Background
Loneliness, physical ailments and unendurable pain are the usual accompaniments of old age. Physical incapability worsens the situation further by giving rise to frustration and disgust. It is in such conditions that the old people are in desperate need of the care and attention of their loved ones. However, it is not always easy for the family members to assume the role of the caregiver as it involves a lot of time, energy as well as higher levels of endurance. Moreover, several health and safety issues like “bathroom safety, pain management, nutritional care, special care for patients with incontinence” (Kernick, 2003) etc. are to be taken into consideration. The above factors become comprehensible by analyzing the situation of Mr. Trosack, who has undergone total hip replacement surgery. As the case manager, it is important to assess the situation of Mr. Trosack and prepare a discharge plan accordingly.
Assessment of the situation
Mr. Trosack’s case raises several concerns pertaining to healthcare. The issue of safety as regards the patient’s health and needs has been totally ignored.
Healthcare issues
Mr. Trosack’s apartment needs to have a lot of free space which is important to ensure his safety. To this end, the furniture of his small apartment must be reduced to bare essentials. The bathroom needs to be re-modified with emphasis on usability as well as safety. The medicine cabinet should be furnished with the latest medical details of the patient. The kitchen more or less, caters to the safety needs of the patient. However, some minor changes are required so as to make it more convenient for Mr. Trosack’s use. In the absence of an elevator and total reliance on two staircases, the accomplishment of certain daily chores like disposal of the trash, provision of groceries etc. is a major problem. The situation demands the services of a homemaker to supervise these activities and many more like clearing the food stuffs that have long passed the expiry dates etc. Scattered rugs are a potential source of danger for the patient and must be removed immediately.
Regular medication and care related to day-to-day medical assistance is a significant aspect in this case. Mr. Trosack needs regularization in the context of health which would include not only medication but also exercise and methodical hygiene.
Another important issue in this case is nursing observation. It is essential to record the medical details of Mr. Trosack in a day-to-day basis and compile these records to prepare a weekly evaluation or progress report on Mr. Trosack’s health.
Important issues
One very important aspect in this case is pain management. It is obvious that pain would be a constant issue in Mr. Trosack’s case. However, it is better to deal with this problem through non-medication implementations like mental counseling and exercise. Medication can be included in the list of pain management but it would be treated as an emergency option.
Similarly, spiritual counseling should be taken into consideration in order to make Mr. Trosack more responsive towards positive vibes of life. This is a factor that renders great strength to believers and this would be very helpful for the patient.
Likewise, nutritional care would ensure that the patient is kept in a well balanced diet and this is a fundamental factor of recovery. It is believed that positive attitude and proper nutritional care are better medication than medication itself.
Members
The members rendering the services are usually experts in the fields of “basic nursing observation, pain management, mental health counseling, homemaker and personal care help, plus pastoral care and spiritual counseling” (Zimmer, 2008). In this particular case, Mr. Trosack requires the services of a nurse to provide him with medical support including pain management, a home-maker in carrying out the daily household chores and a psychologist to help him overcome the mental strain caused by this surgery as well as boost his self-confidence. Both the elders and their families are benefited from the services rendered by the members. The trained members not only take optimum care of the patients but also create opportunities for social interaction. In the process, the caregivers are relieved of their services throughout the day. On the other hand, the family members convinced of the safety and well-being of their loved ones can pursue their daily routine without any tension.
Safety assessment
In the present context, the term ‘safety assessment’ refers to the services offered to Mr. Trosack although it incorporates several categories. The main aim of the members is to ensure that their services fulfill the physical, mental, social and theraupic requirements of the patient in keeping with the guidelines prescribed by the physician.
Discharge Plan of Care
It is crucial for the family members to understand the importance of the members’ services. As these services basically cater to the medical needs of the patients, Medicaid can pay the various licensed organizations for making these services available to the low income group patients like Mr. Trosack.
Family
The family has a crucial role to play in speeding up the recovery of Mr. Trosack after discharge. He would be discharged only after going through the details of the interview and assessment of the safety situation. Prior to his discharge, the family members would be made aware of the kind of care that he would require at the moment as well as his present and future requirements.
Post-operative care rendered to a patient is very important. The family members of Mr. Trosack are best qualified to understand his needs and oversee his recovery. The support of friends and family are crucial in such situations.
Feelings of loneliness and social isolation hinder the recovery of the patient.The family of Mr. Trosack must ensure that the patient doesn’t suffer from isolation and always keeps company. Moreover, they should attend to the psychological needs of the patient so as to avoid the occurrence of post-operative trauma.
Last but not the least; the family should also Endeavour to build the patient’s self-confidence which would accelerate the recovery process. Counseling offered by trained psychologists would also be of immense help.
Social isolation
Mr. Trosack is more prone to be affected by the feeling of social isolation since he lives alone in his apartment. The problem needs to be addressed by implementing an effective strategy. Although a number of prevention models exist like universal, selective, indicated etc., the choice of the appropriate preventive measure baffles the caregiver since symptoms of depression are relative. This is even more confusing in the case of Mr. Trosack who doesn’t exhibit any apparent symptoms of depression. In such situations, it is advisable to use both the selective and indicated models so as to gauge the propensity of his developing this feeling if the situation demands. Overall, the general suggestions for Mr. Trosack would include provision of timely and effective care, application of preventive measures, sufficient sleep and rest, prevention of the feeling of loneliness and strong social support.
Psychological recovery from illness
Post traumatic stress disorder (PTSD) is a common psychological occurrence among elders. This refers to the various ways in which the patients express their sufferings like anger, frustration etc. The situation is further aggravated by feelings of indifference, loneliness and incapacitation. It is for these reasons that the services of the psychologist are encouraged. In the present case, Mr. Trosack doesn’t exhibit any apparent stress disorder except a feeling of withdrawal. This however, must not be overlooked as the patient must be provided with medical care as well as support of the family.
Discharge placement for Mr. Trosack
The discharge of Mr. Trosack has been recommended based on his reports that appear normal. He has an average B/P of 160/100. He has been prescribed Glucophage 500mg twice daily as he is a patient of non-insulin dependent diabetes. He has been asked to check his blood sugar level at home and has been given a glucometer for this purpose. He is overweight and has been asked to reduce weight. The medicine Percocet is suggested in case of occurrence of post-operative pain. However, it is important that the members provide him with adequate care and medical support. It should be noted that the family members of Mr. Trosack lack the needed medical training for this assistance, or none are medically trained to provide the medical needs. Nevertheless, they can always provide emotional and social assistance.
References
Kernick, D. (2003). Getting Health Economics into Practice. Oxford: Radcliffe Medical Press.
Zimmer, C. (2008). Training in Care giving in Pathophysiology: Cases of older adults. Journal of Nursing, 5(11), 243-252.