This assignment is going to look at long-term illness, and the impact it has on the individual quality of life. It will discuss the contemporary, political health and social care concerning a long-term illness. In this essay will focus on diabetes type one. It will also identify the pathophysiology and discuss how diabetes1 affects the patient physical and their mental health being. It will also look at how it affects the patient families and friends. And it will highlight the importance of Integrated care and of multidisciplinary teams and the role a nurse in supporting patients with long-term illness.
According to the statics, more people in the UK are living with a long-term condition (WHO, 2011), which is due to current medication and the NHS gets treatment regardless of income or age. Lloyd (2012) Living with some long-term conditions contribute to more frequent, and longer hospital stay. Carrier, (2009) states that living with a long-term illness makes it difficult for the individual to live an ordinary life. It creates a level of uncertainty due to the progression and reappearance of the conditions, which brings complications and side effects. Treatment. Long-term illness is one that cannot be healed but managed through medicine or rehabilitation (Department of Health, 2008). Roddis (2016) identifies that long-term illness has a negative impact on people having to manage their daily activities WHO (2005) defines long-term conditions as lasting diseases or non- contagious disease. Individuals with long-term conditions often find it challenging unsettling health problems that have an impact on mental, social and emotional repercussion. The DOH, (2013) Acknowledged that there are 1-3 people in the UK existing with a long-term illness. Most people who are living with a long-term condition are over the age of 65 NHS (2018). In the United Kingdom, more than fifteen million people are living with long-term conditions. (DOH, 2009). Asthma, epilepsy, cancer chronic obstructive pulmonary disease are some examples of long-term conditions.
World Health Organisation (2011) identified that there is a rise in long-term conditions leading to more deaths than compared to non-communicable diseases. 50% of people over the age of 65 are living with two or more long-term conditions The Government has put policies in place to help tackle the long-term conditions issues and set strategies in place. The National Service Framework (2005) aims to bring a high standard of healthcare to meet a satisfactory nationwide standard (NSF 2001). They intended to break the discernment offer and provide holistic care and fast services suitable to the needs of the patients (DOH, 2005). And The NHS Mandate (2016) helps to promote equality and preventing inequalities. Building satisfactory schemes, for long-term care and to empower people about long-term conditions. It helps in preventing ill health and supporting people to live a healthier life. The National Service Framework aims to bring a high standard of care in all areas to a satisfactory national standard (NSF, 2001) to provide holistic care and fast services suitable to the needs of the patients (DOH, 2005). DOH (2005) acknowledged vital values to be used as strategies for managing long-term illness which will be used across UK Social service and Public Safety which included working in partnership with patients and their families, supporting self- management, promote adapted aids to help patients manage their medicine and working in a patient-centred flexible and cohesive. The Gold standards framework supports people living with long-term conditions to live well and die well with consistent, high-quality care patient-centred care, enhanced staff self-confidence, and collaboration work amongst the team (DOH, 2005). National service framework for diabetes sets excellence principles in place for the care and management of diabetes. According to the World Health Organization (WHO), they are more than 180 million people worldwide living with diabetes as a long. By 2030 the number of people living with diabetes will have doubled (WHO 2006).
When an individual has Type 1 diabetes the body is unable to produce a hormone called insulin, the condition can be severe, and, life threating where your blood glucose level in your body is too high lifelong (Diabetes, UK, 2017). Type 1 diabetes is caused by autoimmune destruction of the insulin-producing b cells of the islets of Langerhans (William, 1998). Once a considerable number of islet cells are destroyed, you will produce little or no insulin. Insulin is a hormone that comes from a gland situated behind and below the stomach pancreas. The role of the pancreas is to secrete insulin into the bloodstream, circulating the insulin allowing the sugar to enter your cells. When blood sugar level drops so do the secretion of insulin from your pancreas (William, 1998). The lack of insulin in the body means patients are prone to the development of Ketoacidosis. There are a lot of complications that comes with type 1 diabetes which includes heart and blood vessel disease, nerve damage, kidney damage, foot damage, nerve damage in feet increases the risk for foot complications which can lead to cuts, wounds if left untreated may lead to toe, foot or leg amputation (William, 1998). Complications in pregnant due to high blood sugar levels can be dangerous for both mother and baby. Common signs and the symptoms for type 1 diabetes are increased thirst, increased, urination, weight loss despite increased appetite, muscle cramps, lethargy, visual disturbances, and ketoacidosis may be present (Diabetes, UK, 2017).
Hypoglycaemia is when a patient that has diabetes and their blood glucose levels become very low. Symptoms of hypo include feeling shaky, sweating, tingling lips, feeling weak, hunger and nausea. Hypoglycaemia can be brought under control by eating or drinking something with sugar (Diabetes, UK, 2017). If the sugar levels do not go up after having the drink the patient might need to a have an emergency injection of a hormone called glucagon Hyperglycaemia occurs when your blood glucose levels have become very high. Symptoms of hyperglycaemia include extreme thirst, dry mouth, blurred vision, drowsiness and frequent need to pass urine. Hyperglycaemia can lead to complications such as ketoacidosis, which can cause unconsciousness and even death (IDF 2013). Genetics is one of the risk factors the presence of specific genes indicates an increased risk of developing type 1 diabetes. Type 1 diabetes cannot be prevented, but people with type 1 diabetes can take steps to prevent or delay the development of complications by keeping their blood glucose level at the target level (IDF 2013). They should also regularly meet with a health care professional to check for any signs of complications so that they can receive treatment as early as possible. Family history if you have a sibling or a parent with type 1 diabetes you have an increased risk of developing type 1 diabetes. Obesity and environmental factors are also risk factors that predispose diabetes (Diabetes, UK, 2013).
Living with diabetes as a long-term condition can have an impact on mental health. Good mental health is about feeling good about your life and being able to cope with problems when they happen. A mental health problem is a problem with someone’s mind that makes it difficult for them to live a normal life (Diabetes, UK, 2017). People with mental health problems can often live healthy lives if they get the right treatment and support. Recent public mental health work supports the Human Rights Act by highlighting the links between poor mental health and inequalities (CQC, 2010). We know that poor mental health can both be a consequence of difference and result in social, economic and health disparities. It recognises that effective action is needed to eliminate the stigma that can contribute to poor mental health (CQC, 2010). Shame can lead to people to suffer in silence and can affect their ability to recover. Diabetes UK is a leading diabetes organisation that provides essential information on services available locally and support group for patients and families living with Diabetes.
Nearly two decades ago Fielding and Llewellyn (1987) pointed out the effective nurse-patient. Which identified that communication was central to the quality of care the patients received, stating rather poignantly that, connection is both one of the most demanding and challenging aspects of a nurse job and one which is frequently avoided or done poorly although central to the issue of patient care (Gault et al., 2017). Encouraging people to change their attitude towards a health issue is an essential part of any health education programme, but people’s values can be particularly resistant change. It is usually difficult for some patients with diabetes to change their mindset and lifestyle, for example, their diet. It is often frustrating for nurses to realise that this may not lead to a change in their behaviour an understanding of the complex relationship between a person’s knowledge, attitude and practice can assist professionals in realising why clients may continue to live in a certain (Maulk, 2012). The nursing problem-solving approach means nurses must link the person, therefore, using the problem-solving approach means nurses must relate the specific illness to the factors that could affect the disease. These involve psychological, emotional, social environment, spiritual and time if there’s any of these identified then it should be addressed as they form part of the individual’s well-being (Nicol, 2011). Developing care of plan should always begin with a thorough nursing assessment which is essential to ensure that the correct diagnosis. The nursing process has four interactive stages which are assessment, planning, implementing and evaluation. According to Swonden (2013) nurse will be able to look at the outcome in this instance to see if the patient can maintain the blood sugars and have the required dose of insulin.
The most key role of a diabetic nurse is the strategy of empowering and educating a patient. The patient is more likely to comply with treatment regime if they understand the system and the reasoning behind it and the knowledge and tools to achieve (Dunning, 2009). District nurses must act as teachers and counsellors, helping perform caregiving duties in the absence of a nurse (DOH, 2009). Therefore, play an indirect but crucial role in keeping with patient’s progressive condition, and that their requirements will probably change during life. District nurses play a vital role in the primary care for those suffering from long-term diseases. Their home visits and interaction with patients, provide emotional support by developing close, trusting relationships and it enables them to identify other health problems, e.g. legs ulcers or problem with eye sits for patients with diabetes 1 (Dunning, 2009). The practice nurses play a clinical role in screening, maintaining and supporting people with diabetes. The characters and responsibilities of the nursing team relating to the diabetes care include, prevention, advice, using behaviour change and health coaching techniques, an awareness of how mental health issues can affect people with diabetes, assessing and meeting the patient nutritional needs, urine monitoring, oral therapies, injectable therapies, identifying and treating hypoglycaemia and hyperglycaemia (DOH, 2009). The standards aim to improve the quality of services. The NSF for diabetes will help people manage their insulin; specialist diabetes nurses help them achieve the condition and reducing time spent in the hospital. Diabetes UK is a charity that offers support to people with diabetes and their families, and it also spends a lot of money on research trying to find cures and other methods that can support individuals living with diabetes1 to live a better fulfilling life (Diabetes UK, 2017).
The 1989 white paper, caring for people, followed by the NHS and Community Care Act 1990, shaped the development of the professional and Inter-agency (IPIAC) in the last decade (DOH, 2010). More recently the government has issued policy documents promoting collaboration to improve efficiency and effectiveness. T the 1998 white paper states that modernising social services, which reported that people do not fit into neat service categories, and if partner agencies are not working together, it is the user who suffers” (DH, 1998 PARA6.5). The main important factor of the role of multi-disciplinary and inter-agency working it enables everyone involved, in providing care to bring and combine their skills and expertise. Within the multicultural society which increases the opportunities of learning new skills which contribute to an improvement in health and social care experiences, system and structures because the all implement their different skills to create a better way of providing care (Care Services Improvement Partnership, 2006). With so many different professionals working together it has helped with the improvements and advancements of care provision for people undertaking care services in the UK. A multi-disciplinary and inter-agency team have improved with the service providers and more, so it has created better teamwork and communication skills amongst the health care provider. inter-professional communication failures are known to be the root cause of adverse events. The increase of effective communication will support government policies such as The Quality and Outcomes Framework (QOF, 2013) and the NHS Outcomes 2013/14, which have been produced to improve patient care through meeting the outcomes of the five key domains, which is a legal requirement of the Care Quality Commission (CQC, 2011). Collaboration between health care providers is necessary for any healthcare setting since there is no single profession which can meet all patient’s needs, especially in a diabetic one patient. Consequently, excellent quality of care depends upon professionals working collaboratively in inter-professional teams.
To Improve the quality of patient care and ensure that the goals of care are being achieved, many settings are using the collaborative care delivery model. The collaborative approach involves teams of health professionals working together to provide more coordinated and comprehensive care to clients. Collaboration in health care settings involves professionals assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving and making-decisions (Glasby, 2008). Collaboration between health care professionals can increase team member’s awareness of diverse types of knowledge and skills. Affirms that inter-professional education is a collaborative approach to develop students as future inter-professional team members. The various cultures, norms, and languages of each profession make the process of interdisciplinary collaboration resemble the bringing together of inhabitants from diverse backgrounds. The Morecambe Bay Report (2015) also acknowledged the cultural differences between the inter-professional team which led to severe and dysfunctional failures of clinical care.
As members of an inter-professional health care team, it is imperative that the basis of our different knowledge and skills set be acknowledged and understood. As an inter-professional, we must realise what other healthcare professionals do, how to access their services and follow the team’s goals and needs from their perspective (Gault, 2017). For instance, in collaborative partners working to achieve quality care, we must find ways for healthcare professionals to become good collaborators and competent team members. Different views should be recognised and inter professionals must share their views, justify treatment approaches, and most importantly involve the patient. The success of collaborative working relies on sharing patient concerns as well as professional perspectives, values, and beliefs. A common barrier to effective communication and collaboration is the hierarchy between professionals (Gault, 2017). Communication failures in an inter-professional setting arise from vertical hierarchical differences, concerns with upward influence, role and power conflict, and ambiguity. Communication is likely to be distorted or withheld in situations where there are hierarchical differences between communicators (Glasby 2008).
Regarding verbal communication, a clear explanation of procedures should be explained to the patient in terms that they can understand considering age, ethnicity, and level of understanding. Professionals can often be poor listeners, as they are too busy to listen appropriately and jump ahead to reach their conclusions and appear impatient and high handed as they already have a fixed idea of what they intend to do. A vital method of communication between the inter-professional team is through the patient’s records. (Glasby, (2008) identifies that good record keeping should be accurate and is essential for professional practice. Most patient records are handwritten and this at times present barriers because some professionals use meaningless phrases, abbreviations, and jargon which are difficult to comprehend, files should be documented in a way that they can be understood. If paperwork is not recorded, correctly then the healthcare giver has failed in his or her profession and legal duty.
The multidisciplinary team works well in long-term care situations because it is virtually impossible to tease apart the ever-changing social and health care needs of the dependent individual and their family. When it comes to recommending patients to the right support system for example referral to social workers, podiatrist and district nurses, they all play a vital role in deciding the diabetic patient next line of action (Dunning, 2009). A further barrier to effective verbal communication within an inter-professional team may be found within styles of speech. Speech that is heavily accented, containing technical and medical jargon or spoken too quickly may present communication barriers. For the inter-professional team, student nurses and patients, when caring for patients with hearing, learning, or language difficulties. The negative impact of the role of multi-disciplinary and inter-agency working in the social care is that the entire process of them working together doesn’t always work because of communication breakdown between different teams ( Glasby, 2008). Too many organisations working with one patient can get difficult at times patients might have an appointment with a podiatrist, and the district nurse might be coming to see him at the same day if not arranged properly sees the patient missing one or both appointments.
In conclusion, this assignment has shown the impact of a long-term condition on the individual health, mental health. The physical aspects it can have on individuals. It has also provided government policies that support long-term conditions. It has looked at the importance of collaborative working between agencies. Effectively teamwork ensures the patient gets the best care. It has also highlighted the importance of the nursing role in supporting the patient with long term-conditions by empowering, educating them to manage their conditions they can live a fulfilling life.