This academic assignment will discuss the various primary health care agencies that are available to Mary who is a 75 year old widowed woman who suffers from diabetes and has just undergone a total hip replacement. She lives in a two-storey house on her own with no downstairs bathroom or bedroom. According to Keleher (2001) Primary Health Care incorporates personal care with health promotion, the prevention of illness and community development. The philosophy of primary health care includes the interconnecting principles of equity, access, empowerment, community self-determination and intersectional collaboration.
It encompasses an understanding of the social, economic, cultural and political determinants of health. In order for Mary to live in the community the skills of a multi disciplinary team are required. According to Maginn (1993) teamwork is a group of people with different abilities, talents, experience and backgrounds who come together for a shared purpose or common goal. Before discharge can occur the patient will require a detailed and individualised, documented discharge plan.
For the successful and independent discharge of Mary the skills of a vast number of services must be utilised. These include the Occupational Therapist, the physiotherapist, the public health nurse, the general practitioner, the day centre, meals on wheels and also a home help attendant. This academic assignment will attempt to both highlight the services available to Mary and the role which each occupies in ensuring the success of her recovery and her re-integration to the community following her surgery. Occupational Therapy
Occupational therapy services are designed to help people who have any form of a disability whether that be physical, social or psychological to try and achieve the maximum degree of independence in order for them to live their daily lives. According to Reed and Sanderson (1999) Occupational therapy could be described as the use of purposeful activity with individuals from various types of backgrounds who may be limited by physical injury or illness, psychosocial dysfunction, developmental or learning disabilities, poverty and cultural differences or the aging process in order to maximize independence, prevent disability and maintain health.
According to Holland et al (2008) maintaining a safe enviroment is a basic human survival skill and the assessment and provision of the correct aids is essential for normal everyday life to be achieved. The occupational therapist will assess Marys case individually and see which of the activities of daily living that she is or may have difficulty completing, and they will attempt to help find a solution as to how these difficulties can be addressed. In Mary’s case this would involve a pre assessment of her home to determine which supports would be most wisely initiated.
Punwar and Peloquin (2000) describe assessment to be a process which is designed to evaluate or estimate a client’s current functional status. The occupational therapist will be able to provide aids and appliances or help facilitate any adaption which may need to be completed in the home to ensure a safe environment is maintained. It is essential Mary has adequate access to the kitchen, bathroom and bedroom. It is also important for a patient who has undergone a total hip replacement not to attempt to sit in a low position.
This may require an assessment of the height of her bed, chairs and toilet seats to ensure she does not damage her hip while attempting movement between them. Other items which may need to be provided for her are stair rails, or thing else which may assist her in achieving her activities of daily living as independently as possible. Physiotherapist The skills of the physiotherapist will be essential to ensuring the patients successful and independent living in the community.
According to the charted society of Physiotherapists (2002) physiotherapy is the healthcare profession which is concerned with human function and movement with the goal to maximising the person’s potential. Physiotherapists aim to identify and make the most of movement ability by health promotion, preventive advice, treatment and rehabilitation. The role of the physiotherapist begins almost immediately post operatively and their aim is to assist the patient in gaining and restoring mobility but also ensuring that they have as smooth and comfortable of a rehabilitation process as possible.
Following discharge one of the main problems Mary may experience is that she may be nervous and lacking confidence about her ability and have a fear of falling. The physiotherapist will help reassure her over her capability and also to educate her as to which exercises will be of most benefit to her in promoting her recovery. During regular physiotherapy sessions Mary will be encouraged to undertake passive exercises which will both improve joint mobility and help prevent the possibility of deep vein thrombosis occurring.
Nicholson (1985) found that a patient’s ranges of movement improved significantly when treated with passive joint mobilization. The physiotherapist will help support Mary and also help ensure that during regular contact with they will prevent possible muscle wasting and joint immobility. They will also teach Mary basics such as safe movement in and out of her bed, correct sitting in a chair and also how to use her crutches properly. The physiotherapist will play a crucial role in ensuring the success of the operation by giving the Mary the opportunity to regain an active lifestyle.
Public Health Nurse The role of the public health nurse is to provide basic nursing care while offering both advice and assistance to any queries in which their patients may have. They help act as a co-ordinator of care between the patient, hospital and community services. Upon discharge from the hospital the public health nurse should make regular visits to the patient to ensure that they are coping. The public health nurse should be at the centre of Mary’s care while living at home.
They will be needed to communicate with other members of the multi disciplinary team to help establish the best possible care plan for the individual. Wiemann and Giles (1988) describes communication to be an ongoing and dynamic sequence of events into which two people contribute, in which each affects and is affected by the other person in a system of reciprocal determination. The public health nurse will be responsible for informing the various members of the multi disciplinary team of any changes in Mary’s health which she feels requires intervention.
In the care of Mary post operatively she will initially require help to ensure that relevant precautions are taken to prevent wound infection and hematoma. The site of the wound will need to be kept clean and free from debris. She will also need help in applying sterile dressings aseptically to the wound site. According to Rhinehart et al (1999) the use of aseptic technique involving meticulous hand washing with antimicrobial soap, the use of barriers and also maintaining a clean environment should be adapted to prevent the possibility of wound infection.
This theory is supported by Baker et al (1999) who emphasised the importance of both hand washing and the use of sterile equipment during the procedure. The nurse should keep close observations over Mary’s control of her blood glucose levels as she has a history of high glucose levels which may impinge on her wounds healing ability. General Practitioner The role of the general practitioner in the case of Mary’s care will be to both to monitor any pain she may experience with her hip replacement but also to help ensure that she remains medically stable in particular ensuring that her diabetes remains under control.
King (2001) (cited by Dealey 2006) supports the fact that one of the most frequent causes of a wounds delayed healing in a diabetic patient is because of high glucose levels which encourages the proliferation of bacteria. For this reason Mary’s doctor should attempt to stablise her diabetes to within recommended guidelines. According to Taylor et al (2003) general practitioners are involved in a medical speciality which is concerned with the total health of the individual. It involves the biological, clinical and social sciences and their scope is not limited to a specific age, sex or organ system.
The doctor will also take relevant precautions such as the prescribing of antibiotics if Mary acquires any infection which will help fight the infection before it has the opportunity from entering the hip. This is supported by Allgower (1971) (cited by Trohler and Schlich 2006) who stressed that once an infection has been identified a rapid course of treatment can prevent a catastrophe. They can also offer her help in a number of non-medical ways such as giving her any support or advice that she may require about her health post operatively.
The general practitioner can help Mary in living successfully in the community by regular health assessments and if required they can refer her to the care of the orthopaedic surgeon if they feel she is not progressing as well as expected. Community Dietician Miller (2008) discussed the dietician’s role and how they will assess the nutrional needs and usual eating pattern of the individual and establish a plan of care aimed at attaining and maintaining the person’s optimal nutrition.
The dietician will educate Mary in the importance and benefits she will experience in her general health if she adapts to eating a balanced healthy diet. Apovian (2006) describes a balanced diet as the intake of appropriate types and adequate amounts of foods and drinks to supply nutrition and energy for the maintenance of body cells, tissues, and organs, and to support normal growth and development. Mary would greatly benefit from the help of a dietician especially due to the fact that she has quite poor control over her diabetes.
They could help her to meet her daily nutritional needs by making changes in her current diet. By altering her eating habits she could achieve a healthy diet plan which would both bring her diabetes under control and also aid her wound healing. The dietician will help Mary to prevent any undesirable weight change and also work towards the achieving and maintaining of good general health. Home Help This is a service whereby a carer provides both practical and emotional one on one care to help a person live independently without the need for institutional care.
It will enable Mary to return to her own home safely while giving her the independence and dignity she deserves. Lowenthal and Haven (1968) (cited by Nussbaum et al 2000) describes the maintainence of one stable, intimate relationship to be one which is strongly associated with good mental health and strong morale. When home help care is given to Mary it may initially involve helping with her to maintain her basic hygiene needs such as washing as she will be unfit to get into a bath due to the risk of damaging her hip.
Roper et al (2000) noted that it is necessary for patients to wash at regular intervals in order to keep the amount of natural flora of micro-organisms on the skin within a manageable amount which in turn will help reduce the risk of wound infection. It may also be required that the home helper assists in maintaining the household by completing cleaning duties such as hovering or vacuuming, as these tasks may not be able to be completed by Mary as they would require her to stand for a long period of time. The level of care needed by Mary can be mutually decided by Mary and her home helper depending on Mary’s individual needs.
This form of empowerment will help Mary feel secure in knowing that the level of help she receives will only be given at a level she is comfortable with. “Empowerment refers to increasing the spiritual, political, social or economic strength of individuals and communities. It involves the empowered developing confidence in their own capacities” (Downey 1988 pg. 119). When home assistance is given it can act as a companionship to Mary, as she is living alone. It will help to reduce some of the isolation she may feel following the operation as a result of her initial reduced mobility.
Machielse (2006) supported the fact that the expectation that in times of need one can count on help and support from another person is essential for a person’s well-being and health. Day Centre The day centre can help provide both personal and social amenities in the successful living in the community for Mary. A day centre provides the patient with an alternative to either hospital or residential care. They offer a range of services such as transport to and from the facility, if requested by Mary they can help her maintain her hygiene needs by the provision of bathing and showering facilities with the assistance of a health care attendant.
They offer health monitoring services which will be particularly helpful to Mary as they can help monitor her diabetes. Also while attending the day centre she can take part in daily exercise programmes with the help and advice of the day centre staff. The day centre will also give Mary a social outing where she can both meet and interact with other people in her community. This is something which she may find very worthwhile as she is currently living alone. While attending the day centre Mary will also be offered therapeutic care such as the opportunity to get her hair done, take part in games of bingo or participate in art classes.
All of these activities may bring Mary a rejuvenated enjoyment into her hobbies. Chitrac (2008) states that when we have a hobby or interest it causes the quality of our life to grow by enhancing our level of happiness. Meals on Wheels Following her surgery Mary may find it difficult to prepare her own food as it would require her to stand for a long period of time something which she may find quite challenging. The meals on wheels service offers the provision of nutritious home cooked meals for those who or either unable to purchase or prepare their food on their own.
The service also acts with both social and security elements. It will help Mary socially as because she is living on her own she may look forward to knowing that somebody is going to be calling. She can talk to that person to find out what is going on in the outside community without the feeling of isolation. Gammon (1999) found that when people feel isolated they can experience depression, sleep disturbances and even hallucinations. They can also feel forgotten and that no-one will come when they need help. The fact that a person will come on a regular basis and a specified time can eliminate this isolation.
Conclusion This academic assignment has attempted to discuss the various primary health care services that are required in order for Mary to live the most independent life possible in her community. It has shown that the skills of a multidisciplinary team are needed in order for Mary to gain the most out of her operation, including the importance of both communication and teamwork between all relevant parties. Also it has highlighted that her care doesn’t end when the operation is completed but on the contrary it is only the start of her care and her follow up requires a vast number of other skilled people.