Report Writing Assignment

Ax2–Case Management Formulation and Plan

*Indicate questions which require referencing

• Formulation

*Conduct a short review of literature and present an outline of evidence regarding intervention with your client.

1. What does literature tell us about goal setting and/or client directed care?
2. What role does interpersonal skill, particularly ‘rapport’ play in client intervention?

*What approach will you take to intervention with your client? And,why is this the most effective way of addressing your client’s goals?(Strength-Based, Rights-based, Person-centred, or Needs-based)

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*Discuss an aspect of a behaviour change model, practice or intervention, and how it influences intervention with your client?

(ie. Self-efficacy and personal responsibility)

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• Case Management Plan

1. Organisation, Service and Role

Organisation:______________________________. Service or Program:______________________________.

Service Description and your role: _____________________________________________________________________

Other Service Providers Involved:

_____________________________________________________________________

• Client Demographics

Name:_______________________________. DOB:__________. Gender:____________________.

Address:__________________________________________________.

Primary Presenting Issues (brief summary):

_____________________________________________________________________

Within the table, address the following questions;

What are the immediate, short, and long-term needs?

What are your client’s associated strengths or abilities?

What are the client’s goals for intervention?

Discuss your client’s family structure, dynamics, communication and decision-making.

How did you support the client to ensure the goals are realistic and achievable?

_____________________________________________________________________

!) Consider inserting a tool like a Genogram, or model with a legend.

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Who are the key stakeholders involved within your client’s care and what are their goals, roles and responsibilities?

Provide a link to an appropriate service referral form (if available) relevant to the care of this client and discuss the process for accessing this service

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What processes or strategies will be implemented to regularly monitor the effectiveness of your client intervention? Ie. goals, service provision and client and stakeholder satisfaction.

_____________________________________________________________________

How often will you monitor your client’s Case Management Plan?

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Discuss any known or potential limitations to confidentiality within your client intervention, and what strategies will or have you used to ensure your client is aware of this information/limitation?

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Discuss any known or potential ‘duty of care’ concerns relating to your intervention with your client, and how you will ensure the risk is mitigated and your responsibility is upheld?

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How will you ensure that intervention with your client adheres to relevant organisation and regulatory standards?

_____________________________________________________________________

What avenues of appeal or complaint exist for your client or their carers?

(Specifically to this client) What gaps are you able to identify in your own experience, skills and how will you address them?

_____________________________________________________________________

Client Centered Care

Client centered care is not a new concept for healthcare but it has gained popularity these days as it helps to improve the healthcare outcomes in a better way. Healthcare professionals, particularly nurses have been trained for quality healthcare services. It is also known as ‘patient or family oriented care’ as interaction happens between staff, patient and family members. Patient and family both plays an important role in service delivery and are the important components of the system. Another important point to be noted here is that the decision making process which is worked out by taking individual views of patients, families and health staff as well. Client centered care improves relationship of patients and healthcare providers.

In healthcare setting, decision pertaining to patient treatment is very important to understand. Negative outcomes have been observed if decisions are based upon the experience and opinion of health staff. The above stated issue can be mitigated by following client centered approach in nursing practice. This approach put the patient at the center of decision making process. Patient receives power to decide about his health. It does not mean that they got freedom for anything rather allows people to play a role of an expert hence resulting into better healthcare results (McCance, McCormack, Dewing, 2011).

Client centered care seeks people’s desires, opinion to find out better solution. It is important to pay attention and respect to patient’s thoughts. Health of the people can be managed effectively through sharing of decisions.

Earlier people were given healthcare services by the service provider as they used to feel that it is good for the patient. The scenario has changed and service providers have become flexible in their approach and first discuss with the patient and family members. Client center care is an individual or personalized care having following advantages –

• Sharing of information
• Respect of views of patients and families
• Better quality of health services
• Involvement of family members
• Psychological and emotional support

Client or patient centered care remove pressure from the healthcare staff and patients receive the service as per their desire (Hughes, 2011). Also improves the quality of services. It also assists to reduce the burden of disease as people will decide about their health and will live longer. Therefore, strengthening of thoughts of people is an important strategy from public health point of view. Integration of this strategy in national agenda as main public health policy will definitely improve healthcare indicators. It has become world widely accepted concept.

The service delivery system could be enhanced if nurses are trained or given regular sessions of patient centered care. Improvement in medical practice, especially nursing care services, would definitely alter the current situation of health system. Number of patients getting benefits out of client centered care would increases tremendously. Length of hospital stay will also reduce which in turn will decrease health expenditure. Overall, it can be said that it is a new transition within health sector (Berwick, 2009).

Interpersonal Skills

Healthcare delivery depends upon inter professional skills of healthcare service providers. Building relations with patients helps to deliver good quality of services. Standard of health system majorly rely on skills of staff. Quality healthcare services largely affected by two important parameters – communication and establishing relation with people. Communication happens two ways – between health staff and patient and within service providers. Both ways are important for service delivery with improved results (Zwarenstein & Reeves, 2006).

Interpersonal skills form an integral part of nursing profession. This profession interacts with community members on daily basis so need to have good communication skills. Their roles and responsibilities include take care of diseased person. During critical conditions of patients, they cannot speak so it is become important to understand their needs and desires through nonverbal communication. Due to constant interaction with people within healthcare setting, they are expert to understand their feelings and support them emotionally. Effective communication contributes to higher level of satisfaction among staff which in turn increases morale of them for better interaction. This also leads to lower level of stress among nursing staff otherwise high turnover rate occurs.

Use of interpersonal skills as healthcare strategies promote functions, quality and wellness of healthcare delivery system. A nurse advocates for those patients who cannot speak hence in this scenario understanding of needs is very crucial.

Interpersonal communication works on similar principle of Maslow’s hierarchy of needs. Maslow’s theory has three steps to achieve effective communication power – safety, love & esteem, and self-actualization. Safety is very important at first point. From patient point of view, he must feel secure while treatment or within the hospital. Once this stage is crossed, a bond is established between patients and nurses. Finally self-actualization denotes development of inner sense towards good health of the people. Experiences and education level of nurses are directly related to feelings, perceptions, and values of the patient.

Exchange of information and ideas happens through communication and mode of interaction could be verbal & nonverbal. Interpersonal skills assist in creating a healthy environment to impart knowledge or information. As nursing profession is to work with patients so non-verbal function more effectively than verbal method of communication. Miscommunication has negative impact on services as they disrupt the whole chain of communication and medical errors occur because of the same reason.

Sharing of knowledge creates sense of responsibility among all nursing staff for their work. Healthcare system revolves around interaction with patient, quick decision, knowledge sharing and early treatment. This all happens when healthcare team is qualified enough to understand the needs of their patients.

Today’s demand is to strengthen inter personal nursing practices to build up trust with patients and their family members so that maximum number of people can avail the services of healthcare system. Interactive environment helps to achieve set goals and objectives of the system. This leads to transparent communication among health professionals and the related health staff. In another way, people receive quality healthcare services and results into improved health status of the country.

Practical Approach for the Client

Person centered is preferably the best approach to address client’s goal as client or patient defines his/her willingness for the treatment part. This way always benefitted the client and nursing staff as well. This increase the participation of the patient in decision making process. Needs based approach is quite effective in special conditions only.

Behavior Change Model

Behavior change models assist to understand the client’s attitude for disease prevention approaches. There are various types of behavior change model, for example, psychological model. Model is based upon the following attributes – perceived severity, perceived benefits & risks, action, and self-efficacy (Hardeman et al, 2002).

Perceived severity – seriousness of the issue (disease condition)

Perceived benefits – patient’s perception towards effectiveness of treatment or actions performed to fight against the disease

Perceived risks – patient’s perception for risks associated with treatment procedure

Self-efficacy – patient’s determination to perform a particular behavior

Behavior change model is essential from a nurse point of view as it finally work upon self-efficacy nature of the patient. In the beginning, a patient perceive behaves in a very negative way and perceives that disease cannot be cured. Nursing practices develop self-efficacy behavior that strongly affect self-determination to adapt their life style and start working on positive thinking.

Client Demographics

Primary Presenting Issue

The primary presenting issues are anxiety, lower motivation level, and feeling of hopelessness of the patient. It is easy to predict about the mental and physical health status of the patient. For a nurse, it is very difficult to handle the situation as the patient might be living with low self - esteem and determination. Hence, communication provides enough psychological support to the patient. The main task of the nursing staff is to make the patient comfortable in difficult conditions so that he prepares himself for any other associated risk.

Immediate Goals

Immediate goals are to stabilize the health condition of the patient and establish a strong relationship between health staff and the patient.

Short Term Goals

Short terms goals are the following –

• To attend a general physician appointment
• To obtain a mental health treatment plan
• To attend counselling sessions (one session per week)
• To attend catholic care
• To monitor and review set goals continuously

Long Term Goals

Long term goals are the following –

• To fight against anxiety so that it does not have any impact on school attendance or submissions
• To meet friends to develop confidence

Strength and Abilities of the Client

It is outlined in the given example that client is mentally strong and engaged in self-seeking behavior. Client has strong friends and family support. He has already undergone similar type of condition earlier and finally came out of the situation very strongly without any demotivation. He is passionate for attending school classes and sports activities. He has positive attitude for his mental status and health recovery.

Client’s Goal for Intervention

Client goal for intervention is to develop morale or confidence level so that he can enjoy among his friends without any anxiety issue. Another goal is to work upon feeling of hopelessness.

Client’s Support

The given task is to persuade the client that the set goals are realistic and achievable. Proper message should reach up to the client so that he also takes some initiatives and build up rapport with the staff. Client centered approach is much better and effective for such scenario.

Family Structure

Client has very supportive family environment. They all are involved in decision making process with effective communication between family members and client.

Key Stakeholders

Strategies for Monitoring of the Effectiveness of Interventions

Satisfaction level of Client’s and Family Members

Monitoring would be based upon by collecting information from client and family members as well. Here it is important to plan out an open ended survey to find out the satisfaction level and accordingly rating can be given on the scale of 0 to 10, where 0 represents lower level of satisfaction and 10 represents higher side of the satisfaction.

Timeline

In the beginning, monitoring can be done every week to know the progress of the health condition of the client. Later on, it can be planned to carry out monthly survey. This might help to change the intervention strategy as per the results of these studies.

Limitations

One of the main limitation could be the availability of the client to attend such type of satisfaction survey. He might not be agree to carry out these steps so proper information has to be communicated through friends or family members.

Duty of Care

If client rejects the intervention plan or does not follow the suggestions then situation would become worse than ever to deal with. This could be mitigated through strong interpersonal skills only.

Adherence to Organizations and Regulatory Guidelines

Guidelines issued by the Government are strictly followed in healthcare setting. Interventions are designed based upon the given instructions. Adherence to the principles and guidelines, is an important aspect of the success of the planning. The healthcare authorities keep an eye on the follow up of the plan. Client is also observed for proper follow up and family support is also needed to achieve the goals and objectives.

Appeal or Complaint

Gaps

It can be predicted that client is active except problem of anxiety. He is not able to face his friends because of low motivation level. Dealing with issue would improve the whole health status. Positive point with the current study is that the situation is under control so will not create any further problem.