Psychology is the systematic study of human behaviour, thinking processes, problem solving behaviour, emotions or mental processes (Peters et al., 2016). It also used to study how the mind works or affects a person’s behaviour. While, sociology is the systematic and scientific study of social behaviour, relation, interactions, patterns of behaviours, cultures of everyday living and life (Thompson, 2013; Giddens & Sutton, 2017; 2010). The above terms will used to demonstrate a critical and systematic understanding or awareness of the psychological and sociological factors which influence patient care. It will further discuss the importance of carrying out patient risk assessment and safeguarding, and how it promotes safe and effective patient care. Also, shows a detailed /current knowledge of interpersonal working and how it promotes holistic person centred care. For confidentiality reasons, it is imperative that the client discussed in the case study will be addressed using a pseudonym as Mr D ; this is in accordance with the Nursing and Midwifery Council code of professional standards, practices and behaviour (NMC, 2015).
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Mr D is a middle age male with a complex health needs. He has a current health history of peripheral vascular disease, type 2 diabetes high blood sugar, obesity, high blood pressure, hypertension, and diabetic leg ulcer. He was admitted at the hospital for 16week due to self-neglect and continuous refusal to take medication, insulin and treatment. After receiving medical treatment and care at the hospital, he was medically fit for discharge by health professionals. But few weeks after, Mr D was re- admitted at the hospital with Peripheral Vascular disease (PVD), because his diabetic leg ulcer has become seriously infected causing a blockage in his vein and poor circulation in his f foot, and needed emergency surgery to have his right above-knee Amputated. On the other hand, the term peripheral vascular disease (PVD) has being defined as when the built up of fatty substances in the arteries prevent the movement of blood from entering the leg muscle or vessels causes a blockage in the arteries (Alonso et al., 2011; Cristian, 2006; Coffman & Eberhardt, 2003), While amputation is a surgical removal of part of the body such as limb, foot, leg, arm or finger (Yagnik, 2007).
When planning care for Mr D, It is important for health care professionals involved in Mr D’s care to understand how amputation could influence or triggers his psychological and sociological behaviours and emotional needs and these concerns should be included into his care and treatment plan. For example, undergoing an amputation or the loss of a person’s body part can cause variety of psychosocial behaviour and sociological crisis responses such as stress, loss of self-esteem, coping processes, emotional reactions, attitude change, extensive mobility problems, decreased quality of life and reduced interpersonal relation with people (William et al., 2004; Horgan & MacLachlan, 2004). Amputation can trigger anxiety problems and depression including other potential risk factors for example, poor outcomes, psychological and sociological distress, pain, lower scores on the physical, psychosocial, social areas such as; activity of the daily living, change in quality of life (QoL), change in physical and social activities, comorbidity and social support (Schrier et al., 2019; Knežević et al., 2015 ).
Some studies shows that there is a decrease in quality of life for individuals with amputation, and these includes physical capacity, physical aspects and emotional aspects (Sinha, 2014; De Godoy et al., 2002) and thus can influence the individual’s psychological, social and everyday living (Cristian, 2006).
Likewise, having a critical knowledge of Mr D’s psychological and sociological wellbeing, and ensuring that these needs are met involves the appropriate use of the holistic assessment tools such as the Nursing Models Virginia Henderson models of assessment(1969), Roper-Logan and Tierney Models of assessment (1966);using these models in practice (Roper and Henderson) forms the main part of the nursing process, because it creates the process of effective communication, holistic assessments, doctors and patient therapeutic relationship, knowledge of patient background, actual patient diagnoses and treatment, thus provides opportunity for shared decision making whereby diverse professional for instance; doctors, nurses occupational therapy, dietician, physiotherapists and social workers (Dougherty & Lister, 2015; NICE,2014; Murphy, 2013; Holland et at., 2008; Wilkinson, 2007). It can be said that all of these said models was used to form Mr D’s holistic care plan, as well as communicates and outlines any safeguarding risk issues that might present when informing his care which was then used to provide holistic individualised care plan that is centred on his treatment and care needs including; his sociological, psychological, spiritual, cultural and environmental circumstances, and by taking in considerations Mr D’s physical health, independence, activity of daily living, coping strategies, social, physical and emotional wellbeing (Mueller, 2010; McClelland, 2004).
However, it can also be argued that these models can sometimes appears to be used incorrectly by some professionals, because they follow practices that view patient as being dependent on them and can somewhat be seen as conflicting of autonomy (Pearson et al., 2005). Secondly, most professionals can often see the process of using the models as overwhelming and it’s often rushed, which can lead to inaccuracies as well as improper care (Hardey, 2000).
By using holistic nursing assessment in Mr D’s care plan has enabled other professionals involved in his care to contribute and generates an integrated approach that was aimed at proving in-depth understanding of the circumstances leading to his admission. It was documented that Mr D has a mental capacity to make decision, so understanding the reasons for his self-neglect and refusal of treatment is paramount and requires other professionals such as social workers, mental health team, doctors/ nurses, occupational therapist and psychologist needed to be involved in his care, because it help understand if his behaviour was a planned or deliberate, and it has actually assisted in providing on-going support and interventions were necessary to support him pre- op and post –op, including activities of the daily living, cognitive functioning, self-care, promoting independence and mental health (Mlinac & Feng, 2016; Zamanzadeh et al., 2015).
According to Maslow (1943), he argued people are motivated to become the best they can possibly be either by spiritual, physically, intellectually and emotionally, and that people are motivated to achieve certain needs, only when that needs take precedence over others, and if these needs are not meet the human body cannot function properly or progress further (Mc Leod,2018) . In the care of Mr D, having a deeper knowledge of his physiological needs as well as sociological needs are the most important for care plan assessments as all of these factors (psychological and sociological factors) play a huge role in patient recovery, safety and security needs and health outcomes while other needs may become secondary until these needs are met (Tay & Diener, 2011).
In addition, the medical decision whether or not Mr D needed an amputation, medical treatment, social worker services, diabetic nurse and holistic care was not only made by a team of professional, but different professionals contributed to his care assessments process . It was identified that, Mr D has a complex heath needs that required the services of different professionals in order to provide holistic individualised care that does not only focus his physical, emotion and spiritual health, but also creates opportunity to development in-depth knowledge of his sociological and psychological health care needs, including post op care after amputation, infection control, pain management, diabetic support, social housing support and thus, it was central to ensure Mr d ’s health care needs were met by appropriate professionals . More so, Parez-Merino (2014), suggested that a person with complex needs may require the services of different multi-agency assessment and approaches that provides on-going person-centred care that is centred around the patient care provision, and as a result, provides better integrated care, effectiveness communication, interventions, that promotes better patient outcomes and quality of services (Flanagan et al., 2017).
Similarly, planning for Mr D’s discharge was somewhat challenging. It was documented that, Mr D have a history of self-neglect, refusal of treatment and support, and his a type 2 diabetic patient with other complex health issues, so therefore, there is a safeguarding risk issues that needs solution, and various social systems and support network of professionals needs to be in place to assist in developing a holistic support care plan that helps improve his health outcome. Although, Mr D has the mental capacity to make decision; It was assessed that it was in his best interest under the Mental health act (2005) code of practice; that his health care needs ought to be met, so therefore, informing the services of social worker, dietician, district nurses, OT (occupational therapy), physiotherapy was paramount because the services has a duty of care to safeguard their patient and ensure that general care delivery is safe and his care needs are met. The MAC act also helps to protect the rights of individual to make own decisions as many as possible (NHS England, 2014). Also, it is vital to balance people’s right to making own decision with right to safety, treatment, and protection from harm, but it is wrong to make assumptions that people can’t make decisions to protect themselves.
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Using the care act 2014, safeguarding of vulnerable adult Act 2006 and the NMC Code of ethics which covers all areas of patient care including; autonomy (patient independence & decision making), Beneficence (to promote good intentions) Non-maleficence (to prevent harm) and principle of justice (to promote fairness), assisted professionals to provide holistic care that identifies and understands Mr D health backgrounds, psychological and sociological perspectives better (Ellis, 2017; Pearson et al., 2005).
Some of the significant benefits of the exact care delivery provided to Mr D point that, care was carried out in such a way that it was professional and promoted respect for privacy and dignity for example, every aspects of his care needs, such as personal care, treatment, administration of medication, handovers and doctor rounding’s was complete in ways that valued and maintains his dignity and human rights. However, it can be argued that staffing levels is clearly one of the major issues that are believed to have a significant impact on the care quality delivered to patient care and safety.
Secondly, different professionals were also involved in Mr D primary care and continuity of care. It entails that his care assessment allows for and open honest and effective communication and autonomous working amongst different professional. According to Fleury et al., (2017), suggested that professional working together provides opportunity for collaborative working , open honest communication and shared decision-making, and generates proficiency, adaptivity, and proactivity shared decision making that helps to reduced medical error and mistakes , promotes safety and cohesion. However, research has showed that it promotes the sharing of common health goal, promotes better team working, differing backgrounds and skills which have assisted in assessing, planning, or documented and evaluating patient care plan (Xyrichis & Ream, 2008).
In addition, different professionals also contributed to ensuring that Mr D gets all the support in needed post-surgery, and this contribution was used to appraise his psychological and sociological needs, and help provides person focused and individualised care plan. For example Mr D is obese and his diabetic on insulin and so needed the services of dietician to provide appropriate healthy diet plan, weight management and health interventions that prevents further health consequences such as cardiovascular disease. Studies also revealed that obese individuals are more likely to have higher risk of developing cardiovascular disease (Wilding, 2014; Bogers et al., 2007). Likewise, health care assistant, doctors, physiotherapist , occupational therapist was all involved in delivering of holistic and individualised care that acknowledges psychological and sociological needs, as well as any safeguarding issues that arises during the development of his care plan assessment.
Mr D’s care was managed in ways that complies with the legal and agreed ways of working, by also considering ethical and legal policies and procedures that govern how care ought to be delivered to patients, because it is a fundamental aspect of care and personal focused are (Hocking & Tomlin, 2016; NMC 2015; Buka, 2008). Throughout Mr D hospital stay, all professionals informing his care plan assessment worked together and demonstrated effective communication and team working skills that provides and identifies what care needs are appropriate to maintain optimum health, provides support and guidelines that considers Mr D’s physical, emotional, psychosocial and sociological health outcomes.
In conclusion, the case study enabled me to be more familiar with the policies and procedures concerning the safeguarding of patient, some examples include; the Care Act 2014, the Mental Capacity Act 2005 and how to assess it. More so, I have gained more information on how to provide safe patient assessment by working collectively and interact effectively with different professionals so help provide the best possible individualised care that meets the needs of people we support. In addition, I have used Graham Gibb’s (1988) reflective tools to enable me reflect on my placements and help better my knowledge in the nursing practice and become a good reflective practitioner. The case study enabled me to have more understanding on the importance of understanding patient sociological and psychological factors that influences care assessment, holistic care and care delivery.
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