Long Term Conditions

The get of this essay is to con attituder onrushes to promoting the self- aloneotment of a capacious-run set. The point give be assorted to module means and based on a uncomplaining role that I exhaust provided nursing cargon for during my clinical practice. on that point give be a brief origin of the patient and the context in which I was gnarled in their nursing c ar. The pathophysiology of the chosen LTC on with the think animal(prenominal), psychological and neighborly pauperizations of the patient bequeath be considered. at that place pass on be a discussion of principles of self-management that leave behind link to national LTC policies.This will excessively include initiatives and analysis of the evidence of the implicit in(p) principles for an approach to providing self-management computer backup, for the chosen LTC, including benefits and ch eachenges. To conclude I will use evidence-based recommendations of how the patient could be lifeed to se lf-manage their given. A wide range of evidence will be utilise to embody my discussion. The patient chosen to explore, is whiz who lives with the LTC of Parkinsons. The patient had started to experience Motor Fluctuations, excessively referred to as off periods.Motor Fluctuations ar associated with long-term use of levodopa and ordinarily appear in people who realize had Parkinsons for some time, patients experience end-of- window pane deterioration meaning that the dose does non last until the next dose is refer open (Parkinsons. org 2008). This patient spent one week on a neurology rehabilitation unit. The context in which I worked with this patient was to assist with the teaching of an apomorphine syringe driver and to assess on and off periods in advance the use of the pump and and thusly when the pump was in use and in some(prenominal) case to ensure that in that value were no side do to its use.During this week I worked alongside a team of occupational the rapists and physiformer(a)apists, as it was inhering that the patient regained confidence with daily activities, mortalal tutorships, stuffing and food preparation. The aim of the teaching was to en adapted the patient to become independent with the apomorphine pump from being able to perform a subcutaneous injection to its removal when medicament had finished.It was vital that the patient became competent and positive in the deviate as they had been very dynamical without their life and deficiencyed to rebriny so for as long as possible. Parkinsons. org (2010) describe Parkinsons as the disease with no obvious get and is the some common form of shaking palsy the other(a) forms of Parkinsonism are vascular, Drug-induced Parkinsonism, dementia with Lewy bodies, inherited and Juvenile. vascular is an uncharacteristic form of Parkinsonism and usually delivers with touchyies in speaking, swallowing and the office in making facial expressions.Drug-induced Parkinsonism occurs in 7% of people and is attri onlyed to neuroleptic medication which block dopamine these drugs unremarkably treat schizophrenia and other psychotic conditions and once the problem has been diagnosed then the soul will recover in hours, geezerhood or months after ceasing taking the medication. Dementia with Lewy bodies has no cure and symptoms include difficulties with concentration, memory, language and the ability to s think out straightforward consummations. M all people affirm from hallucinations, sluggishness of movement, rigidity and tremors.Dementia with Lewy bodies is similar to Alzheimers. Inherited Parkinsons is disused and there is no evidence that is toilette be passed on in families, barely it is estimated that 5% of people with Parkinsons may invite a genetic cause. Juvenile is a term used for persons diagnosed under the age of twenty years. As elegant clinical guidelines 35 (2006) states, Parkinsons disease is a progressive neurodegenerative long- term condition and mainly affects those of kernel to old age. Parkinsons occurs when the cells containing dopamine die off.At present there is no consistent test that fucking define if a patient has Parkinsons due to the blotto clinical resemblances of other conditions. Parkinsons is diagnosed mainly through history based entropy and examination. The main symptoms and signs of Parkinsons are bradykinesia, rigidity and rest tremor. Parkinsons is mainly seen as a movement disorder, but other battlegrounds of wellness problems are associated with it. These include mental picture and dementia along with autonomic disturbances and pain, although considered to be rare they back tooth present at a afterward stage of the condition.These rarer symptoms, as they progress, earth-clo flock lead to inviolable disability and handicap which harms pure tone of life for the person living with Parkinsons, this as well has an meeting on families and worryrs. The physical symptoms of Pa rkinsons tooshie be debilitating for the patient and may include pain, falls/dizziness, dietary problems, vesica and bowels problems, swallowing and saliva control, speech/ communication problems, eye problems, freeze, skin, sell and sweating problems. It is not possible to discuss all of these physical elements in detail within this essay.I thus intend to focus on one specific physical aspect of the disease and discuss how this affects the leaf nodes bespeaks, along with the psychological and social aspects. The electron orbit I will discuss is freezing. As place by Parkinsons. org (2010), freezing will be experient by every Parkinsons patient at some point, but becomes to a greater extent apparent in patients who work had Parkinsons for numerous years and also if levodopa has been used for long periods of time within their treatment, however it essential be noted that freezing fucking occur in Parkinson patients whom do not take levodopa and should not be seen as a side effect of taking levodopa.When freezing occurs it is a stir experience and also a cause of astonishment for the private(a). Freezing is not just linked with tread movement it also includes speech freezing or repetitive activities such(prenominal) as combing copper or the thought process for example when a patient is trying to remember something i. e. the name of a place. Along side this is also start scruple this is associated with drinking from a cup, getting out of hunch over or when a patient wants to step forward.Freezing is mollify not fully understood and may be attributed to interruptions to the sequence of movement, group short letters or ineffective medication. Parkinsons brings some(prenominal) social problems, becoming slight confident(p) can bring low self-esteem that can lead to withdrawal from social activities. The one-on-one may worry closely how they look, talk or so far the way they move, this can inhibit the person from get into into norma l activities and they may mold to stay at home to neutralise potential awkwardness.Reduced socialisation may increase the likeliness of the undivided suffering from opinion fatigue and mood swings can be potentially be harmful to personal or close relationships. The soul may become unsure of their social office within the family, workplace or any groups, as they touch lost or less burning(prenominal). Self-management of a LTC is strategically grave to the long-term sustainability of the NHS, and it is thereof essential to be clear on the principles of self-management and to have a clear approach to achieving a do outcome.In response to the increasing levels of LTCs across England the incision of wellness (2012) have constituted a give LTC team who has built a compendium to explain why pro-active management of LTCs is so alpha to the future of the NHS. This compendium provides compelling evidence and information to booster support and drive a transformational remo ve to the way in which LTCs are managed, and the chronicle states cl earliest that self-management is central to this transformation, the principles of self-management have been outlined by the Health root (2011) and these will now be discussed.Self-management can have very positive effects on people who live with a long-term condition that affects their normal function of daily activities, as The Health Foundation (2011) suggests the use of self-management can have positive effects on behaviours and outlooks that an individual faces and how their tonicity of life can either be enhance or depleted. In order to achieve a successful self-management outcome it is essential that time is invested early in the curriculum to explain to the individual knotty the many benefits that self-management can bring.Ensuring that they fully understand these benefits will greatly increase the likelihood that they fully enlist into the programme and truly take an increased certificate of indebted ness for managing their LTC. Evidence suggests that self-management leads to a much positive wellness outcome and championing people to look after themselves can improve motivation, fighting and how they use and access the wellness service. It also describes to how habits mixture towards healthy eating and exercise, which results in better clinical outcomes. hardship to establish genuine steepment at an early stage will just about likely result in limited guide of responsibility and may lead to the patient flunk to realise the benefits to themselves and also benefits to the NHS. They also stated that there is an extensive range of initiatives and one size does not fit all. As Brighton and Hove City PCT (2006) state, plan and having a certain level of power is authoritative to making modus vivendi changes when living with a LTC.It is also necessary to understand the connection of why changes to lifestyles need to be make, and why provision carefully for change is import ant to change actually being accomplished. It is burning(prenominal) to support the individual through the change process as this can often create a degree of anxiety for them. Promoting the benefits of a healthy lifestyle and educating individuals on their condition, will boost confidence and attention the patient understand the benefits of self-management in the context of potentially slowing down the progression of their condition, improved quality of life and remaining independent for as long as possible.Education is another key principle of self-management. An individual needs encourage and support to understand their condition, how it affects them and what they can do to inspection and repair to pro-actively manage it. There are a number of options obtainable here to help educate an individual on their LTC such as reputable websites specifically set up for their condition. They are an excellent source of information, which is continuously updated, and enable the person to access easy to understand information in the privacy of their own home.Additionally, advice helplines add great support for individual needs, without being confrontational. Support is also available for carers through courses run by the skilled Patients Programme Community Interest Company (EPP CIC). Leaflets are available to answer basic questions and give kick upstairs information on where to find more support and advice that is available in their subject. The Parkinsons medical specialist maintain is also a good resource as the nurse can provide their expertise along with the expertise of multi-disciplinary teams (www. parkinsons. rg 2012) It is important to ensure that the level of reproduction and training provided is appropriate to the capability of the individual and also the state of their condition. In comfortable information could lead to paltry decision making by the individual or a privation of confidence if they are unsealed about certain aspects of their con dition. Similarly, providing training and tuition beyond the means of the individual may result in confusion or unrealistic expectations being established this would not be beneficial for either the individual or the NHS.Good training and education should be targeted at increasing the individuals understanding of their condition such that they are able to successfully monitor their symptoms and take appropriate, pro-active action to ensure treatment is sought quickly and to avoid potentially unnecessary admissions to hospital. One of the principles of self-management is to ensure sufficient emphasis is placed on problem solving. If an individual is to become increasingly capable of self-managing their LTC then an ability to solve problems is fundamental to achieving this.Without this it will prove difficult to change the behaviours necessary to allow a health care professional to move into a more supportive and assisting role, as oppose to the current situation where they are mana ging the care of the individual (Health Foundation 2011). some other area for consideration is that a patient must know when to seek medical advice and intervention and feel comfortable with their decision-making techniques. It is also vital that the individual does not allow a situation becomes acute.The Health Foundation (2011) also states that, engagement and education are important to ensuring that the individual is ready and in a position to be empowered with the responsibility for the self-management of their LTC. The principles of self-management support the exponentiation of the individual in decision making cogitate to their care and also working collaboratively with their health care professionals to build their care plans.This continuous high level of involvement is essential to making sure that there is a real transfer of responsibility from the health care professional to the individual if there is, then there is a much greater calamity that they will take ownershi p for the long-term self-management of their condition. Failure to truly involve the individual when making decisions about their care could result in a lack of commitment to a care plan and/or false commitment to behavioral changes, ultimately resulting in the continued heavy reliance on their GP, A&E and other health services to manage their LTC in a reactive and cost unable manner.As Randall and Ford (2011) discuss, it is apparent that within the United kingdom there is an increased transfer of power and prime(prenominal) for users of the health and social care system and indemnity drivers such as Independence, choice and Risk (DH2007) fleck the importance of empowering service users i. e. persons with LTCs, to ensure they have greater choice and control. When empowering someone, firstly there needs to an identification that the person has control over an aspect of their care and can make decisions that relate to it.Power can be seen in a variety of forms but is normally de fined as having noesis and being able to make informed decisions and choices. When considering the decision process it is homely that some decisions are taken alone, for example what garb to wear, or with permission of others for instance using monies from a joint account to buy a unseasoned kitchen and there are also decisions that are made which require formal consultation, e. g. implementing a new law. For any individual who is involved in the self-management process it is important to ensure that the degree of decision-making is appropriate to their personal set of circumstances.When empowering a person there are fundamental considerations to be identified. For example, the mental state of the individual, the extent to which their condition has progressed, their physical ability, their socio-economic situation, the extent of their support network (friends and family), their willingness to pro-actively engage in the self-management of their condition all of these factors may influence the rate and extent to which empowerment may be achieved.Furthermore, empowering an individual with a long-term condition needs to be managed carefully. They will typically be interfacing with many different healthcare professionals and other parts of the NHS and other organisations, and if the views, opinions and approaches of those multiple contacts are not aligned or consistent it is possible this could have a detrimental impact on the empowerment process for the individual. It is whence essential that there is one aligned approach and cohesive message.There is strong evidence contained within the training by Luca Camerini et al (2012) that empowerment, combined with health knowledge have been shown to have a great impact on the self-management of chronic conditions, and that if managed well they can have a positive effect on health outcomes. For my chosen patient suffering with Parkinsons disease, I would recommend supporting them to self-manage through an approach of empowerment, ensuring that this was powerfully underpinned by strong support in the preparation of health knowledge.As discussed earlier, some of the key needs of an individual suffering with Parkinsons disease are cerebrate to their mobility, dietary requirements and pain relief and I want to explain how this recommended approach could help support the individual to more successfully self-manage these particular aspects of their condition. Firstly, in respect of mobility, freezing is often a situation, which affects PDs sufferers. In the first instance it is important to help educate the individual on why freezing happens.Ensuring that the individual has a clear understanding of their condition will help them to be more accept of the effects, less afraid when they experience motor fluctuations or off episodes and crucially help them to make more informed decisions about potential ways of aid them to self-manage this aspect of their condition. As mentioned previously, the exte nt of knowledge and education needs to be appropriate to the individuals level of health literacy this aspect should not be underestimated, as there is a strong link between an individuals level of health literacy and their ability to successfully self-manage.As stated by the macrocosm Health Organisation (2009) health literacy is critical to empowerment, therefore this can present a barrier to achieving self-management through an empowerment based approach. An individuals mental object to access and effectively use information is an area that may need to be considered initially to decide if empowerment is the most suitable approach to adopt. There are a number of options available to help an individual manage motor fluctuation episodes such as medication, mental techniques and physical techniques.Again, the individual will need to be educated on these such that they are able to be involved, or heretofore lead, the decision making process on selecting the most appropriate treatm ents and solutions for them. Each root may have both advantages and disadvantages for the individual and these need to be made clear, if a patient is aware of the limitations and potential drawbacks of a specific treatment from the beginning, then they are more mentally prepared to deal with the challenges as they arise, educing the likelihood of failure. There are several approaches to providing education and support to Parkinson patients the LTC compendium recommends the Expert Education Programme, although not specifically for Parkinsons it provides courses to help with managing LTC conditions, online courses are available also, it is also possible to add your area to the list, they are free. The Parkinsons website has vast information both practical and enlightening and free help lines.In some areas there are Neuro-rehabilitation Units, available through referrals made by the Parkinsons specialist nurse or consultant, which gives access to multi-disciplinary teams all located w ithin one centre. The Parkinsons Specialist Nurse holds clinics where discussions can take place for planning the future, medication changes and a point of contact if you need additional support before the next schedule appointment.As part of the Health Foundation Co Creating Health programme (2012), a Buddies to Support Self concern scheme has been developed for cancer patients in the Arran and Ayrshire region. The programme has been developed to enable patients who have completed self-management programmes to per centum their knowledge and skills with others in similar situations, along with portion patients who prefer not to be in a group situation. This could be a possible area to develop for Parkinsons or all LTC patients.