Assignment: Assembling Evidence-Based Nursing Interventions that Maximize Wellness for Complex Patients with Chronic Co-morbid Conditions, and Consistency with Chronic Care Delivery Model

Assignment: Assembling Evidence-Based Nursing Interventions that Maximize Wellness for Complex Patients with Chronic Co-morbid Conditions, and Consistency with Chronic Care Delivery Model

Assignment: Assembling Evidence-Based Nursing Interventions that Maximize Wellness for Complex Patients with Chronic Co-morbid Conditions, and Consistency with Chronic Care Delivery Model

Assemble evidence-based nursing interventions that maximize wellness for complex patients with chronic co-morbid conditions and is consistent with chronic care delivery model.
GEL-7.02: Apply ethical reasoning to ethical issues within the field of study.
Mr. Bale is an 85-year-old who is oxygen dependent following a recent diagnosis of Chronic Obstructive Pulmonary Disorder (COPD). (He has a history of smoking 2 packs per day for 50 years.) He also has two other chronic co-morbid conditions, Congestive Heart Failure (CHF) and hearing loss. Mr. Bale and his wife live independently at the home of their eldest son, daughter-in-law, and two grandchildren. Two other children also live close. Mr. Bale immigrated to the U.S. from Mexico many years ago and became an American citizen 15 years ago. Mr. Bale’s primary language is Spanish; however, he does speak and understand limited English. His family generally translates for him.

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Mr. Bale is receiving Western healthcare through the local healthcare system, but also continues to use cultural remedies he learned in Mexico many years ago. Recently there has been a concern that he continues to smoke in the house despite the agreement he signed to stop smoking when oxygen therapy was initiated.
For this case study, you will write a 3-4-page descriptive essay that addresses each of the elements listed below.
1. Introduce the reader to Mr. Bale, his family, and his situation.
2. Think about the impact that Mr. Bale’s three co-morbid conditions would have on him and his family.
• What health/safety problems and risk factors can you identify?
• Explain why the identified problems and risk factors are threats to Mr. Bale’s health and safety.
• How would the Chronic Care Model assist in Mr. Bale’s care?
3. If you were the home health nurse, how would you approach this situation?
• What evidence-based interventions would you employ to address at least three of Mr. Bale’s health issues?
• What communication strategies would you employ?
• Provide rationale for your choices.
4. There are several ethical situations in this case study regarding Mr. Bale and his family.
• Identify one ethical dilemma.
• What is the underlying ethical principle behind the identified dilemma?
• Propose two possible solutions to this ethical dilemma.
• Which solution do you support as the appropriate course of action and why?
Assignment Requirements
Before finalizing your work, you should:
• be sure to read the Assignment description carefully (as displayed above)
• consult the Grading Rubric to make sure you have included everything necessary;
• utilize spelling and grammar check to minimize errors; and
Your writing Assignment should:
• follow the conventions of Standard English (correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• use APA 7th edition format.

References
Lin, Y., Chen, H., Brown, R. A., Li, S., & Yang, H. (2017). Health care predictive analytics for risk profiling in chronic care: A Bayesian multitask learning approach.. MIS Quarterly, 41(2), 473.
Horwitz, D. L. (2015). Implementing the chronic care model: A grassroots approach. Physician Leadership Journal, (5). 12.
Vallente, R. P. (2016). Chronic care model (CCM). Salem Press Encyclopedia Of Health.
Pasricha, A., Deinstadt, R. M., Moher, D., Killoran, A., Rourke, S. B., & Kendall, C. E. (2013). Chronic care model decision support and clinical information systems interventions for people living with HIV: A systematic review. Journal Of General Internal Medicine, (1), 127.
Lu, J. F., Chi, .J., & Chen, C. M. (2013). Advocacy of home telehealth care among consumers with chronic conditions. Journal of Clinical Nursing, 23(5-6), 811–819.
Schulman-Green, D., Jaser, S., Martin, F., Alonzo, A., Grey, M., McCorkle, R.,…Whittemore, R. (2012). Processes of self-management in chronic illness. Journal of Nursing Scholarship, 44(2), 136–144.

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 Assembling Evidence-Based Nursing Interventions that Maximize Wellness for Complex Patients with Chronic Co-morbid Conditions, and Consistency with Chronic Care Delivery Model

Mr. Bale is a chronically ill patient in dire need of holistic, comprehensive and patient-centered chronic care. At 85-yearss of age, the patient was diagnosed with Chronic Obstructive Pulmonary Disorder (COPD), Congestive Heart Failure and hearing loss. He has a history of more than 50 years of heavy cigarette smoking. Although the patient is supplied with home oxygen, the respiratory status of the patient steadily deteriorated as depicted the loss of speech capability. As a Mexican immigrant, Mr. Bale may not be fully accessible to comprehensive health care services, and hence the growing pressure to combine both western healthcare and cultural remedies in managing is worsening health conditions.

Impact of Comorbidities on Patient and Family

Oprea et al. (2015) mentioned that chronic diseases are becoming the key causes of morbidity, poor quality of life and mortality among elderly patients. Regarding health/safety problems, the three commodities may significantly contribute to the impairing quality of life for the patient and his family. Equally, the heightening risk of multi-morbidity in COPD individuals is cited to play an instrumental role increasing mortality in end-phase patients. Some of the chronic risk factors include smoking, the risk of adverse drug reactions as well as the risk of problems linked to ageing such as falls, cognitive impairment and the inability of the patient to access universal health coverage, particularly if the migration from Mexico to the United States has been illegal (Gentry & Gentry, 2017).

Mr. Bale’s health and safety is increasingly threatened by the highlighted major health problems and risk factors based on how heightens the possibility of his admission to the Intensive Care Unit, and subsequent placement on BiPAP. Gentry and Gentry (2017) stated that the complex comorbidities of COPD may contribute to the increased risk of hospitalization, higher levels of poly-pharmacy, reduced quality of life and higher mortality. Equally, continuous involvement in smoking by the patient may contribute to influence the progressive nature of airflow limitation as a result of the abnormal inflammatory response of the patient’s lungs to the notorious gases or particles from cigarettes. Equally, the lack of universal coverage significantly reduces the patient’s ability to access and utilize superior quality chronic care for managing the comorbidities, resulting in under-treatment (Hillas et al., 2015).

The Chronic Care Model (CCM) will be adopted an evidence-based policy response to identifying and responding to some of the key areas surrounding prevention, diagnosis, monitoring and treatment of the chronic illnesses, and patient outcomes. Oprea et al. (2015) commented that the use of evidence-based treatments revolves around ensuring proper care organization for chronic diseases, use of appropriate tools, and the availability of adequate and competent health care professionals. In Mr. Bale’s case, the Chronic Care Model demands the establishment and maintenance of functional relationships and interactions between the patient and his care team; personalization of care and the use of evidence-based solutions to the identified problems and risks (Pirina et al., 2017). The CCM-led quality improvement initiatives will be focused on promoting multi-disciplinary care and support as the fundamental basis for enhancing the outcomes of chronic diseases, reducing medical errors, improving quality of care through leveraged attention to comorbidities experienced by the particular patient (Hillas et al., 2015). 

Interventions by a Home Health Nurse

A key recommendation is to develop and implement a comprehensive and relevant Health Care Home specifications. Pirina et al. (2017) mentioned that, having appropriate specifications in place may foster the adoption of evidence-based training and education for enabling health care providers, practice managers, nurses, patients and other key parties to engage in collaborative efforts aimed at improving the quality of chronic care and patient outcomes and experience. Some of the communication strategies used include the use of training sessions, workshops, focus group discussions and the provision of reading materials on the various topics of interest.

Another key recommendation is the adoption of patient-centered approach in the delivery of chronic care. Oprea et al. (2015) insisted that the development of a well-measured personalized strategy to support the particular patient can be prove instrumental in mobilizing relevant resources and competencies to support the realization of set goals and to boost decision-making in complex situations. Some of the communication strategies favored in this evidence-based intervention include face to face communication with the patient and other key parties to ensure one-one interactions (Hillas et al., 2015).

Another key evidence-based intervention is related to the creation of effective mechanisms to support flexible and dynamic team-based care. Given the complexity of dealing with chronic diseases such as COPD, efforts geared at promoting inter-disciplinary collaboration may allow the various specialist involved in the care to engage in a formalized and continuous way through increased coordination within the particular Health Care Home (Pirina et al., 2017). Formal communication options include the use of notice boards, meetings and discussion forums may provide meaningful ways for communicating the various aspects surrounding the realization of this particular evidence-based intervention (Amo-Setien et al., 2019).

Ethical Situations

The ethical dilemma in Mr. Bale’s case is related to when withholding or withdrawing life-sustaining interventions is appropriate. Given that the patient is currently receiving oxygen therapy, the ultimate decision to terminate the end-of-life care presents a major ethical dilemma.  The ethical principle of autonomy recognizes the underpinning right and decision by the patient to require or refuse withdrawal of, undesired medical interventions such as life-sustaining treatments (Pirina et al., 2017). Some of the solutions to these ethical dilemma include the use of formal channels by the physician to grant the patient’s request to withhold or withdraw ICU support. Another solution of addressing the ethical dilemma is transferring care of the patient to another physicians in the event of contested interests and perspectives about the impact of patient’s autonomy on the health care process and outcomes (Hoehner, 2017).

References

Amo-Setien, J., Abajas-Bustillo, R., & Sarabia-Cobo, C., & Ortego-Mate C. (2019). Characteristics of nursing interventions that improves the quality of life of people with chronic diseases: a systematic review with meta-analysis. PLOS ONE. https://doi.org/10.1371/journal.pone.0218903

Gentry, S., & Gentry, D. (2017).Chronic Obstructive Pulmonary Disease: Diagnosis and Management. American Family Physician, 95(7):433-441. https://www.aafp.org/afp/2017/0401/p433.html

Hillas, G., Perlikos, F. and Tzanakis, N. (2015).Managing comorbidities in COPD. Dove Press, 10(1), 95-109. https://doi.org/10.2147/COPD.S54473 

Hoehner, P. J. (2017). Ethical and legal issues of geriatrics. Geriatric Anesthesiology, 27-51. https://doi.org/10.1007/978-3-319-66878-9_3

Oprea, L., Braunack-Mayer, A., Rogers, AW., & Stocks, N. (2015).An ethical justification for the Chronic Care Model (CCM). Health Expectations, 13(1), 44-64.

https://doi.org/10.1111/j.1369-7625.2009.00581.x     

Pirina, P., Pes, R. & Fois, G. (2017).Prevalence and management of COPD and heart failure comorbidity in the general practitioner setting. Respiratory Medicine, 13, 1-15. http://dx.doi.org/10.1016/j.rmed.2017.07.059