Primary Care and the Adult Nursing Patient 'Write a critical account of the health needs of a patient with a long term condition you have met/cared for in the community'

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Primary Care and the Adult Nursing Patient

'Write a critical account of the health needs of a patient with a long term condition you have met/cared for in the community'


This essay will provide a critical account of the health requirements of a patient suffering from a chronic medical condition. It will concentrate on the experience of caring for a diabetes sufferer within the community. Due to the nature and longevity of the patient’s condition, a greater standard and longer duration of care was required. The Nursing and Midwifery Council (NMC, 2008) Code of Professional Conduct Guidance on has been maintained throughout this essay and therefore, all names have been altered for the purpose of confidentiality and anonymity. Permission to discuss the case anonymously has been given by the patient and staff involved.

The patient.

Mr Thompson had been suffering from type 2 diabetes for many years. Despite the occasional minor ulcer on his right foot, for a diabetic man of 69 he had generally been in good health. However without his wife, who had passed away three years ago his adult children, whose family commitments meant they were seldom around. His ulcer quickly worsened. The pain became so unbearable that he contacted his surgery and to complain that his foot ulcer made it difficult to walk. It was confirmed that an appointment would be made for Sarah, the district nurse, to visit Mr Thompson at his home.

During her visit Sarah used a Doppler test to examine his foot. According to Bradshaw (1994) concept of need, patients experience different types of needs and it was clear from Mr Thompson’s complaints that a ‘felt need’ was present. Any possibility of a mere exaggerated expressed need was soon eliminated when upon physical examination Sarah found grounds to diagnose the matter as serious. Evidently both normative and comparative needs applied in Mr Thompson’s case-as he was experiencing a higher level of suffering than would normally be expected of a diabetic sufferer. He was therefore referred to a multidisciplinary foot care team.

In order to determine appropriate treatment according to Clinical knowledge Summaries; National Health Service (CKS) (NHS 2009) the team would asked the patient numerous questions. By reviewing Mr Thompson’s medical notes they could identify any history of foot complications and may require repeat, altered treatment methods and medical advice if no foot care advice had been given previously. Mr Thompson stated that whilst he had initially followed all advice given by medical staff he had been very negligent since becoming a widower and this had not been the first time he had required such assistance. In the immediate aftermath of his wife’s death Mr Thompson had shown similar signs of neglect and consequently a Community Matron was assigned to provide help and support. As a Community Matron her role involved caring for the patient in secondary settings and encouraging self sufficiency. Community Matron (NHS 2009) points out that   Matrons generally work as part of multi-professional and multi-agency teams with several members involved in caring for one patient. In Mr Thompson’s case the Matron took particular care to include his family in organising a better care plan to control his diabetes and tend to his foot ulcers.  She acted as ‘case manager’ a first point of call for general care, providing support and giving advice.  She also performed regular examinations on the patient and managed all comprehensive medical history notes. Such extensive planning, partnerships, follow-up visits, assessing and evaluating, were essential to meet his ever-changing health and social care needs. But in such situations the job of a Community Nurse is far from easy. Their schedules can be erratic visiting patients monthly or as frequently as several times a day.

Recent government policies aim to improve the quality of patient care, reduce the number of hospital patients and deliver more health care to patients at home. But this coupled with the aging UK population and increased diabetic survivor rates means the demand for (out-patient) care is increasing. On one hand such statistics positively indicate success in medical advancements and a healthier population; however the link between old age and diabetes may also explain the increased number of sufferers. The overall effects are that hospital staff are increasingly struggling to meet demands. Shift work may rise and even fewer Matrons will work independently on a case-by-case basis, thus resulting in a breakdown of strong patient-nurse relationships. Instead continuity of care may operate primarily through partnerships, shared nursing roles and the involvement of social services, voluntary agencies and NHS organisations such expert Patient Programmes Community Matron (NHS 2009). However with a number of cases involving staff negligence and abuse of elderly patients proper training and monitoring of staff would be crucial but may also prove time consuming and costly. (Leeds general hospital 2007)

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Due to the interpersonal nature of their duty, District nurses play a crucial role in the primary care those suffering from long term illnesses. Their home visits and interaction with family members, provides emotional support by developing close trusting relationships, and quickly identify health problems. With Mr Thompson’s growing dependency on carers and unsuitable home conditions, Sarah decided it best to admit him into a residential care home. By consulting his family and obtaining his permission before finding a suitable home she executed a good care giving strategy. The Darzi’s report Department of Health (DoH 2008) view that patients ...

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