have an effect on his brain due to decrease in blood oxygenation called hypoxemia, Marieb,(2016).This causes harm to the patient’s psychological health and wellbeing because it can create deficiency that interrupts the patient’s capacity to hold back emotions, (Giardino et al, (2016). However, nurses use mindfulness based cognitive therapy to minimise the impact of emotional imbalance which promotes and reinforces his health and wellbeing, (Morgen, 2017). Unfortunately, healthcare professionals pay less attention to psychological impact of Mr Bowl’s respiratory illness. The writer researched and found out that cognitive behavioural therapy decreases anxiety and improves life expectancy of patients with respiratory illness, (Buck, 2015). Adequate cognitive behavioural therapy exercise was offered to Mr Bowl due to anxiety to reduce panic attack and improve his breathing, (Heslop et al, 2015). British lung foundation, (2018) identified that most vulnerable patients focus on their inability to perform daily activities, which contributes emotionally in prolonging their health situation as a result of anxiety. Nevertheless, to promote Mr Bowl’s health and wellbeing, psychological model of coping should be acknowledged by healthcare professionals to help in health empowerment and reduce poor perception associated with poor health, (Walker et al, 2017). Public health, 2017 believes that pathogenesis of disease and progression of healing progression is absolutely unsuccessful on biological evidence and psychological coping approach. However, social factors like social support increase, in order to prevent loneliness and inadequate living condition which affects patient’s health and wellbeing. According to Giddens & Sutton, (2016) Functionalism theory shows that Mr Bowl’s health condition can influence his capacity to perform social activities, for instance, being unemployed which resulted to poverty. Wilson, (2016) pointed out that such conditions can upsurge feeling of frustration and delay the process of healing. The patient’s frustration can result to stressful condition which influences his body function, through behaviour, thoughts, and his feelings. Haralambos & Holborn, (2017) theory of stress indicates that stress is triggered when the body responds to physical pressures arising from events of life. Although, Mr Bowl’s physical and mental health condition can be influenced by stress in a negative way. The writer observed that the patient copes with stressful situation by pushing through which can help in his ability to deal with breathing issues. Despite high demand for environmental health and wellbeing that is limited as a result of poor availability of human and non-human resources, the ward nurses support Mr Bowl by encouraging positive behavioural attitude , to enhance his ability to control the increased pressure on his health and wellbeing, (Bambra et al, 2014). According to Royal College of Nursing, (2018) Health promotion is vital to prevent illness, maintain healthy life style and actively promote physical changes in the physical health and wellbeing. Royal College of Nursing, (2018) promoting health and wellbeing as a way of nursing clinical practice, help to support Mr Bowl’s likelihood of sustaining healthy standard of living. Nurses help to educate the patient through the provision of necessary information in order to enhance the knowledge and understanding of his health situation throughout the stages of his life. Tannahill model of health promotion, (2013) suggests that in order to maintain positive health, effective communication is essential due to its usefulness in supporting nurses to create awareness on preventing adverse behaviour and belief which impacts on good wellbeing, however, the importance of nurses being good listeners helps in promoting the patient’s lack of understanding of his health situation and how to be treated, (NMC, 2018). Public Health England, (2017) adds that intervention such as health promotion campaign will impact positively on the patient health and wellbeing. Negative Life experience upsurges reaction to the usual body function, (McLeod, 2015). For instance, Mr Bowl is a heavy smoker and he did not have intention of quitting despite that he had developed type 2 respiratory failure conditions. The stimuli that  activates his desires to smoke cigarette influence his physical health and seriously affects his breathing, thereby causing psychological feeling of distress which raises emotional distress, (Moller, Deci, Ryan 2015).The writer learnt that duty of care is essential in nursing profession to help in providing relevant information on promoting the patient health and wellbeing, for instance, smoking cessation and  the effect of poor observation on particularly respiratory failure conditions and  to encourage the patient to routinely use Non- invasive ventilation (NIV). This will reduce preventable complication and to treat and promote the patient’s health and wellbeing from biopsychosocial viewpoint. In conclusion, effective health and wellbeing involves the interaction of biopsychosocial model and its approach to patient’s health condition which contributes to his quick recovery. The patient’s biological, psychological and social needs are harnessed to support a healthy lifestyle, standard of living, effective care provision and delivery whenever patient is treated from a broad range of health situation. It also helps to gain an understanding of the anatomy and physiology of the patient illness. Health promotion is relevant and essential in nursing as it helps to promote, enhance the quality of life and focus on prevention of the illness. It encourages positive lifestyle and behaviours that enhances the patient ability to control the pattern of living. The impact on health and wellbeing enhance confident, knowledge and understanding of a wide range of the patient health situation. Reference list

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