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Supporting people with long term health conditions

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This report reflects on the care needs of 67 year old Kingsley, at 55 he was diagnosed with Type 2 Diabetes then at 65 Kingsley suffered a stroke. After a lengthy stay in hospital he was moved to a nursing home where he currently lives, he is not happy in the nursing home and wishes to be discharged and return home to the care of his wife. He displays his unhappiness to care staff with bouts of anger and frustration. He has a social worker assigned to his case who is currently undecided if Kingsley should return home to his wife, he questions the layout of the home and his wife's ability to cope with Kingsley's care needs. Kingsley and his wife have some difficult decisions to make and should be able to discuss these with the social worker as these will have a fundamental impact on where he lives as this will be instrumental to his wellbeing.

Living with a long term health condition can have its challenges when receiving health care, its paramount that a care user receives the correct level of support and information available. A psycho sociological perspective offers a holistic approach which addresses an individual's needs and an anthropological perspective which offers a biological study of the human being.

A psycho sociological perspective addresses an individual's psychological health and wellbeing needs which are individual to functioning within human society. This perspective highlights that factors such as age, gender, environmental living conditions and the individual differences that people face are to be considered in health needs and care issues.

A psycho-social approach to public health aims to incorporate the environment which will address the health of groups of people by social context, social class, location and how accessible they are to local resources. In the past this has been referred to as the social model of health (K217, Learning Guide 2, p43).

The structure of the social model of health aims to make health services more affective, accessible and acceptable to individuals. The components are as follows (K217, Learning Guide 2, p43).

To acknowledge the influence that health has on political, economic, social, psychological, cultural and environmental factors and also biological factors.

To improve health a focus must be placed on the socio-economic environment.

To achieve community participation with shared decision making between lay people and practitioners.

Health services to collaborate with other government agencies and sectors.

Commitment to equity and accountability in health.

The use of evidence which is qualitative and quantitative.

The concept of this perspective is that the focus of social causes are linked to illness rather genetics. If the social causes which are causing a detrimental effect on health are addressed then a better quality of life and sense of wellbeing are to be achieved. In Kingsley case he is not socially active because of the environment he is currently living in, which is restricting him from participating in any social networks, which gives the practitioners power over him so he is then not part of the decision making regarding his wellbeing.

Holism perspective

The practice of holism is to recognise that each person's needs are unique to one's own identity. It acknowledges that focus is to be given to lifestyles and choices which have an impact on health and illness. The approach links all aspects of a person's physical, mental and emotional state to create a composition of a state of health and illness.

The approach of a biomedical perspective will address medical conditions with a biological, anatomy, and a physiology view but ignores an individual's needs, as a holism approach would address the individual's needs which would have an effect on lifestyles and choices.

So a Biomedical perspective has a place in some health conditions such as Diabetes which will address the medical needs such as insulin. But a holistic approach will identify the whole person combining their mind, body and spirit. This can be helpful for practitioners to understand how a Diabetic may be feeling with effects of injecting insulin, are they coping with self management of the condition. The whole person approach to care is to give service users the ability to move on from the professional dominance in the doctor centred model and to achieve the self care model which is to encourage independence. (K217, Learning Guide 2, p42).

Discussion.

The contribution of theory.

Do theories have a place in health and social care services and how can they help people like Kingsley who is suffering from a long term health condition.

Theories in health and social care are developed from two perspectives

Good research and medical engagements which results in theories from evidence.

Generalised practice and an understanding of experience within a profession, these theorises are developed from practical experiences.

Theories in understanding long term health conditions can be found in two perspectives bio medical and the social model of health. The bio medical approach is that the body functions normally but when things go wrong a specialist can repair the body; its focus is that biological problems can be addressed with medicine. The social model of health recognises biological factors but also includes the recognition of the influence of health being a matter of psychological and social addressing the wellbeing of an individual.

If just a bio medical approach to theory was taken of Kingsley's situation he would have been diagnosed with two long term health conditions a stroke and type two diabetes by a practitioner then undergone biological treatment in hospital, were tests were taken and symptoms were controlled with medication. He is now living with two conditions controlled by medication. Bio medical may adapt mechanical metaphors which presume that a practitioners approach is to be an engineer and to fix what is malfunctioning with medication (K219, leaning guide 1, p36). The N.H.S. point out that a stroke is a medical emergency and should be diagnosed as soon as possible this would be in a bio medical environment. A bio medical view would be taken to determine the emergency treatment needed and also for after care with medication, therapists, physiotherapist and G.Ps. The N.H.S also highlight that the social model of health should be incorporated into a patients social care needs social workers would assess a patient and their carers needs and offer services such as meals on wheels and home care services (N.H.S. 2011).

A purely social view of theory to long term health conditions would offer Kingsley and his with sociological support in dealing with his conditions addressing needs for his wellbeing. Kingsley has experienced a change to his identity, because of his illness he feels he can no longer contribute in society. Kingsley's illness has made it impossible for him to work so he now relies on the welfare benefit system so his identity has changed from a working man providing for his family to the sick role. The sick role can be identified when an ill person becomes exempt from a social role of responsibilities examples are because of illness, a sick person will not get better without being taken care of and the sick person will want to overcome illness and should be obligated to seek the correct professional help to deal with an illness (Parsons, 1951, p.294). This theory of the sick role has an element of social care and bio medical, society will address an ill persons needs with benefits and care issues and a biological factor will be present with medication.

What can be learnt from research and practice guidelines?

Research show that suffers from a long term health condition such as a stroke may face physical disabilities and suffer from social exclusion which can lead to spoiled identities. The Stroke Association commits approximately two and a half million pounds per year in to research of stroke prevention and treatment .Two key achievements are (The Stroke Association 2011).

Staying physically fit after 40 cuts risk of a stroke. People who are physically fit after the age of 40 can lower their risk of stroke by as much as 50 percent, 'compared to people who aren't as physically fit' (The Stroke Association 2011).

The benefit of occupational therapy for stroke care home residents. A recent study funded by the Stroke Association has shown how beneficial even a small amount of occupational therapy can be to residents in care homes who have had a stroke. The study, carried out is extremely significant as the care home population is an understudied and extremely vulnerable group (The stroke Association 2011).

The research suggests that prevention can reduce the risk of a stroke and that life style changes and rehabilitation will help with the recovery process, learning to deal with the effects that the stroke has had on them and learning to adapt to the limitations caused by stroke. Rehabilitation would also address the need for any support in dealing with social, emotional and practical issues.

A government report on long term health conditions and self care (Your health, your way, 2009) is aimed at promoting discussion between health and social care professionals and people with long term health conditions, it addresses what options, support and information are available for health care users who wish to self care. The N.H.S. and social services want to encourage people with long term health conditions to self care, its shared aims and values for the transformation are to ensure that service users and their carers are not discriminated because of illness or disability and are supported to be able to:

Live independently and be able to sustain a family unit, which will avoid children taken on inappropriate caring roles.

To stay healthy and to be able to recover quickly from illness.

The ability to exercise control over their own life and if appropriate the lives of family members.

To participate economically and socially as active and equal citizens.

Have the best quality of life, irrespective of illness or disability and retaining respect and dignity.

(Your health, your way, 2009, p.4)

Self care is build around a holistic process that places the service user at the centre of their own care but also recognising that different issues can impact on an individual's health and wellbeing so the process is supportive, individual, flexible and non-judgemental, the focus is solely on enabling the individual to achieve the outcomes that they want for themselves.

People who use services completed a survey prior the transition to self care and after the changes had occurred the findings are.

(Your health, your way, 2009)

(Your health, your way, 2009)

The results show how being empowered to take a more active role in health and well-being can improve quality of life. People who are living with a long term condition can benefit enormously from being supported to self care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life and be more active and independent (Your health, your way, 2009, p.6).

Theory and practice.

The social model of disability (K217, Learning Guide 6, p43) plays a significant part in a care service user's life, such as Kingsley. This theory accepts that people will experience differences in life because of health issues such as stroke and diabetes, but questions that the difference is the problem when society does not adapt to such differences. The theory was introduced in the 1970's when disabled activists debated that society is the problem that faced disabled people not the individual's disability. This approach has a commitment to improving the lives of disabled people, by promoting social inclusion and removing the barriers which oppress disabled people (Tom Shakespeare, 2006, p 9).

The biomedical paradigm ignores the differences between individuals and is criticised for overlooking social influences which have an effect to health care (K217, Learning Guide 2, p40). This is clear in the case of Kingsley; he has received biomedical treatment in the past for type 2 diabetes and now for a stroke from medical practitioners. Kingsley is now experiencing differences in life to an able bodied person as well as a change to his identity to being disabled because he cannot walk or use his right hand without being aided. The nursing home were Kingsley now lives accepts his disabilities and provides care for him such as assistance to walk and use his right hand. Two people assist Kingsley to get out of bed, shower and dress him. The environment is restricting his independence and making him disabled relying on assistance and there are no aids he can use himself which would give him control of his care.

Empowering people who use services (K217, Learning Guide 10, pp28-34) is a theory which would allow Kingsley to become involved in his health care needs. The focus of the theory is the concern regarding the need for people to participate in their health care needs, and that empowerment will encourage them to use services and empower them to participate within them. People need to be encouraged to use health care services but also need to empower themselves to participate within a service. Health and social care services encourage users to become empowered; this can be with support groups with people who share similar experiences (Diabetes NHS, 2011). Key factors of the theory are that power and control should be equally divided between service provider and user, several options will be available to the user which there will have knowledge on, information supplied to assist in making decisions and if the user is dissatisfied with the system has the option to decline any further use of the system and make a complaint. Involving people who use health and social care services with empowerment gives them achievement by (K217, Learning Guide 10, p30).

Having control and being engaged with services.

Equal share of power with practitioners.

The contribution of planning individual services and the development of good practice.

Including all members of society.

Empowerments goal is to involve participation at all levels in care services allowing users to have a say and to be engaged in their care needs working with practitioners to satisfy care needs. Empowerment is a 'way of equalising the distribution of power between users of services and practitioners' (Tuner, MacKian, Woodthorpe, 2010, quoted in Learning guide 10, p.30).

Kingsley's care needs are being dictated to him by the care home and his social worker if he was to be empowered to use care services and was to empower to participate in services he may be more actively contented with his care needs.

Conclusions and recommendations

Who cares for Kingsley and where he receives care are now important decisions to make. The decisions will influence his care needs and his future wellbeing. This report highlights the concerns that people who have long term health conditions face with care needs and the services that provide care.

Clearly when a person suffers from an illness such as a stroke or diabetes an emergency response for care is received from a medical practitioner who will offer a biomedical diagnoses and if needed medical treatment and medication. As was the treatment Kingsley received, the next phase in the care process is how after care support and treatment is provided for people with a long term health condition.

Kingsley's individual care needs have not been addressed; he may be adequately receiving biomedical care in the nursing home and his basic fundamental needs for living such as shelter, food and warmth are being provided his individual needs are not being considered.

Kingsley wishes to return home to the care of his wife, a psycho sociological perspective will identify that his individual psychological health and wellbeing in society is not being fulfilled. The care home environment is restricting him from participating in main stream society; he cannot be active within society because he has no access to social networks. This will be a fundamental reason for his bouts of anger and frustration as before his illness he was social active and provided for his family. Kingsley's care needs are unique to his new identity as a disabled person with a long term health condition, along with a psycho sociological perspective a holistic approach will help to identify the impact this is having on his health, lifestyle and wellbeing.

The social worker assigned to Kingsley is concerned that his wife would not be able to cope with his care needs, one option is to recognise what difficulties in society will be restricting Kingsley because of his disability (The social model of disability). The care home is disabling Kingsley because of its lack of practices and environment.

If the social worker was to work with Kingsley and his wife to identify the support needed to provide a self care package such as direct payments (K217, Learning Guide 10, p29) this would allow them to be independently in control over which services they use. Allowing them to live independently as a family and able to participate economically within society.


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