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Shared Care Plan

Table of Contents



Facilities and organisation needed to be accessed by Liam’s parents.

Patient care goal and associated barriers.

The essential skills needed in registered nurse (RN)

Relevant health development project in local health network and impact of it over Liam’s care plan


Reference list

Introduction to Liam Complex Care Case Study

The providence of better quality of life and clinical care to each and every individual of a nation should be the goal of the healthcare sector of a country. Australia has adopted the same and the Australian government is moving on with the mission to promote the access of the patient and their family members in the best medical facilities. In the provided case study, it has been identified that Liam is a boy of 15 years and has multiple clinical complications like Asthma and JIA (Juvenile Idiopathic Arthritis) which has imparted negative impact over his lifestyle and health issue has promoted the occurrence of social withdrawal within him. The purpose of this essay is to identify and analyse the best care plan for the said patient, in order to provide a better quality of life to him.

Discussion on Liam Complex Care Case Study

Facilities and Organisation Needed to Be Accessed by Liam’s Parents

The case study has informed that Liam has the acute condition of Asthma exacerbation. Hence, the parents of the patient should communicate with the National Asthma council of Australia. In recent times, with the integration of technology in the field of medical science and communication, the process of consultation and management of the acute condition has turned easier. The National Asthma Council has published their guidelines in the official website to easily communicate with the patient and to provide them guidelines as well. As per the official website, the first aid of Asthma includes positioning of the patient in the upright position, four puffs of grey or blue reliever with or without the spacer (National Asthma Council, 2020). Four deep breaths should be taken and four minutes should be observed after the inhalation. Moreover, the organisation has published an asthma handbook which should be collected by the parents. The asthma handbook contains more than 500 recommendations to keep the infant patients safe from the acute asthmatic attack.

On the other hand, the utilisation of technology and National Health Service should also be taken by the parents of Liam in the time of crises. As per the official report, the calling of triple zero helps in the providence of medical care and the availability of ambulances is also managed with the same (National Asthma Council, 2020). Hence in the time of acute attack this help should be taken by the parents of Liam.

The primary intervention includes the keeping away from the cause of irritation and this should be managed with self-care.

Patient Care Goal and Associated Barriers

  • To manage the issue of acute asthma exacerbation

The case history of Liam has proved that the patient has to take hospital admission for four times at the last summary for acute asthma attack. This is needed to be managed to provide the patient a better lifestyle. Hence, the development of a patient centred care model is necessary for the long term. However, the barrier is the climatic condition of Westtown as dust storms are frequent for drought. On the other hand, in the place of his father, Michel, the patient also gets attacked by allergens as there are cattle farming. Bousquet et al. (2018) has mentioned that regular use of mask helps in the minimisation of the allergen interaction with the patient and this helps the patients of asthma to be safe for a long time. This should be applicable for Liam’s care plan but the other boys of his age do not use it regularly and this may create a mental discomfort or psychological stress over Liam. Hence, this is another barrier which should be managed with psychological aspect analysis and emotional support by the caregiver.

  • To identify effective medicine for long term purpose

As per the case study, it has been noticed that corticosteroid preventer is nasally administered for the patient on a regular basis. The general practitioner has prescribed the same for Liam. Cooper et al. (2015) has criticised the long term application of corticosteroid drugs for asthma prevention and have mentioned this drug has specific side effects like swelling of arms for fluid retention, eye pressure elevation leading to glaucoma and hypertension as well. The case study has revealed the occurrence of the same in the body of Liam as he has a mild swelling in the left knee. Additionally, NSAIDS-BD naproxen has been applied as regular medication for JIA which often invokes depression among the patient (Lopes-de-Araújo et al., 2016). The case study has revealed that Liam has the issue of social withdrawal which may be the side effect of the mentioned drugs. Hence, identification of proper drugs is necessary to address the issue of side effects in the patient along with the development of a patient-centred care plan. The major hindrance in achieving the goal is that the playpen is still not associated with any health development project near to his location and he has to travel 250 km from Westtown to consult his doctor about the complication of JIA. Additionally, his regular physicians have also transferred to Youbeaut clinic which has also created a lack of communication between the doctor and the patient. This communication gap should be managed and the parents of Liam have to take proper steps to involve their son with local health development projects to get guidance about long term care and medication.

  • To design special care plan for JIA

The development of pain management strategy should be done for Lima as per his age and body weight. As per the viewpoint of Hanns et al. (2018), joint effusion, limited movement, muscle spasm and swelling is associated with the complication of JIA that can be managed with anti-inflammatory medication. Moreover, the application of splints during night and moist heat pad helps the child patients to get instant relief from the pain (Stoll et al. 2018). The restriction in overstraining of the muscles and the reason behind the same should also be explained. However, all these caregiving processes need intense communication of the child patient with the caregiver on an individualistic level. The major barrier is that Liam has no proper caregiver and both of his father and mother are busy with their respective professions. Appointment of a registered nurse and regular session for nursing should be implemented for the caregiver of Liam.

The Essential Skills Needed in Registered Nurse (RN)

The skill of critical thinking along with the skill of the development of a patient-centred care model is highly essential to manage the goal that has already been stated in the upper section. Liam has two major chronic illnesses like Asthma and JIA which is deteriorating his lifestyle than that of the other boys or girls of his age (as per the case study). Hence, the development of a tailor-made caregiving plan is essential to manage the patient and his emotional needs as well. As per Bahrudin et al. (2019) Abdellah has developed the patient-centred model of caregiving in which the pendulum of caregiving oscillates within major three factors like client-centred, nursing centred and disease centred. The analysis of the physical discomforts like pain from JIA or wheezing or short breath for asthma should be done to develop a patient-centred care model for Liam. In this process the application of critical thinking skills is essential. Additionally, the identification of effective long-term medicines should also be done by the RN and in this case the skill in pharmacology is also needed in the selected RN.

In the case study, it has been noticed that responsibility of Liam is taken by both o f his mother, Erica and his father, Michael. However, his father and mother are separated and have their own family which has created a gap in taking active initiative for long term treatment and caregiving to Liam. The father of Liam is associated with farming and remains busy with the same while his mother is a full-time bank worker. This has invoked a gap in the process of caregiving and continuous support to Lima. Hence, a RN is needed for Lima to manage the acute situation of his asthma and JIA. As per the idea of Wei et al. (2020), Asthma is a chronic disease which persists for life long and appropriate medication along with a modulated lifestyle helps the patient to lead a better and healthy life. Hence, it can be analysed that the aspect of patient education is highly important. The RN of Liam should have skill in the patient education which is specifically targeted for the teenagers. As per the viewpoint of Cockcroft (2018), identification of the irritant causes like dust, smoke, vehicle and firework fumes, cattle and being away from the same helps in the minimisation of severe asthma attacks. The RN have to transmit this knowledge to Lima through patient education. On the other hand, regular intake of medicine and the importance of the same should be explained to Lima in order to make him more efficient in managing his own health ailments.

The process of juvenile caregiving is quite complex and it demands the analysis of child psychology. Jensen-Doss et al. (2018) has research in the field of nursing and has mentioned that the analysis of adolescent psychiatry is essential to provide emotional support to the teenager patient. In this case also, the skill of psychological support providence in the RN is also essential. Kobak et al. (2015) has mentioned that the secure base model of caregiving cycle is applicable for juvenile patients with chronic diseases. This model includes the aspects like child's behaviour and need, feeling and thinking of the nurse, style of caregiving along with the child's feeling and thinking. All these factors are interdependent and have created a cyclic form. Hence, the RN should have the skill of implementation of the theoretical model into practice while caregiving to Liam.

Relevant Health Development Project in Local Health Network and Impact of It Over Liam’s Care Plan

In Australia, the health development project is organised at the national level for providence of clinical support to the community of the country and infant patients are also specially targeted in this programme. This is applicable for the case of Liam as well. Australian government has taken the strategy to support the patients with different types of arthritis among which JIA has also been focused and this has developed the health development programme called Time To Move. As per the official report JIA has affected more than 5000 infants around Australia and has created a major juvenile health issue in the national level which triggers joint damage, disability and growth abnormality as well (Arthritis Australia, 2014). In order to manage the same, community-based musculoskeletal issue management has been integrated with the care plan. Additionally, the primary and secondary prevention plan has been mentioned in the strategy of JIA management which includes awareness development and self-management as well. However, in the aspect of nursing the report has provided disappointing data. It has been mentioned that only 30 to 50 nurses are available to take care of the issues associated with rheumatology. Hence, the availability of efficient nurses for lima is quite critical.

Conclusion on Liam Complex Care Case Study

At the end of the study, it can be concluded that the management of infant patients is a complex process which demands the development and implementation of individualistic care plans. The case study of Liam has also revealed the same. The patient has the complication of JIA and acute asthma which should be managed with the development of a caregiving plan afd in this case, the application of analytical skill, critical thinking skill, the skill of patient education along with the skill of emotional caregiving is needed. The direct and individualistic communication with the caregiver is necessary for the teenager patients like Liam which is not present in the family of Liam. Hence, the appointment of an RN is essential for regular caregiving sessions and development of long-term caregiving goals along with the lifestyle modulation goal. JIA creates excruciating pain in the joints and specifically in the right hand and shoulder and left knee of the patient which demands pain management drugs with the use of warm moist heat pad and restricted muscular strain. All these factors can be managed with the involvement in the local health development project.

Reference List for Liam Complex Care Case Study

Arthritis Australia, (2014). Time to Move:

Arthritis. https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/09/Final_Time_to_Move_Arthritis.pdf

Bahrudin, M., Sudiwati, N. L. P. E., & Wulandari, T. (2019). Development of Diagnosis Determination Model in Nursing Process based on Patient Centered Theory. Indian Journal of Forensic Medicine & Toxicology13(4), 1596-1599. https://doi.org/10.5958/0973-9130.2019.00533.4

Bousquet, J., Arnavielhe, S., Bedbrook, A., Fonseca, J., Morais Almeida, M., Todo Bom, A., ... & Siroux, V. (2018). The Allergic Rhinitis and its Impact on Asthma (ARIA) score of allergic rhinitis using mobile technology correlates with quality of life: the MASK study. Allergy73(2), 505-510. https://doi.org/10.1111/all.13307

Cockcroft, D. W. (2018, February). Environmental causes of asthma. In Seminars in respiratory and critical care medicine (Vol. 39, No. 01, pp. 012-018). Thieme Medical Publishers. https://doi.org/10.1055/s-0037-1606219

Cooper, V., Metcalf, L., Versnel, J., Upton, J., Walker, S., & Horne, R. (2015). Patient-reported side effects, concerns and adherence to corticosteroid treatment for asthma, and comparison with physician estimates of side-effect prevalence: a UK-wide, cross-sectional study. NPJ primary care respiratory medicine25(1), 1-6. https://doi.org/10.1038/npjpcrm.2015.26

Hanns, L., Cordingley, L., Galloway, J., Norton, S., Carvalho, L. A., Christie, D., ... & Baildam, E. (2018). Depressive symptoms, pain and disability for adolescent patients with juvenile idiopathic arthritis: results from the Childhood Arthritis Prospective Study. Rheumatology57(8), 1381-1389. https://doi.org/10.1093/rheumatology/key088

Jensen-Doss, A., Ehrenreich-May, J., Nanda, M. M., Maxwell, C. A., LoCurto, J., Shaw, A. M., ... & Ginsburg, G. S. (2018). Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET): A comparative effectiveness trial of a transdiagnostic treatment and a measurement feedback system. Contemporary clinical trials74, 18-24. https://doi.org/10.1016/j.cct.2018.09.011

Kobak, R., Zajac, K., Herres, J., & Krauthamer Ewing, E. S. (2015). Attachment based treatments for adolescents: The secure cycle as a framework for assessment, treatment and evaluation. Attachment & human development17(2), 220-239. https://doi.org/10.1080/14616734.2015.1006388

Lopes-de-Araújo, J., Neves, A. R., Gouveia, V. M., Moura, C. C., Nunes, C., & Reis, S. (2016). Oxaprozin-loaded lipid nanoparticles towards overcoming NSAIDs side-effects. Pharmaceutical research33(2), 301-314. https://doi.org/10.1007/s11095-015-1788-x

National Asthma Council, (2020). Asthma First Aid.. https://www.nationalasthma.org.au/asthma-first-aid

National Asthma Council, (2020). Australian Asthma Handbook. https://www.nationalasthma.org.au/health-professionals/australian-asthma-handbook

Stoll, M. L., Kau, C. H., Waite, P. D., & Cron, R. Q. (2018). Temporomandibular joint arthritis in juvenile idiopathic arthritis, now what?. Pediatric Rheumatology16(1), 32. https://doi.org/10.1186/s12969-018-0244-y

Wei, X., Jiang, P., Liu, J., Sun, R., & Zhu, L. (2020). Association between probiotic supplementation and asthma incidence in infants: a meta-analysis of randomized controlled trials. Journal of Asthma57(2), 167-178. https://doi.org/10.1080/02770903.2018.1561893

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