NUR272 Mr. Arron Case Study Sample

Palliative, Rehabilitation and Continuing Care

Introduction to Palliative, Rehabilitation and Continuing Care

The present case is of Mr. Arron who is thirty-nine years old and was living with swollen lymph nodes in head and neck region and was suffering from the soreness of muscles and this was seen after his holiday in the south-east Asian region. He had believed that his symptoms were due to his busy lifestyle. He works full-time as a sound engineer and works for the betterment of the LGBT community of North Lakes. After the demise of his parents, he shifted back to his family home and there are no identified close partners. In the video, Arron states that he as his health literacy is less and it took him more time to get over the shock. For the assistance of the patient, it is required that the course of illness that is seen over time and in a progressive illness like the present one it is required that nurse understands the trajectory of the disease (Erickson et al. 2019).

Main Body of Palliative, Rehabilitation and Continuing Care

In the present case, the nurse is expected to use the Corbin and Strauss chronic illness trajectory. This framework consists of six steps and they are the identification of trajectory phase; identification of problems and establishment of goals; establishment of meeting the goals; identification of factors which might hinder the attainment of goals; implementation of intervention and evaluation of the effectiveness of interventions (Burke et al. 2016).

The Person

As a nurse, it is required that complete assistance is given to the patient so that the health outcome can be positive. In case of chronic illness like the present one which is progressive in nature, the health outcome is usually death but the knowledge, information and skills of the nurse can alter the quality of life of the person (Falvo and Holland 2017). As a nurse, it is required that one has knowledge regarding the pathophysiology of the disease. The present case is regarding HIV and the main cause of the condition is due to unprotected sexual contact or sharing needles with one who is an infection or even getting blood from an infected individual (Rodger et al. 2016). It is not a contagious disease but it is a communicable one and it is only by blood and not merely by the contact with the person. It has a long-dormant phase and being HIV positive does not mean a person has AIDS as former is the condition and the latter is the disease.

In the present case, the action of the nurse in support care is such that Arron can be made to understand what he is going through. It is often seen that once the patient understands the disease process it is more helpful for him to make healthcare decision. The patient does not have health literacy related to his condition and even in self-management and this might be the cause of hindrance towards gaining the knowledge that is being provided to the patient (Jeong and Kim 2016). It is important as the patient needs to understand what is happening to take actions for the betterment of the quality of life.

The Close Interpersonal Relationships

Interpersonal care is required in the present case as the disease is still viewed as a social stigma and it is the duty of the nurse to make sure that the patient feels more at ease as the relation between the patient and nurse is the one which is built on rapport and trust. The nurse should be caring and sensitive to the current condition of the patient and it can be achieved by the help of effective verbal as well as non-verbal communication (Helms et al. 2017). This will help in the formation of relationship which can help the patient in coming forth with the information as and when his condition changes so that appropriate measures can be taken for prevention or mitigation which would otherwise change the quality of life. As nurse should possess best communication skills possible and few of the things that can be used is empathetic listening, active listening, maintenance of eye contact and appropriate body language (Hermann, Long and Trotta 2019).

As the present case is of HIV, which since historic times have been associated with homosexuality and polygamy which can be extremely sensitive for the patient to discuss due to the fear of stigmatization. This can be deemed as a barrier to communication and hindrance to close interpersonal relationship between the nurse and the patient (Alshammari, Duff and Guilhermino 2019). There are many changes that might take place in the body and systems which the patient needs to identify and report so that appropriate measures can be taken. In the video, Arron seems positive and talks regarding having less knowledge but is aware of some aspects of prevention and this can help in creating positivity and facilitate interpersonal communication. Arron also has a sister with whom he is currently living and she can be of valuable importance in creating and enhancing communication which is the positive factor in favour.

The Organisation (of healthcare)

Healthcare organizations’ role in the care and prevention of HIV is profound. People suffering from HIV require continuous care as the condition is a chronic and progressive one. The progressive nature of the disease condition is often associated with large and substantial morbidity and mortality. To ensure that there is the reduction of the expected and substantial morbidity and mortality which is present globally and universal access to the comprehensive healthcare facility is one such measure which can reduce it (Kendall et al. 2018). Any healthcare facility that is present should possess a few services which would make it effective for the care of HIV patients. The services that are required and expected are there should be voluntary as well as confidential counselling and testing for HIV infection. It should be able to provide services for the prevention of transmission of infection in the vertical direction as well as between the partners; provision of prophylaxis treatment against opportunistic infection. Diagnosis of the other conditions which are related to the condition and provision of antiretroviral treatment and palliative care are other services that are required to be present in the healthcare organization (Kendall et al. 2018).

In the present case, Arron extends his concern over the fact that the spread of COVID-19 has extended in the isolated pockets in the community. The area of residence of the patient is remote and the level of healthcare services that are present might not be able to provide all the services possible and in the video, it is seen that he has to travel by vehicle to get his healthcare setting which over time can be challenging (Wang, Kung and Byrd 2018). HIV is a condition which reduces the immunity of a person and the chances of other infections increase and it makes him more prone to COVID-19. These factors can work as a negative factor as it might affect the accessibility and affordability of the treatment.

The Community – Community Networks/community Support

When a person is going through any medical condition and it can affect the psychological state of a person. It is required that a person has adequate social support to help him in tackling the situation. This is a requirement as being HIV positive can affect not only physical health but also the mental health of a person (Fauk et al. 2017). This is mostly due to the stigma that is associated with the condition which has caused negative attitude among others in community and society which leads to many changes in the social structure of a person. This is often denoted as social drift and there is an obvious change in sexual behaviour and affect the self-image of a person (Painter 2018). The individual can lose his employment due to his condition and as a part of treatment financial resources could be lost as well and lose friends and family who are considered to be a source of support.

As a part of nurse care, it is required that the nurse should be able to help the patient in finding the social support so that he can get through the condition not isolated but with considerable support. The patient does not have a close partner and he is not married either but he lives with his sister who can be a source of support. As a care nurse, it is the duty and responsibility to help not only the patient but the family as well to understand that course and implication of the disease. In this case, the sister can be educated regarding the condition so that the negativity is reduced and support can be provided. This is a factor which can work in favour of the care plan that is being formulated. Alternatively, a support group can be found which can help Arron in finding the social support but as he mentioned in isolated communities there are COVID-19 cases and this is a factor which acts negatively in terms of support provision (Painter 2018).

Equipment / Other Services

Physical and palliative care is not the only ones which are required by the patient but he also requires continuous monitoring and good nutritious food so that the immunity of the patient is maintained. This is one of the additional services that are required by the patient (Palar et al. 2017). This is because HIV is a condition which affects the CD4 cells of the body and eventually reduces the immunity of a person. Antiretroviral therapy, as well as good supplementation with better nutrition, can help in improving the quality of care of a person. Another service that can be a requirement for the patient is psychological support from a specialist, not merely social support. As the mental health of the patient can be affected due to suffering from a chronic progressive disease and in such cases, psychological support from the specialist might be necessary. Mental health along with physical health is required for the better quality of life and have a better outcome.

As a nurse, it is required that the action is taken towards guiding the patients towards the required specialist for nutrition as well as psychiatric help. In the present case, the place of residence and the healthcare facility accessible might be a negative factor which can affect the care plan. The other factor that can be a negative in the present case would be the socio-economic condition of the patient which might not help the patient in getting the required resources.

Conclusion on Palliative, Rehabilitation and Continuing Care

The present case was of Mr. Arron who is thirty-nine years old and was showing symptoms like muscle soreness and swelling of lymph nodes which existed for around 10 months. He was diagnosed with HIV after a series of tests and he made a video to capture his journey. In this assessment, Corbin and Strauss chronic illness trajectory were applied for the nursing care plan. In the context of the person, it was seen that his level of health literacy was reduced and was a hindrance for patient education. Interpersonal communication is an important part of healthcare and is essential. Suffering from such a condition can cause a lack of social support and it is of utmost importance.

Reference List for Palliative, Rehabilitation and Continuing Care

Alshammari, M., Duff, J. and Guilhermino, M. 2019. Barriers to nurse-patient communication in Saudi Arabia: An integrative review. BMC Nursing, 18(1), p.61. https://doi.org/10.1186/s12912-019-0385-4.

Burke, S.O., Kauffmann, E., LaSalle, J., Harrison, M.B. and Wong, C. 2016. Parents' perceptions of chronic illness trajectories. Canadian Journal of Nursing Research Archive, 32(3). https://cjnr.archive.mcgill.ca/article/view/1588.

Erickson, M., Shannon, K., Sernick, A., Pick, N., Ranville, F., Martin, R.E. and Krüsi, A. 2019. Women, incarceration and HIV: A systematic review of HIV treatment access, continuity of care and health outcomes across incarceration trajectories. AIDS (London, England), 33(1), p.101. https://doi.org/10.1097/QAD.0000000000002036.

Falvo, D. and Holland, B.E. 2017. Medical and psychosocial aspects of chronic illness and disability. Jones & Bartlett Learning.

Fauk, N.K., Merry, M.S., Sigilipoe, M.A., Putra, S. and Mwanri, L. 2017. Culture, social networks and HIV vulnerability among men who have sex with men in Indonesia. PloS One, 12(6), p.e0178736. https://doi.org/10.1371/journal.pone.0178736.

Helms, C.B., Turan, J.M., Atkins, G., Kempf, M.C., Clay, O.J., Raper, J.L., Mugavero, M.J. and Turan, B. 2017. Interpersonal mechanisms contributing to the association between HIV-related internalized stigma and medication adherence. AIDS and Behavior, 21(1), pp.238-247. https://doi.org/10.1007/s10461-016-1320-2.

Hermann, R.M., Long, E. and Trotta, R.L. 2019. Improving Patients' Experiences Communicating With Nurses and Providers in the Emergency Department. Journal of Emergency Nursing, 45(5), pp.523-530. https://doi.org/10.1016/j.jen.2018.12.001.

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Painter, T.M. 2018. Social support networks: An underutilized resource for the prevention of HIV and other sexually transmitted diseases among Hispanic/Latino migrants and immigrants. Journal of Health Care for the Poor and Underserved, 29(1), pp.44-57.

Palar, K., Napoles, T., Hufstedler, L.L., Seligman, H., Hecht, F.M., Madsen, K., Ryle, M., Pitchford, S., Frongillo, E.A. and Weiser, S.D. 2017. Comprehensive and medically appropriate food support is associated with improved HIV and diabetes health. Journal of Urban Health, 94(1), pp.87-99. https://doi.org/10.1007/s11524-016-0129-7.

Rodger, A.J., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., Van Lunzen, J., Corbelli, G.M., Estrada, V., Geretti, A.M., Beloukas, A. and Asboe, D. 2016. Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy. Jama, 316(2), pp.171-181. https://doi.org/10.1001/jama.2016.5148.

Wang, Y., Kung, L. and Byrd, T.A. 2018. Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting and Social Change, 126, pp.3-13. https://doi.org/10.1016/j.techfore.2015.12.019.

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