Case Study
Mary is 48 years old, married to George and a mother of three teenagers. She works as a teacher in a primary school. She is obese and being treated for hypertension and asthma. She does not exercise very often as she is symptomatic of hip bursitis that has responded neither to medication nor to physiotherapy. In the last 6 months, she has been bothered by symptoms of perimenopause with frequent hot flushes. She has been offered hormone therapy, but she is uncertain about accepting as her mother died from breast cancer 2 years ago.
Concept of Long Term Conditions (LTC’s)
Long term conditions and issue for health and social care
Long-term conditions are those situations in the medical field in which the patients could not cure completely but based on proper treatment, the implications and symptoms could be controlled. There are different kinds of implications an individual faces due to long term conditions such as long-term conditions could affect individual finances, education, accommodation, job, or role within the family. An individual with a long-term condition may be accessed to many sources such as voluntary organizations, the government, health, and social services but the role of nursing is very important in taking care of the individual with long-term conditions. In the current case, Mary is facing the problem of two important long-term conditions, including hypertension and asthma. Hypertension and asthma, according to studies, are affecting hundreds of millions of people around the world. As Mary is facing the issue of asthma due to which bold high pressure is also the medical issue facing Mary because the increased severity of asthma is the main reason in the case of Mary due to which the presence of hypertension is associated. The most important thing regarding the association between hypertension and asthma is that studies have not yet identified the underlying causes of this association. Comorbidity is the term used for the coexistence of two diseases in Mary. In this perspective, the causal relationship between hypertension and asthma in Mary could be pointed out by comorbidity. For instance, cardiovascular damage could be caused by the problem of hypertension in Mary due to which other consequences may be faced by Mary, such as kidney problems, stroke, and heart failure. Alternatively, confounder effects may have resulted in comorbidity currently facing by Mary, such as predisposing to multiple health problems and lifestyle or environmental factors. An asthma attack in the case of Mary could be triggered by stress, and the risk of hypertension is always associated with long-term stress exposure. Asthma and hypertension in the case of Mary also result in the third health issue of obesity.
Long term conditions such as hypertension and asthma are creating serious challenges for health and social care systems. The key aspect regarding these challenges is that on the estimated basis about 70% of the primary care budgets are taking by the long-term conditions and with the increase of multimorbidity, the management of long-term conditions would become unsustainable without consideration of modernization and significant changes in services such as nursing. Some of the important factors that are making it difficult for health and social care to manage long term conditions are given below:
- Lack of proper training of community nurses in caring for people with long term conditions and lack of a proper system of placing nurses ideally to provide care
- People with such issues are unaware who to approach because of a lack of care-coordination with these people
- It is hard to access psychological and emotional support for people with long term conditions
- Lack of ability of the health care system to identify the most vulnerable individuals who need extra support and help
- Self-care is not encouraged by the healthcare professional; they often consider passive recipients of care (Croneri, 2020).
Impact of living with LTC’s
Physical needs
Based on the case of Mary, it could see that age of Mary 48 years, and she is currently facing a long-term condition of hypertension and asthma, but along with it, she is also obese. The main physical need for Mary is to do exercise on a regular basis, but due to the issue of hip bursitis, she does exercise very often. Mary is also a working woman in a primary school. In this perspective, the school management needs to take proper measures for the easy sitting of Mary in class. The most important factor that is needed to be considered by Mary is to focus on healthy eating because she must have to reduce the alcohol, caffeine, and salt in the food. Based on looking at the case, it could be seen that Mary needs to spend time with the local community because this is the main reason that she stayed busy at home and school. She must need to recognize that interaction with people would keep her happy, and it would help in reducing the issue of hypertension. She must go for hormonal therapy, and physiotherapy and medication must need to be started by Mary for getting treatment for hip bursitis, which is creating a significant physical problem for Mary.
Psychological needs
The psychological needs of Mary are directly linked with having access to extra advice from the community nurses, but it is noted that in the modern health care system lack of psychological and community programs that are the main factor of creating psychological problems for the people with long-term condition hypertension and asthma. Mary needs to talk openly, and the health care provider and community nurses need to provide friendly services, and in keeping her happy, the role of her husband and children is very important. Her husband needs to take him out of the home with the children so that she can enjoy it for some time. The health care provider needs to provide deeper mental health support so that Mary could realize that she can change her current situation (Jelen, 2016).
Educational needs
Mary needs to have a proper understanding and learning of the current issues she is facing as she is being treated with hypertension and asthma, so education needs of Mary are based on being familiar with these two issues in terms of recognizing the symptoms and importance of medication and exercise for reducing these health issues. Understanding Mary would eventually help her husband and school management to understand her current situation as the medication for hypertension and asthma work in different ways, so she needs to increase her understanding of using medication. It must realize her that the best treatment for long-term conditions is to have a proper action plan. She is facing the issue of symptomatic hip bursitis, but she has never realized how much medication and exercise and physiotherapy is a must for her due to a lack of her basic understanding of the consequences of not taking care. Learning about the current issues would help her to build strong relationships with nurses who are involved in her treatment. Education would make her able to ask questions from the healthcare providers. Mary needs to get proper training in monitoring her hypertension and asthma over time. She must be aware of the severity and frequency of symptoms.
Interpersonal, inter-professional, and organizational issues
Due to the current issue of long-term conditions of hypertension and asthma, it would make it possible that the interpersonal relationship of Mary would be greatly affected. As she is a married woman with having three teenagers so lacks proper control of the long-term conditions, Mary’s behavior toward both the children and husband would be crude. In simple words, it could be said that this long-term condition could impact the relationship of Mary with not only her family members but also with friends and other individuals in society. It is very difficult for Mary to take care of her children and do work at home because she is facing other symptoms of hip bursitis.
In the context of consideration of the inter-professional issues of these long-term conditions, it could see that Mary is very disturbed because of current situations due to which it may be possible that she could not perform the duties in her primary school in a professional manner. There are more chances of conflicts in the school with other colleagues. In this perspective, Mary needs to inform the school management of her current situation. She needs to provide medical reports to the school management to make them aware regarding the issue of hypertension and asthma.
Organization and management of the long-term conditions are becoming an issue because of the shortage of the health care provider because it has seen that single individual is involved in dealing with different components of care due to which burden on them is creating. Lack of a structured care management plan is another major factor of creating the issue in the organization of long-term condition of hypertension and asthma. In addition to it, it has been seen that screening tools are not effectively used by the nursing staff due to lack of proper training. Discouragement of self-care is another factor that is creating difficulty in managing the long-term conditions. There is another common perception among the communities and social care providers that hypertension and asthma is the common problem in older people due to which proper attention is not given in enhancing the awareness of the people such as Mary regarding the best way of doing exercise on a regular basis.
Management and support
Precaution Adoption Process Model (PAPM)
There are different kinds of theories of individual health behavior available, and based on these theories, the behavior of Mary towards her current long-term conditions could be predicted. Precaution Adoption Process Model (PAPM) is one of the well-known psychologically focused models that could be very important to be considered by Mary in the context of deciding how she could come to a new decision for controlling her current long-term condition of hypertension and asthma. The most important thing regarding the consideration of this model is that Mary could apply it to current missing actions such as she can take proper action to the gradual development of her habitual pattern of behavior such as proper diet and exercise. Irving Janis and Leon Mann (1977) started initial work on the PAPM based on evaluating the responses of people towards health-based threats. There were seven stages identified by the model based on which the behavior of Mary could base on taking actions for controlling the current long-term issues. The first stage of the model is based on the level of unawareness of Mary with the consequences of current issues she is facing. Mary would enter into stage 2, based on getting awareness of the issues, but still, she does not entertain the idea as an issue. After the awareness, Mary would enter into stage three of the model, which is based on the decision-making process. At this level, Mary could decide to go for hormone therapy offered to her and start making the schedule of doing exercises on a regular basis. After realization of the fact that hip bursitis is the key issue due to which Mary is not able to take proper actions on controlling and managing her long-term issue then she would enter into the next stage of the model. At this stage, new behavior by Mary could be developing for dealing with the current issues (Weinstein et al., 2020).
Social cognitive theory
This theory believes that change in human behavior is affected by a combination of different inside and outside forces. Based on this theory, it has been identified that individual behavior in the process of reciprocal determinism could be affected by environmental interaction, behavior factors, and personal factors. Benefits, barriers, outcome expectations, and self-efficacy are some of the important aspects of this learning and change in this model. In this perspective, based on the application of this change model, Mary could develop self-efficacy based on consideration of different sources such as physiological and affective states, social persuasion, vicarious experience, and mastery experiences. In this perspective, Mary needs to increase her interaction with other people so that she can understand the ways based on which these kinds of issues could be managed (Ozyilmaz et al., 2018). Interaction with other people would help Mary to find out those people who have successfully established control over these kinds of long-term issues. This model could enable Mary to identify those challenges, obstacles, and barriers which have been faced by other people in dealing with hypertension and asthma. Based on this theory, Mary must realize how her lifestyle habits could have an impact on her long-term conditions. Based on the realization of the importance of self-efficacy, Mary could make a proper plan of action, such as taking medication at the proper time and setting a time for doing regular exercise. Exercise is the key factor in managing hypertension and asthma. The existing behavior of having feared that show does not want to go for hormone therapy because her mother has died due to breast cancer. This behavior could be changed to have a belief in her efficacy (Bandura, 1998).
Telehealthcare
Different techniques are available based on which technological ways of providing health care services could be ensured. Telehealth is considered as a process of using electronic services for supporting wide ranges of remote services such as monitoring, education, and patient care. In the context of gaining an advantage, telehealth must be integrated into hospital-based practices and traditional ambulatory. This telehealth is considered a disruptive technology that could change the current system of the traditional healthcare system, but it has a greater level of potential of transforming the method of providing health care services especially in the nursing sector. Telehealth is the best way of increasing the satisfaction of patients and reducing the cost of providing healthcare services to people. Based on the application of telehealth technology in health care services, a patient-oriented delivery system could be developed. The most important aspect regarding the use of technology is that it would help the health care providers such as nurses to manage an increasing level of relationship and information, it would help in decreasing the costs, and it would increase the quality and access to better healthcare services. The most important aspect regarding the successful implementation of telehealth in providing service is that it is not wholly concerned with the expensive and sophisticated telecommunication systems and equipment, but rather it needs structural and organizational mechanisms that are important for the implementation of different types of healthcare delivery (Touger & Wood, 2019)
There are different kinds of benefits that could be attained based on using this kind of technology delivering health care services such as it would increase the capacity of delivering the healthcare services to those areas where services have not been provided. Another important aspect of telehealth technology is that unnecessary hospital referrals are reduced by this technology. A third important benefit of using this technology in the health sector is that it helps in decreasing professional isolation because it enables providing decision support to from specialist centers. For instance, in case of consideration of the responsibilities of emergency nurses it could see that this technology would enable the emergency nurses to manage the patients with having minor injuries based on having a backup of emergency consultants and accident consultants if they need it. In addition to it, other most important benefits of using this kind of technology health care system are that it increases the access of health professionals to up to date information about new practices and ways of treating people with long term conditions (Staff, 2020).
The most important perspective of the use of technology in the healthcare sector in the context of patients is that it would increase the provision of services to the patients based on making improvements in the access of patients to therapeutic and diagnostic services. This kind of technology is also used in the perspective of increasing the awareness of the people regarding the self-care procedures based on which individuals with long-term conditions could take action.
Concluding Remarks
To pen it off, Mary needs to focus on the development of her understanding regarding the long-term conditions such as hypertension and asthma so that she can be the area of the consequences that could be faced by her. Based on the realization, she has a family, so she must have to take care of herself. The best way of controlling hypertension and asthma is to do daily exercise. The most important aspect in respect to making the people independent is that the community and social provided must increase the self-assessment and self-care attitude and motivation among the people for dealing with long term conditions. Long-term conditions remain over time, so it must need to be realized Mary that personal care is the only way of dealing with these issues. The role of government is also very important in increasing the awareness of the long-term conditions and for this investment should be made in developing effective self-management training programs for the patients currently facing the issues of long-term conditions. There are different kinds of weakness and issues occurring in the health and social care systems, so it is very important that health and social care providers need proper training and understanding of the dealing with long term conditions. In the context of consideration of the role of society, it has concluded that the people around individuals facing long-term conditions need to under the physical, psychological, and professionals needs. Patients with long-term conditions need support from not only the family and friends, but they to need valuable support from the health and social care provided and society as a whole.
Referencing
Bandura, A., 1998. Health promotion from the perspective of social cognitive theory. Psychology and Health, 13, pp.623-49.
Croneri, 2020. Care of Long-term Conditions: In-depth. [Online] Available at: https://app.croneri.co.uk/topics/care-long-term-conditions/indepth.
Jelen, , 2016. Living with a long-term condition: the importance of psychological support. [Online] Available at: https://www.kingsfund.org.uk/blog/2016/03/long-term-condition-psychological-support.
Ozyilmaz, A., Erdogan, & Karaeminogullari, A., 2018. Trust in organization as a moderator of the relationship between self‐efficacy and workplace outcomes: A social cognitive theory‐based examination. Journal of Occupational and Organizational Psychology, 91(1), pp.181-204.
Staff, M.C., 2020. Telehealth: Technology meets health care. [Online] Available at: https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-20044878#:~:text=Telehealth%20is%20the%20use%20of,or%20support%20health%20care%20services.
Touger, R. & Wood, B.R., 2019. A review of telehealth innovations for HIV pre-exposure prophylaxis (PrEP). Current HIV/AIDS Reports, 16(1), pp.113-19.
Weinstein, N.D., Sandman, P.M. & Blalock, S.J., 2020. The precaution adoption process model. The Wiley Encyclopedia of Health Psychology, pp.495-506.
