Care Plan Rationale
A care plan has been developed around Vahid to address his specific needs, providing him with, and directing, individualised care including different interventions. The care plan will ensure his condition is understood and his health and well-being are managed effectively. This rationale focuses on three interventions proposed; the evidence-based will be outlined and discussed, along with an analysis of the strengths of these treatments and any associated barriers.
A care plan is a written document used and altered daily. It forms a template that defines the areas that the plan covers (Sudore et al., 2019). Care plans can be simple, focusing on the essentials of care, while others can be very detailed, including mobility, prevention, psychological needs, and sexuality (Knight et al., 2019).
Berman et al. (2016) believe care planning is equally important for healthcare professionals and patients. Encouraging patients to be involved in their care empowers them to achieve their ultimate goals and increases treatment compliance. As a collaborative process, it allows shared decisions between the patient and the healthcare provider (Niranjan et al., 2019). However, Hearn (2019) considers that one of the hardest barriers in establishing this method of patient healthcare is forming a professional relationship. Van, (2018) identified that an early establishment of a relationship based on trust, respect, and communication is needed for the successful patient-involved care plan. If these factors are not met, it can cause a huge strain on this relationship, potentially delaying or even stopping the patient’s recovery (Metzger, 2016).
Vahid’s care plan has outlined very limited social contact and he hardly leaves his flat, indicating that he is socially isolated. Taube et al. (2018) describe social isolation as the absence of social interactions, involving little or no communication with friends or family, leading to individuals socially withdrawing for long periods. Many factors can contribute to social isolation, including long-term illness, being a refugee, language barriers, Stigma, socioeconomic struggles, or domestic violence (Chen et al., 2017). The Global Assessment of Functioning (GAF) and Internalised Stigma of Mental Illness (ISMI) scale will be use by a nurse to gain an understanding of the severity of his mental health condition, social withdrawal and to what extent intervention can work (Lally, 2017 and Laws, 2018).
One intervention outlined in Vahid’s care plan is for him to be introduced to the local Afghanistan community and welfare centre where he can go every Tuesday, Thursday, and Friday and meet fellow Afghans. He can also attend prayer on Fridays at the Mosque. This is to empower Vahid to be more sociable (Shishehgar et al. 2017). Vahid will likely benefit from such an intervention as it brings together a collection of people with similar life-experiences, enabling them to communicate and interact with each other within the same cultural context, with similar values, and religious understanding (Turrini et al., 2017).Cusack, (2018) stresses that traumatic experiences can be a barrier to reduce through social relationships engaging as one will get moral support and encouragement thus can face the problems easily. Shannahan (2018) specifies that refugees rely on their faith when departing from their country. Tay (2019) highlights that Muslim attending Mosque reduces the adverse effects of mental stress in five keyways: personal attention; information gathering; prayer; sociability; appreciation of others; and feedback of performance. Traumatic experiences can be reduced through social relationships engaging as one will get spiritual support and encouragement thus can face the problems easily (Poscia, 2019). Psychosocial factors need if remain unmet and these can have adverse implications for physical health (Schrempf, 2019).
Vahid’s care plan revealed that he had decreased appetite as well as several physical health issues such as extreme fatigue, cold hands and feet, and dry mouth. The grief experienced due to loss, torture, and rape can detriment a refugee’s mental health (Sveen, 2016). The World Health Organisation (WHO), (2020) endorses that health care professionals should give priority to the mental health needs of refugees. Community Psychiatric Health Nurse (CPN) can assess Vahid for Post-traumatic stress disorder (PTSD) using Trauma Screening-Questionnaire (TSQ) before referring him to a consultant or psychologist. He will form a medical diagnosis using tools such as the Diagnostic or Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11) (NICE, 2019; NIMH, 2019,). Wilker, (2015) argued that the mental disorders in the DSM-5 are diagnosed by symptoms, not causes. (Weathers, 2018) also emphasises that the tools only tell about features of the disorders, not their cause. Public health England (PHE), (2017) stressed that the clinical presentation of a mental health problem differs in various cultures. Meegan, (2017) highlights that during episodes of depression in most cases, an individual reduced sense of taste and smell resulted in no interest in food. (Finkelman, 2017) found a relationship between loss of interest in food and mental disorders, such as depression and anxiety.
(Proserpio, 2018) contended that individual’s diet and eating habits are not just affected by his religion (Islam) if other psycho-social factors influencing dietary requirements such as cultures, identity, and environment cannot be addressed. (Mancini, 2017, Guede, 2017) emphasises that any vahid’s food habits are affected by several factors like social status, stress and tension, others’ influence, and religious expression when eating at a local Afghani restaurant on Friday with another Muslim. (Talib et al, 2015) pointed out that Halal food goes beyond religious obligation and is part of the Islamic lifestyle. Activities identified in Vahid’s care plan are to introduce him to the local Afghanistan supermarket, restaurants, and green walking. The support worker should encourage Vahid to go and do his shopping Monday and Wednesday.
The role of the Nurses is to educate and to advocate, ensuring right information is conveyed to patients, empowering informed decisions which are essential to maintain Vahid’ autonomy (Scott, 2017). This comprises evolving good therapeutic relationships to support and empower Vahid (Bastable, 2017). The nurse should deliver holistic care in order to encounter unmet needs through professional intervention (Weberg et al, 2018).
Staff to monitor and record his weight accurately, to help review his progress, and plan interventions ensuring his needs are being met. Due to eating good food, Vahid will have a normal glucose level, enabling him to be well and healthy (Kahn, 2019). Studies reveal that diet and food offer benefits including pain regulation, positive health promotion, well-being, and a decrease in comorbidities such as obesity, thus reducing NHS healthcare costs (Kahn, 2019, Færch, 2015).
Equality Act 2010 and the Health and Social Care Act 2012 are the measures taken by the government which oblige health care professionals to provide proper care to Vahid regardless of his social status (refugee). His medical record is protected by Social Care (Safety and Quality) Act 2015 outlines which he has rights to privacy, confidentiality, the security of their medical records (Mahmood, 2017). Society’s self-perception of a refugee might change by government policies, public attitudes, and trends (Joel, 2017). Vahid’s right to autonomy is paramount, justice, maleficence, and no-beneficence (Beauchamp, 2019).
Vahid did not report his bad accommodation to the landlord; regardless of poor ventilated being infested with mice. Vahid’s CPN would arrange individualised sessions to discuss all factors that affect his health, including biological, social, spiritual, and cultural dimensions. The role of the nurse is to work as a leader to coordinates with other team members (dietician, psychologist, and physician) to identify patient’s centred care needs (Crowell, 2015).
The nurse should know about both verbal and nonverbal communication. Vahid who does not speak Native English will find it difficult to communicate health professionals can understand more of him through nonverbal communication particularly when he chooses not to engage (Ali and Watson, 2018, Small, 2014). Staff can observe Vahid’s body language form of gestures and eye contact to communicate and empower him to record changes when pain rises. An interpreter can facilitate communication during appointments (Wensley et al. 2017). Green’s (2017) study specifies that an individual like Vahid with limited English proficiency might experience classism, perceived discrimination, and get less access to regular healthcare services without an interpreter. (Ali, 2018) reveals that people from some cultures fail to understand clinical terminologies (e.g, Lachrymation for the excessive flow of tears and Xerosis for dry skin). These gaps have a detrimental effect on the clinical consultation outcome.
The care plan outlines that Vahid has expressed that he can no longer tolerate his physical pain. The nurse, in collaboration with other professionals such as pain clinic, Action on pain group, and pain management may identify the cause of pain, leading to effective individualised pain management (Brown, 2017). Sharing information between health professionals about Vahid’s physical and mental condition will help to understand him, gather correct data, reduce his pain, and deliver quality care (Bastable, 2017).
Vahid has difficulty sleeping because of pain, which affects other areas of his life such as looking for a job, daily activities, and eating. (Hadi, 2016) contended that despite that exercising outdoors, and other social activities have been shown to improve self-esteem and mood and improvement in social connections may worsen the pain and can result in avoidance of activities. Vahid’s completion of a pain chart over 24 hours will help guide the diagnostic process, track the progression and severity of the pain; providing nurses with an insight into the cause of his pain, to determine the correct treatment plan (Jacques, 2019).
Research has established that in comparison with other forms of intervention, such as informing staff when in pain, patient’s self-detection of intensity and frequency of pain, using a visual analogue scale (VAS) is more useful. It uses a 10cm scale, with “no pain” at one end and “worst pain” at the other (Joseph et al, 2017). It helps professionals to identify the causes of pain and treat it (Creswell, 2017). If the source of Vahid’s pain is not found, it will become more severe and influence his mood, sleep, and daily activity (Adler, 2016). Nash, (2016) discusses that the simplicity of the visual analogue scale (VAS) can make it difficult for healthcare professionals, to understand and interpret the pain score. The perception of pain varies in individuals. Some rating scales don’t specify the intensity of the pain (Joseph, 2017). Nurses can overcome this barrier by regularly communicating with Vahid when he is in pain. Noback (2015) believes that increased awareness, communication, and understanding of health issues will enable health care professionals to achieve a better understanding of Vahid’s pain and find the correct treatment option.
To conclude, this rationale has explored the reasons why Muslim Afghan community support, diet and cultural food, and pain management thought communication have been outlined for Vahid’s care plan. The evidence that supports their use for individuals suffering from social isolation, and symptoms related to depression physical health, has been analysed along with the barriers and limitations. The three support types: (i) the effectiveness and success within Afghan community support groups, (ii) diet and diet education, and (iii) pain management communication tools all show potentially significant results. They overcome the cultural and socio-economic barriers that need to be taken into consideration to achieve holistic care. Healthcare professionals should address these barriers early on within Vahid’s care plan to ensure he can successfully attend and complete his treatment.
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