The Child Client - Question 1

Australia's healthcare system is one of the efficient and best around the world, and the framework currently being used for assessing outcomes and allocating resources needs to be updated. To explore new ideas, using policy enforcement and organizational power, an interdisciplinary research approach may be implemented in the fields of performance assessment, efficiency, and patient care improvement (Dixit and Sambasivan 2018). Hospital administrators, administrators, and clinical management professionals may use a multidisciplinary approach to develop innovative performance assessment models that incorporate economic efficiency, quality, clinical and patient outcomes for the allocation of resources and change in performance.

The model of care that is relevant in this case study is Family-centered care (FCC). It is a collaborative framework for patient and health care provider decision-making in health care. Since the patient is a 6-month-old baby and cannot take decisions regarding her health so the parents make decisions for the care. Many medical procedures, hospitals, and health-care associations find FCC the cornerstone in pediatric health care (Kuo et al 2012). Despite widespread support, FCC remains inadequately incorporated into clinical practice. Multiple medical societies, healthcare services, federal and state legislative bodies have recognized FCC as an integral part of the performance of patient care, satisfaction, and medical services as a philosophy of care, and the associated term patient-centered care (PCC) (Wagner 2015).

Fundamental misunderstandings persist regarding the understanding of FCC, it’s implementation, and how to determine the family-centered care. FCC can't deliver on its commitments until health care providers gain greater awareness and respect for FCC. Most of all, FCC is a change of attitude in the way clinical treatment is provided.

 In this approach, the information exchange is open, objective, and unbiased (Kuo et al. 2012). The health care provider is expected to show respect for diversity, linguistic and cultural practices, and care expectations are characteristic of the working relationship. Participating groups, including families at the level they select, make medically informed choices that best match the interests, talents, beliefs, and abilities of all those involved. The desired results are adjustable and not inherently absolute from the medical care programs. Direct hospital services and decision-making reflects the child within the community within the context of everyday routines and standard of living.

The government have to make policies and approaches where the family centred care remains adequately incorporated into clinical practice. An important consideration of those with the power to maintain or strengthen health inequities is also needed (Durey and Thompson 2012). Present health policies and procedures promote centralized treatment where there is often no voice for those disadvantaged. Examining the success of these approaches in decrease health inequality allows health care professionals to consider objectively whether or not the health and well-being policies and practices promote or make concessions, a significant step in changing the debate that positions the children or the group of population who need family centred care.

The essence of delivering care often requires a multidisciplinary, collective approach to manage care in a manner conducive to optimal patient satisfaction, efficiency, and health. The four core components of the care process: Assessing patient needs, planning, providing care, and coordinating care, treatment, or services (CAMAC 2015). Treatment plan-based strategies, including patient awareness or advice about treatment, diagnosis, or services. Management of treatment to facilitate consistency at the end of an episode of treatment or during referral, discharge or transfer of patients.

The Child Client - Question 2

In this particular case, there were problems in the healthcare services which was not addressed. Prati is a 6-month-old baby girl who presented to the paediatric emergency department (ED) with pallor and lethargy. She was provisionally diagnosed with exacerbation of oesophageal stenosis and admitted to the paediatric inpatient unit. The patient was monitored overnight by nursing staff and had further episodes of vomiting documented in the patient chart.

The RN on duty continued giving her feeds and had stopped it only for some time. The RN did not carry out nursing interventions by providing the medications to stop the vomiting. The baby physical appearance was pale which should have been reported to the doctor. The baby was monitored and reviewed by the registered nurse (RN) in every 30 to 60 minutes but it was documented as 1 to 2 hours. The discrepancies in the documentation of the patient was seen. The patient mother was continuously checking the baby which should have been the duty of the RN. The baby pain assessment was not performed and the nurse reported that there was no evidence of pain. The urine output of the patient was less and it increased in the morning which was a health issue as the patient was vomiting initially. In the morning the nasogastric (NG) tube was found to be no longer in the place. The doctor was busy so the next RN on duty in the morning started oral hydration without informing the doctor. The patient continued to have episodes of vomiting and did not tolerate any of the oral fluids. The doctor arrival was delayed and that led to more worsening of the situation of the patient health.

The standard of treatment patients seek is a basic aspect of modern medicine. The professionals in the healthcare system are important, but their lack of experience can raise questions about the quality of the care provided. It needs close and seemingly inadequate oversight, with the consequent effect on both the quality of healthcare and academic outcomes. Innumerable challenges have arisen in recent decades, arising from the growing complexity of health systems, medical technology growth, rising patient and family demands, and high costs. Such challenges require practical approaches that will ensure that patients receive the best treatment, at the right time and implementing protocols that guarantee quality care.

The outcome would have been better if all the health issues would have been taken care of. The patient should have been provided medication for the vomiting as continuous vomiting made her pale. The pain should have been assessed using a paediatric pain assessment tool it should not have been subjectively measured. The improper documentation of the patient conditions can result in negative outcomes in the patient health. the patient was dehydrated because of the continuous vomiting. She also suffered from haemodynamic instability which leads to electrolyte imbalance as there was a lot of fluid loss from the body (Dilli et al. 2018). The RN instead of starting the oral feeds should have escalated the condition to doctors on an emergency basis. These steps would have certainly changed the health outcome to positive for the patient.

It was clear that healthcare professionals faced many difficulties in handling the patient treatment, which included not only included the language barriers as the child was not capable to respond, but also limitations within their departments as well as disharmony between the law and their professional standards (Suphanchaimat 2015).

The Child Client - Question 3

The patient was continuously vomiting so the person-centered care demanded her to give medications for the problem. The patient should have been given small amounts of electrolyte solution which helps in intestinal co-transport, enhances water and salt absorption. Liquids not only help avoid dehydration but are also less likely to cause more vomiting. The patient suffered serious dehydration. This can be dangerous and life-threatening if the dehydration is allowed to reach a significant degree as it can lower the blood pressure and cause hypovolaemic shock. To prevent this, the patient is forced to drink enough additional fluids to recover what was lost from vomiting up.

The pain measurement should never be subjective. The paediatric pain assessment tool should be used to check the pain of the child. Pain assessment relies on the examination of the child's cognitive development, clinical context, and typology of pain (Beltramini 2017). The rates of pain are different. Most of the pain assessment tools in paediatric rely on the behaviour of the child (Beltramini 2017).

In high-risk infants admitted to intensive care units, hemodynamic instability or dysfunctions are usual. Monitoring and intervention methods of these conditions may, however, display variations between the units. Different factors can harm the hemodynamic state of infants (Singh 2018). The patient in this case showed the hemodynamic stability because of the prolonged vomiting. The electrolyte balance and the stable flow of blood in the body gets affected during the severe vomiting.

The improper documentation of the patient conditions can result in negative outcomes in the patient health. in this case the documentation was not done properly. Health documents form an integral part of a patient's care. For two important purposes, the doctors and medical institutions must keep patient records properly (Mutshatshi et al. 2018). The first is that it would aid them in the clinical assessment of their patient profile, in evaluating the outcomes of the procedure and in preparing treatment protocols. It also assists in preparing national health care plans for the future. Yet, the problem of the suspected medical negligence is of similar significance in the present environment. In a case where the patient or the family claims medical negligence, the legal system relies solely on documentary evidence (Mutshatshi et al. 2018)

Also, the patient condition deteriorated as the doctor on duty was delayed in some other commitments. The patient became pale, lethargic, and had decreased bowel sounds. The RN started oral administration without informing the doctor. Although the doctor was on duty and was busy checking other patients but the infant condition would have not worsened if the patient was attended on time. The case should have been escalated by the nurse so that the patient would have been attended faster. Interactions between patients and doctors can be difficult at times. According to the NSQHS standards the patient has to be provided safety at the health care setting along with the care but this was not followed (ACSQHC 2019). Due to inconsistencies in understanding, interpretation, and/or interaction between the patient and the medical practitioner, these difficult experiences may occur and may be triggered by the doctor, the patient, or both (Mathews et al. 2015). These situations usually go against the health condition of the patient like in this case study. Contact between the patient and the medical practitioners can then be prejudiced (Hardavella 2017).

The Child Client - Question 4

Multidisciplinary team support is a core aspect of this treatment model. Registered practitioners and community health and other providers in the health and community care system offer care (NSW 2014). The multidisciplinary team for this patient will consist of physicians, professional nurses, mental health professionals, counselors, social workers, occupational therapists, police officers and occasionally people from other disciplines as well. The nursing care has to be made sure even after the patient is discharged. The team has to provide support services at the patient's home to ensure ongoing care. The nurses can also help the parents of the patient to use the NG tube and manage the NG feeds during the patient's discharge. The patient can be educated about the disease symptoms, treatment, and interventions required. The parents can be made referrals to support services to ensure ongoing care and support. The mental health professionals can also help the patient parents in dealing with the emotional and physiological stress.

The parents of the patients can take help from the support group of people with similar problems so that they can get guidance in handling the situation. The care decisions are believed to impede collaborative collaboration between long-term parents of children and practitioners, and other members of the multidisciplinary team (Swallow et al 2013). The integration of sharing roles with transparency in health care systems between team members provides great value. They also play a vital role in educating family members about how to provide care for the patient after making the shift to home (Babiker et al. 2014).

References for The Child Client

ACSQHC. 2019. The NSQHS standards. https://www.safetyandquality.gov.au/standards/nsqhs-standards

Babiker, A., El Husseini, M., Al Nemri, A., Al Frayh, A., Al Juryyan, N., Faki, M. O., Assiri, A., Al Saadi, M., Shaikh, F., and Al Zamil, F. (2014). Health care professional development: Working as a team to improve patient care. Sudanese Journal of Paediatrics, vol.14, no.2, pp.9–16.

Beltramini, A., Milojevic, K., and Pateron. D. 2017. Pain assessment in newborns, infants, and children. Pediatric Annals. Vol.46, no.10, pp.e387-e395. https://doi.org/10.3928/19382359-20170921-03

Comprehensive Accreditation Manual for Ambulatory Care (CAMAC). 2015. Provision of care, treatment, and services. Retrieved from https://foh.psc.gov/tjc/provisioncts.html#:~:text=The%20provision%20of%20care%2C%20treatment,Coordinating%20care%2C%20treatment%2C%20or%20services

Dilli D, Soylu H, Tekin N. 2018. Neonatal hemodynamics and management of hypotension in newborns. Turk Pediatri Ars. Vol.53, no.1, pp.S65-S75.

Dixit, S. K., and Sambasivan, M. 2018. A review of the Australian healthcare system: A policy perspective. SAGE Open Medicine, vol.6, 2050312118769211. https://doi.org/10.1177/2050312118769211

Durey, A., and Thompson, S.C. 2012. Reducing the health disparities of Indigenous Australians: Time to change focus. BMC Health Serv Res. vol. 12, 151. https://doi.org/10.1186/1472-6963-12-151

Hardavella, G., Aamli-Gaagnat, A., Frille, A., Saad, N., Niculescu, A., and Powell, P. 2017. Top tips to deal with challenging situations: Doctor-patient interactions. Breathe (Sheffield, England), vol.13, no.2, pp.129–135. https://doi.org/10.1183/20734735.006616

Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. 2012. Family-centered care: Current applications and future directions in pediatric health care. Maternal and Child Health Journal, vol.16, no.2, pp.297–305. https://doi.org/10.1007/s10995-011-0751-7

Mathews, M., Ryan, D., and Bulman, D. 2015. Patient-expressed perceptions of wait-time causes and wait-related satisfaction. Current oncology (Toronto, Ont.), vol.22, no.2, pp.105–112. https://doi.org/10.3747/co.22.2243

Mutshatshi, T. E., Mothiba, T. M., Mamogobo, P. M., and Mbombi, M. O. 2018. Record-keeping: Challenges experienced by nurses in selected public hospitals. Curationis, vol.41, no.1, pp.e1–e6. https://doi.org/10.4102/curationis.v41i1.1931

NSW 2014. Multidisciplinary Team Care. Retrieved from https://www.health.nsw.gov.au/healthone/Pages/multidisciplinary-team-care.aspx

Singh, Y., Katheria, A. C., and Vora, F. 2018. Advances in Diagnosis and Management of Hemodynamic Instability in Neonatal Shock. Frontiers in pediatrics, vol.6, no.2. https://doi.org/10.3389/fped.2018.00002

Suphanchaimat, R., Kantamaturapoj, K., Putthasri, W., & Prakongsai, P. (2015). Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens. BMC health services research15, 390. https://doi.org/10.1186/s12913-015-1065-z

Swallow, V.M., Nightingale, R., Williams, J. et al. 2013. Multidisciplinary teams, and parents, negotiating common ground in shared-care of children with long-term conditions: A mixed methods study. BMC Health Serv Res. vol.13, pp.264. https://doi.org/10.1186/1472-6963-13-264

Wagner, E. H., Bennett, S. M., Austin, B. T., Greene, S. M., Schaefer, J. K., & Vonkorff, M. 2015. Finding common ground: Patient-centeredness and evidence-based chronic illness care. Journal of Alternative and Complementary Medicine (New York, N.Y.), vol. 11 no. 1, pp. S7–S15. https://doi.org/10.1089/acm.2005.11.s-7

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