Holistic and complex account of patient care
Recent discussions on the sociology of the nursing profession have tended to go beyond the focus of a relation of nursing to clinical medicine in general. May and Fleming (1997) reflects on the importance of analytical stability and points out that sociologists have not paid enough attention to the ways in which nursing is constructing its difference from medicine and the professional imagination involved.
On a different sociological aspect, Baines et al. (2005) introduced a new concept of psychosocial profiling as a tool providing a surgery team with a psychological framework for identification, intervention and management of non-compliance. According to the authors this help in increasing the understanding of emotional problems which are experienced by patients before surgery because of problems associated with side effects and uncertainties of chronic illnesses.
Psychosocial profiling is adaptable to the needs of a patient before and during the process of surgery or a transplant and every patient is given the opportunity of psychosocial support to help him to secure emotional stability and compliance with medications and postoperative care. Baines et al further suggest that implementation of this strategy moves healthcare professionals from being gatekeepers to managers and facilitators of holistic care in patients undergoing surgery.
In this essay we describe several methods and approaches to holistic care considering physiological, behavioral and management perspectives in nursing. Our case study is a 55 year old patient who underwent heart related surgery and is being considered in the postoperative phase of care. Our emphasis here is the study on quality of life of the patient and we focus on improving the QOL of our 55 year old male patient. Therapeutic approaches range from counseling, palliative care to monitoring of sleep disturbances, holistic nursing assessment, whole person based care, creative, spiritual care and use of complementary medicines and alternative forms of therapy.
Delineating Approaches to Patient Care
Some of the approaches to patient care and nursing management have theoretical as well as pragmatic values. For instance, palliative care has been considered an important part of disease management guidelines and should not be limited only to people whose conditions are serious, but can also be used as an approach to minimize suffering in patients who are in early stages of disease.
The approach for upgrading existing disease management and service guidelines involves including palliative care. Disease management guidelines include prognosis, diagnosis and recommendations for whole patient assessment. Treatment sections involved in patient management are discernment of patient goals for care, continuous goal reassessment, palliative care interventions, and treatment decision including expected improvement.
The role of the interdisciplinary team as well as palliative care and consultative services is important and important aspects of these are grief and bereavement care and care during fatal disease conditions (Billings, 1998). An integration of palliative care in introductory, diagnostic treatment and management guidelines for significant illnesses has been recommended by the authors.
Dobratz (2005) also overviews the holistic, hospice and palliative care models and relate to end of life care outcomes. This is another theoretical model built on Freire’s model on overcoming oppression used as a framework for raising nurses’ awareness of end of life issues and quality of care required at this time. A positive patient nurse interaction has been recommended.
Another method of care is the whole person care model. Thornton (2005) discusses a theoretical model of whole-person caring approach and argues that such an approach has resulted in increased patient satisfaction, and is the foundation of a comprehensive healing environment. The whole-person caring approach is used as a useful framework for healthcare education as a theoretical construct and is congruent with an educational setting. More studies on the whole person care model were done by Donadio (2005) who demonstrated the transformational effects of whole health education.
Donadio suggests that the holistic model of health education and behavioral interaction provides a tool for nurses, physicians, and staff to redirect the momentum of care towards current, in-the-moment, relationship centered whole person care approach which in turn improves healthcare worker and patient relationships, patient satisfaction and outcomes.
However, holistic nursing care involves more than just theoretical models of therapy and includes comprehensive therapy, alternative treatments, and use of complementary medicines as well as concerns for patients’ spiritual and religious needs. The use of complementary and alternative medicines (CAM) supplements orthodox medicine and is widely accepted in clinical settings. This is an expanding area of practice and Kilbey (2005) discuss the risks and benefits of using CAM.
As far as meeting patients’ spiritual and religious necessities is concerned, Ledger (2005) suggests that nurses have a duty to meet the spiritual, religious and cultural needs of patients as identified in the Nursing and Midwifery Council’s standards for nurses. It is widely believed that even though people may not have a direct religious affiliation, they may still have spiritual needs. Ledger considers the meanings of spirituality, religion and how nurses can meet the needs from patients’ perspectives. There is enough research evidence to suggest that a patient’s spiritual or religious needs may not be addressed by nurses. Using spiritual assessment tools and the need for providing spiritual care are the measures recommended.
Fairley (2005) describes the viewpoint of a critical care nurse in a consultant clinical role within the surgical high dependency unit in teaching hospital trust. The nature of advanced nursing practice in the context of critical care has been shown as not an acquisition and application of technical procedures undertaken by doctors but an integration of medicine and nursing where holistic nursing assessment is combined with symptom focused physical examination. A reflective account of practical problems in nursing was related to role integration, professional autonomy, legal and consent issues, non-medical prescribing and role evaluation. Integrating the role of an advanced nurse practitioner within the clinical team seems to be a primary focus.
On a more educational aspect, examining how healthcare services should be understood and taught in medical schools, Tresolini and Shugars (1994) suggest that an integration of psychosocial and biomedical factors in health and illness is necessary. The researchers used a qualitative research design and data were collected through document review and semi-structured interview conducted in 17 medical schools. The interviewees were from internal medicine, pediatrics, family medicine, psychiatry, and preventive/behavioral medicine. Development was focused on defining scope and character of an integrated perspective, delineating ways to incorporate such perspectives in medical education, and identifying facilitatory factors and obstacles of incorporating such perspectives.
The interviewees conceptions on an integrated perspective suggested that there is a theoretical need for a broader scientific model and a practical need for more inclusive approaches to medical practice. The ideal curriculum has been suggested as patient centered, integrated, developmental and population based. Strong leaders, development programs and reform of reward systems have been identified as facilitatory whereas ignorance of appropriate curriculum design, implementation and negative attitudes of faculty and administrators have been described as barriers to an integrated perspective in medical education and training. An integrated model of healthcare emphasizes the fact that medical curricula should address the development of physicians’ knowledge, attitudes and skills as well as relationships of physicians with patients and community at large.
Tags: diagnostics, healthcare, holistic, illnesses, palliative care, patients, physicians, surgery
