According to Czypionka et al. (2020), Complex care refers to integrated health and social services provided to individuals with multiple, interconnected needs. These needs can be physical, psychological, or social and often present challenges for healthcare professionals as they require a multidisciplinary approach (Taberna et al., 2020). In this presentation, we will focus on Nancy, a retired teacher aged 75 years old, who has been facing complex care needs due to her various chronic conditions, including obesity, type II diabetes, and hypertension, which result from microvascular and macrovascular damage combined. She also faces mental and socioeconomic challenges. Also, the presentation will critically explore the challenges faced by individuals like Nancy, who have complex health and social care needs. We will also discuss collaborative working between various healthcare professionals in managing these challenging situations while incorporating evidence-based practice informed by relevant policies and legislation.
Introduction to Complex Care
Complex care is an umbrella term that encompasses several layers of intricacies and challenges faced by individuals with multiple health needs. It involves coordinating and integrating diverse healthcare services to address physical, psychological, social, or economic issues for effective patient outcomes (Sreedharan et al., 2022). According to Haque et al., (2018), The Department of Health defines Complex Care as a collective effort addressing long-term conditions, such as hospital-acquired infections, requiring multiagency involvement in treatment planning strategies.
In everyday clinical practice, we encounter patients who present individualized symptoms related to their associated medical conditions; however, given pre-existing regularities, it becomes critical during any therapeutic intervention that the role played by non-medical challenges is also addressed. These demands link available resources to provide better financial support and mental well-being. Improved bedridden lifestyle changes per home living cite specific person-environment limitations, causing additional hindrances.
Additionally, complex care involves various agencies from both the NHS setting and the private sector, along with charities, which require joint assessed value skill sets, supporting critical thinking abilities. Each medical professional’s priority needs must be met, rather than challenging formulating evidence-based guidelines, with the team assessing and prioritizing solutions and agreeing on forward action plans directed at retaining, ultimately ensuring a safe, holistic approach. All contribute systematically to improving quality.
Several pieces of literature have been published highlighting frameworks defining Complex Care and its various dimensions. One notable study by Cross and Lloyd-Jones (2018) notes the overlapping nature of complexities in healthcare settings, implying that there is more to complex care than only addressing multifactorial medical needs (Gandarillas & Goswami, 2018). From this, we can extrapolate vulnerabilities associated with commencing treatments for patients who present multiple symptoms that influence individual physical challenges, accreditation associated with various comorbidities, therapeutic adherence, and planning multiagency interventions.
Moreover, according to the Department of Health (2009), attention should be paid to delivering high-quality healthcare (Glynne et al., 2019). As U.K. Prime Minister Theresa May stated, ‘quality control relating better case management, managing Complex Healthcare Needs, improving to address comorbidity administration techniques effectively, operating patients’ medication, along with other mental consequences, daily living participation procedures also provide valuable insights into current service provision (Gov.UK 2023). Considering recent changes within the National Healthcare Services from April 1st – March 30th, improving the population’s experience has beneficial factors (Pujolar et al., 2022). Working collaboratively with colleagues through several mediums at different stages of treatment processes, making proactive decisions, analyzing potential risks, mitigating law society programs, and minimizing severe dangers. As multidisciplinary teams work together, communicating ensures information is shared without compromising data, including risk factors.
The NMC code highlights professional responsibility when working with individuals presenting challenging conditions, encouraging safeguard guidance, always dignity, privacy independence, and responsive care environment care (NMC Code 2015). Ensuring all relevant policies are followed and patient individual rights are respected. There is a lot of focus on healthcare professionals’ acknowledgment of changes in service provision, continuously adapting health legislation, and nursing roles aiming at a much-needed path innovating understanding of cost-effective quality.
Patient Scenario – Nancy’s Profile
Nancy’s profile presents multiple interconnected health challenges that require complex care management. She is a 75-year-old retired teacher who has been diagnosed with severe obesity, type II diabetes mellitus, and hypertension. These conditions have resulted from her lifestyle choices, which have led to weight gain over the years. In recent weeks, before being admitted to the hospital following an unfortunate fall down the stairs due to heart palpitations arising from a hypoglycemic attack caused by poorly managed Type II Diabetes Mellitus, weakened sodium levels leading to hypervolemia, accident, and emergency admissions, and strengthening community nurse assistance calls upon the nursing team.
Living alone makes it challenging for Nancy as she struggles with limited mobility, resulting in feelings of isolation. This was further compounded when she suffered fractures on both legs post-fall, making her wheelchair-bound and causing dependency. Although mostly independent in activities of daily living, she now requires assistance during personal hygiene tasks, undressing, and dressing up, proving even more physically and mentally taxing and taking a toll on her previous social commitments, specifically associated with loneliness, comorbidities develop – depression, sepsis, HBN, MRSA, cellulitis, osteomyelitis, value skill set – pharmacist interactions.
The complexities involved become evident through various intertwined factors like psychological and physical barriers impairing successful rehabilitation program results, developmental empowerment while addressing specific cognitive needs, withdrawal subconsciously in self-treatment, serenading personal neglect, and depression. This individual’s long-term conditions and psychological barriers associated with repeated health admissions require efficient behavior management strategies involving multidisciplinary staff from several healthcare institutions for safe discharge planning addressing comorbidities (NMC, 2018).
Nancy’s only source of support is her daughter, who lives out of town, adding another layer of complexity to the situation. She relies mostly on community services for additional help as she struggles with limited mobility due to recent fractures post-fall, which is proving challenging. By conducting a thorough evaluation, considering Nancy’s medical background, the team responsible for managing her complex needs can also examine the social dynamics of co-dependent relationships within her family. This will enable them to offer evidence-based and high-quality support while collaborating across different disciplines to assist Nancy with self-care commitments and enhance her independence. Additionally, this approach aims to foster achievable goals that will aid in transitioning patients like Nancy back home safely. It is essential for the team to fully understand any legal implications under the Assessment Community Living Act when working with vulnerable adults like Nancy.
When creating a comprehensive plan to address Nancy’s needs, it is important to consider her physical and psychosocial challenges (Karla et al., 2018). This requires considering individual behavioral psychology to effectively implement interventions for weight loss, promote healthy lifestyles, suggest emotional wellness strategies, and design structured activities. It is crucial to engage motivation through empathetic interactions and establish a strong therapeutic relationship with the help of skilled professionals to achieve improved outcomes both medically and financially. Collaboration between traditional healthcare settings and unconventional sources, such as volunteer groups focusing on community cohesion development or libraries promoting acceptance and equality, will play an integral role in this process. Additionally, speech therapists may offer one-on-one sessions to teach spoken words, benefiting Nancy’s overall communication skills (Schot et al., 2020).
Challenge 1 – Weight Management
One of the main challenges in managing Nancy’s complex care needs is her weight management. As mentioned earlier, obesity poses great risks to an individual’s health and well-being (World Health Organization, 2023). As healthcare professionals managing individuals with challenging health and social care needs, we must promote healthy lifestyles through various interventions, such as educating patients about unhealthy eating habits and promoting exercise regimes that best fit every patient. This could include developing tailor-made food diaries to reduce portion sizes, avoid emotional eating behaviors, and provide realistic weight loss goals. Furthermore, the critical role of addressing psychological aspects of weight management must be considered (Puhl et al., 2020). Involving professionals like psychologists to provide support to individuals struggling with body image issues is essential for developing comprehensive intervention plans that facilitate therapeutic recovery and physical independence.
Moreover, establishing positive relationships among nurses who care for patients with Complex Care Needs is key to fostering commitment and engagement in behaviors that support rehabilitation (Molina-Mula & Gallo-Estrada, 2020). Collaborative efforts in this regard are instrumental in improving efficiency following medical procedures, ensuring continuity of care, and respecting patients’ dignity and opinions in medication discussions (Kleinpell et al., 2021). This strategy is particularly crucial when dealing with the challenges associated with Surprise Associated Symptoms in a professional healthcare setting and enhances the autonomy of nurses.
Nurses are pivotal in this context since nursing care can help identify underlying medical issues and medications that may hinder effective weight loss (Warr et al., 20221). Recognizing the psychological implications is equally important, as it strengthens therapeutic relationships between nurses and patients, providing reassurance and ultimately promoting successful outcomes. Involving support groups, a measure endorsed by Mant et al., (2022) and Tolosa‐Merlos et al., (2023), has been proven to build confidence and improve holistic lifestyles, leading to increased physical independence. Additionally, engaging with family members or caregivers is imperative to ensure continuity and success (Backman & Cho-Young, 2019). This engagement offers valuable insights into an individual’s daily routine, food preferences, and eating habits, which are crucial when developing nutritionist-approved meal plans and considering lifestyle choices.
In the case of Nancy, various literature sources have highlighted the difficulties faced, particularly after significant weight loss, which can result in loose and detrimental skin flaps and mental depression (Buchwald et al., 2011). Active participation in managing these complex needs can be beneficial for her well-being. It can promote self-care behavior changes, effectively reducing the risks of obesity and associated comorbidities such as diabetes and hypertension.
Challenge 2: Safety at Home/Mobility Management
Ensuring safety at home for individuals with limited mobility, like Nancy, requires careful planning and consideration from healthcare professionals. Firstly, the challenge of organizing bariatric equipment can arise due to NHS funding limitations (RDASH (2021). In such cases, involving an efficient multi-professional team will minimize time wastage and ensure timely access, meeting safety requirements and promoting mental health, leading to beneficial outcomes. Moreover, identifying appropriate discharge plan options is vital as it supports successful rehabilitation processes (Cameron, 2020). Healthcare professionals must consider available resources within a community setting while addressing issues arising from a lack of privacy and dignity, preventing intervention delivery, and competing unsuccessful solutions requiring improvements to meet risk situations. Pragmatic management, realistic importance, informed understanding, and strict osteomyelitis regulations are necessary to avoid causing infections via dressings (Govaert et al., 2018).
Another aspect highlighted through this challenge involves post-fall considerations toward patients’ recovery process. Nurses should work closely with other members of multidisciplinary teams while inviting dietitian support services to work together on the best possible sites, ensuring persons are better supported and avoiding depression or distress, leading to feelings of abandonment and potentially resulting in higher reliance on drinking alcohol as a coping mechanism. Struggling with life quality while attempting to reduce dementia symptoms and providing companionship and rehoming into one’s comfortable surroundings are essential in relieving caregiver stressors. These include patient self-care options earlier when promoting mindful pain management.
Furthermore, involving family members or neighbors in providing care and education is crucial. This helps develop a supportive network for Nancy and can assist with home modifications towards her safety at home, such as installing handrails near stairs or improving lighting to reduce the risk during nighttime. Collaborative working between healthcare professionals in addressing these challenges will be beneficial, as it would provide holistic support for individuals like Nancy who require comprehensive interventions to manage their complex health needs effectively while transitioning them back safely within community settings (NMC, 2015). This requires constant communication amongst nurses accessing services outside NHS funding, particularly unorthodox providers, to make better decisions and defend against patient historical incision care management decisions. Supporting collaboration among multidisciplinary teams is essential for addressing concerns raised by such patients regarding privacy and dignity while ensuring the best possible outcomes, reducing financial implications, and making multiagency teamwork more efficient. Tissue viability considerations include energy saving through identifying wearing methodical association, familiarizing comfort, assessing the level of ability, assessing play motivation, choosing modalities, and using locally sourced furniture that caters to mental and physiological needs (Durán-Sáenz et al., 2022). Extending media interaction and lifestyles comfortably to accommodate good digestion and quality lifestyle improvement, advocacy, and ending loneliness is essential for emotional benefits, being sociable, and sharing common experiences.
Finally, intervention delivery solutions must target positive social interactivity in therapeutic communities, guiding towards lessening sepsis and social symptoms, proportionally making pain management accessible and attainable, and expecting delivery expectations early on. Complex care needs require a comprehensive approach involving collaborative working between healthcare professionals to ensure effective management of physical, psychological, and social challenges faced by individuals like Nancy. By critically exploring our role as nurses in coordinating such challenging cases while incorporating evidence-based practice informed by relevant policies, we can successfully support patients towards positive outcomes that promote self-care, empowering them economically.
Slide 7: Challenge 3 – Leg Ulcers Management
Leg ulcers are a common complication in individuals with diabetes, like Nancy. Managing leg ulcers involves addressing the underlying condition while promoting wound healing and controlling infection (Evans et al., 2019). In addition to this complex care need, Nancy also requires catheter care at home. District nurses play an important role in managing dressing changes for patients with wounds; however, they may face challenges due to limited resources or staffing issues. This highlights the importance of collaborative working between healthcare professionals involved in her care.
Furthermore, as mentioned previously, numerous complications can hinder successful wound healing, including comorbidities requiring specific interventions (Tickle, 2021.). Moreover, it is crucial to ensure appropriate stocking levels remain available, ensuring associated pressure ulcer contamination continues reducing overall exposure risk while adhering to strict procedures and putting patient safety first. Improve access; permissive blood flows through efficient elimination of contaminations. As professionals with a strong focus on critical thinking, we are responsible for proactively seeking out and exploring opportunities for addressing unmet human needs and enhancing volunteer services within the London and Dartford Area Hospitals NHS Trust. This endeavor aims to improve individuals’ overall quality of life, particularly those dealing with Complex Care Needs. District nurses must establish partnerships and collaborate with pharmacists (El-Awaisi et al., 2018). This collaboration should encompass guidance on medication administration schedules, strategies to reduce the risk of falls, and the efficient administration of insulin techniques. Additionally, maintaining strict control over medication dosages and encouraging self-administered consultations with general practitioners offers a promising approach to preventing the exacerbation of infections.
Although advancements in wound management techniques have led to positive outcomes, there remains a risk of further complications with leg ulcers. This is where multidisciplinary teams become crucial as they can collaborate and work towards different interventions that will support the individual’s recovery. Managing catheter care also requires collaboration between healthcare professionals such as nurses and therapists (HSE Health Protection Surveillance Centre, 2022). It involves ensuring appropriate catheters are used along with regular maintenance practices (NICE, 2020). Furthermore, the approach would encompass the management of infection-associated risks through counseling before discharge. This involves collaborative efforts to eliminate common blood-borne pathogens by ensuring the correct administration of medications, issuing warnings, addressing potential contamination breaches, and developing comprehensive catheter management care plans.
Incorporating family members or social networks to educate patients on self-catheterization has been recognized as beneficial. This approach helps reduce patient anxiety and fosters a better understanding of properly maintaining equipment with clear guidance and instructions. Schutzer’s journey in managing non-management is dynamic and interactive. It involves enjoying a liberated and confident experience, especially for women undergoing drip therapy. The advantages of this mentally reassuring outreach program extend to social interaction, professional development, entertainment for pediatric patients, and, most importantly, the dissemination of practical knowledge and enhanced confidence. It is highly recommended for building rapport, promoting commitment, and expediting vascular assessments. Maintaining proper standards for residents enhances their resilience and contributes to improved care standards.
Slide 8: Collaborative Working
Collaborative working involves the involvement of different healthcare professionals to provide a comprehensive multidisciplinary approach to managing complex health and social care needs (Morley & Cashell, 2017). In Nancy’s case, this would involve nurses coordinating with other agencies like therapists or district nurses to manage various physical challenges such as leg ulcers efficiently. However, challenges can be faced while efficiently organizing services when planning rehabilitation interventions, employing successful quality of life, and allowing independent value to avoid a negative impact on others. In addition, cross-working between NHS sectors also benefits service users and staff, maintaining stability while promoting self-esteem by improving the knowledge base, ability safety, and reducing re-infection. It is still a vital part of increasing positive outcomes. The role played by each member in the development and delivery process must always be defined according to these directives, state legal frameworks, monitoring implementation laws, and supporting delivery. The NMC Code of Conduct should relevantly guide support for Professionals as limited capacity qualities lay changes and act safely, confidential instill joiner expected behavior standardize Emergency Departments, most effective.
Moreover, it highlights how coordinated effort benefits patients requiring multiple discrete comorbidities. Medication errors are avoided, and better governance inefficiencies are reduced through effective multiagency collaboration. For example, suppose optimal conditions are healthily practiced on discharge. Similarly, we discuss innovative ideas while considering cost-effective practices addressing health needs. In that case, the service is received from the multi-professional team. Involving family members and carers in the care planning process is also crucial. Being aware of their patient support network, we must include them as key stakeholders to promote successful outcomes. Working together helps individuals feel supported during difficult times and provides an opportunity to encourage embracing diversity through self-assurance. That embodies incorporating the ‘Open Culture’ concept, allowing person-centric environments to exceed social expectations. Collaborative working can also extend beyond traditional healthcare organizations. Involving voluntary or charity groups may provide unconventional yet effective interventions to address various challenges faced by complex patients like Nancy (DoH, 2016).
Furthermore, numerous advantages are associated with collaborative working approaches among colleagues and specialist teams, multidisciplinary find identification recognition, reduced avoidable admission episodes reoccurring, concluding supporting evidence between reducing Complex Care Needs and better stability in community services. Collaboration within different sectors, including NHS, cannot be emphasized enough since this would facilitate decision-making while ensuring policies and techniques are legally guided. Protocols are carried out successfully to raise and ensure active participation, stimulating positive mental impacts, healthy/unfitting lifestyles, and patient independence. Another important aspect highlighted when discussing collaborative efforts includes clinical governance involvement, enabling efficient practice assessments, recording vital unity, all supporting initiatives, providing apps and regular support, maintaining quality, and integrating the project to individualize one’s own needs, person-centricity by involving self-care, allowing expressions of the Patient-Centered Approach. In conclusion, collaborative work is imperative in managing the complex health and social care needs of such individuals as Nancy. It promotes a comprehensive approach toward addressing multiple challenges while ensuring safe patient outcomes through evidence-based practice. Thank you for your attention. Any questions?
Slide 9: Conclusion
Nancy’s case highlights the complexities of managing an individual with challenging health and social care needs. It requires a comprehensive approach involving collaborative working between healthcare professionals to address physical, psychological, and social challenges to manage her conditions effectively.
As nurses, we must critically explore our professional role in coordinating her complex care needs while considering relevant policies and legislation that can inform evidence-based practice toward safe patient outcomes.
The complexity of Nancy’s case emphasizes the need for critical thinking skills while making clinical decisions aligned with NMC guidelines(2015). By acknowledging individuals’ medical history, providing specified interventions catering to both physiological/psychological requirements not only directly reassuringly improves quality but empowers person-centric settings to successfully re-engage in meeting diverse Complex Care Needs
Thank you for listening. Any questions?
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