Strategies To Support And Empower Patients Living With Long Term Conditions (LTC) When Planning Discharge From Hospital: A Case Study Of Lewy Body Dementia Patient
Discharge planning of a patient seeks to bridge the existing gap between the healthcare service and the location where the patient is discharged. The essay aims to illustrate a discharge planning method, with an emphasis on the medical history of the patient, role of individual healthcare workers who will form a part of the multidisciplinary team while caring for the patient. It will also elaborate on the role of involving the patient’s family in the discharge care plan, and the significance of communication.
Discharge planning refers to the procedure that aims to improve coordination of care services after a patient is discharged from a healthcare setting, such as, an organization (Shepperd et al. 2013). It also aims to reduce the length of hospitalization and works towards minimizing rates of unplanned readmissions to the hospital. Complex discharge occurs in cases when the discharge destination and date are not determined easily, the current condition hampers ability of the patient to return home, and needs provisions for residential care, or bariatric services. It is most prevalent for homeless people. However, Angelo would require a simple discharge, where social care and health professionals will take practical steps for improving the health status of the patient. Members of the multidisciplinary team will provide practical advice, and assistance for the same. In this case scenario, discharge planning of the patient Angelo will involve conducting an exhaustive assessment of his daily activities and planning the optimal delivery of appropriate healthcare services that will be administered by the multidisciplinary team. Effective discharge planning is considered imperative for care continuity of patients. Primary care trust, local authorities, housing organization, private and voluntary organization and the healthcare setting are the key stakeholders who will play an essential role in discharge planning.
Package of care refers to the combination of healthcare services that are combined together for meeting the assessed preferences and demands of a patient. It forms an essential part of formulating a care plan that arises while conducting a thorough assessment or review of the concerned patient. In other words, package of care encompasses procedures or steps that are describe the exact needs of a patient, and also aim to ensure optimal delivery of care services or healthcare equipment that provide assistance to the patient to lead a comfortable and purposeful life (Metzelthin et al. 2013). According to the National Health Service, care packages are provided to patients who suffer from disabilities, illness or accidents (Nhs.uk 2018). In this case scenario, an effective conversation must be initiated with the patient Angelo, to identify his individual preferences in regards to what kind of care services he requires and expects from the healthcare professionals. Furthermore, he is also found to live alone in a sheltered accommodation, near his daughter’s house. Thus, his package of care must involve giving importance to his social life that includes his daughter and other acquaintances who will be able to assist him while conducting daily activities. The care package should provide him assistance in dressing, washing, meal on wheels, aids and adaptation, frozen foods, and laundry. Moreover, importance will also be given to obtaining details related to the medications for hypertension and hyperlipidaemia that he is currently on. The package will also focus on implementing a dietary control, and lifestyle modifications, for enhancing the health related quality of life of the patient.
Dementia is an umbrella term that refers to a broad category of brain diseases that are responsible for causing long-term and gradual loss of ability to think, or remember. This affects the daily functioning of an individual. Most common types od dementia include vascular dementia, lewy body dementia and frontotemporal dementia (Prince et al. 2013). Lewy body dementia is a progressive brain disorder that occurs due to abnormal deposition of a protein, called alpha-synuclein. The disease is found to worsen over time, and brings about changes in cognition, behavior, and movement. Research findings state that lewy body proteins are principally found in areas of the brain stem, where they are found to exert their action in a way that depletes dopamine, the major neurotransmitter. This often results in manifestation of symptoms that are characteristic of Parkinson’s disease (Walker et al. 2014). In patients suffering from lewy body dementia, the abnormal proteins get diffused throughout different regions of the brain, and results in a disruption or depletion of the neurotransmitter acetylcholine, thereby leading to development of disturbances or disruption of the patient’s thinking, perception, and behavior (Burton et al. 2012). Lewy body dementia often exists in two forms, either pure form, or in combination with other changes in the brain that are typically found in Alzheimer’s or Parkinson’s disease patients (Jones and O’brien 2014).
Most common signs and symptoms of the condition include impairment in executive functioning, attention, and visuospatial function. Similar symptoms have been observed in the patient Angelo Davies, who claimed to suffer from progressively increasing confusions and hallucinations. Visual hallucinations as experiences by the patient can be correlated with development of well-formed images (small gnomes as visualized by the patient in this case scenario) that are usually perceived by patients in absence of any real stimuli (Onofrj et al. 2013). According to research studies, around 85% individuals suffering from lewy body dementia display some features that are common with Parkinson’s disease, such as, rigidity, slowness in movement, and tremor at rest (Thomas et al. 2018). Thus, the fact that Angelo had issues in stability maintenance and suffered from frequent falls, can be considered as an important diagnostic character. Furthermore, admission of the patient to the ward can be correlated with the fact that in addition to deficits in attention and memory, core features of lewy body dementia often include autonomic dysfunction. Such dysfunctions are commonly related to fluctuations in blood pressure, heart rate variability, urinary incontinence, heat intolerance, and syncope (Beishon et al. 2014). Thus, presence of hypertensive symptoms in Angela acts as major risk factors that are likely to worsen his condition over time.
Discharge Care Plan For a Patient With Lewy Body Disease
10 steps of discharge planning need to be applied while caring for a patient. These steps encompass starting planning for patient admission, identifying simple or complex needs of the patient, clinical management plan development within a day of admission, coordinating transfer or discharge process of the patient, setting an expected data for discharging the patient within 48 hours of hospital admission (Denson, Winefield and Beilby 2013). Clinical management review, involving carers and patients, planning appropriate discharge strategy over seven days and discharge related decision making are other aspects of the principles. Furthermore, discharge planning also encompasses the act of assisting the patient to make informed choices. The Mental Capacity Act provides certain rights to patients who are not in a condition to make informed decisions regarding the healthcare plan they will be subjected to (Nhs.uk 2018).
Managing the patient suffering from dementia with lewy body will require involvement of an interdisciplinary team of healthcare workers who must ensure appropriate arrangement of transport of the patient to home or care centres. An assessment of Angelo’s living condition and his needs, with respect to the manifested health conditions will be assessed. A written care plan will be formulated for the patient that will record the individual needs and preferences. In this case scenario where the practitioner nurse advised Angelo to get consultation from psychiatrists for symptoms related to hallucinations and motor in-coordination, the specialist healthcare team will be responsible for plan the provisions of developing appropriate treatment or interventions for the patient. An assessment will be conducted to see how Angelo copes with his health condition after returning home. Generally, the patient will choose where he wishes to live upon discharge from hospital. However, in case of dementia with lewy body, he might be unable to decide for himself. Efforts shall be made to establish contact with his daughter to allow her to make important decisions. He will also be provided with necessary equipments such as, wheelchairs, grab rails and hoists to prevent adverse consequences due to injurious falls. Efforts will also be taken to ensure if Angelo will benefit from a range of intermediate care services that will be provided to him. This will help him regain confidence and self-worth. Before discharging the patient, the medications that he is currently on and medications for treating dementia with lewy body will be discussed with the general practitioner.
Cholinesterase inhibitors will be selected as the appropriate medications or standard treatment for the patient. These drugs will be administered based on their property of increasing concentration of chemical messengers that govern higher cognitive faculties related to thought, memory, and reasoning. Furthermore, the patient will also be subjected to carbidopa-levodopa that will reduce prevailing symptoms of slow movement and muscle rigidity (Stinton et al. 2015). Efforts will be taken to assess medication side effects before his discharge, such as, excessive salivation, gastrointestinal upset, frequent urination, and tearing. The person is currently under lisinopril medication due to the fact that is primarily used for treating the presenting complaints of hypertension and cardiovascular abnormalities. The discharge plan will be framed in a way that will be efficiently manage associated side effects such as, dizziness, cough, headache, diarrhea and weakness. Angelo had been prescribed atorvastatin to improve his high cholesterol levels. Hence, the discharge plan will be formulated in a way that assists the patient to manage related side effects such as, muscle pain, swelling, weight gain and memory problems. Conversation with the client will also help in determining if Angelo wants his prescribed medicines to be arranged in pill organizers or dossette boxes, for their easy administration (Matthews et al. 2013). Daily routines will be created to prevent him from getting confused while carrying out daily activities. The benefits of exercise on behavioural and physical health will also be discussed with the patient (Brodaty and Arasaratnam 2012).
Discharge Planning and Importance of Effective Communication
Owing to the fact that the patient Angelo lives close to his daughter’s home, it is imperative for the hospital authorities to form a liaison with social services for creating provision that will supervise and support him with his daily activities such as, dressing, laundry, feeding, and washing. Patients with lewy body dementia are more likely to experience a myriad of emotions, namely, frustration, confusion, fear, anger, grief, uncertainty, and depression (Donaghy et al. 2018). It is also crucial to make his daughter know about the possible behavioural manifestations of lewy body dementia in the form of hallucinations or delusions, which in turn will assist her to offer necessary support when required and demonstrate a tolerance towards such behavioural symptoms.
A conversation with his daughter will also help her understand about the impacts of the diagnosed condition on his finances, social and personal life (Nurjannah et al. 2014). This will assist her to offer support to her father by reassuring, listening, and displaying a positive attitude towards the patient. Support can be taken by his daughter from social care services or organsiations that will facilitate easy coping or recuperation from the condition. Prior to his discharge a follow-up appointment needs to be schedules that will inform the patient about the continuity of care services. Furthermore, the general practitioner should also be involved in regularly monitoring the vital signs of Angelo, which might act as potential risk factors for the worsening of dementia related symptoms. A discharge checklist will also be used within 48 hours before he is released from the ward.
Research evidences suggest that discharge-planning processes that systematically integrate informal caregivers or family members in the process bring about significant reductions in rates of recurrent hospitalizations by 25% (Gonçalves?Bradley et al. 2016). Family caregivers are responsible for assuming considerable care responsibilities for the patients. Involvement of the family members often helps them accurately conduct wound management techniques, medidcation administration, and operation of specialized equipments. Providing appropriate training and support to his daughter will play a crucial role in fulfilling her responsibilities. This will effectively prevent readmission of the patient and will pave the way for decision making that will guide the process of recovery, and maximize independence. Involving the patient himself in his long-term care plan will ensure that his personal needs are well recognized, thereby facilitating him to cope better with the prevailing conditions. Close collaboration with the patient will help to determine need of caregiver training opportunities, or other supports.
Designing Comprehensive Care Package to Meet Individual Needs of Patients
Complexity of the case scenario requires development of lengthy communication processes between the patient, his family members, and interdisciplinary team involved in discharge planning. Communication problems between the service users and the carers act as major barriers in patient discharge. There is a need to develop an effective interagency an interdisciplinary communication for ensuring satisfactory care transfer (Allen, Ottmann and Roberts 2013). Thus, communication between the healthcare workers and the patient is central to bring about a smooth transition from hospital to home or community settings. Appropriate verbal and non-verbal skills will be put to use for explaining the proposed discharge plan to Angelo and his daughter and recognizing any unmet needs on the part of the caregivers (Atwal, McIntyre and Wiggett 2012). According to the Nursing and Midwifery Council, it is imperative to treat all individuals in a way that upholds their dignity. This will be achieved by treating the patient with respect, compassion and kindness. All possible efforts will be taken to avoid false assumption making regarding his preferences or choices. Furthermore, an effective partnership will be fostered to deliver the care services in an effective way. The rights of the patient to refuse or accept the proposed steps of discharge planning will be respected. Moreover, the codes of practice will also be followed with the aim of obtaining appropriate informed consent from Angelo, and documenting it before beginning the planning process (NMC 2015). A duty of confidentiality will be maintained to the patient and necessary information related to his health will be protected, in the best interest of patient safety. Effective discharge planning will also involve empowerment of the individual and will strengthen the position of the patient. Empowering the patient through implementation of education activities that will help him understand his physiological status and facilitate self-management of activities, die, care regimens and medications will be beneficial. Most patients wish to remain independent as long as they can. Thus, the discharge plan will be framed in a way that promotes functional independence of the patient in conducting daily living activities. Independence will be encouraged by determining if he can prepare meals for himself or have reliable meal transportation or delivery options.
To conclude, it can be stated that discharge planning process considers the preferences and health needs of the patient while formulating the plan. While planning for discharge of a patient as Angelo with complex needs related to lewy body dementia, provisions for accurate arrangement that will facilitate continuity of care are required to be maintained. Appropriate resource allocation, training and support from the healthcare workers will ensure prevention of readmissions. Furthermore, emphasis should be given on empowering the patient and fostering an effective conversation for delivering person-centred care services.
Role of Healthcare Professionals and Family Members in Discharge Planning
Allen, J., Ottmann, G. and Roberts, G., 2013. Multi?professional communication for older people in transitional care: a review of the literature. International Journal of Older People Nursing, 8(4), pp.253-269.
Atwal, A., McIntyre, A. and Wiggett, C., 2012. Risks with older adults in acute care settings: UK occupational therapists’ and physiotherapists’ perceptions of risks associated with discharge and professional practice. Scandinavian Journal of caring sciences, 26(2), pp.381-393.
Beishon, L.C., Harrison, J.K., Harwood, R.H., Robinson, T.G., Gladman, J.R.F. and Conroy, S.P., 2014. The evidence for treating hypertension in older people with dementia: a systematic review. Journal of human hypertension, 28(5), p.283.
Brodaty, H. and Arasaratnam, C., 2012. Meta-analysis of nonpharmacological interventions for neuropsychiatric symptoms of dementia. American Journal of Psychiatry, 169(9), pp.946-953.
Burton, E.J., Mukaetova-Ladinska, E.B., Perry, R.H., Jaros, E., Barber, R. and O’Brien, J.T., 2012. Neuropathological correlates of volumetric MRI in autopsy-confirmed Lewy body dementia. Neurobiology of aging, 33(7), pp.1228-1236.
Denson, L.A., Winefield, H.R. and Beilby, J.J., 2013. Discharge?planning for long?term care needs: the values and priorities of older people, their younger relatives and health professionals. Scandinavian journal of caring sciences, 27(1), pp.3-12.
Donaghy, P.C., Taylor, J.P., T O’Brien, J., Barnett, N., Olsen, K., Colloby, S.J., Lloyd, J., Petrides, G., McKeith, I.G. and Thomas, A.J., 2018. Neuropsychiatric symptoms and cognitive profile in mild cognitive impairment with Lewy bodies. Psychological medicine, pp.1-7.
Gonçalves?Bradley, D.C., Lannin, N.A., Clemson, L.M., Cameron, I.D. and Shepperd, S., 2016. Discharge planning from hospital. The Cochrane Library, pp.1-105.
Healthlinkbc.ca. 2018. [online] Available at: https://www.healthlinkbc.ca/sites/default/libraries/healthwise/media/pdf/hw/form_ug5162.pdf [Accessed 28 Mar. 2018].
Jones, S.V. and O’brien, J.T., 2014. The prevalence and incidence of dementia with Lewy bodies: a systematic review of population and clinical studies. Psychological medicine, 44(4), pp.673-683.
Matthews, F.E., Arthur, A., Barnes, L.E., Bond, J., Jagger, C., Robinson, L., Brayne, C. and Medical Research Council Cognitive Function and Ageing Collaboration, 2013. A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. The Lancet, 382(9902), pp.1405-1412.
Metzelthin, S.F., van Rossum, E., de Witte, L.P., Ambergen, A.W., Hobma, S.O., Sipers, W. and Kempen, G.I., 2013. Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial. Bmj, 347, p.f5264.
Nhs.uk. 2018. What is the Mental Capacity Act? – NHS.UK. [online] Available at: https://www.nhs.uk/conditions/social-care-and-support/mental-capacity/ [Accessed 28 Mar. 2018].
Nurjannah, I., Mills, J., Usher, K. and Park, T., 2014. Discharge planning in mental health care: an integrative review of the literature. Journal of Clinical Nursing, 23(9-10), pp.1175-1185.
Nursing and Midwifery Council., 2015. The Code- Professional Standards of Practice and Behaviour for Nurses and Midwives. [online] London: Available from https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf.[Accessed on 28 march 2018].
Oesterhus, R., Soennesyn, H., Rongve, A., Ballard, C., Aarsland, D. and Vossius, C., 2014. Long-term mortality in a cohort of home-dwelling elderly with mild Alzheimer’s disease and Lewy body dementia. Dementia and geriatric cognitive disorders, 38(3-4), pp.161-169.
Onofrj, M., Taylor, J.P., Monaco, D., Franciotti, R., Anzellotti, F., Bonanni, L., Onofrj, V. and Thomas, A., 2013. Visual hallucinations in PD and Lewy body dementias: old and new hypotheses. Behavioural Neurology, 27(4), pp.479-493.
Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W. and Ferri, C.P., 2013. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer’s & dementia: the journal of the Alzheimer’s Association, 9(1), pp.63-75.
Shepperd, S., Lannin, N.A., Clemson, L.M., McCluskey, A., Cameron, I.D. and Barras, S.L., 2013. Discharge planning from hospital to home. Cochrane Database Syst Rev, 1(1), 1-91.
Stinton, C., McKeith, I., Taylor, J.P., Lafortune, L., Mioshi, E., Mak, E., Cambridge, V., Mason, J., Thomas, A. and O’Brien, J.T., 2015. Pharmacological management of Lewy body dementia: a systematic review and meta-analysis. American Journal of Psychiatry, 172(8), pp.731-742.
Walker, Z., Possin, K.L., Boeve, B.F. and Aarsland, D., 2015. Lewy body dementias. The Lancet, 386(10004), pp.1683-1697.environment