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The elements in Ben’s medical history that is making him medically complex are his post-traumatic stress disorder, depression, and back injury. Post-traumatic stress disorder is a persistent disorder related to mental health that happens after some traumatic life event (Lancaster et al., 2016). According to Calarge et al, (2017) depression is termed as a Psychological disorder characterized by a regular miserable mood and loss of interest in daily activities. Depression is considered as an impactful factor that deteriorates physical as well as emotional health. It affects the immune system and makes it weak, and the patient’s body finds it difficult to fight with the infection and to overcome it. Depression also contributes to making the patient’s body more exposed to chronic ailments (Ghaffarzadegan, Ebrahimvandi, & Jalali, 2016). Ben has a back injury that he got when he met with an accident, this accident made his L4-L5 fused. His injury often makes him feel chronic back pain and it is making his case medically complex because fusion of vertebrae has no solution except surgery and the surgical procedure is quite complex and the result of this surgery is not much successful. It involves complicated dissection of bone that may result in some more complex fusions. The overall situation is making Ben more medically complex as in his case, Posttraumatic stress, depression, and chronic pain are linked with each other and this situation is known as multimorbidity. However, both physical and mental elements are also contributing to Ben being medically complex as according to Tortajada et al, (2013) Multimorbidity can be defined as the simultaneous occurrence of three or more than 3 chronic health conditions. In this condition, a person’s more than 3 body systems get adversely affected even without specifying an index chronic stipulation. An individual suffering from multimorbidity also suffers from a poor quality of life, mental distress, disability, and a high mortality risk. Besides this, there are multiple requirements that are associated with multimorbidity that surpasses the personage impact on health status as well as the healthcare system. This impact on the healthcare system and the individual health status involves a wide range of resources, and thus, needs the strategies to be developed and focus on the organization of incorporated care for an individual under this condition (Harrison et al, 2014) and such a condition of multimorbidity has the potential to affect an individual’s health and life and this is what makes Ben’s case more complex.
In Ben’s nursing care management plan, there have been both conflicting management as well as the conflicted treatment element. The conflicting management in his management plan is advising him to visit a psychiatrist for his post-traumatic stress disorder not very often but, later on, he is advised to visit a psychiatrist at least once in a week and this is where both of the statements are contradictory and conflicting. Although, if the medication prescribed is also noticed then, it is seen that he has been prescribed Oxycodone and Oxycodone is an opioid. From Ben’s medical case, it has been seen that he was suffering from depression and it has been reportedly seen that taking opioids by patients of depression for pain relief is not safe as it may worsen the mental health. According to Sullivan, (2018) Opioids are generally used by patients that are suffering from chronic pain but, it increases the risk rate of anxiety, depression, and bipolar disorders. Along with this Opioid shows the greater risk of developing an addiction and dependence on itself as it is highly addictive as it changes brain chemistry in such a way that makes an individual to need it more and more. Ben is already a patient of depression so; using Oxycodone (an opioid) may increase the addiction for this drug and risk his psychological health and this is quite risky as well as contradictory to each and a conflicted treatment element in Ben’s case.
Situational complexity is termed as a distinction between technical and socially complicated situations. In situational complexity, there is a need to follow a prescribed course of action and should be flexible & responsive (Chazdon & Grant, 2019). In Ben’s case, the situational complexity is his loss of employment, family’s condition, and self stigmatization. Losing a job, the feeling of being unemployed, and not getting a job again is something that will affect any individual psychologically. This situation act as a barrier in his nursing care management plan because losing a job and not getting another might result in facing economical issues later, and Ben was suffering from multimorbidity i.e, he was suffering from many health issues be it physical or psychological and this health condition requires a lot of expense in terms of treatment and medication and being unemployed may result in him being financially weak. Ben’s family condition is also contributing to being a barrier in his nursing care management plan as since the time he has been living with his parents, he finds himself alone and he does not have anyone with whom he can talk. Depression should be discussed and family plays a key role in helping an individual to come out of it. Family can be his emotional and social support but, in his case, he does not have anyone to support him emotionally and socially. No social and emotional support will create obstacles in his nursing care management. There is always a need for social and emotional support for the betterment of care management and health outcomes. Lack of social support creates a strain on the individual itself as well on the care management system (Friedman, 2016). Ben’s relationship with his father is also not that good that he could share about his problem with him and his father was also struggling with mental issues while having a good relationship with his mother was also doesn’t seem to help him here as his mother does not want to discuss about mental illness. So, he doesn’t have anyone he can talk, discuss, or share his problem and this thing will also act as a barrier. In addition to all these factors self stigmatization is also a factor creating hindrance in his nursing care management plan because stigmatization has been considered as one of the most challenging factors faced by any individual with mental health issues as this adversely affects the individuals by being negatively stereotyped, facing social rejection, isolation, and discrimination while self-stigmatization results in the withdrawing of the individual from social support, avoidance of treatment, rejection of help, and even treatment withdrawal (Hing & Russel, 2017).
Multimorbidity is generally explained as the coexistence or presence of two or more than two persistent health issues within a person without an index condition. Multimorbidity of chronic conditions strikingly worsens the health outcomes in patients along with increasing the treatment burden and cost of the health service. Multimorbidity is related to the extensive health-care utilization as well as with a large number of prescribed drugs for the individuals with multimorbidity (Morrison et al, 2016). Primary healthcare professionals are frequently belligerent for the diagnosis of mental depression, and the person suffering from multiple chronic health issues this also contributes to increasing the additional complicating challenges. The diagnosis, as well as the treatment of mental disorder, also has an impact on the general practitioners Regardless of the high occurrence rates and significant effects of this condition on the patients, general practitioners, physicians, as on the health care systems; the main focus is still on its diagnosis and treatment of the diseases. The impact of this condition i.e., multimorbidity on the diagnosis and treatment includes disease patterns. These disease patterns can be mono- versus multimorbidity, disease combination that could be somatic-somatic; somatic-mental; mental-mental, and expressing the relatedness between two different disorders that are generally unrelated. It has three variables that have been further categorized into three more subgroups. These subgroups symbolize the physicians from various unrelated fields of specialization: they can be the residents of an emergency department, general practitioners, or psychiatrists (Hausmann et al, 2019). Effective and competent long-term management of the co-occurrence of chronic diseases has been one of the most challenging things that health-related and is faced by the patients, their family members, healthcare providers, and society more appropriately also for those who provide funds to the health care services. Multimorbidity possess considerable complications for health care policies as well as for the resource allocation decision making. The complexity that is related to multimorbidity management has a wide range of sources (McPhail, 2016).
Chazdon, S. & Grant, S. (2019). Situational complexity and the perception of credible evidence. Journal of Human Sciences & Extensions, 7(2).
Friedman, A., Howard, J., Shaw, E. K., Cohen, D. J., Shahidi, L., & Ferrante, J. M. (2016). Facilitators and barriers to care coordination in patient-centered medical homes (PCMHs) from coordinators' perspectives. Journal of the American Board of Family Medicine, 29(1), 90–101. https://doi.org/10.3122/jabfm.2016.01.150175
Ghaffarzadegan, N., Ebrahimvandi, A., Jalali, M. S. (2016). A dynamic model of post-traumatic stress disorder for military personnel and veterans. PLoS ONE 11(10): e0161405. https://doi.org/10.1371/journal.pone.0161405
Harrison, C, Britt, H, Miller, G and Henderson, J (2014). Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australia general practice. BMJ Open, 4, 1–9.
Hausmann , D., et al. (2019). Sensitivity for multimorbidity: The role of diagnostic uncertainty of physicians when evaluating multimorbid video case-based vignettes. PLoS ONE 14(4), e0215049. https://doi.org/10.1371/journal.pone.0215049
Hing, N. & Russel, A. M. T. (2017). How Anticipated and experienced stigma can contribute to self-stigma: The case of problem gambling. Frontiers in Psychology, 8, 235. doi: 10.3389/fpsyg.2017.00235
Lancaster, C. L., Teeters, J. B., Gros, D. F., & Back, S. E. (2016). Posttraumatic Stress Disorder: Overview of Evidence-Based Assessment and Treatment. Journal of clinical medicine, 5(11), 105. https://doi.org/10.3390/jcm5110105
McPhail S. M. (2016). Multimorbidity in chronic disease: Impact on health care resources and costs. Risk management and healthcare policy, 9, 143–156. https://doi.org/10.2147/RMHP.S97248
Morrison, D. et al. (2016). Managing multimorbidity in primary care in patients with chronic respiratory conditions. npj Primary Care Respiratory Medecine 26, 16043. https://doi.org/10.1038/npjpcrm.2016.43
Sullivan, M. D. (2018) Depression effects on long-term prescription opioid use, abuse, and addiction, The Clinical Journal of Pain, 34(9), 878-884. doi: 10.1097/AJP.0000000000000603
Tortajada, S. et al, (2017). Case management for patients with complex multimorbidity: development and validation of a coordinated intervention between primary and hospital care. International Journal of Integrated Care, 17(2), 4. DOI: http://doi.org/10.5334/ijic.2493
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